 Hello from the Lowy Institute in Sydney. We're coming to you this morning from the lands of the Gadigal people of the Eora Nation and we pay our respects to the traditional owners and their elders past, present and emerging. My name is Shane McLeod. I'm the project director here at the Australia Pup when you're getting network at the Institute. We work to connect people between our two countries and given the limits on the ability for us to do that in person at the moment, we're pleased to be able to host this event today online. We're able to do that thanks to the ongoing support of the Department of Foreign Affairs and Trade and also our event sponsors Coca-Cola Amatil and Bank South Pacific. Unfortunately, it's not a positive story we have to tell today. COVID-19 has dominated lives around the globe for more than a year. The story in P&G today is especially difficult. Since the start of February, official case numbers in P&G have quadrupled. Officially, 91 people have died, but the reality is likely many, many more people have succumbed to the virus. Port Moresby has been bearing the brunt of the outbreak with high case numbers and sick patients overwhelming hospitals. International medical teams have arrived to help and so have vaccines, but there's a huge task ahead to try to bring the pandemic under control. And that's in the capital. In P&G's provinces, the virus has also been taking a terrible toll. After cases were confirmed from Manus earlier this month, the virus has now been officially detected in all of P&G's 22 provinces. But as to how the provinces are contending with the virus, we've heard less. We know that provincial hospitals have at times been overwhelmed that testing has been difficult to access. Data poorly gathered and misinformation a major challenge. We're fortunate today to have with us three panelists who can shed some light on the situation in P&G beyond the capital. First to Vanamo, where we have Dr. Stella Jimmy from the West Seapic Provincial Health Authority. Good morning to you, Dr. Jimmy. Good morning, Shane. Now you're the Provincial COVID-19 Response Coordinator. Dr. Jimmy is also a pediatrician by profession and she's the Director of Curated Health Services with the Provincial Health Authority. Next, we go to Garoka where we have Dr. Pamela Tolliman joining us from the Institute of Medical Research. Good morning, Dr. Tolliman. Now you're a Senior Research Fellow and you're part of the IMR's team supporting the national COVID-19 response. And you're also working on validation of antigen rapid diagnostic tests in the P&G context. So we'll be talking to you more about that shortly. Finally, to Melvin where we have Professor Brendan Crabb, CEO of the Burnett Institute, Professor Crabb. We might be having a video issue with you there. We will get Dr. Crabb back on the line. Dr. Crabb is intimately familiar with health in P&G as well as his research into malaria. He's also has an interest in newborn and maternal health. He's also actively involved in Australia's COVID-19 response. So we'll be looking forward to your contributions, Brendan. Now the technology is a little against us this morning. We've had a few issues getting started and there are apologies if you were trying to watch us via our Vimeo link. Unfortunately, that platform has not been available for us this morning. We hope if you are watching us, you can share our Facebook link and get people connected to you as well. Brendan, your back's great to see you there. I might go first to Vanamo to Dr. Jimmy and to ask you about the experience you've had there in Vanamo with the pandemic. We know that earlier this year, you were hit particularly hard, particularly early with the surging case numbers. What's the experience been like and where are things at now in West Pacific Province? Yeah, Shane, we got hit at the most weakest point. The thing that we dreaded, we didn't want to happen to us, did happen to us with the health workers being the most affected. When we had that, our third case for the province actually when on the third of the 12th of February and this case was unlike the ones to we saw last year. We had very quick transmission of the infection amongst the health workers in the hospital and that almost brought us to our knees because the significant number of the health workers were affected and we couldn't sustain the services. So we just have to scale down to emergency services. And the infection just spread very rapidly within the urban setting with a number of clusters happening in town. We had the closed setting in the prison and also in the community. So the numbers just rose very quickly for us and we didn't have like the capacity to manage if that was to continue. So we had to institute some aggressive measure initially to have a lockdown in the province to which lockdown to try and have a control of this outbreak which we did have some control and we brought it under control and we have all recovered and health facilities are now back in operation especially the hospital and district hospital that were both affected at the same time. So we have a regime services and the number of cases have gone down. When you're dealing with an outbreak like that what are the things that you found that you needed the most? Like what was effective for you in being able to get a hold of the scale of the outbreak but also to quickly respond to it? I think the team that we identified that we really needed the most at the time was the human resource, the health workforce. So with like for my hospital we had five of the doctors and that's like five out of the seven doctors we had at the time going into quarantine and isolation so that just we were just not able to manage so the team we identified that we really needed was the health workforce to support us at the time but we did not have that help immediately. So we just had to make do with what we