Fiji’s Minister for Health and Medical Services has declared an HIV outbreak.

Dr Ratu Atonio Rabici Lalabalavu announced 1093 new HIV cases from the period of January to September 2024.

“This declaration reflects the alarming reality that HIV is evolving faster than our current services can cater for,” he said.

“We need the support of every Fijian. Communities, civil society, faith-based organizations, private sector partners, and international allies must join us in raising awareness, reducing stigma, and ensuring everyone affected by HIV receives the care and support they need.”

In early December, the Fiji Medical Association called on the government to declare an HIV outbreak “as a matter of priority”.

As of mid-December, 19 under-fives were diagnosed with HIV in Fiji.

The UN Development Programme has recently delivered 3000 antiretroviral drugs to Fiji to support the HIV response.

World’s largest epidemic
A report released in mid-2024 showed that in 2023, 6.7 million people living with HIV were residing in Asia and the Pacific, making it the world’s largest epidemic after eastern and southern Africa.

“Among countries with available data, HIV epidemics are growing in Afghanistan, Bangladesh, Fiji, the Lao People’s Democratic Republic, Papua New Guinea and the Philippines,” the report said.

The regional director of UNAIDS Asia Pacific Eamonn Murphy said rising new infections in Fiji “put the entire Pacific region at risk”.

“Prioritisation of HIV by the government is critical for not only the people of Fiji, but the entire Pacific,” he said.

“Political will is the essential first step. There must also be community leadership and regional solidarity to ensure these strategies work.”

UNAIDS said the 1093 cases from January to September was three times as many as there were in 2023.

Preliminary Ministry of Health numbers show that among the newly-diagnosed individuals who are currently receiving antiretroviral therapy, half contracted HIV through injecting drug use. Over half of all people living with HIV who are aware of their status are not on treatment.

Second-fastest growth
“Fiji has the second fastest growing HIV epidemic in the Asia and the Pacific region,” Murphy said.

He said the data does not just tell the story about a lack of services, but it indicates that even when people know they are HIV-positive, they are fearful to receive care.

“There must be a deliberate effort to not only strengthen health systems, but to respond to the unique needs of the most affected populations, including people who use drugs.

“Perpetuating prejudice against any group will only slow progress.”

UNAIDS also said the HIV Outbreak Response Plan called for a combination of prevention approaches.

Since the sexual transmission of HIV remains a significant factor, other key approaches are condom distribution and pre-exposure prophylaxis (PrEP), a treatment taken by an HIV-negative person to reduce the risk of contracting HIV if they are exposed.

UNAIDS support
Through the Australian government’s Indo-Pacific HIV Partnership, UNAIDS is supporting Fiji to scale up prevention approaches.

United Nations Resident Coordinator in Fiji Dirk Wagener said the outbreak declaration and the launch of high-impact interventions, such as needle syringe programmes and PrEP, marked a critical turning point in Fiji’s efforts to combat the epidemic.

“The Joint UN Team on HIV, with UNAIDS as its secretariat, stands ready to provide coordinated and sustained support to ensure the success of these strategies and to protect the most vulnerable.”

The HIV Surge Strategy includes tactics for Fiji to achieve the Global AIDS Strategy targets — 95 percent of all people living with HIV aware their status, 95 percent of diagnosed people on antiretroviral therapy, and 95 percent of people on treatment achieving a suppressed viral load.

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

A Whanganui iwi leader says the Aotearoa New Zealand government’s decision to ease covid-19 measures at this time is a disgrace and shocking.

He is warning Māori to stay vigilant against omicron and prepare for more to come.

Tūpoho chair Ken Mair says Māori must continue to be extremely careful and take precautions against covid-19, despite the government’s new strategy to begin living with the virus.

Yesterday, Prime Minister Jacinda Ardern said gathering limits would ease before the weekend, with no limit for outside venues and gatherings of up to 200 allowed inside.

Vaccine passes and scanning would no longer be needed from April 4, and mandates would be scrapped for all except those in the health and aged care sectors, Corrections and at the border.

But Mair said the country was far from out of the woods, as shown by the number of daily covid-19 cases being reported — with 11 new deaths and 18,423 infections.

