Thanks to financial and in-kind support from New Zealand's Ministry of Foreign Affairs and Trade (MFAT), the Pacific Community has been able to equip the Cook Islands with one of the most advanced COVID-19 testing platforms at the early stages of the pandemic, making this Pacific island country one of the first to be able to conduct massive testing in real-time.
This story is part of a series dedicated to the collaboration between the Pacific Community (SPC) and New Zealand's Ministry of Foreign Affairs and Trade (MFAT), as part of the renewal of their multi-year partnership.
“We have a simple message for all countries: test, test, test.” On the 16th of Mach 2020, as the world prepares to face the greatest pandemic in modern history, the World Health Organization (WHO) Director-General sets a clear guideline.
Testing is one of the key components in the fight against COVID-19. It allows countries to identify people who have the disease, and to scale-up their care services if needed. Testing positive patients also prevents them from being in contact with other people, and therefore contributes to slowing the transmission of the disease.
In the Pacific, testing is made even more important given the geographical disparity of the countries and territories that make up the region. Without a clear picture of the COVID-19 status of their population, it is impossible for countries and territories to make informed decisions regarding the opening of their borders to goods and services, which are critical to most of their economies, or to implement repatriation plans for their many nationals who work or study abroad.
Within the first months of the pandemic, the WHO-led multi-stakeholder Joint Incident Management Team, of which MFAT and SPC are part, was quickly able to set up an assistance programme allowing countries to test, thanks to the utilization of 4 module GeneXpert machines, a testing equipment initially deployed to help Pacific countries face other transmissible diseases such as tuberculosis and HIV/Aids.
“This first step was critical – but it was just a first step”, said Vijesh Lal, a laboratory specialist from Fiji who works for SPC’s Public Health Division (PHD). In his role, he provides technical guidance to the Joint Incident Management Team (JIMT) on lab related matters pertaining to COVID-19 testing.
“In a period full of uncertainties, it allowed the countries to test their population without having to send the tests to Australia or New Zealand. Now the problem with this equipment is that the cartridges you need for COVID-19 testing take a long time to produce. Also, getting the test results take more time – less than 100 tests can be conducted each day. In the event that a large outbreak occurs, it is quite limitative.
The solution to these challenges is called Real-Time PCR (RT-PCR) facility. Basically, a RT-PCR facility is a COVID-19 testing center equipped with advanced testing machines and operated under a very specific technique that allows hundreds of tests to be conducted in just a few hours - with the ability to get the results on-site. It is considered the “gold standard” for COVID-19 testing.
Under the guidance of its previous director, Dr Paula Vivili, SPC’s Public Health Division conducted a survey in June 2020, in which some of the member countries of SPC volunteered to pilot the installation of RT-PCR facilities, including the Cook Islands, to which MFAT has agreed to provide financial support for the installation of the facility.
However, the setting-up such a facility poses important challenges in the Pacific, especially during a global pandemic.
“Building a RT-PCR facility must follow very strict procedures, in particular in regards the refurbishing of the building which will host the testing centre. Without the possibility of having RT-PCR experts travel to Avarua, the capital city of the Cook Islands, we had to find alternative solutions”, explained Vijesh Lal.
SPC was able to hire local engineers who, although they did not have specific experience with RT-PCR facilities, managed to successfully refurbish the building, thanks to their good knowledge of medical facilities as well as remote support received from Australia-based laboratory experts in PCR from the Doherty Institute.
The other big challenge was the procurement of the advanced medical equipment necessary for the operation of the testing centre.
“This is where the support from MFAT has been extremely valuable’, explained Vijesh Lal. Our counterparts from MFAT mobilized a large network of contacts procurement experts and even the national airline with whom they negotiated to ensure that the equipment was delivered quickly.”
MFAT contracted The Pacific Pathology Training Centre (PPTC) to procure a second set of equipment from New Zealand suppliers to ensure that the RT-PCR capability was in place before two-way quarantine free travel (NZ-Cooks) began.
But there was another problem, that was tackled thanks to the flexible nature of the MFAT funding.
“We quickly realized that the cost of the project had been underestimated. This is the risk when we work in a context as uncertain as that of a pandemic: everything becomes more difficult, everything costs more. Also, working with systems as sensitive as RT-PCR facilities adds a significant layer of complexity’, said Vijesh Lal. We quickly informed MFAT of this challenge and were able to benefit from a budget extension without which the project would never have been implemented.”
MFAT also contracted PPTC to deliver face-to-face training of laboratory staff at Rarotonga Hospital when Doherty’s (the Australian based supplier contracted by SPC) was unable to travel to the Cook Islands due to border closures. PPTC worked closely with Doherty’s to ensure integrated training - Doherty’s developed training modules and delivered the online training and PPTC delivered the face-to-face training.
PPTC also assisted the Rarotonga Hospital laboratory with the development of standard operating procedures, workflows, and has continued to provide significant ad hoc advice to the Cook Islands.
Today, the facility is operational and medical staff have been fully trained to conduct mass COVID-19 testing. But one of the main benefits of this project is also its versatility.
“We are all optimistic that the COVID-19 pandemic will end soon. These RT-PCR facilities will then be reused to test for other recurrent epidemics in the Pacific such as dengue, chikungunya, zika, leptospirosis and measles - and thus contribute to the long-term health of the people of the Cook Islands and other peoples of the Pacific.”
Story written by Alexandre Brecher, Corporate Communications Office