have on the workforce that's on the ground re-organize, rearrange our services and seek help from our neighboring province, ECP, Provincial Health Authority to at least send us two of their doctors across to just see the services through the first two weeks when we were all in isolation and quarantine. Dr. Tolliman, I might come to you and get a bit of a sense of how things have been in Garoka because I know in Eastern Highlands you've had quite a sharp outbreak as well and a lot of it centered I gather on the university but what's it been like being in Garoka and trying to I guess contend with a pandemic like this while you're directly involved in the national response? Yeah, so thanks, Shane. We are in Garoka, that's the headquarters of where the PhD is to do medical research. We may have just lost our... Increase the cases in slain. Oh, we're getting you back I think Pamela just hold on a sec. Am I back? Yeah, you're back, go for it. All right, yeah, thanks. You're correct in saying that the Eastern Highlands has seen an increase that's been the case. So there was initially an outbreak within the university but it's fair to say that there is widespread and sustained community transmission in the province. In the last week we reported the province reported 92 new cases and apart from the NCD and Western province I think Eastern Highlands is the next province that reported the most number of cases in the country. And is it a situation that's under control now or is it something that's still causing a big challenge there for your provincial health authorities? Look, I think it's interesting when you talk about control. I think it's hard to gauge when we are still really needing to test and gauge the status of the problem. So I think it's kind of difficult for me to say whether something, the situation is under control or not. I think that we have had issues with resources on the ground I know in March we continue with the testing. So that's been a challenge. But it's very challenging when on the streets people we know that there is transmission in the community but you certainly see people who are not wearing masks and social distancing in the community is really seeing that, so that is a challenge. I'm interested to know from your colleagues from IMR sites around P&G, is it a similar story? We do hear about the provinces where there are significant case numbers but we now have a situation where there are cases in every province in P&G. So are you hearing similar stories in terms of the impacts outside? Yes, similar stories, but I think as the issue I think, and I probably will speak a little bit more on this when we talk about testing is that data isn't being captured in the international tally. But there's certainly anecdotal cases of people becoming symptomatic, but we may not necessarily, as with the rest of the country, we may not be actually reporting the true numbers. The true scale of things. We are having a few dropouts in your link but it's still pretty remarkable that we can have this video chat between Sydney, Melbourne, Garoka and Vanamo. So we're gonna press on. We'll come back to you shortly Pamela. I want to go to Brennan Pratt now in Melbourne. Brennan, you have amazing connections in P&G. You through the Burnett Institute have operations right across the country. What are you hearing and what are you hearing are the real challenges in provinces in P&G? Well, thanks Shane and thanks for putting this event on and it's fantastic to hear from people who are actually there experts like Dr. Jimmy and Dr. Tolman, thanks so much. And I know that there's connection issues but it's just precious, very precious to hear from people on the ground. I'm not, I'm in Melbourne. Burnett is also very provincial, obviously in Britain and the Western province are a focus for us. And clearly in those places we're hearing really significant stories of COVID as a problem, all of our connections, all of our staff and hospitals and the health services there are under really serious pressure from COVID. I mean, I got interested, very interested in the month or so ago. It's just for more than a year and they've been programing P&G both from the Australian side and the P&G side that I've had hand in. But a month or so ago, we started to realize we were in an unequivocative emergency and Dr. Tolman's already said that the testing doesn't paint a real picture. I mean, I'm gonna stick my neck out and say that there's 10,000 cases which is confirmed is a very, very significant underestimate. I say that for a number of reasons. One is we know that testing is symptomatic and it won't get all those symptomatic people maybe by a factor of three, four or five. Already that means there are really 30,000, 40,000 cases. Then there are all the asymptomatic people in P&G who will be transmitting virus. In P&G, that's a lot higher than many other countries because the age demographic, average age in P&G is just 22. And so there will be a lot higher rates of asymptomatic carriers in P&G than in most of the Western countries. So that means we're now up to something like 100,000 or 200,000 people positive. And that fits much more. In fact, it's still an underestimate with the sentinel case, sentinel groups like pregnant women in CD at 8% positive, for example. And our NGO partners having similar sort of numbers, 10% of staff, 20% of staff. So there really is every likelihood we're closer to 100,000 people positive now even as a wide estimate. And for reasons Dr. Pollerman said, still going north. So we desperately need testing to tell us that true. Am I right? I mean, in that estimate, but we know the number is way more than 10,000. We also know it's going like this, a steep slope up. So the last month has been trying to raise the alarm, especially in Australia, but also in P&G that we have something we didn't expect. I certainly didn't expect to be happening at