“It just seems crazy that the government are putting in place this strategy right now, at the worst time in regard to the high numbers of omicron within our community. It’s extremely dangerous,” Mair said.

Radio NZ News reports that Director-General of Health Dr Ashley Bloomfield said Māori had the highest rate of community cases of covid-19, overtaking Pacific people at 28 per 1000. Rates for NZ European and Asian ethic groups is 21 per 1000.

‘Where’s the Māori lens?’
“Where’s the Māori lens over this? Certainly, within our community there are hundreds [of cases] and there are a number in hospital.

“I just can’t understand a strategy where there hasn’t been any real analysis with substance in regard to the impact upon iwi, hapū and Māori, noting that we’re an extremely vulnerable community in the context of respiratory and asthma ailments.”

Mair said he understood some Māori leaders had been in discussion with the government and had made recommendations for the new strategy, but it appeared they had been ignored.

“I’ve been deeply concerned over the last couple of months where there doesn’t appear to be a strong Māori voice coming through or anything that might indicate that the government have a clear understanding of the ramifications of their decision around the covid strategy.

“This is a classic example — decisions being made right in the midst of cases going up, new variants around the corner, without understanding the impact and implications for Māori. I just think that’s a disgrace and shocking.”

Mair said he thought the strategy had been politicised, with Labour’s polling and political pressure the key factors.

“What motivates you to put in place an extremely dangerous strategy? You can only assume the motivation’s around political expediency and the impact upon economic wellbeing, without having the health lens driving your decision making.

Risk for vulnerable ignored
“The decisions by the prime minister and the government clearly have not taken into account the real vulnerability of Māori, and I think Māori, iwi and hapū have to be extremely careful in this precarious time.”

Yesterday, the prime minister said restrictions were being eased because it was safe to do so. Mair said this ignored the risk that remained for the vulnerable and sent the wrong message.

“I think because of the government’s strategy, people are saying things like: well, we’re going to get it anyway, it doesn’t matter, let’s get on with it and get back to normality as quickly as possible.

“The problem with those comments, of course, is the vulnerability of our Māori community, hapū and iwi is extremely high.

“I think our community in general is beginning to take a kind of defeatist approach and we should be, I think, extremely careful and vigilant in regard to dealing with this omicron.

“I have no doubt in my mind there’ll be more variants around the corner and we should always be prepared.”

Local Democracy Reporting is Public Interest Journalism funded through NZ On Air. Asia Pacific Report is a community partner.

Article by AsiaPacificReport.nz

Public Health measures are restrictive ‘health’ imposts by an authority over some or all of the people subject to that authority. In most cases they are both ‘merit goods’ (having benefits which people ought to be willing to pay for), and ‘public goods’ (goods whose benefits are shared).

Quarantine may be such a measure, whereby a sub-population is cordoned off from the rest of the population. Quarantines may be ‘domestic’, whereby the quarantining authority has jurisdiction both inside and outside the cordon. Or quarantine may be inter-territorial, restricting the entry of ‘foreign’ people (or certain foreign biota) not otherwise subject to the restricting authority. A quarantine is a cordon that demarks an area from which people may not leave unless given specific permission to leave. The principal beneficiaries of quarantines are people on the outside of the cordon.

Today, from the point of view of a resident of Hamilton, New Zealand, there are two protective quarantines. People may not arrive from ‘the rest of the world’ (meaning the cordon is New Zealand’s international border), and they may not arrive from ‘Auckland’. (For both cases, we note the ‘specific permission’ proviso.) While the authorities in Hamilton cannot influence other public health in the foreign quarantine zone, Hamilton forms part of a jurisdiction – New Zealand – that can impose additional measures (eg lockdowns) upon the people in the Auckland domestic quarantine zone.

In general, public health measures always have costs, and usually have benefits. Those costs and benefits may change over time. Public health measures can only be justified if the benefits exceed the costs; so, clearly, whenever the benefits of a measure are zero, then a public health measure cannot be justified.

