Objective: To prevent importation of coronavirus disease 2019 (COVID-19) to Vanuatu, since March 2020, all travellers to the country have been required to complete a 14-day quarantine in a government-designated facility. A short message service (SMS, or “text message”) system was developed to collect information on symptoms of COVID-19 among travellers in quarantine. A trial within a cohort study was conducted among travellers arriving to Vanuatu by air from 27 October to 7 December 2020 to assess SMS acceptability, efficiency and utility and whether SMS-based health monitoring was as effective as in-person monitoring in identifying people with COVID-19 symptoms. Methods: Control group participants received standard monitoring (daily in-person visits) and participants in the intervention group received a daily SMS text requesting a response coded for symptom development. Differences between the two groups were determined using chi-squared tests. Results: Of the 495 eligible travellers, 423 participated; 170 were allocated to the control group and 253 to the intervention group. At least one return SMS text was received from 50% (107/212) of participants who were confirmed to have received an SMS text. Less than 2% (4/253) of the intervention group and 0% of the control group reported symptoms. Discussion The SMS intervention had a high level of acceptability. SMS is a useful tool to monitor symptom development among people in quarantine and for broader public health programmes that require follow up.

The Pacific island nation of Vanuatu is vulnerable to emerging infectious diseases, including epidemics and pandemics; chronic food and water insecurity; and natural hazards, including cyclones, earthquakes, tsunamis, landslides and flooding. In March 2020, the World Health Organization characterized the outbreak of novel coronavirus disease 2019 (COVID-19) as a global pandemic. By the end of April 2020, Vanuatu had reported no confirmed cases of COVID-19. Data from several sources are collected in Vanuatu’s COVID-19 surveillance system to provide an overview of the situation, including data from case investigations and management, syndromic surveillance for influenza-like illness, hospital surveillance and laboratory surveillance. Review of data collected from January to the end of April 2020 suggests that there was no sustained increase in influenza-like illness in the community and no confirmed cases were identified. Lessons learnt from the early implementation of surveillance activities, the changing landscape of laboratory testing and pharmaceutical interventions, as well as the global experience, particularly in other Pacific island countries, will inform the refinement of COVID-19 surveillance activities in Vanuatu.