this pace and scale. Brendan, thanks for that. We might go to Dr. Jimmy in Vanimo because I am really interested in this question of testing. So can you give us the situation for you there in Vanimo? If the patient presents at Vanimo General Hospital today and you think that they're a COVID case, what resources do you have available to you to test and to find out if that person is a positive COVID case? Okay, we now have the cartridges available to us for the gene-expect testing. We have that machine in the hospital and we've also been given the antigen testing. So we have these two tests available for us on the ground and that we can do. Okay, so that's okay, Shane, for us that they've been setting to do that testing. Our challenge for the province in terms of testing is just to operationalize these things, to expand the testing in the province. It's an issue for us given our challenges with the logistics that's involved and just the geographical isolation and the challenges that we have to reach and bring the samples in. It's just a fit in itself. Trying to mobilize all these things and organize the testing, scale up testing. So in the district hospitals that they've been setting, it's okay, we have these things, but when we go out to the district to scale up it, that's a big challenge for us to increase our testing capacity. And I'm guessing at the moment that testing is focused on people who are either symptomatic or where you know they've been in close contact with someone who is a positive case. So it's not surveillance testing at this point and you're not really able to go much beyond what you can do there in Dynamite. Yes, more or less we are, it's based on our ILI and SARE surveillance at the health facility settings and contact tracing of positive cases. But then there's also issues with delay in reporting of results that have been sent externally in following up on the positive cases context. So that data kind of reporting and gathering, do you mean what you're reporting back to the national level or what you're able to track and trace locally? Locally we can, when we do that testing locally, we can immediately do the contact tracing. It's the test that have been sent externally that there has been delays in the release reporting of the results. So that's the one that we are having issues with and that's also contributing to the disparity in our results provincially and also the ones released from the National Control Centre. And how big a problem is that you think in terms of knowing the scale of the outbreak? Like I said, because we have these delays in releasing of the results, reporting back of the results, you see, by the time we get back the results, they're already over two weeks and people have already gone past the quarantine isolation period. And now we don't have the fresh information to be chasing up on the context. So that makes it a big issue for us on the ground trying to keep abreast with the evolution of the outbreak on the ground. All right, I'll go to Dr. Tolliman now in Baroka. Dr. Tolliman, you're involved in some of the work to verify, I guess, and see the value that these rapid tests can do in tracking and tracing and identifying the scale of the pandemic in PNG. How far are they being deployed at the moment? What have been the issues in sending them out there and what role will they play going forward? Well, they're incredibly important, Shane. They're absolutely, Dr. Ginny's comments about how it's been incredibly frustrating for clinicians and these control officers to contend with the long turnaround times. I absolutely acknowledge that, you know, the three kind of districts or provinces that are on the tally is having the largest number of cases reported, are centres where, or provinces where there's been a lot of support for testing. So you've got NCD, a lot of resources have been mobilised for testing in Port Moinesby. In the Eastern Highlands, you have the IMR is situated here and has been able to support the Eastern Highlands Provincial Hospital and the PHA here. And in Western province, OCTETI Mining Limited has shown incredible leadership in supporting the diversity of and reach and strength of the health areas that have really don't have that same kind of level of support in testing and other kind of responses. The Pan-Bio COVID-19 test has been approved for rollout in the country and these test kits should be in the process, if not already delivered to PHAs throughout the country to really, you know, fill that gap in testing and being able to have, you know, a test result for guide management. They, as you know, they are rapid, they're meant to be used and have a quick turnaround. So Pan-Bio will give a result within 30 minutes and that's incredibly important to make a management decision. The IMR has been involved in validating and we will continue to keep to the partnership with the NDOH and other partners like OCTETI Mining Limited in validating different tests and technologies as they become available for validating for use within the PNG context. So really thinking about different use case scenarios and guidelines as to how they should be used. As Professor Crabb mentioned, this issue around testing in Asian climatic population is incredibly challenging. So part of this validation is looking at not only the performance, most of these rapid test kits have been validated already for use within symptomatic cases. So kind of strict, kind of clear for presentation. But there's limited data not only in asymptomatic cases and that's exactly the data that we're trying to gather to see how we can best use these new tests and technologies to measure the extent of the infection for example in asymptomatic population. So I think recently the pandemic, national pandemic control controller issued a directive that the Pan-Bio antigen test that's being rolled out in the country does not require a