Inflatable dinghies and Zoom medical training: how a remote Pacific atoll got Pfizer

The elders of Nukunonu atoll in Tokelau at the wharf on Monday morning, dressed in white and singing songs, held a banner that said: “Welcome”.

In the distance, a small inflatable boat made its way to them carrying a New Zealand defence officer dressed in full protective gear and 12 precious boxes. Inside the boxes were just over 700 doses of Pfizer vaccine, enough to cover the 346 residents of Nukunono who are eligible for the vaccine.

“I am relieved and elated. It is overwhelming as well,” said Aukusitino Vitale, the chair of the Tokelau national Covid committee. He had spearheaded the community’s efforts to secure the vaccines since March 2020, and for him, the arrival of the first boxes of the vaccine meant he could now sleep easy.

“To be honest with you, I had not slept well since March, this was a culmination of efforts between the New Zealand government, NZ Immunisation Advisory Centre, UN agencies and our own team on the ground in Tokelau, and so on Sunday morning, when the ship was close, I finally felt at peace,” he said from his office in Tokelau.

Tokelau is a dependent territory of New Zealand about 3,500km north of Auckland with a population of about 1,500.

It is one of the most inaccessible atolls in the world. Without an airstrip and with shallow coastal waters, the atolls can only be reached by dinghies, canoes or small rafts.

In pre-Covid times, visitors to Tokelau had to fly to Samoa and then board a boat to Tokelau, which ran fortnightly and took 24-32 hours to make the journey, depending on the atoll destination.

In order to get the vaccines safely to Tokelau, the New Zealand ministry of foreign affairs and trade, ministry of health, defence force and the government of Tokelau worked to find a route and transportation method that would not compromise the cold chain.

The result was that HMNZS Wellington, a New Zealand defence force vessel with 76 crew, transported vaccines to the open water outside the reef near the islands. Helicopters were then meant to transport boxes from the ship, but bad weather meant they couldn’t take off from the carrier and instead small rigid-hulled inflatable boats were deployed to each of the Fakaofo, Nukunonu and Atafu atolls.

Tokelau is one of the few places in the world that has stayed Covid-free throughout the pandemic. Its borders have been closed since March 2020, which meant that during the drop off of the vaccines, a contactless delivery had to be observed.

Back in New Zealand, the healthcare support team were still nervous about the weather and ensuring that the vaccines maintained the right temperature.

Rosa Toloa, Tokelau’s director of health, was in contact with them to ensure readiness of staff and equipment in the hospitals.

“We do not have air access, so the challenge was to get the vaccine to Tokelau and maintaining the right temperature of the vaccine from New Zealand to Tokelau to ensure efficacy of the vaccine,” she said.

But even the preparation for the vaccine rollout faced challenges. Tokelau’s health sector, which is made up of three doctors – one on each atoll – and 36 nurses, had to be trained to administer the vaccines over Zoom, an effort that was nearly impossible given the poor internet connection.

“We had to do training of vaccinators on a new vaccine, there’s a lot of new information on the vaccine that we needed to be well aware of and be well prepared for,” said Toloa. “The challenge was around training the nurses and refreshing vaccinators through a mobile internet network that was very challenging. But we managed to do it, and get the nurses up to speed. It has taken months of preparation for everyone.”

With a prepared staff, equipped hospitals and a willing population, Tokelau’s department of health successfully administered over 60% of the first doses in the first two days of the rollout.

As Vitale, the head of the Tokelau national Covid committee, felt the pinch of his first dose on Monday, his feeling of relief was not just for himself but for his small island community.

“This has been a blessing, it gives us the comfort and confidence that our people are protected from the devastation of Covid-19, and the potential loss of who we are as a culture and a people. We feel much safer now.”

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