Public health measures include such things as seatbelt and helmet mandates (for cars and motorcyclists). In New Zealand there are two seatbelt mandates: the requirement for cars to have compliant seatbelts installed, and the requirement for people in cars to wear seatbelts. In both cases, these can be regarded as permanent mandates, because it is generally accepted that the benefits of these mandates do exceed their costs, and it is accepted that neither the costs nor the benefits are likely to change much.

Quarantine Example One: Los Angeles 1924

In 1924, a residential district – populated mainly by migrants of Mexican origin – suffered an outbreak of plague. Although known as a migrant area, there was no evidence that this area was in any sense dirtier than other parts of Los Angeles; on the contrary it was arguably cleaner than a number of other suburbs.

On the basis that this was bubonic plague, an immediate domestic quarantine cordon was placed by the local authorities around the affected streets. In addition, a major rodent hunt was instigated. It turned out to be mainly the even more dangerous pneumonic plague (a human-to-human transmitted respiratory disease that is several orders of magnitude worse than delta covid), and that the rodent hunt was largely ineffective as a measure to deal with this particular public health emergency. The quarantine cordon, which was adjusted a few times as new cases emerged, proved to be extremely effective. In the end, there were about 45 cases and 40 deaths, a case fatality ratio of about 90 percent. The quarantine was lifted when there were no more cases.

Beverly Hills is a different part of Los Angeles. As a result of suburban plague, quarantine was appropriately placed in just part of Los Angeles. That was the whole point; the quarantine allowed the rest of the city, places such as Beverly Hills, to live as normal. (Though all Los Angelinos might have expected to be visited by rat-hunters).

Covid19: the View from Hobart, Tasmania

Tasmania is a state within Australia, a federal polity. Like Hamilton, Hobart is affected by two quarantines; but in this case these are both quarantines that the government in Hobart cannot influence what happens within either of those zones. Both are extra-territorial quarantines, one set by the federal government in Canberra; the other set by the state government in Hobart. All the Tasmanian government can do is determine which other parts of Australia are in their Tasmanian imposed quarantine cordon.

Further, the Tasmanian government is free to rule that – because Tasmania has imposed a quarantine, but no part of Tasmania is subject to a domestic quarantine – then there is not a problem in Tasmania which requires any local public health mandates with respect to the Covid19 pandemic. And, because Tasmania does not at present have a Covid19 problem (except for externally-sourced disruptions to its economy, and its ability to get extraterritorial Tasmanians into Tasmania), any public health measures imposed within Tasmania would be unjustified; because the benefit (zero) would be less than the cost.

New Zealand is of course free to impose a quarantine on Tasmania (ie as part of a wider extraterritorial quarantine); indeed New Zealand has indeed included Tasmania in its cordon around the rest of the world. And it may be true that the overall cost of exempting Tasmania from our cordon would be more costly than not exempting it; for New Zealand the main cost would be risk arising from a lack of trust in the independent decisions made in Hobart with respect to how Tasmania manages its ‘Bass Strait’ cordon. (We might note that if the costs of New Zealand’s policy incurred by people in Tasmania were included as policy costs, as well as the costs of an exemption to people in New Zealand, the answer about whether or not to exempt Tasmania might be different.)

Hamilton’s problem

Hamilton is similar to Hobart, in that it does not have community Covid19. Hamilton is different from Hobart, in that it does not have the authority to exempt itself from the kinds of public health mandates that are appropriate to quarantined places (such as Auckland). Hamilton is not allowed to be exempt, as Beverly Hills was at the time of the 1924 Los Angeles plague outbreak.

In New Zealand we are seeing uninfected places being mandated to emergency public health measures, even though they do not have a public health emergency. Hamilton benefits, of course, from both the ‘rest of the world’ quarantine, and from the Auckland quarantine.

Quarantines are emergency measures by definition. There is really only one level of quarantine; it’s a binary, it’s either on or off. Within a quarantine zone, it is appropriate for an authority with jurisdiction (eg the New Zealand government) to impose other measures, and that those measures should vary depending on the severity and nature of the problem. But it is not appropriate to impose emergency public health mandates on an unquarantined and unaffected territory.

