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Widespread distrust and refusal of the COVID-19 vaccine in Papua New Guinea (PNG) is being linked to a rising number of mothers choosing not to bring their children forward for other vaccinations.

And as immunity levels decline in the most populous Pacific Island nation, it is only a matter of time before a devastating disease outbreak occurs, health experts say.

The nation successfully held the COVID pandemic at bay with strict measures, including border closures, until March 2021 when cases began to surge. Now, PNG has recorded a total of 46,427 cases, including 909 in the past one and a half months.

Yet the COVID vaccination rate in the large Pacific Island nation remains dramatically low at just 7 percent of the population for the first dose and 5 percent for the second dose. In comparison, Fiji’s COVID vaccine uptake is at 99 percent for the first and 89 percent for the second dose.

Distrust of the COVID vaccine in PNG has spread to a general distrust of all vaccinations, according to local health professionals.

“COVID vaccine resistance has translated into the hesitancy of mothers and families to have their babies vaccinated,” said Professor Glen Mola, head of obstetrics, gynaecology and reproductive health at the School of Medicine and Health Science at the University of Papua New Guinea in Port Moresby.

The hesitancy is based on “the mistaken fear that the nurses in the baby clinics might covertly vaccinate the baby against COVID-19,” Mola told Al Jazeera.

While PNG’s health services have been under severe strain with the demands of the pandemic, a high level of public distrust of the vaccine is a leading factor in the low uptake.

Woman with grey hair sits on chair, looking at the camera while a man bends over to administer the vaccine. He is wearing a cap, blue t-shirt and blue gloves. There are some people waiting behind them, including children
A woman receives COVID-19 vaccination in Papua New Guinea [Photo courtesy of ChildFund]

Dr David Mills at the Kompiam Rural Hospital in the remote Enga Province, located in the mountainous highlands of the PNG mainland, said there will be serious health implications as infant vaccinations decline.

According to the United Nations Children’s Fund (UNICEF), the uptake of a third dose of the vital DTP (diphtheria, tetanus and pertussis) vaccine in PNG infants, for instance, plummeted from 64 percent in 2009 to 31 percent last year.

“Trust in the health system generally has deteriorated due to the poor information being disseminated,” said Dr Mills, referring to “the persistence of conspiracy thinking” around COVID as well as the overplaying of the level of threat it posed to PNG and a perception that COVID health messaging was only being disseminated for financial incentives.

“We are expecting epidemics of measles, pertussis [whooping cough] or polio to emerge at any time due to the chronically low vaccine coverage – particularly measles is a concern,” he said.

Even before COVID-19, a number of challenges plagued the rollout of the routine infant immunisation programme in PNG, where more than 80 percent of people live in rural and remote areas.

Three mothers with four children stand against the backdrop of a wooden fence and a hut with a straw roof. Two more children lean against what looks to be a corrugated iron shed on the other side of the fence
Families living in the rural and remote highlands of PNG suffer due to poor roads, transport and health services. Hela Provice, PNG [Catherine Wilson/Al Jazeera]

In the highlands, health services have very limited reach beyond the main urban centres. Nationwide, there is a lack of qualified health and medical professionals in PNG. The country has fewer than 1,000 doctors for a population of nearly 9 million.

While the country’s child mortality rate has fallen over the past 15 years, neonatal and infant mortality rates remain the highest in the region – at 22 and 35 per 1,000 live births respectively.

The PNG government recommends all children up to two years of age should at least be immunised against tuberculosis (BCG vaccine), diphtheria, tetanus, pertussis, polio and measles. Yet, the percentage of children in this age group who have completed all basic immunisations dropped from 52 percent in 2006 to 35 percent in 2018, while those who had not received any vaccinations rose from 7 to 24 percent in the same period.

The onset of the COVID pandemic in early 2020 placed immense additional strain on PNG’s already fragile health system and opposition to the COVID vaccine has presented a huge additional obstacle, said Olive Oa, health programme manager in PNG for the humanitarian organisation, ChildFund.

“Initially, when the pandemic first emerged in the country, there was a lot of misinformation [about COVID-19] … circulating before official information was available,” Oa told Al Jazeera.

“Vaccine hesitancy was prevalent in the general population, not just mothers, including among health workers at all levels. And there is still a lot of hesitancy,” said Oa, who is training community health workers in the COVID vaccine in PNG’s Central Province.

A phone survey conducted in the country last year revealed that 78 percent of respondents who were not planning to take the COVID vaccine were worried about side effects, 53 percent did not trust vaccines at all and 23 percent said they did not think the vaccine would work, according to a World Bank report.

The Australian National University’s Development Policy Centre reported that immunisation rates among children in PNG have now dropped to dangerous levels. A recent survey in the highland Western and Hela Provinces, for example, revealed that only 20.6 percent of children had received three or more inoculations and 31 percent had not received any at all.

Mother is wearing a purple dress. Her child is on her hip, held with a white strap tied behind her neck
A mother and infant in the town of Goroka, Eastern Highlands Province, PNG. Tackling COVID vaccine hesitancy is crucial to stopping the decline in infant health vaccinations in the country, health officials say [Catherine Wilson/Al Jazeera]

Health experts believe the country’s waning vaccination rate was a leading cause of a measles outbreak in 2014, a resurgence of polio in 2018 and the ongoing tuberculosis epidemic.

The country’s Department of Health is now warning that, if urgent action is not taken, “there will be another measles epidemic in the next few years”.

Amid the dire predictions, PNG’s government has outlined a strategy to upgrade community-level health facilities in rural communities and train more health workers to extend the reach of immunisation programmes, which will require substantial funding and investment.

Health researchers have also recommended more effective engagement with communities in a bid to increase people’s trust in health services and amplify public health messages about the importance of COVID, and other, vaccinations.

Based on her experience in the field, Olive Oa says that “education needs to be central”.

That means educating health workers, trainee health professionals, parents, community leaders and religious groups in the value of COVID and other vaccines, she says.

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