‘The fear of this vaccine is real’: how Papua New Guinea’s Covid strategy went so wrong

In mid-October Dr Clement Malau, a Harvard-educated public health specialist and former secretary of the Papua New Guinea health department, was alarmed to discover he had gone viral. Only he hadn’t.

Someone had posted a 20-minute audio clip as a “speech from Dr Clement Malau regarding the vaccine”, the orator sliding between English and Tok Pisin – PNG Pidgin – to deliver an eloquent, tub-thumping rant against Covid-19.

By the time Malau was alerted, the clip was super-spreading across Facebook and WhatsApp groups, propelled by high-profile PNG figures. It’s still there, feeding into anti-Covid and anti-vaccine zealotry.

Access to social media remains relatively low in PNG – Pacific communications expert Dr Amanda Watson says there are only around 600,000 smartphones in circulation in a population of nearly 9 milioni, and most households aren’t online. But the online maelstrom is quickly broadcast into communities via the “coconut wireless", or word of mouth. It fuels the distrust underwriting the nation’s disastrously low vaccination rate, with less than 4% of the adult population fully vaccinated despite the availability of jabs in all provinces. Nel frattempo, a third wave of the pandemic overwhelms hospitals and overflows morgues.

Malau tracked his impersonator, forwarding details to authorities. “And they have done nothing.”

So he’s using Facebook to try to counteract the lies “all by myself”. He has acquired nearly 5,000 followers, many desperate for reliable information which they will, a sua volta, share with their wantoks (communities). With respect, empathy and lots of “God Bless PNG!", he goes toe-to-toe with the angry and the fearful.

Malau understands the landscape and the stakes all too well. He was director of PNG’s National Aids Council in the 1990s when many of his compatriots didn’t believe in HIV. His team had to devise clear, simple messaging that would resonate across a diverse nation of 800 languages and low literacy.

While he encourages Covid-19 vaccination, e posed for cameras in Port Moresby when he got his first jab in May, Malau argues that jabs alone won’t cut it in PNG. “If we do not understand our own setting, we will be bulldozed down the track of just vaccine alone.”

Echoing other medical and social science specialists who know PNG, Malau sees crippling failures in the messaging and strategy of the nation’s pandemic response. Confusion and distrust from the earliest days spiralled out of Australia’s shifts on AstraZeneca, which Papua New Guineans were told they must take even as younger Australians were told it wasn’t safe. The continuing failure to tailor pandemic campaigns to local conditions risked “a disaster if we don’t manage it properly”.

Some say it’s already disastrous. The obstetrician Prof Glen Mola has spent 50 years in PNG trying to claw back staggeringly high maternal mortality rates, only to see them blow out five-fold at Port Moresby general hospital as the virus has struck pregnant women. The first casualty was just 18 Anni, the latest 27. “I’ve never had to watch people die because they are just too exhausted to take the next breath.”

PNG’s official pandemic death toll è 546, but a lack of data and testing means the true casualties are unclear. At Port Moresby hospital there were 40 o 50 Covid deaths a day in early November, dropping lately to around 10, but Mola wonders if people are not presenting “because the perception might be that if you go, you die”.

Even as families mourn mounting casualties in their Facebook posts, “with all the vaccine phobia and people who have provoked this fear of vaccination … it’s getting worse”, Mola says. At home in the evenings, he hears anti-vaccine proselytisers spread the word across the surrounding settlements on loudspeakers.

“The fear of this vaccine is real,” says Dr Fiona Hukula, a Port Moresby-based anthropologist with the Pacific Islands Forum Secretariat. In Madang, on the other side of the country, the Divine Word University president, anthropologist and Catholic priest Dr Philip Gibbs has had countless conversations with staff and students trying to persuade them to get jabbed. “It’s an emotional issue, not a rational issue," lui dice. “I got the impression that students here are more afraid of the vaccine than they are of catching the virus.”

In the absence of clear, strategic information, dangerous rumours ignite. Come cases surged and the highlands town of Goroka suffered a spike in deaths in October, high-profile locals were among those who lined up for their first jabs. But before immunity could kick in, several got Covid and died, Mola says. “And so then the deaths are blamed on the vaccine.”

Social media has supercharged fears, but Hukula argues that it has been made worse by the absence of good, locally attuned information. “From the very beginning of the pandemic … we didn’t have a clear communications strategy.”

Back in April 2020, as PNG recorded its second confirmed case of coronavirus, Hukula, Gibbs and their Australian colleague Dr Miranda Forsyth co-wrote an appeal to national and international health authorities to ensure that they recognised local contexts – social and cultural as well as practical considerations like access to soap and water and the feasibility of social distancing – in crafting pandemic messaging for the people of PNG.

They warned: “The government and society at large needs to act fast to prevent the spread of fear that is a catalyst for violence and social unrest.”

In PNG, “education/messaging about causes of sickness and death based on science alone are not sufficient to quell doubts about the root cause of harm and why it occurs and impacts some people and not others”. They also insisted that all information be translated not only into widely spoken Tok Pisin and Motu, but where possible into local vernacular.

Ma 18 months on, other than a multilingual pamphlet written by Mola, which he’s lobbying authorities to circulate, there’s little evidence that has happened.