confirmatory PCR test. So if the antigen test comes back as positive that it's taken as a positive and the patient should be managed as such. So that will hopefully cut down the sort of wait time in making those decisions around legal management, quarantine, et cetera. So I might go to Professor Crabb because he was co-author on an article that appeared in a straighter newspaper just over the last couple of days talking about things Australia could do to be helping P&G right now and you talked very much about this testing idea. So what would that involve? What can Australia do to help with this testing effort in P&G beyond what's currently been happening I guess in terms of shipping samples back and forth to labs in Australia? Yeah, it's a good question, Shane. And I might go back a step and just say perfectly from an Australian point of view I've found our own government's attitude to the region and P&G for the whole last year really positive. So there's just been an open door from the Australian side and of course anything that's come from the Australian wanting to assist P&G has been a dialogue with P&G. So that side of things has been horrific. I do think though that we have all, as I said earlier been caught up by a surprise given how well P&G has managed things for the last 12 months. I guess this sudden surge came as a bit of a surprise. So we're talking about what can Australia do with this emergency situation that differs from what it was doing and planning to do over the next eight year or two. And testing, I guess there were three major components to what Australia could offer. The first is non-vaccine help in interventions. And the top of the list there is testing as well of course PPE for healthcare workers those who are gonna come into close contact with COVID cases for other reasons, masks for the general population and so on and so forth. These non-vaccine related interventions or tools that we know helped so well. The second thing Australia was interested in supporting and I'm not sure how far that's got is dealing with COVID misinformation which is right here in Australia and is particularly big in P&G of course. And the third is vaccines. But you are specifically about testing and Pamela has hit the nail on the head. I think there's a huge role for Australia to support P&G rapid tests. Rapid tests are not what we use here in Australia. We use PCR based testing and there are reasons for that. It's not about quality. It is though about whether the central authorities get to learn about the results of the test. So for P&G these antigen based tests at the real time as Dr. Thornman said, is so important that we can assist in that regard. But we can also help build lab capacity. The IMR is a shining light in the Central Public Health Laboratories in Port Moresby, a shining light. But across the country we need strength and laboratory capacity. Not gonna be super helpful in this next month of the emergency but in the six months to come and the 12 months to come and the 24 months to come all of which I think will have COVID as an issue. That lab strengthening is something Australia could really help support P&G. All right, Brendan and Crabb, you've mentioned there this issue of misinformation. This will seem like an interesting segue because we've ended up being here on Facebook today. It's been a very good place to host this video when we had a few tech issues but Facebook's a massive part of the information ecosystem in P&G. And I'm interested, perhaps first I'll go up to Vanimo and to Dr. Jimmy and ask her how people are getting their information about the COVID-19 pandemic and how big a factor do you think things like social media are in that general mix of information that people are getting about health? Yeah, that's a big challenge that we have right now in trying to manage this misinformation about COVID because the social media has had a significant impact on the, as a source of information that people have been resorting to. And it has, it was, and it is continuing to be a challenge for us in trying to get the message for COVID-19 and especially in the people adapting the, what we call the Tuplapasin, adapting to the health protocols of COVID-19. So yes, that has been a big issue for us in which regard to the social media. Have you been able to overcome it by your own local messaging, by being able to speak to people? Have you been able to, given the emergency you've been facing? Is there a role for awareness, community awareness, that type of thing? Yes, we have our risk communication team that goes out to do awareness from the coordinating from the provincial like the student districts working with our partners or stakeholders, disseminating the information, going on the whatever media that is available for us, platform, especially the radio, but even though that coverage is not big, but as much as possible, disseminating the information that we can get across to all our partners and stakeholders in the community. And even going down, working with our local level governments and going down right down to the religious to try to disseminate this information on COVID-19. So, Dr. Tolliman, I'll come to you because I know the IMR has been very heavily involved in some of the work around information and vaccines. And that has been a point of some political contention as well as community contention. How important is it that there are authorities that people can turn to to talk about perhaps their concerns, perhaps the information they're seeing about vaccines and what more can P&G health authorities do to, I guess, smooth the path for a national vaccination program? I think the video... Hi, Shane, am I still online? The video just dropped out as soon as you started to chat. But if you go for it, I think we'll keep the video on me and talk about it. Oh, there you are. I think we can come back to you now. For many people in