(Nationwide ‘Level 4 lockdowns’ are a special case when an authority imposes an effective quarantine on its entire self; a situation that can only be justified if there is a non-trivial chance that the whole of a ‘motu’ is infected by a pathogen that is sufficiently infectious to justify a ‘quarantine’ solution.)

It is an oxymoron to have emergency public health measures in places that do not have an emergency; and, by definition, harmful in that the costs (non-zero) must exceed the benefits (zero).

Zero Road-Deaths

In 2018, Associate Transport Minister Julie Anne Genter initiated a road death elimination policy. Sensibly, and practically, the policy was never more than aspiration. If we were really concerned to save these lives – about 400 per year in New Zealand – the government could introduce a nationwide ‘car lockdown’ policy. They could prohibit cars from being driven on public roads. Certainly, there is an ‘abundance of caution’ argument that the benefits – mainly, but not only, lives saved – would exceed the costs. The government could introduce car lockdowns as an emergency measure (maybe triggered by an unusually bad year on the roads), and then leave them in place as a permanent measure.

Doing the cost-benefit calculus.

Good cost-benefit ‘calculus’ is complex. More importantly, accurate cost-benefit calculus can only be done democratically. The people need to be involved – and in two ways. The first way is that people need to be asked what they like and don’t like, with the understanding that benefits (utility) and costs (disutility) are subjective (meaning that they vary from person to person), and without asking leading questions which reflect the researchers’ own likes and dislikes. The second way is that ‘revealed preference’ (especially re appetite for risk) needs to be taken account of, whereby costs and benefits are assessed from what people do (and don’t do) rather than simply what they say. In terms of both ways, the information – and methodology – needs to be ‘open-source’, subject to ongoing public evaluation and re-evaluation. Even for rapid emergency public health measures, retrospective (and democratic) evaluation of costs and benefits is required.

Important forms of potential cost are ‘unintended’ and ‘unforeseen’ adverse consequences. In the democratic cost-benefit accounting process, such possible consequences need to be explored, and concerns properly documented; this approach deals with the policymaking problem of ‘wilful blindness’. (While it can be argued that certain events and implemented policies have had some unintended and unforeseen benefits – historians may include the late-medieval Black Death (‘plague’) and the fiscal policies implemented during the Great Depression – little weight in policy discussions should be given to such possibilities.)

All public health measures have costs, some of which may not be obvious. Most public health measures have benefits. All public health measures should be evaluated in a democratic way; albeit retrospectively for emergency measures, for which speed is the essence. Public health measures for which the costs exceed the benefits should be avoided. And, while technocrats and bureaucrats may participate (even oversee) such cost-benefit calculations, they should never be allowed to commandeer what is necessarily a democratic process.

Appropriate quarantines work.

In Los Angeles in 1924, with its plague outbreak, neither a quarantine nor any other public health measure imposed on Beverly Hills, or San Francisco, would have done anybody any good however. That’s because these places had no known cases, and almost certainly had no unknown cases. Even San Francisco, which had had its own plague outbreak a few years earlier. Hamilton, almost certainly has no Covid19 community cases today; it deserves to have at least the same level of public health freedom that Hobart has.

————-

Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.

Perth in Australia was plunged into a three-day lockdown after community transmission was linked to a returnee from India.

Fiji finds itself in similar situation due to a returnee, also from India.

Australian officials say overseas travel is allowed only for “the most profound humanitarian or compassionate reasons, under strictest of circumstances”.

What about Fiji? Under what circumstances is overseas travel allowed? Under what circumstances was the India returnee allowed to travel in the first place – do citizens have a right to know?

Australia has recognised the risks and effectively banned international travel, even though thousands of Australians will be unable to return home for now.

What is the Fiji response to international travel in light of the latest infections from abroad with 12 new cases yesterday? Are we tightening things up or not? The citizens need to know what the government is doing.

Reports indicate Australia adopted varying responses with regards to high-risk countries, including North America and Europe.

Tightening up
Given the crisis in India, Australia has taken steps to further tighten departures after it was found people were travelling for weddings, funerals and sports.