“They’ve hardly put out any messages in Tok Pisin,” says Paul Barker, the director of the PNG thinktank the Institute of National Affairs. “They’ve got an army of Australian high-powered consultants around the Covid centre [in Port Moresby], but they’re not knowing how to communicate.”

Other key planks of the response are similarly far short of the mark. Centralised vaccine hubs where people wait many hours “are not practical for people – for elderly, for mums with babies, the disabled”, Hukula says.

Fearful people want the reassurance of familiar health workers from their local clinics. “They should have gone out to the markets, to explain to people clearly that this is a vaccine that’s going to help.”

The Guardian sought comment from the department of health but received no response.

The lessons of local responses to epidemics of HIV, tuberculosis and, nel 2018, the colossal operation to extinguish a potentially devastating polio outbreak – blamed on the breakdown of the health system and eroding childhood vaccination rates – are grounded in awareness campaigns enlisting trusted figures and targeting community leaders, in sending health workers and specialists deep into urban and rural communities to deliver programs.

Hukula and her colleagues also drew insight and warnings from their years investigating attacks against individuals accused of sorcery and witchcraft, which have risen in some parts of PNG. There’s an enduring belief that bad magic, rather than disease or misadventure, is to blame for an untimely death. This has become entwined with Christian evangelical and Pentecostal beliefs. It was inevitable that coronavirus would be caught in that web.

“In a society where we have those very firm beliefs, that misfortune can happen because of the supernatural, this just feeds really well into this whole [religious] narrative,” Hukula says, referring to widespread conspiracies that the vaccine causes infertility and death.

Fear and faith dominate PNG Facebook discussions around Covid-19, secondo a recent report by ABC International Development, analysing more than 100,000 posts and comments logged on popular public news pages in the six months to 30 settembre.

Lately the conversation is preoccupied with false claims of long-term, debilitating side-effects from the jabs. “That fear is driving the vaccine hesitancy in a big way,” says research leader Vipul Khosla.

In terms of faith, a strong thread of posts reflects what Barker hears from colleagues in his office who say they don’t need the vaccine because “Jesus Christ is my saviour”. But he and other experts caution that the influence of extremist social media posts can easily be exaggerated.

Un analysis of Covid commentary on one popular, public Western Province page on Facebook by two University of Melbourne anthropologists with decades of experience in PNG, Dr Monica Minnegal and Dr Peter Dwyer, found people were engaging with the material critically and selectively. “Most participants did not take either religious tropes or conspiracy theories as primary sources of comfort or explanation.”

The forum had played a positive role in the health emergency, loro hanno detto, arguing that better, cheaper internet access for people in remote regions would enhance the spread of crucial information and engagement with health programs.

Lately the researchers have become concerned by the tenor of responses to “no jab, no job” policies and perceived mandates for vaccinations. Dwyer says: “They feel their autonomy is being assaulted, and they are much more concerned by that [than] they are by vaccination.”

This is cultural, not a question of “silly beliefs”, says Minnegal. “It’s too easy to say social media is spreading misinformation. This is about a social movement.”

The argument that social media has untapped useful potential is echoed by Watson, who says even townspeople with internet access struggle to find credible information. Nel frattempo, they’re relied on to convey news to family and friends. “The vast majority of people live in rural villages where they don’t receive daily newspapers. In many places they don’t even have radio signal.”

One theme in the ABC analysis is “a lot of discussion on the role churches should play in advocating for vaccine uptake”, says Dr Prashanth Pillay, who co-wrote the report. People are questioning whether they should be involved in the Covid discussion at all. “There’s the idea that the church is the place for biblical teachings, and it should not veer from that.”

This plays out as the mainstream churches dial up their vaccine advocacy, with the Catholic cardinal Sir John Ribat declaring he put his trust in God and got vaccinated. For some this was comforting, says Gibbs, but others “say that vaccines are a sort of weakness, because it means that you don’t trust that God is going to protect you”.

Martyn Namarong, a political activist and writer, has just spent weeks at the bedside of his mother in Port Moresby general hospital, where she’s being treated for Covid-19.

The Christian apocalyptic views swirling around Covid are nothing new, Namarong says. Vaccine advocates need to tone down the noise rather than shout louder. “When it comes to people’s religious views, you cannot change them. It’s like telling PNG Christians that Buddhism might be a good idea – it’s not going to happen.”

Covid campaigners “need to try to actually engage more … see us as human beings and friends as opposed to opponents on a particular issue”. And they must recognise the daily struggles of life in PNG. “Most people live a very cyclical existence. The view of time is you just wake up in the morning, you go to sleep, and the next day you wake up, everything’s new again. It’s about survival.”

Like Malau, Namarong urges more regard for variables people can control – good diet, air quality. “So you’re not seen as just ‘vaccine, vaccine’. You are seen to address a public health issue as opposed to pushing out the vaccine agenda … Let’s co-opt some of the message from the people who have reservations.”

Namarong says his mother is recovering. But describing what he’s observing in the hospital, and in the capital, lui dice: “It’s scary. That’s the word I would use. We can see the system is trying to adjust to cope, but it is just at the edge … one spike and everything collapses.”

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