34 Asia The EconomistMarch 21st 2020
21Banyan 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 populousstate, 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 dilapidatedhealth 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 Pacificdetecting 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 publichealth—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