COVID 19 continues to threaten the Pacific
The global pandemic has had a serious impact on PPTC operations, causing a sizable disruption to our overseas in-country training programmes, and to the Wellington Centre based courses, due to international border closures.
We are however fortunate that both the PPTC’s External Quality Assessment Programme and the Diploma programme have continued relatively uninterrupted.
With the virus spreading globally, all efforts are being made to ensure that countries are prepared and ready to respond, in situations where COVID infection has been detected.
In the Pacific, countries are increasing their efforts to ensure that their health services have reached an acceptable level of preparedness to rapidly detect and respond to the threats of COVID-19.
The PPTC is continuously assisting in Pacific preparedness against COVID 19 and is currently working with WHO (World Health Organization), NZ Ministry of Foreign Affairs and Trade, Pacific Ministries of Health, the Pacific Community (SPC), the Australian Dept of Foreign Affairs and Trade (DFAT) and the Doherty Institute (Melbourne) to establish COVID diagnostic and treatment facilities in Pacific Countries, the majority of which would face the devastating effects of COVID in the event of community spread .
Selected PPTC activities (2020-2021) currently delivered to the Pacific can be listed as follows:
Tokelau: In 2020, the New Zealand Ministry of Foreign Affairs and Trade (MFAT) engaged the Pacific Pathology Training Centre (PPTC) to implement the procurement and refit of a shipping container that would accommodate a GeneXpert with associated training and support. As part of this activity, the PPTC has been required to work with the container supplier to ensure that the mini testing laboratory is fit for purpose, with remodelling based on detailed specifications provided by WHO and SPC. The PPTC has overseen the procurement of a biosafety cabinet and its installation into the container laboratory. Furthermore, the PPTC has procured additional laboratory equipment for basic diagnostic testing (as requested by Tokelau) and has overseen the supply and installation of this equipment into the container as well as its transport to Tokelau.
The laboratory units have been successfully set up in Nukunonu, allowing for the country to now have a functional laboratory capable of effective diagnosis and management of the disease. Through online zoom sessions, the PPTC has successfully set up a GeneXpert for the testing of COVID-19, a Haematology FBC analyser, Blood Gas analysers, a Cardiac POC Troponin T analyser, and a DCA Vantage for the hospital’s laboratory service. The PPTC staff continue to work with Tokelau laboratory staff, Mr Orisi Matatolu and their Director of Health, Dr Silivia Tavite in setting up request forms, operational manuals, handbooks and clinical guidelines, and continue to work on method development for the local setting. Once international travel resumes, the PPTC intends to travel to Tokelau to provide further training and support to Tokelau.
The Kiribati Medical Services is awaiting the refurbishment of their existing hospital facility to house a molecular testing platform (RT-PCR) to test and diagnose the SARS-CoV-2 virus. This refurbishment has been delayed and will take approximately a year to complete. In order to ensure that testing can commence as soon as possible, it has been proposed that a container unit is refurbished as a mobile PCR laboratory while the hospital facilities are upgraded. The Pacific Community (SPC) and the Government of Kiribati (GoK) have engaged the PPTC to oversee the refurbishment of shipping container units, to be used as a mobile PCR laboratory. As part of this project, the PPTC is currently working with the container supplier to ensure that the testing laboratory is fit for purpose, with remodelling based on detailed specifications discussed with the Kiribati Health team, SPC and the Doherty Institute. The PPTC will oversee the shipping and transportation of the container units locally within New Zealand and internationally, to Tarawa, Kiribati.
The container units are due to depart New Zealand on the 12th of March and is scheduled to arrive in Tarawa on the 27th of March. The laboratory units will then be set up by local trade staff with online support from the PPTC, making it ready for the mass testing of SARS-Cov-2 on RT-PCR platforms.
Healthcare is provided by Foou Hospital, Alofi which has 20 beds, outpatient clinics, pharmacy, X-ray, ultrasound and medical laboratory. Non-communicable diseases, such as diabetes, high blood pressure/hypertension, gout, asthma and cancer are a major health care concerns in Niue. Although there are currently no cases of COVID-19 in Niue the country needs to be prepared for its introduction as the movement of people recommences with the likelihood of transmission. These preparations will include a testing strategy and capacity appropriate for the population of Niue and its visitors.
The COVID-19 pandemic has highlighted the need for improved biosafety within Niue’s medical laboratory services. However, it has also provided an opportunity to build general capacity, and sustainability. WHO has contracted the PPTC to design and arrange the construction of a mobile/container laboratory, with the inclusion and implementation of appropriate validated/verified equipment that will deliver the range of necessary tests. The PPTC will also provide the relevant training to staff as well as reagents and kits delivered on a regular basis to support this medical laboratory service for Niue’s Foou hospital.
Progress is ongoing, with almost all laboratory equipment and consumables being delivered to the PPTC ready to be installed into the laboratory units. The units are being refurbished in Nelson, and are expected to be in Wellington for the fit-out by early March. These are expected to depart Wellington by mid-March, arriving into Niue early April, after which the PPTC staff will provide on-line zoom training sessions to Niue Health Staff to set-up the laboratory and the installed laboratory equipment.
Fiji CDC (Centre for Disease Control and Prevention)
The PPTC has been commissioned through SPC supported by DFAT to conduct a virtual external Laboratory Quality Management Audit of the CDC based in Suva Fiji.
An Audit will be conducted by the PPTC Quality Manager/ Consultant Mr Russell Cole in February using the SLIPTA audit tool modified by the PPTC to include all the elements of the ISO15189 standards.
The SARS-CoV-2 pandemic has required the rapid introduction of large scale molecular detection methods in diagnostic laboratories across New Zealand. Diagnostic laboratories have had to meet unprecedented demand for testing to support the NZ COVID-19 Public Health response. However, limited reagent supply chains have led to a number of challenges including the rapid introduction of kits and methods to ensure ongoing laboratory testing capacity. New Zealand is now well on the way towards “elimination” of COVID-19 with very low numbers of detected cases each day. Due to the 2019 Coronavirus outbreak, the PPTC has been asked to establish an EQA programme for the SARS-CoV2 disease for the Pacific region. The purpose of the SARS-CoV-2 EQA programme is to provide additional quality assurance for laboratories in the Pacific region, given that there are no positive results being detected.
With the assistance of ESR, who are supplying the programme materials and their technical expertise, a COVID-19 EQA panel has now been incorporated into the existing PPTC EQAP ( which provides for other medical laboratory science disciplines, supported by the New Zealand Ministry of Foreign Affairs and Trade.)
Both WHO and MFAT contributed to the funding of the newly developed COVID-19 panel and its delivery. The PPTC dispatched two cycles of the COVID-19 panel to 23 Pacific Laboratories in 2020, and two additional cycles have been scheduled for 2021. It is hoped that further funding will be available to continue this programme beyond 2021.
Under the COVID-19 support provided to the Pacific Region by the New Zealand Government, the PPTC is supported by the Ministry of Foreign Affairs and Trade to provide ongoing laboratory technical advisory services to the Pacific Ministries of Health and to its regional stakeholders including MFAT.