Michael Cassell, Senior Technical Advisor, EpiC
Ignatius Mogaba, Papua New Guinea Country Representative, FHI 360
Simon Nianfop, Social & Behavior Communication Officer, FHI 360
Lisa Stevens, Senior Technical Advisor, FHI 360

Cover Photo: A peer outreach worker receives his first dose of the AstraZeneca vaccine after a sensitization training (Photo Credit: Simon Nianfop, FHI 360/PNG).

Public confidence is necessary for vaccines to achieve maximum impact. Circulating misinformation about vaccine quality, safety, and efficacy can undermine the benefits of even the best vaccines and can create opportunities for viruses to adapt and mutate, which can reduce vaccine effectiveness.

In Papua New Guinea, the Meeting Targets and Maintaining Epidemic Control (EpiC) project receives support from the U.S. Agency for International Development (USAID) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to address the disease threats posed by both COVID-19 and HIV. At the intersection of these efforts are key populations such as men who have sex with men, transgender people, and sex workers. These individuals face very high HIV infection risks, as well as substantial COVID-19 exposure risks. For people living with HIV (PLHIV), especially those with immunosuppression from untreated or inadequately treated HIV, exposure to COVID-19 may lead to more severe COVID-19 symptoms. Stigma, discrimination, and other social and economic factors can also present considerable barriers to key populations and PLHIV trying to access health services.

Two ministers of Parliament display their vaccination cards after taking the Johnson & Johnson vaccine (Photo Credit: Simon Nianfop, FHI 360/PNG).

While COVID-19 vaccination is becoming more available in Papua New Guinea, vaccine hesitancy now poses a major challenge to the nation’s response to the virus. As of October 15, 2021, at least 194,962 COVID-19 vaccine doses have been administered in Papua New Guinea—enough to have fully vaccinated only 1.1 percent of the country’s population.

To build confidence in the safety and benefits of vaccination, the EpiC Papua New Guinea team is engaging key opinion leaders as vaccine champions. On September 11, 2021, 10 senior government officials—including eight ministers of parliament—were vaccinated in Port Moresby at a mobile site operated by the Motu Koita Assembly (MKA) in partnership with the National Capital District Health Authority and the EpiC project. During this event, the lawmakers encouraged fellow nationals to protect themselves against COVID-19 by embracing vaccination. More than 1,890 individuals have been fully vaccinated at EpiC-supported mobile events in Port Moresby since the first batch of Johnson & Johnson vaccine arrived in Papua New Guinea in mid-August.

To better understand potential vaccine hesitancy among key populations in Papua New Guinea, the Key Population Advocacy Consortium, a network of local civil society organizations (CSOs) representing key populations, conducted a survey among its network. Among 793 key population community members who responded, only 435 (54.9%) said they would be vaccinated if COVID-19 vaccination were offered to them. Only 8 percent of those who responded said they knew much about the available COVID-19 vaccines or how well they work.

For the EpiC team, these findings signaled an urgent need for action. The team began to implement COVID-19 vaccination sensitization activities as part of routine service delivery interactions with HIV program clients. In the process, the team quickly saw a need to address critical gaps in vaccination knowledge and uptake among the service providers supporting these clients.

Because trained peers deliver many of the HIV activities that reach and engage key populations in the community, the EpiC program has prioritized safety and security measures for these lay providers. Since the beginning of the COVID-19 pandemic, the program has established procedures and protocols to give providers sustained access to protective equipment, to enable them to safely and securely conduct outreach through social networking and other virtual channels, and to conduct face-to-face outreach in safe conditions and in compliance with local regulations and movement restrictions.

The COVID-19 infection risks that these individuals may face because of their dedication to their work prompted the EpiC Papua New Guinea team to strengthen efforts to support COVID-19 vaccination education and access for this critical workforce. The team developed a comprehensive, tailored two-day sensitization training for peer outreach workers, adherence counselors, and trackers (expert clients who help the team find people with interrupted HIV treatment). Immediately following the first training, 15 of the 46 participants sought and received their first dose of the AstraZeneca COVID-19 vaccine. 

Ideally, this increased confidence will itself become contagious. The expectation is that in addition to closing gaps in access to lifesaving HIV services, lay providers can serve as persuasive ambassadors to overcome vaccine hesitancy among the key populations they serve, as well as in the community more broadly. Given the heroic HIV epidemic control efforts these individuals are already leading, they should be powerful allies in the effort to stop the spread of COVID-19.