Papua New Guinea, Facebook is the internet and it's one of the only portals where they get information and exchange information. It's really incredibly important that if you try to battle every single piece of misinformation out there, you will just struggle and become overwhelmed and be on the brunt of a lot of attacks possibly. I think one of the strategies we've tried to employ and we need to continue to get better and perhaps we need to get more support here is where there's sort of a vacuum of information, people will fill it with garbage. So we need to get good, accurate information that's been, you know, says to be able to be absorbed by the masses in a quick and easy way and to use platform for accurate information. That's incredibly important. So you need to fight by getting good information out there. I don't mean to say fight in that way, but, you know, in terms of interacting, everything. Well, what's been a concern for me is the health workers and I think, and even the misinformation around within our health worker workforce. So I think that's a good place to start, to start with even in the Institute of Medical Research, we've tried to work with our own staff because that gives you a gauge of possibly what's happening out in the community so that you kind of can start with your own health workers and then kind of look at spreading information, good, accurate information throughout our community. That's great. Dr. Toderman, thank you for that. We've got some people who are asking comments and the place to do it because of the technical situation we're in at the moment is actually back on Facebook. So thanks for watching and I can see a few people have been asking some questions there. So what we might do with the last 15 or so minutes of the event today is actually go to some of these questions and I'll get our panelists to give us their responses. The first one I can see, which is I think worth sort of bringing up in the situation where we're talking about testing was about encouraging people to come forward for testing. So we have a question here. How do you encourage people to want to get tested and how do you encourage people to use that information and to respond in a community sense? So it might go to you, Dr. Jimmy, I mean, getting people to come forward for a test has it been an issue and what has worked in encouraging people to step forward? Thank you, Shane. I think a lot of it has to do with our health seeking behavior. So that is also what we've seen with COVID-19 and we have some of the things that we have done at the health facility to encourage for testing and separating out the services from the general services or making services separate and specifically for people with respiratory symptoms. So they don't have to sit in a queue and wait and all these things. So these are some of the, in terms of service-wise and also making the test to be available locally so they can be informed by results. So now with the antigen testing, that should, I think, improve with the people because that was one of the discouraging thing was that they were not able to get their results immediately and know what their status are. But I think with the rollout of the antigen and us encouraging more people to come in, but like I said, it's still a challenge because of the health seeking behavior. And then the association of the disease, COVID-19 and the implications that go with it when you are diagnosed as COVID-19. And I think from the perception that we're getting is people not wanting to be quarantined and going into isolation. And then like ProcSecREP has said, majority of our people, given the population pyramid are young and they're mostly asymptomatic and the symptoms are very mild. People just disregard the symptoms because of our health seeking behavior. And they will not come to the hospital because they have a small, minor cold or sneezing or a small fever. These are things that really, they disregard this kind of symptoms so they will not present unless they're very sick. Then they come to the hospital. All right, Dr. Jimmy, thank you. I've got one here which is for Dr. Tolliman which asks, you've been a strong leader promoting evidence-based medicine and reliable information and as a consequence, you personally have suffered some social media attacks from groups that are opposed to things like vaccination. So this is a question from someone working in the health sector. What advice do you have for health workers who are dealing with that kind of attitude, that kind of, I guess, criticism that they're facing in the field? I think consistently we think about serving our people and we need to, in a kind of a humble and approachable way, just convey that we are in the field of service to people. So it is something for me. The response needs to be, you know, locally defined and locally led and this is the way in which we can change and respectfully move our people to a place so they can understand and respond to the present danger that we face. So it's been an interesting journey and kind of understanding that behavior doesn't change overnight and set views don't change overnight, but we need to continue to be consistent in our messages. We need to kind of put service, you know, at the forefront to say to people, this isn't about, you know, curtailing their liberties and their movements. This is about the good of our communities, the health of our communities, the well-being of our country. That's sort of been the position I've taken personally. I'm sure Dr. Ginny will add to that. She might have some experiences of how she sort of, you know, responded. Yeah, Dr. Ginny, would you like to respond to that? How you deal with that sort of, that approach you might get from patients who have been informed, I guess, by that misinformation? Sorry, Sharon, I didn't hear the question. I'll just ask you if you've had similar experiences