The Economist - USA (2020-03-21)

34 Asia The EconomistMarch 21st 2020

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Banyan No island is an island

R

emote andpristine, the tiny island

nations of the Pacific are often the

object of apocalypse-proofing fantasies.

But if you think they are in any state to

ride out covid-19, dream on.

Many Pacific jurisdictions have

thrown up barriers to the new corona-

virus. In late January the Federated States

of Micronesia banned entry to travellers

from countries with confirmed cases.

The Cook Islands, Fiji, French Polynesia,

New Caledonia, Papua New Guinea

(png), Tonga and Vanuatu have banned

cruise ships. Anyone coming to Samoa

has had to produce a medical certificate.

In early March the Marshall Islands

sealed itself off, banning all inbound

visitors. Even supply vessels must wait 14

days at sea before berthing.

The economic cost will be devastat-

ing. The island states import nearly

everything. Moreover, tourism is the

main earner for many. Fiji had a full-

blown fiscal crisis even before empty

hotels removed a big source of revenue.

The Northern Marianas, an American

territory, relies on vanished visitors from

China, Japan and South Korea. Writing to

President Donald Trump for help, the

governor warned of the “unequivocal

and complete collapse of the founda-

tions of our private sector”.

If the measures kept the coronavirus

at bay, they might be worth it. But they

won’t. Already, five cases have been

confirmed in Guam, five in French Poly-

nesia (including a returning member of

France’s National Assembly), two in New

Caledonia and one in Fiji. One is suspect-

ed in png. Testing facilities barely exist

in the South Pacific—samples are sent to

Australia or New Zealand—although Fiji

has raced to set one up.

The coronavirus has many routes to

spread. png, the region’s most populous

state, has a porous border with Australia,

just across the Torres Strait, and a land

border with Indonesia. It is trying to seal

the sea-lanes to the nearby Solomon Is-

lands. Tuvalu and Kiribati are among the

tiniest, most isolated states in the world,

yet many of their menfolk work as sea-

farers, with a history of carrying infectious

diseases home. Half of the populations of

Samoa and Tonga are abroad, many in

infected countries. There are more pos-

sible vectors than isolated atolls.

It is cause for alarm. The Marshall

Islands is only now recovering from a

dengue outbreak infecting 3,000, followed

by bursts of influenza. It left the little

hospital in the capital, Majuro, looking

“like a war zone”, says the health secretary,

Jack Niedenthal. An outbreak of measles in

Samoa in December killed 83, most of them

children. Both countries are racing to

respond to covid-19. But the Marshall

Islands has just six ventilators. Of just 100

protective gowns, goggles and gloves, the

hospital got through 22 sets investigating a

single suspected case. Meanwhile, the

Solomon Islands has such a dilapidated

health system that many will view the

main hospital in Honiara, the capital, as

the last place to go with covid-19.

To cope with the pandemic, Pacific

islanders will be thrown back on support

networks such as family and church.

People are all too used to catastrophes,

from cyclones to tsunamis. Only rarely,

as Jonathan Pryke of the Lowy Institute

in Sydney puts it, do they feel the hand of

the state. Traditional networks will prove

a blessing, but also carry risks if in-

fections are carried back to villages from

capitals. It helps that Pacific populations

are relatively young (covid-19 guns for

the elderly and infirm). But high rates of

non-communicable diseases, notably

diabetes, put more people at risk. Thanks

to an atrocious diet (think Spam and

Kool-Aid), seven of the ten most diabetic

countries are in the Pacific. The hospital

in Honiara saws off three limbs a day.

Peter Kenilorea, an opposition figure

in the Solomon Islands, says the govern-

ment is unprepared. In its speech mark-

ing the opening of Parliament in Honiara

this week, only two sentences were

devoted to covid-19. A radio station in Fiji

has been broadcasting public-health

advice for weeks about washing hands.

Yet the government will not let it link

those messages to the pandemic, lest

they spark panic.

Australia and New Zealand both

emphasise what New Zealand’s leader,

Jacinda Ardern, calls “a duty of care” to

Pacific nations. Both countries have

promised to send medical equipment

and personnel. But Sheldon Yett of Un-

icef says that the region’s travel clamp-

down hampers the movement of aid

workers and supplies. And once Austra-

lia and New Zealand face full-blown

crises of their own, how much will they

look out for the Pacific?

What’s in store for the small places of the Pacific

detecting only cases with foreign origins. “I

suspect that if we did 20 times more tests

we might find 20 times more cases,” says

Ramanan Laxminarayan of Princeton Uni-

versity. “I personally think we are already

in the thousands if not tens of thousands.”

Should the virus have indeed slipped

past India’s barriers, there is little reason to

think it will follow a different course from

elsewhere. That would put India’s epidem-

ic about two weeks behind America’s and

perhaps a month behind Italy’s. That is

alarming, given how poorly prepared India

is. Decades of under-investment in public

health—recent budgets have averaged a

meagre 1.3% of gdp—have left it with a thin

and creaky system (see chart on previous

page). There are not enough doctors, not

enough beds and not enough equipment

for the country’s 1.3bn people, even in or-

dinary times. Moreover, these scant re-

sources are unevenly distributed. Excel-

lent private hospitals and prestigious

public medical schools mean that big cities

such as Delhi and Mumbai may be reason-

ably served. But in 2017 some 63 children

suffering from encephalitis died when the

oxygen supply ran out at a state-run hospi-

tal in Gorakhpur, a drab provincial city near

the border with Nepal. India’s 100,000-odd

intensive-care beds, which cater to per-

haps 5m people a year, could be faced with

that many in a month.

The public is not well prepared either,

particularly for a disease that primarily af-

flicts the lungs, and is more severe in pa-

tients with pre-existing conditions. The

prevalence of both extreme air pollution

and drug-resistant tuberculosis do not

bode well. Indians also account for an esti-

mated 49% of the world’s diabetics. Wide-

spread poverty not only exacerbates such