In March of 2020, the world turned upside down. Across the globe, COVID-19 forced closures at borders, businesses and schools. Hospitals were overwhelmed. Governments scrambled to develop socially and economically balanced policies. And pharmaceutical companies worked round the clock to develop testing modalities and vaccines.
In the small island nation of the Kingdom of Tonga, however, while most of the world struggled with the pandemic, strict border measures coupled with a 90+ per cent primary series vaccine rate meant that the country was able to stave off its first community transmission until 1 February 2022, a solid two years after the World Health Organization (WHO) declared the pandemic.
Yet rather than resting on the relative calm that the Government’s policies had helped to create, Tonga’s Ministry of Health used that extraordinary grace period to ensure that, when the disease finally did arrive in the 170+ island archipelago, the country would be ready.
With the support of the India-UN Development Partnership Fund and in partnership with WHO, the Government implemented a three-pronged containment plan to strengthen its capacity for quarantine and/or isolation in multiple health facilities in Tonga. The project included mechanisms to strengthen (a) infection prevention and control, case management, testing and dead body management; (b) the cold chain for vaccine delivery; and (c) the capacity of the health information system for better data collection, analysis and reporting of COVID-19 cases and registration of COVID-19 vaccinations.
As the project implementer, WHO procured and donated essential items – from hospital beds, mattresses and sheets to professional washing machines, and from portable IV stands to wheelchairs – all to strengthen isolation and quarantine capacity.
In an example of South-South knowledge-sharing, the project took a cue from neighbouring Fiji, which was quickly overwhelmed once community transmission occurred and sought to strengthen its laboratory capacity. Among other things, this included the acquisition of GeneXpert. This rapid diagnostic testing machine — originally developed to detect the presence of tuberculosis — returns coronavirus results in roughly 45 minutes, requires less expertise than standard rapid testing mechanisms, and is generally more cost-effective than the alternatives.
Donated technological equipment, including laptops and tablets, were instrumental in strengthening the vaccine command centres’ capacity to collect, analyse, and report vaccine coverage data, and as well as helped to improve the efficiency of decision-making. It also supported individual health centres to utilize the newly introduced electronic medical record system, as well as their capacity for disease surveillance.
Ongoing, detailed discussions with Tonga’s Ministry of Health helped to ensure that any planned procurement was not duplicated with the WHO donations and was consistent with the Ministry’s needs. They also aimed for the sustainable development of Tonga’s health system capacity to respond to future communicable disease outbreaks.
By project’s end in December 2022, there had been no COVID-19 outbreaks in the country. But with the support of the project, Tonga is well-positioned to deal not only with ongoing, routine health challenges but also any potential return of COVID-19 or even a future respiratory disease pandemic. While testing runs, on average, 40 tests per week, during the February–March 2023 influenza outbreak, the average doubled to 90 per week. In the event of an outbreak, the Ministry of Health is equipped to handle approximately 500 tests per day.
Overall, through the support of the India-UN Development Partnership Fund and WHO, Tonga’s overall health system is stronger than at the start of the pandemic as well as well-positioned to address future health challenges. These are significant benefits for the people of Tonga.