to Dr. Tolliman, how you encourage your healthcare colleagues to push back against misinformation that might be being brought forward by patients. Yes, we have organized, we've been organizing within the PHA, targeting our health staff, getting the organizing in a structure-wise, setting up our systems from the provincial elect, what is right down to the districts, to the health facility, and having forums in place and getting the message to be delivered, same message delivered to all our health workers and having common forums and workshops and things like that in getting our staff through all these things with COVID because we've had a whole year of preparation and trying to get our staff prepared and especially dealing with the fear of COVID and all these things and in managing the patients with COVID. So we've put a lot of work into getting our staff on board with this. And it has paid off our staff. And then we've experienced it firsthand with us getting the infection itself and going through the experience and coming out of it. So I think that has brought us to another place and our experience with COVID and managing and handling COVID. We are more confident now in going forward with COVID. Professor Crabb, can I come to you and ask you about vaccines? And this, I guess, slightly tricky situation that Australia is in now regarding vaccines. Australia is having issues with the rollout of vaccines and has made some medical recommendations about the AstraZeneca vaccine, which is very much central to the COVAX project and it's rolling out around the world and in countries including Papua New Guinea. Is Australia in a tough spot trying to support vaccination in PNG given the differing messages that are sort of being sent for the Australian audience versus what I guess is the situation in Papua New Guinea? Well, yes, they are in a tough spot, but in a tougher spot than they should be and the challenge is what's just been talked about in the last two or three topics. The theme that's run through that is misinformation, lack of education, lack of community understanding. So in support of both Dr. Jimmy and Dr. Tolman have been saying, but extending it a step further than just trying to manage Facebook and getting good information out there. The most important thing in countering misinformation is leadership. Leadership, politically, we're not so pleased to see the Prime Minister Murrupi get immunised, that sort of thing's so important, but leadership from any group that has respect within the province or a community, church groups, private sector, sporting heroes and so on. That sort of leadership is so important in setting the tone for what ends up on Facebook and in any other media source. And so to your point about vaccines, here we are finding ourselves in this deep worrying discussion about a vaccine that is fantastically good compared to any vaccine, somewhere in the range of 75 to 85% effective against symptomatic COVID and 100% effective against hospitalisation and death. And that is incredibly safe, but not perfectly safe as our most interventions. So we find ourselves in this controversy that I find grossly overblown, but there we are and it needs to be counted with this leadership. The situation with the AstraZeneca vaccine, it and vaccines like it, which are adenovirus-based vaccines that are largely heat stable and relatively inexpensive. So easy to move around countries, easy to store in fridges and easy to get to people. Adenovirus vaccines like the Johnson & Johnson vaccine that it's another one, Russian Sputnik 5 vaccine that is also very promising. They're all adenovirus-based. They're the only realistic option for the near term for many countries in the world and including Australia for a large proportion of the population of Australia. And I just encourage ways to find people to embrace them. We have a blood clot issue that affects something like four or five in a million people and maybe fatal in one in a million people who get immunised. And that's of course a terrible, terrible outcome. But even blood clots themselves are a much higher frequency problem in COVID-positive people than they are in COVID-immunised people, little on the effects of COVID itself. So we find ourselves in this tricky situation because of that one big elephant which is misinformation, poor communication, poor storytelling, poor linking up to the community. As has been said by Dr. Tolman and Dr. Jimmy, where they really need to be educated and finding solutions themselves to communicating the messages to their communities in the right way. It's a fabulous vaccine. It'd be a tragedy if things stand in the way of either Australians or Papua New Guineans, in this case, getting immunised with it. And some really positive comments just in the last couple of days, I think from senior officials here in Australia talking about the opportunity, given what's happening in Australia now in terms of prioritising other vaccine options, that there may be a greater supply available from Australia as well. So I'm keen to hear from our colleagues who are joining us from the provinces of P&G. Dr. Tolman, what have you heard about the vaccine? What have you heard about when it might be available for you in Garoka? So far, no news. We are checking every day. I really can't offer any kind of happy news as to when we in the Eastern Highlands or even in the Institute for Medical Research will be getting the vaccine. I wish I knew if we'd be able to share. But for me personally, I'll take any vaccine. Very generous vaccines in the first instance and then the covax supply being mobilised is really promising news. I think we just hope that there is a transparent distribution of the vaccine to the provinces where they are most needed and just continue to work with trying to get accurate information out there to, you know, quell fears and to just reassure people that