Critics have condemned the Australian government for what they see as its laxity, and for risking lives and dealing a potential blow to the economy.

What about Fiji? On what grounds are people travelling? Were people allowed to travel for weddings, religious reasons and for funerals? We need answers.

How big a risk is it to us as a nation to allow return travel from hot spots like India and the US?

In light of the new cases, have the international travel guidelines been changed or are they still the same?

Dr Shailendra Singh is senior lecturer and coordinator of the journalism programme at the University of the South Pacific. This comment is from Dr Singh’s social media posts and is republished with permission.

Article by AsiaPacificReport.nz

This chart orders countries by their Covid19 death rates in the seven days to 16 July. The seven worst countries are in Latin America; all except Panama being large countries. Two other large Latin American countries (Guatemala and Ecuador) are in the top 11 for recent Covid19 deaths. Of the larger countries in South America, only Venezuela is not in the top 23, though Argentina is much better than its neighbours. The top 23 countries include 13 from Latin America.

Mixing it with these, in the top 25, are some small countries (under 10 million people) in the ‘greater Middle East’, plus Iran, Iraq, South Africa and the United States. Nothing east of Iran, though Kyrgyzstan comes in at number 26. With the exception of the United Kingdom and Russia, the remainder of the countries in the chart are also in the greater Middle East (that includes the Balkans).

In Peru, the worst affected country over the last week, two-thirds of cases are in Greater Lima, which has one third of Peru’s population. While Peru had a very strong initial lockdown, it looks as though the main source of runaway coronavirus infection has been Peruvians returning from Europe and North America via Lima (Callao) Airport.

Peru has a lower incidence of new infections than Brazil, which suggests that Brazil will overtake Peru – ie exceed Peru’s death rate – in the next week or so.

Looking as the data sorted by identified cases rather than by deaths, we see countries with low death rates (mainly because they have younger populations and/or better resourced hospitals), countries with recent outbreaks, and countries which have substantially increased their level of testing.

The Arabian countries continue to show strongly. But note Israel (and Palestine), South Africa and the United States. In western Europe, only Luxembourg shows up, suggesting a combination of an Australian-style outbreak and increased testing. We also note that Costa Rica – with the same population as New Zealand, and a popular destination for New Zealand travellers – has many cases of Covid19 (though not many deaths).

Although Kazakhstan and Kyrgyzstan show up in this chart (and the Maldives), no country in South Asia or East Asia shows in the chart. While it is true that most of the few cases being caught at Auckland Airport originated in South Asia, we should note that by far the majority of people in South Asia – and people travelling from South Asia – are not infected with SARS-Cov2, the virus that causes Covid19.

We also note that the only country from continental Africa that shows in either chart is South Africa. On March 27 I wrote: “I have some confidence that Asia and Africa will end up with much lower rates of infection than Europe. I am much less confident about Latin America” (Covid-19 Virus: Australia, Canada, New Zealand, the World). So far, my prediction has been correct. Let’s keep hoping for Africa and India.

By RNZ News

New Zealand has reported six new cases of covid-19 today – double the number yesterday –  and one further death in the coronavirus pandemic, while two clusters have also closed.

In a statement, the Ministry of Health said there were six new cases of covid-19, bringing the total number of confirmed and probable cases to 1485. Two of the new cases are confirmed while four are probable.

Five of the new cases have links to a known source, while one is still being investigated.

READ MORE: Al Jazeera coronavirus live updates – WHO says coronavirus ‘natural in origin’

So far, 1263 people have recovered – 85 percent of the total cases. Five people remain in hospital.

The death toll has gone up to 20 now, after a Rosewood Rest Home resident in his 80s – who was transferred to Burwood Hospital – died this morning.

He was identified as George Hollings, whose family have said they would remember “as a real Kiwi bloke, a rough diamond, who loved his deer stalking”.

The ministry has said he was considered to be a probable case of covid-19, and had underlying health conditions.

Family ask for privacy
The family has asked for privacy to grieve, and paid tribute to the staff who took care of him.

“We can’t speak highly enough of the care Dad received. You’ve clearly chosen the best, most compassionate staff to work at Burwood,” they said in a statement.

