Problem: Coronavirus disease (COVID-19) reached Tuvalu’s shores in November 2022, making Tuvalu one of the last countries in the world to experience community transmission of the disease. With minimal capacity to deliver critical care and a small health workforce that had been further depleted by COVID-19 infection, response priorities rapidly shifted to the outer islands. Context: The outer islands are accessible only by boat, with travel taking from 6 to 24 hours. The return of high school students to their home islands for the Christmas holidays had the potential to place further pressure on the islands’ medical facilities. Action: A multiorganizational collaboration between the Australian and Fijian governments, the Pacific Community, the Tuvalu Ministry of Social Welfare and Gender Affairs (MoHSWGA) and the World Health Organization facilitated the deployment of two teams to the outer islands to provide support. Outcome: The team worked with public health and clinical staff to provide technical support for clinical management, infection prevention and control, laboratory, risk communication, community engagement and logistics. Discussion: The outer islands’ response to the pandemic significantly benefited the island communities, the MoHSWGA and the team members who deployed. The key lessons identified relate to the need to strengthen the health workforce and supply chain.

Problem: As of November 2022, over 417 397 confirmed cases and 2631 deaths related to coronavirus disease (COVID-19) were reported in Pacific island countries and areas (PICs). Most PICs have faced challenges accessing therapeutics recommended for the treatment of COVID-19 due to their high demand worldwide and supply chain constraints. Context: The World Health Organization (WHO) coordinates and provides tailored technical and operational support to 21 PICs. Since the start of the pandemic, WHO has worked with partners to establish a mechanism to ensure equitable access to three novel COVID-19 therapeutics (tocilizumab, molnupiravir and nirmatrelvir/ritonavir) for lower-income countries, including 11 eligible PICs. Action: WHO coordinated the requests, procurement and distribution of the three novel therapeutics. In addition, WHO supported PICs by providing trainings in clinical management of COVID-19, developing critical supply needs estimates, and facilitating regulatory approval of clinical therapeutics, including emergency use authorization. Lessons learned: The main barriers to procurement of novel COVID-19 therapeutics were identified as prolonged negotiations with licence holders, sourcing funding, the high cost of therapeutics and limited capacity to provide safety monitoring. Discussion: Uninterrupted supply and availability of essential medicines in the Pacific region is dependent on external and local sourcing. To overcome procurement barriers and ensure access to novel COVID-19 therapeutics in PICs, WHO‘s pandemic support to Member States focused on strengthening regulatory requirements, safety monitoring and supply chain activities.

Problem: From April to September 2021, Fiji experienced a second wave of coronavirus disease (COVID-19) precipitated by the Delta variant of concern, prompting a need to strengthen existing data management of positive COVID-19 cases. Context: With COVID-19 cases peaking at 1405 a day and many hospital admissions, the need to develop a better way to visualize data became clear. Action: The Fiji Ministry of Health and Medical Services, the World Health Organization and the United Nations Office for the Coordination of Humanitarian Affairs collaborated to develop an online clinical dashboard to support better visualization of case management data. Outcome: The dashboard was used across Fiji at national, divisional and local levels for COVID-19 management. At the national level, it provided real-time reports describing the surge pattern, severity and management of COVID-19 cases across the country during daily incident management team meetings. At the divisional level, it gave the divisional directors access to timely information about hospital and community isolation of cases. At the hospital level, the dashboard allowed managers to monitor trends in isolated cases and use of oxygen resources. Discussion: The dashboard replaced previous paper-based reporting of statistics with delivery of trends and real-time data. The team that developed the tool were situated in different locations and did not meet physically, demonstrating the ease of implementing this online tool in a resource-constrained setting. The dashboard is easy to use and could be used in other Pacific island countries and areas.