this is an incredibly important step that we as a country need to take. But it needs to also, you know, it's we're talking about vaccination coverage, which is incredibly important. And we're also, as Professor Crab mentioned, we still have to promote along with vaccination these non-pharmaceutical interventions like Masquerie Institute has been very clear in its support of the government roller of AstraZeneca as an institute. We fully support it. It is safe and it is efficacious. That's really effective. It will prevent severe disease and so incredibly important for our population. And I'll come to Dr. Jimmy in just a sec. But while we do that, I'll just remind you if you do have a question to ask, do add it as a comment on the video here on Facebook and we'll do our best to get it to the panel. And Dr. Jimmy, any news for vaccines for you there in West CPIC Province? We've heard that they're working on consigning for the Monastery region, which we fall under, but that we have not been given a specific date. Nonetheless, we have already made our preparations in the province and the things that we need to get in place before the vaccine arrives. And so that program is in place and we're just waiting. But we've set our date locally for the 17th of May for the rollout of the vaccination in the province. Not too far away and I hope everything goes well in terms of logistics for you. There's a couple of comments here about vaccines and some of the reluctance, the vaccine hesitancy being the case of people worried about side effects. So perhaps if I can go back to you, Professor Crabb, side effects that we're hearing about in terms of the general side effects when people get the AstraZeneca jab. What are you hearing? It doesn't sound like it's too bad, but there's sort of headaches, perhaps a little bit of fatigue. I mean, is that out of order? Would you expect that kind of thing? And for people who don't know much about the vaccine, is that something to be concerned about? It's not something to be concerned about, but it is real and it's real with most vaccines. It depends on which ones you get and it's because of what they're trying to do. A vaccine is something that goes into your body to stimulate your immune system. So when it goes into your body, you get a rush of cells, of your immune cells to the region. You get these chemicals, natural chemicals released to give you immunity at that point in time to what vaccine is. But of course, that's going to give you immunity to the infectious disease itself. So the fever and the headaches and so on that in some people I got vaccinated a week ago and I didn't have those symptoms, but a number of other people of my colleagues did have those symptoms, some of which felt they couldn't come to work a day or two after. So symptoms for 24 to 48 hours are very common with any vaccine and most certainly with AstraZeneca of that sort and nothing to be worried about. They are to be expected and they're a sign that you're generating a good immune response to the virus, which is exactly what you want. So it's real, but nothing to be concerned about. All right, getting another, a couple of other interesting comments and some suggestions here as well. One that suggests that perhaps one of the strategies that might help with vaccine take up would be publicizing the risks of the virus itself versus the vaccine. Dr. Tolliman, do you think that's cutting through to people? Do you think people are aware of the risks of the virus itself or is it part of that misinformation sense that people aren't too worried about the impact that they might get from the virus? Yeah, it's difficult when you have the majority of cases that asymptomatic and for mildly symptomatic. I think the NDOH and partners like the WHO have produced materials to educate people about the complications that can arise and sort of what to expect kind of clinically when you have COVID. But if people, if there's not sort of a connection between personal risk and personal danger, it is difficult for people to really appreciate that. And even for them to not only think about themselves but think about their role in transmitting to people who could be more vulnerable than them to in terms of severity of clinical presentation or possibly death. So if our messages are consistent and we just have to not be relentless in getting that information out there. There's some great questions coming through and it makes me think that there's probably a whole program we could do just talking about vaccines and questions people have about them. But a good one here, just the shelf life of the AstraZeneca vaccine that's at the center of the PNG rollout. Perhaps it's one for you, Professor Crabb, just in terms of the shelf life. How long do vaccines actually last in storage before they can be deployed? And is that going to be an issue that you think in a rollout in PNG? Well, all vaccines last for a long time in the right sort of cold storage. But for the mRNA vaccines in particular, that cold storage is logistically really challenging. So for the vaccines that we're not talking about here, you know, the Pfizer and the Moderna mRNA vaccines that get so much attention. Their downside is their long-term storage has to be at minus 70 degrees, which is an unusually cold freezer. Really hard, even in a wealthy country like Australia, to have that distributed well throughout the country. But other vaccines can get stored for a long period of time, the AstraZeneca at a much lower freezing. But it still needs freezing. And then there's the issue of once it's thawed out and is in the fridge, how long is it going to last? And so sort of not indefinite, but a long, we're talking three, six, 12 months in the freezer, maybe even longer for some vaccines. And then once they're thawed out, how long have you got? And what you hope for is that you have days or a week thawed out in the