COVID-19 Technical Training Support to the Rarotonga Hospital Laboratory Services

 In preparation to open Quarantine-free travel between New Zealand and the Cook Islands, the New Zealand Ministry of Foreign Affairs and Trade (NZ-MFAT), on behalf of the Cook Islands, Te Marae Ora, requested face-to-face technical training support from the Pacific Pathology Training Centre to setup COVID-19 RT-PCR testing in Rarotonga.

 The PPTC accepted this request and in association with the Doherty Institute (Melbourne), delivered face-to-face training in-country which complemented online training that had already been planned for the Cook Islands. Navin Karan, the PPTC’s Project Manager, and Molecular specialist carried out this training for 4 staff in the country which was two weeks in duration, and it is planned that two consolidation one-week visits will follow a month apart.

 Through recent modifications, the laboratory services established a clean room, extraction room, and amplification room for its real-time RT-PCR setup. During the initial two weeks visit, the laboratory was set up with all equipment supplied through Pacific Community (SPC), the workflow was established, and staff were practically trained on all aspects of performing molecular testing for SARS-CoV-2 in the country, which included performing manual extractions from nasopharyngeal swabs. At the completion of practical training, the laboratory successfully performed testing on its  validation panel and went live with clinical sample testing in the second week of May, just before the travel bubble opened on 17 May 2021.

Above: Ms Iva Vakalalabure, Laboratory Scientist performing extractions at the PCR laboratory in Rarotonga. Below: Laboratory Scientists, Ms Iva Vakalalabure and Ms Theresa Tatuava performing result analysis on the CFX Maestro after a PCR run. 

COVID-19 Support to Fiji

Establishing PCR testing Facilities in Nadi

The Pacific Pathology Training Centre (PPTC) is currently working with the World Health Organization (WHO) and the Fiji Ministry of Health and Medical Services (MOHMS) to design and construct a mobile/container laboratory system which will be established in Nadi, capable of RT-PCR testing and a range of other necessary tests near this port of entry. This laboratory would be expected to perform up to 200 COVID-19 tests a day by RT-PCR.

 As part of this contract, the PPTC is also responsible for the implementation of appropriate validated and verified items of equipment as well as the provide reagent supplies and testing kits that would deliver the set testing menus, required by the medical laboratory service for Nadi.

The construction of the 4 unit mobile/container laboratory is now well underway and its footprint will be sufficient for the delivery of RT-PCR testing to include two thermocyclers, two semi-automated RNA extraction analysers, three biosafety cabinets, two PCR work stations and all other equipment associated with the provision of this service. Testing procedures will be in line with existing Fiji and international standards. Initially, the RT-PCR laboratory will be set up for COVID-19 testing. It will however have sufficient scope to expand on the molecular diagnostic capacity in the future.

 Reagent, Consumables and Equipment Support to Fiji CDC – Suva

 Due to the recent spread of COVID-19 through community transmission in Fiji in April 2021, MFAT requested PPTC to supply gloves, gowns, masks, nasopharyngeal collection swabs and VTM, biohazard specimen bags, PCR reagents, a Thermo Cycler for RT-PCR and refrigerated centrifuges to the Fiji Centre of Communicable Diseases (Fiji CDC) to further strengthen their testing capacity. The PPTC has been responsible for the procurement, delivery and installation of the laboratory equipment and consumables to support RT-PCR testing in Fiji. This included logistical and technical advisory support to ensure safe transportation and installation.

The PPTC has been able to procure most of the items and is currently waiting for the delivery of the centrifuges. Through these activities, the PPTC continues to work in partnership with MFAT in responding to and strengthening the Pacific’s health system, including Fiji.

Setup of Bio-Rad CFX96 Thermocycler by Medica Pacifica Staff  and Fiji CDC staff receiving the “turn-key” CFX96 on Tuesday 25 May 2021

COVID-19 Support to Kiribati

The Pacific Community (SPC) and Ministry of Foreign Affairs and Trade (MFAT) on behalf of the Government of Kiribati (GoK) engaged the Pacific Pathology Training Centre (PPTC) to oversee the refurbishment of shipping container units, to be used as a mobile PCR laboratory. As part of this project, the PPTC worked with the container supplier to ensure that the testing laboratory was fit for purpose, with remodelling based on detailed specifications discussed with the Kiribati Health team, SPC and the Doherty Institute.

 The PPTC was also responsible for the final shipping and transportation of the container units locally within New Zealand and internationally, to Tarawa, Kiribati. The container units departed New Zealand on 14 April and arrived in Kiribati on 1^st  May 2021. A number of setup items were also provided to the GoK to help set up the units in Kiribati. The PPTC has delivered multiple remote sessions with the GoK staff to help connect the units together and have them functional.

Above: Initial placement of container laboratory onto a constructed platform                Below: Inside view of the container PCR laboratory in Kiribati – Extraction room.

Electricity and plumbing now awaits completion as does the unpacking and installation of all PCR equipment. Once the laboratory is functional, coordinated training will be provided to dedicated staff by VIDRL (Victorian Infectious Diseases Reference Laboratory) and the Doherty Institute located in Melbourne.

COVID-19 Support to Niue

The PPTC through the support of WHO, designed and arranged the construction and delivery of a mobile/container laboratory, with the inclusion and implementation of appropriate validated/verified equipment. The PPTC was also responsible for the provision of specialist training of staff as well as the provision of essential reagents and kits to ensure that all laboratory test menu requirements had been met for Niue’s Foou hospital.