There are still 16 significant clusters in the country, three of which are now considered to be closed as there is no longer any apparent transmission of the virus in those groups.

A covid-19 cluster is considered be closed after a total of 28 consecutive days – or two incubation periods for the virus – since its most recent report date of a reported case.

The three closed clusters are the Wellington wedding cluster (closed April 25) and the two clusters linked with group travel to the United States – one in Wellington and the other in Auckland – closed today.

Article by AsiaPacificReport.nz

By RNZ News

New Zealand’s Director-General of Health Dr Ashley Bloomfield today confirmed the Health Ministry is “actively looking” at the rules around people visiting dying family members in the Ciovid-19 coronavirus pandemic.

Dr Bloomfield confirmed this in a Q+A session on Facebook this afternoon to talk about masks, bubbles, testing and clusters.

Earlier this afternoon, Dr Bloomfield had announced 19 new cases of Covid-19 including 15 confirmed cases and four probable.

READ MORE: Al Jazeera coronavirus live updates – France’s death toll nears 14,400

A fifth person has died of the coronavirus, a man in his 80s, who was connected to the Rosewood rest home in Christchurch.

During the Q+A, Dr Bloomfield said the Ministry of Health was looking at the rules around people visiting dying family members, especially during a step down to level 3.

“I want to say we are very aware of this, we are actively looking at it.”

Dr Bloomfield started the Q+A by addressing the ongoing debate around the use of cloth masks, and said “the jury is out”.

Masks need changing
“In general, if people want to wear a mask … there’s no specific harm in doing so if you are using it appropriately,” he said.

But he added they had to be changed and cleaned before re-use.

Asked about a new cluster in Auckland, Dr Bloomfield said the cluster had occurred at a private event and there was no further risk of spread to the wider public. He said the Ministry of Health was balancing privacy in deciding to not further identify the cluster.

On testing, Dr Bloomfield said the Health Ministry was not currently planning on doing randomised testing.

“Our positivity rate is still only between 1 and 2 percent.”

He said random testing would require a very large scale to identify even one or two cases. Instead, targeted testing would be conducted.

“Generally speaking for most people, two swabs are taken. Through the mouth … (and) taken through the nose – that’s a very important swab to take.”

Swabs taking cells
The swabs aim to take cells from the back of the throat or nose because that was where the virus was replicating and they needed to be tested.

Sometimes a swab may not get enough cells to properly test for the virus.

On today’s results, he said they tried to turn around tests within 24 hours.

“It gives us a pretty good idea of what’s happened in the past 24 or 48 hours.”

Answering a question on what constituted a probable case, Dr Bloomfield said they were cases where someone who health officials felt had symptoms consistent with Covid-19, had a link to a confirmed case or cluster, or whom had a negative test, or whom had recovered but still had symptoms and the connection.

Dr Bloomfield was also asked what happened to somebody’s “bubble” if they went to a hospital, and he said they could have a high level of confidence that they would not be exposed to the virus due to the stringent measures put in place by DHBs.

“Hospitals will have worked out how to keep people safe who are coming for investigations or appointments.”

Deferred surgery catch-up
He said the Health Ministry was working with DHBs for plans about how to provide as much care as possible and how to catch up on deferred outpatient and elective surgery – plus other – procedures.

However, “some may not happen as they might have in traditional circumstances”, and more consultations could be done remotely, for example.

“They will be changing the way these appointments will happen.”

Earlier, Dr Bloomfield said 546 people have recovered, up 75 on yesterday and there was now 1349 cases of Covid-19 in New Zealand.

Fifteen people are in hospital, with four in ICU. One is in a critical condition in Dunedin.

There were 1660 tests carried out yesterday, with the Health Ministry expecting to see a drop off in testing over Easter. There have now been 62,827 tests carried out in total.

This article is republished by the Pacific Media Centre under a partnership agreement with RNZ.

• If you have symptoms of the coronavirus, call the NZ Covid-19 Healthline on 0800 358 5453 (+64 9 358 5453 for international SIMs) or call your GP – don’t show up at a medical centre.

Article by AsiaPacificReport.nz