Health | The Pacific

25 January 2022

If Papua New Guinea wants to raise its vaccination rate, it must first provide consistent education and support for healthcare workers, Mikaela Seymour writes.

Papua New Guinea (PNG) continues to report among the lowest COVID-19 vaccination rates in the world, with only 3.2 per cent of the population receiving one dose or more.

As usual, during the Christmas period urban workers have returned to their home villages en masse, meaning the country is likely to see an increase in reported COVID-19 cases when the majority return to the workplace in February.

Vaccination is the obvious safe and effective intervention to mitigate against COVID-19 infection and severe illness, however simply procuring more vaccines will not result in an increase in the vaccination rate.

More education for PNG citizens about COVID-19 vaccinations is required, but the current awareness campaigns seem to be having little effect. Simply handing out information pamphlets on vaccination is insufficient; a program of collaborative, relationship-focused engagement is needed.

In this author’s work on the ground with vaccination efforts in Western, Central and Manus Provinces, as well as the National Capital District, there have been several barriers to getting people immunised, none more so than the lack of support for local health workers.

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At the start of the pandemic, there seemed to be an assumption that PNG healthcare workers would intrinsically understand the importance of the new vaccine and be strong allies in the public health response. Unfortunately, this has not been the case, with many workers avoiding vaccination, and some even preaching against it.

Whilst UNICEF and the World Health Organization has been rolling out the training module on the vaccine, it is insufficient by itself to reassure many healthcare workers. This six-hour session, whilst very comprehensive, created angst amongst some, whose takeaway was that adverse events from immunisation were evidence the COVID-19 vaccine was less safe than routine immunisation.

Recent World Bank research confirmed Papua New Guineans trust their local health worker as a source of information on vaccination. Communities are generally much less likely to receive the vaccine if their health worker is not vaccinated themselves, therefore any approach must focus on them first. Continued, deliberate, and appropriate training for staff is required to ensure they feel confident and empowered to discuss the vaccine.

In discussions with nurses at Port Moresby General Hospital, most rolled their eyes at the outlandish claims of vaccination being associated with 5G, population control, and micro-chips. Whilst they were confident to identify misinformation, many were unsure about how the vaccines worked, their contents, or their safety profile. Sustained and targeted education would go a long way to allay these issues.

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PNG’s geography, cost of transport, and living expenses make professional development for health workers difficult around the country. However, many of these workers, even in remote locations, have portfolios overflowing with certificates from workshops and training sessions run by various non-government organisations.

Clearly, it is possible to centralise workers to run these sessions. As the pandemic drags on, however, continued educational input, with the ability to ask questions and respond to new information and concerns as they arise is required. Some initiatives have experimented with online COVID-19 education, but whilst the content was excellent, online delivery is difficult with poor network coverage in the majority of the country.

An example of a successful program can be seen in Western Province, which has seen the second-highest vaccination rates outside of National Capital District. Programs such as the Sustainable Development Program (SDP) Aerial Health Patrol with the Western Provincial Health Authority used their existing networks and relationships to deliver continuous ongoing awareness and advocacy for the vaccine well before it became available.

Once the COVID-19 vaccine was available, SDP representatives had long conversations with health workers, community leaders, and church leaders, who accepted the vaccine and led by example for the good of the community. This approach saw communities reach high levels of vaccination thanks to pre-existing relationships, rather than new, unknown teams turning up once the pandemic had already begun. It also relied on ongoing health visits, rather than one-off surge patrols.

The healthcare workers delivering these community programs were not automatic supporters of vaccination. Many of them began with doubts, however continuous respectful education, with the opportunity for questions and discussion in weekly face-to-face professional development sessions, resulted in a fully vaccinated workforce who were confident community advocates for vaccination.

Healthcare workers in PNG are anticipating and clinically preparing for a likely surge of COVID-19 cases in 2022. These tireless and dedicated workers are the cornerstone of community health and no progress in COVID-19 vaccination will be made without their consent and support. If the government and aid partners fail to engage with them effectively, PNG is on track for yet another year of crisis.

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