Dr Paula Vivili, Director of SPC’s Public Health division, discusses COVID-19 in the Pacific
Can you tell us about yourself?
My name is Paula Vivili, I am the Director of the Public Health Division of the Pacific Community (SPC). I am originally from Tonga, and I have been with SPC for the past seven years. My background is mostly in human nutrition, non-communicable diseases, and public health. All these experiences have helped me deal with the challenges associated with my job here at SPC.
In your career, have you ever faced situations similar to the COVID-19 pandemic?
In terms of magnitude, the answer for most public health people would be no. Dealing with such a large pandemic is a new experience for most, if not all of us. In the Pacific, it is definitely the first time that we’ve had something of this magnitude. We’ve had some experience with epidemics in the region: we often have dengue epidemics, zika, and a pretty bad measles outbreak last year, but we never faced something that big, for the Pacific and the rest of the world. Other coronaviruses like SARS or MERS never spread in the Pacific. Unfortunately, with COVID-19, it’s different.
What are the challenges faced by Pacific countries in terms of response to the pandemic?
In the Pacific, only five countries are able to test for COVID-19: Fiji, French Polynesia, Guam, New Caledonia and Papua New Guinea. The other 17 countries have to send their test samples to New Zealand, Australia, or one of these five countries. However, with the current travel restrictions, their capacity to send test samples abroad is quite limited. This has implications: we’re trying to address the disease, but we’re not able to test locally.
Another important challenge relates to the capacity of Pacific countries to deal with COVID-19 cases: we know that if 100 people get the virus, 80 will have mild symptoms; 15 will have severe illness; and 5 of them will have critical illness and will need intensive care. Many of the Pacific Island Countries only have the capacity to provide intensive care to five people or less at one time. It is therefore important that Pacific countries get as less cases as possible.
How is SPC helping Pacific countries respond to the crisis?
SPC has its key areas of expertise: we’re good at strengthening health systems, strengthening labs, improving surveillance and clinical services capacities, as well as dealing with risk communications. These are the specific areas where we provide support to our member countries.
Before COVID-19 was declared a pandemic, a joint Incident Management Team (IMT), led by WHO was set-up. It allows all the partners (UN agencies, NGOs and donors) involved in the response to coordinate the support provided to countries. Anything a country needs that comes through one of the partners is channelled to the IMT in order to ensure that everyone is on the same page and that we can provide an appropriate response.
For example, on the lab services: our team is involved in a small multi-partner group of experts within the IMT (the Lab Advisory Group). We are hopeful that the group will be able to provide, in the next two weeks or so, all our members will have the capacity to do in-country testing for COVID-19. We hope to achieve that by using a machine which is already available in the countries for tuberculosis testing: the company that created the machine has also been able to create cartridges to test for COVID-19. These cartridges have been approved by the Food and Drugs Authority (FDA) in the United States and the Australian health authorities.
Another example relates to clinical services. The capacity of the countries to deal with cases in the clinical field is quite limited, and SPC is working with its partners to ensure that the needs of the countries in terms of ventilators, as well as other equipment and services around patient management are met.
We also try to make Standard Operating Procedures available to countries to help them better manage their patients.
Amid confinement measures and travel restrictions, how does you team keep delivering?
Prior to the travel restrictions, we were sending teams to the countries – It was not uncommon to have five to ten people in the field at the same time. With the travel restrictions, we now have to provide that support remotely. For example, Fiji recently requested training support with COVID-19 Cause of Death Certification training, in three different sites in Fiji. This work is critical to help doctors to accurately record any deaths from COVID-19 correctly in the death certificates. SPC is the lead agency on that. We are going to deliver these trainings via Zoom (an online conference tool), to the three different sites, on three different days.
We are at a time where internet technologies are a little better in the countries, thanks to donor-funded projects that have equipped the countries with submarine cables – and we realize that without this improvement, it would have been much more difficult for us to manage the crisis.
Any message you would like to send to Pacific people?
People should be alert and cautious, but they should not panic. If people do not come in contact with the virus, there is no chance that they will be unwell. Therefore, a lot of measures that have been implemented with the objective of preventing people from being exposed to the virus. We talk a lot about social distancing. It means keeping a distance between you and others. The virus is spread by droplets, so if you keep your distances, your chances to be infected are much lower. We also encourage people to wash hands a lot. Any regular soap or alcohol-based sanitizers are efficient, but people need to wash their hands for at least 40 seconds. However, whilst we need to be very careful, but we should not stop living. We just need to follow the instructions to protect ourselves from COVID-19.
From a health point of view, what is your vision for after the crisis?
In terms of preparedness and response, this crisis will make countries more prepared than they would ever have been. As a result of what has happened, countries have managed to improve their own health systems; partners, donors, and agencies like SPC have really learnt a lot on how they can support the countries and are now in a much better position to deliver efficient support. Therefore, from a health perspective, countries will be able to better respond to future pandemics, if any.