Wellington celebration of the mobile/container laboratory completion before its journey to Niue.

Inside view of the container laboratory

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.

 Kiribati:

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 12^th of March and is scheduled to arrive in Tarawa on the 27^th 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.

 Niue:

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.

EQAP COVID-19

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.

The Tokelau’s

The PPTC was requested by the New Zealand Ministry of Foreign Affairs and Trade to set up a mobile laboratory unit for Tokelau in response to a potential  COVID outbreak that threatened the small Pacific Nation in May 2020.

 The PPTC  worked with an NZ-based container modification company and successfully arranged the joining of two 20ft containers to house a laboratory setup for Tokelau. This double unit containing an appropriately designed internal infrastructure, along with newly purchased laboratory equipment and consumables was successfully shipped from Auckland to Samoa and then to Tokelau. On receipt in Tokelau’s the portable laboratory was then positioned on the islands hospital campus where water and power were connected.

The PPTC fully equipped the laboratory with general and specialised laboratory equipment and will oversee training of staff on site (once international borders re-open) as well as through zoom. The modification of the container system and the procurement of the equipment began on the 4^th of June and setup was completed ready for transportation to Tokelau on the 24th of July. The PPTC’s experience and expertise enable it to provide the same service to other countries if there is a need, provided funding is available.

PPTC Staff, Mr Ross Adern ( Administrator for Tokelau), NZ Ministry of Foreign Affairs and  Trade, Australian AID, and members of the Wellington Tokelau community at an official gathering to celebrate the completion of the portable laboratory before its departure to Tokelau.

Internal and external photos of the laboratory.

Newly appointed members to the PPTC Board of Trustees

It is of great pleasure that the PPTC welcomes Dr Dianne Sika-Paotonu  and Dr Vladimir Osipov as newly appointed members of the PPTC Board of Trustees.

Dr Dianne Sika-Paotonu is currently the  Associate Dean (Pacific) at Otago University’s Wellington campus and is the first Tongan and Pacific biomedical scientist to be appointed to this role within the Division of Health Sciences at Otago.

Dianne completed her PhD in Biomedical Science at Victoria University of Wellington specializing in Immunology based at the Malaghan Institute of Medical Research. While there, Dianne was a member of the cancer vaccines team and undertook work that explored the modification of these vaccines to generate stronger immune responses against cancer.

Dianne has received numerous awards for her PhD and other research work including the MacDiarmid New Zealand Young Scientist of the Year  – Advancing Human Health & Wellbeing, Colmar Brunton Research Excellence Award, Australasian Society of Immunology BD Science Communication award, Asia Pacific Science Technology Studies Networks New Contributions to Science Technology & Innovation Award – Indigenous studies and the Australasian Society of Immunology Buck Memorial Award among others. Dianne was also recipient of the Royal Order Award- the Most Illustrious Royal Order of Queen Salote Tupou III-Commander, awarded by the late King George Tupou V of Tonga in recognition of scientific achievement.

Dianne has strong research interests in areas of health research relevant to Pacific populations living in New Zealand and in the Region and is an Honorary Research Associate with the Wesfarmers Centre for Vaccines & Infectious Diseases, Telethon Kids Institute, Perth, Western Australia and Victoria University of Wellington, and is an Affiliate with the Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland.

Dr Osipov trained in pathology at the Medical College of Wisconsin, followed by a subspecialty training at the Mayo Clinic, Rochester, USA. He is a Fellow of the American College of Pathologists, and of the Royal College of Pathologists of Australasia and is currently Chief Anatomical Pathologist for Southern Community Laboratories based in Wellington as well as Honorary Senior Lecturer, for the University of Otago. Dr Osipov’s areas of interest include gastrointestinal, skin, lung, urologic and orthopaedic pathology.

The PPTC External Quality Assessment Programme

The PPTC EQA programme has provided its quality service to the laboratories of the Asia–Pacific region for over 30 years. Since 1990 it has been recognised by WHO as a collaborating centre for External Quality Assessment in Health Laboratory Services.

Funded through the NZ Overseas Development programme, this service is delivered to over 100 regional laboratories.

It is provided to National Pacific laboratories free of charge, and this provides invaluable benefit to their national healthcare, directly impacting patient health outcomes. Close to 22 surveys are dispatched throughout the year covering the seven medical laboratory disciplines.

• Haematology
• Clinical Biochemistry
• Microbiology
• Blood Transfusion Science
• Infectious Disease Serology
• Anatomical Pathology
• Molecular Diagnostics – COVID-19 (SARS-CoV-2) (recently added to the PPTC Programme)

Due to the 2019 Coronavirus outbreak, the PPTC was asked by WHO 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, to prove the accuracy of detection rates.

 Pacific Joint Incident Management Team (JIMT)

Since early January 2020, the World Health Organization in the Pacific has been working closely alongside Pacific Governments and Ministries of Health, in collaboration with partners, to ensure that countries are well prepared to respond to the threat of COVID-19.

The PPTC has been invited to join as a member of the Pacific Joint Incident Management Team (JIMT, Lab cell) and WHO is coordinating with Pacific partners that constitute this team, to bring together resources and assist Pacific countries’ readiness to delay the spread of the virus and mitigate negative health and socioeconomic impacts of COVID-19.

Activities that this  team is involved with include:

• Training and technical guidance on critical preparedness, readiness and response actions for COVID-19
• Working with government and community sectors
• Procuring critical laboratory and medical supplies
• Communicating with the public and engaging with communities