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.

Dr Clement Malau started a Facebook page to take on the anti-vaxxers - "The authorities have done nothing"

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 nine million, 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.

Meanwhile, 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, in turn, share with their wantoks.

A Unicef poster features Oro Governor Gary Juffa advocating a rational approach to dealing with Covid

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, and 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”.

Prof Glen Mola with medical students. As Covid strikes pregnant women Port Moresby general hospital, maternal death rates have increased fivefold

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 years old, 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 is 546, but a lack of data and testing means the true casualties are unclear.

At Port Moresby hospital there were 40 or 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.

Dr Fiona Hukula - "“From the very beginning of the pandemic we didn’t have a clear communications strategy” (Robert Weber - The Guardian)

“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,” he says. “I got the impression that students here are more afraid of the vaccine than they are of catching the virus.”

While many Pacific countries had low cases of Covid, the economic impact of the pandemic, particularly for tourism-dependent nations like Vanuatu was devastating.

In the absence of clear, strategic information, dangerous rumours ignite. As 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.

They wanted 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.

But 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 think tank 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.

Martyn Namorong - “The system is trying to adjust to cope, but it is just at the edge. One spike and everything collapses”

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, he says: “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.”