Puzzled Australians may have heard about the extraordinary rate of apparent vaccine reluctance in PNG where less than two percent of the population has been double vaccinated against Covid – compared with Fiji, where the figure is more than 80%.

One explanation is simply that the system has failed the people of PNG. It can be nightmarishly challenging to get vaccinated.

Here is the astonishing story of PNG friends of mine, a couple who live in Port Moresby:

“We began seeking vaccinations in May, when they became available in PNG. There are awareness campaigns encouraging everyone to get vaxed, but they don’t give details on where to seek further information. If we knew where to get up-to-date, accurate information, our initial unsuccessful attempts would have been mitigated.

“In Port Moresby, the first priority for vaccination was given to companies and to other organisations, by appointment. Not knowing this, we went to the primary vax location – the National Football Stadium – and were knocked back, as we were classed as ‘general public’ and not there by appointment through a company or group. They were not able to advise as to when the ‘general public’ would be eligible.

“Our second and third attempts were through our church, with a well-known doctor endorsing us with a group of fellow church members to get vaxed, again at the stadium. Unfortunately both attempts with that group were also unsuccessful. There was no reason given.

“Our fourth attempt, in July, was eventually successful. A cousin found some information on Facebook saying that vaccinations were to be available at Vision City Mall on Thursday and Friday from 3pm to 7pm, and Saturday from 1pm to 5pm.

“On the Thursday we were at the mall at 5pm, and within 30 minutes, were able to get vaccinated with our first doses of AstraZeneca. We were told to come back exactly two months later to get our second shots.

 A nurse at a makeshift Covid hospital in Port Moresby (AFP)

“We arrived at the mall at 5pm on the date we had been given, to get our second doses. But we were advised that we were too late, as the timing for vaccinations had changed, to 9am-5pm. The vaccine officials were not able to say where we might find up-to-date vaccination information.

“We returned two days later, on Saturday at 2pm, and this time were informed that officials administering the AZ second doses had not come that day.

“On the following Monday, October 4, we returned for a third time, and were instead directed to two other locations – a shopping centre, or a netball centre. We went to the shopping centre, but it wasn’t offering second-dose AZ.

"We finally got fully vaccinated later that day at the netball centre. But as we walked back across the courts, were then yelled at and chased off by security guards.

“Not everyone has the resources to check multiple times, at multiple locations, on multiple days. We are fortunate to have a car and the time to go around checking all the locations. We understand how important it is, so we made that effort.”

This account shows how organisational incoherence is playing a big part in the vaccine roll out failure in PNG.

Blame for the slow uptake has been attributed to PNG’s tough terrain – its mountains up to 4,500 meters and its 600 or so inhabited islands, which have always challenged the delivery of health, education and other services.

An epidemic of conspiracy theories on social media has also been blamed, with people in even remote areas having access to mobile phones, their biggest challenge being recharging since few have access to mains electricity.

The private sector, chiefly in the form of Irish company Digicel, engineered a rapid uptake of mobile reception through the country, the most important infra­structure breakthrough since air travel became widespread after World War II, thanks in part to wartime strips.

A reluctance to follow directions from the authorities may also be attributed in part to the steady decline in credibility of all statements from politicians or leading bureaucrats over the years.

Papua New Guineans widely anticipate that many figures in power are corrupt and spinning yarns to pull the wool over their eyes.

PNG women in Cairns seek donations to buy face masks and latex gloves for overwhelmed hospitals (Brendan Radke)

As a PNG friend told me last week: “The vaccine advocates are politicians, and who ever trusted what comes out of a politician’s mouth?”

In PNG, vaccine uptake is not being driven substantially by education levels.

When vaccination was recently offered at the Port Moresby head office of the central bank, the Bank of PNG, only 30 of about 200 staff took up the offer.

There is anecdotal evidence the tide may be turning towards vaccine uptake, towards popular persistence even in the face of delivery challenges.

A couple of acquaintances this week took two hours to come from their village to Port Moresby to get vaccinated and waited in line for three hours.

But they got there and received the Johnson & Johnson/Janssen single-shot variety now prevalent in the capital.

The few who got vaxed early are starting to promote confidence to others in their extended ­families. Images in PNG’s media of body bags being carted out of the Goroka hospital in the Eastern Highlands have also “shaken people up”, a PNG friend told me, “and finally put some fire under them to get vaccinated”.

But Covid is not the only disease to be spreading in PNG as a result of poor access to health services combined with the above. PNG has the lowest vaccination rates in the world for infants.

Stephen Howes and Kingtau Mambon, writing for the Development Policy Centre at the Australian National University, state that its 2019 rate for measles was 37%; diphtheria, whooping cough and tetanus 35% and for hepatitis B 35%.

Howes and Mambon point out that this shocking situation is not inevitable but vaccination rates have “plummeted over the last 15 years”, with the main collapse in 2013-2017.

“The main emphasis then,” they say, “was on providing funds for MPs to spend on local projects. None of this went on health service delivery.”

None – and health budgets were cut in real terms by nine percent in that same 2013-2017 period.

There was also a famous drug corruption scandal linked to the Health Department. Borneo Pacific won a contract, although its tender was millions of dollars above the previously reliable incumbent, and began supplying drugs from the North China Pharmaceutical Group.

The Brisbane-based PNG expert Jeff Wall estimates Australian official aid to PNG will be about $1 billion (K2.6 billion) this year. But a substantial and growing proportion is being delivered directly to the national PNG government rather than, as previously, to specific programs or projects.

About the same amount, $1 billion, has been provided for this year to the 89 MPs representing local area (Open) seats.

These ‘Direct Services Improvement Program’ and other programs are widely known in PNG as ‘slush funds’ which MPs direct personally.

Meanwhile, the national government has increasingly failed to meet its own funding commitments – resulting, for instance, in hospitals running out of urgently needed oxygen supplies as the Delta wave hit.

It emerged the government had failed to pay for a few months, a $5 million (K13 million) bill to the key supplier.

Lutheran hospitals began to scale down their operations this month because the government had fallen behind in its funding commitment to Christian Health Services through which the churches meet a major part of rural health needs.

The missing funding resulted in support staff, for instance, going unpaid since July.

James Marape receives a Covid vaccination in March 2021. In this past week he has defied health orders by addressing mass gatherings of hundreds of people (AFP)

The pandemic practice also has been far from consistent. For instance, as the countdown starts to the national election in mid-2022 Prime Minister James Marape this week has been launching projects in Menyamaya, Wau, Mumeng and other towns in Morobe Province.

He was greeted by hundreds of maskless people, even though pandemic controller David Manning has banned gatherings of more than 20.

“We can debate whether PNG is a failed state,” say Howes and Mambon. “But this is a clear case where the state has failed its people.”

Rowan Callick OBE is an award winning journalist and author. He has twice won the Walkley Award for Asia-Pacific (1997 and 2007) and was Australian Journalist of the Year in 1995. He worked in PNG for nearly ten years and was a correspondent in Hong Kong and Beijing. Rowan has served in senior roles at the Australian Financial Review, Time and The Australian. This article was originally published as ‘A failure of the state: PNG lets down its people’ in The Australian four days ago.