PNG has been a bottom-10 immuniser for measles and hepatitis B since about 2015, and for DPT since about 2010. It has been the worst or second worst immuniser for all three since 2017.

The graph shows the average ranking across the three vaccines for the 10 countries which have the lowest average rankings for 2019.

It is generally a group of countries facing crises of terrorism, refugees and/or large-scale conflict. Plus Papua New Guinea.

How to explain this shocking fact.

Explanations based on PNG’s characteristics struggle in the face of comparisons across countries.

We might say PNG is a fragile and conflict-affected state. The average for fragile and conflict-affected states is 68% for hepatitis B, 67% for DPT and 67% for measles.

PNG’s rates are 42% across combined hepatitis B/DPT and 34% for measles.

We might say that service delivery in Melanesian countries is generally poor. Immunisation rates in Vanuatu and Solomon Islands are 80% or higher for measles, and 90% or higher for DPT and hepatitis B.

A standard explanation is that PNG is geographically challenging and populated by hard-to-reach, remote communities. But that doesn’t explain why its vaccination rates have plummeted over the last 15 years.

Perhaps the data is wrong. 2019 was in fact meant to be PNG’s ‘year of immunisation’, the year in which, responding to an outbreak of polio, a massive immunisation drive was conducted, with significant donor support.

According to UNICEF, more than one million children were vaccinated against measles (as well as rubella and polio) in a nationwide campaign that year.

But the World Bank data (which comes from UNICEF and the World Health Organisation) tells a different story.

So does PNG’s own national data (presumably the original source), which puts measles vaccination rates in 2019 at 34%, and the combined DPT/hepatitis B vaccine at 42%.

These numbers showed no improvement at all over previous years, simply a halt in the deterioration.

Perhaps there are problems with the quality of the PNG immunisation data (and more generally PNG’s over-elaborate health data collection system).

The comments in the UNICEF/WHO country report hint at this. But, even if there are question marks around PNG’s precise immunisation rate, the country’s own national program and survey data both confirm the collapse in PNG’s immunisation rates over the last 15 years or so.

Immunisation rates improved over the 1990s. The real collapse came between 2013 and 2017.

The emphasis then was on providing funds for members of parliament to spend on local projects. None went on health service delivery.

There was a famous drug corruption scandal. The resource boom was over and revenue was falling. Health budgets were cut (after inflation, by 9% between 2013 and 2017).

Then prime minister Peter O’Neill introduced a ‘free health care’ policy at the start of 2014.

Health facilities were discouraged from charging user fees, their most reliable source of revenue. At the time analysts warned this would weaken the health system.

Meanwhile, Australia was reorienting its aid to PNG away from service delivery!

Whatever the questions around the accuracy of PNG’s immunisation data, there is plenty of evidence that immunisation rates deteriorated to crisis levels prior to Covid-19.

Controversies over Covid vaccine make the general immunisation task that much harder.

We can debate whether PNG is a failed state. But this is a clear case where the state has failed its people.

This research was undertaken with the support of the ANU-UPNG Partnership, an initiative of the PNG-Australia Partnership. The views represent those of the authors