fridge, and that's the sort of timeframe for AstraZeneca, rather than just a matter of hours, which is what the concern was for some of the mRNA vaccines. You know, you thawed them out, then your patient's not there to immunize and so you have to throw the vaccine out. So one of my comments earlier was about the stability of the AstraZeneca vaccine. And that's a big advantage of it, that it can be stored in a lower temperature freezer and survive for quite a long time in a normal refrigerator, which gives it a lot of flexibility for transport and for practical use in clinics and health services wherever they might be. Professor Krab, thank you. Now I realize we're right at the end of our event today. So what I thought I would do just at the end here is just to very quickly go around to each of our three panelists. And just if I could get your thoughts, and I'll come to Dr. Jimmy first, just in terms of next steps in how PNG responds to this pandemic, your thoughts on the priorities from where you are in West CPIC, what are the immediate things that will help your region and your town to deal with COVID-19? Okay, Shane, I am at the border province, the international border with the Republic of Indonesia. That's one of our biggest challenges at the moment is going forward, living with COVID-19 along the border because we've had issues, ongoing issues and challenges in managing our border in terms of people crossing the border. So that's one of the issues that we have is to find a way forward of living with COVID-19. Along the border, especially in terms of our trade and all the activities that we usually do along the border and taking on all the COVID-19 as well. Secondly, we are using the COVID-19 as an opportunity for us to strengthen our health systems because a lot of things are not in order and not right. So we are using it as an opportunity to stepping stone to build on it to improve our infection control practices that's within our health system. And of course, the other thing is protecting the population and getting our people to understand the disease and cooperating with us as we move forward in rolling out of the vaccination that is coming on board next month. So that's the immediate thing that we are looking at now is to get our people to understand that and cooperate in their vaccination. But otherwise, we have all these long-term things that our health system has suffered and a lot of things that we still need to do to build up our health infrastructure and all the things that go with it. Dr. Jimmy, thank you. I'll jump across to Professor Crabb. Some perspectives from you. What do you think are next steps, next priorities in how P&G and perhaps Australia's support for P&G evolves over the immediate future? Well, at a high level, I'm still concerned that we haven't, both at an Australian level and at a P&G level, elevated this to the crisis level that I think it's at. But even if it's not there, that we should act as though it is. We've talked a lot today about the fact that we don't have enough information. When you have a disease like COVID, the lessons from the world is we know about it and get. When you need to therefore act as though it's a worst-case scenario, not just on the numbers you've got and there's very good reasons to think that we are in a worst-case scenario that is going to affect the health of P&G directly, the health of P&G indirectly, the economy of P&G and the economy of the trading partners that P&G has in a really dramatic way. So I would like, my main comment is an elevated one. Elevate this to an even higher level than it already is at the moment. There really could be 1-10% of COVID-19 is infected at the moment and I would not be surprised to see that figure bear out over time. And my second point is the same as Dr. Jimmy's. Use it as an opportunity, an opportunity for a step change in health services in P&G. Now, that may not be so apparent in the emergence of this necruffle too, but over the next six months to 12 months to two years, we'll be dealing with COVID in P&G on top of other issues. There are lots of innovative ways to integrate services to spend more, of course, but also to integrate services and do them in a cleverer way at a provincial level, at a community-led level. That is kind of exciting. So using it in that positive sense as an opportunity, as Dr. Jimmy says, is my other message for P&G in Australia. And up to Garoka, Dr. Pamela Tolliman from IMR. What do you think will be the challenges and what are the things that P&G can focus on right now to deal with this emergency situation? Comments provided by Dr. Jimmy and Professor Crabb. And I think I'll just add that, you know, while the advice, support and leadership of bodies like WHO has been extremely important in shaping that response to COVID-19 in Papua New Guinea, the government and especially the health department has to have the same willingness of engagement with national institutions such as the P&G Institute of Medical Research. The importance of research in generating local and contextual evidence can't be a look pandemic when resources and systems are really stretched. So those are sort of my final kind of comments. But thank you for the great discussion. Look, thank you to each of you. I really appreciate you giving up your time today to be part of this. I hope for our audience who followed us across here to Facebook, after a few technical glitches at the start that you founded a valuable discussion. It is why we're here at the OZP&G Network. We try to facilitate these events to get people talking to make these connections. And at the moment, we're doing it in this digital format. So thank you each for being part of it today. And thank you to you watching there remotely. We appreciate it and stay tuned. We'll let you know when our next event is coming up. For now, that's all from the OZP&G Network at the Lowy Institute.