PNG’s plummeting vaccination rates: Now the world’s lowest?

Focus
Papua New Guinea (PNG)’s low Coronavirus (Covid-19) vaccination rate is well known. This blog provides some context for that, and points to the wider problem of falling national immunisation rates, STEPHEN HOWES and KINGTAU MAMBON report
Countries with the lowest immunisation rankings: their average rankings across the three vaccines in 2019. – Courtesy of World Bank World Development Indicators

THE World Bank reports data immunisation coverage for nearly all countries in relation to three vaccines: the measles vaccine; the combined vaccine for diphtheria, whooping cough and tetanus (DPT); and the hepatitis B vaccine.
On all three, the most recent data (for 2019) show that PNG has the lowest vaccination rates in the world for infants: 37 per cent for measles, 35 per cent for DPT and 35 per cent for hepatitis B.
PNG has been a bottom-10 immuniser for measles and hepatitis B since about 2015, and for DPT since about 2010.
It has been the worst or second worst immuniser for all three since 2017.
The graph below shows the average ranking across the three vaccines for the ten countries which have the lowest rankings on average for 2019.
It is generally a group of countries facing crises of terrorism, refugees and/or large-scale conflict.
Plus PNG.
How to explain this shocking fact?
Explanations based on PNG’s characteristics struggle in the face of comparisons across countries.
We might say PNG is a fragile and conflict-affected state.

Immunisation rates for PNG since 2005. – Courtesy of World Bank World Development Indicators

The average for fragile and conflict-affected states is 67 per cent for both DPT and measles, and 68 per cent for hepatitis B.
We might say that service delivery in Melanesian countries is generally poor.
Immunisation rates in Vanuatu and the Solomon Islands are 80 per cent or higher for measles, and 90 per cent or higher for DPT and hepatitis B.
A standard explanation is that PNG is geographically challenging, populated by hard-to-reach, remote communities.
But that doesn’t explain why PNG’s vaccination rates have plummeted over the last 15 years.
Perhaps the data is wrong.
2019 was in fact meant to be PNG’s “year of immunisation”, the year in which, responding to an outbreak of polio, a massive immunisation drive was conducted, with significant donor support.
According to Unicef, more than a million children were vaccinated against measles (as well as rubella and polio) in a nationwide campaign that year.
But the World Bank data (which comes from Unicef and the WHO) tells a different story.
So does PNG’s own national data (presumably the original source), which puts measles vaccination rates in 2019 at 34 per cent, and the combined DPT/hepatitis B vaccine at 42 per cent.
These numbers show no improvement at all over previous years, simply a halt in the deterioration.
Perhaps then there are problems with the quality of the PNG immunisation data (and more generally PNG’s over-elaborate health data collection system).
The comments in the Unicef/WHO country report hint at this.
But, even if there are question marks around PNG’s precise immunisation rate, the country’s own national programme and survey data both confirm the collapse in PNG’s immunisation rates over the last 15 years or so.
Immunisation rates improved over the 1990s.
The real collapse in rates came between 2013 and 2017.
The emphasis then was on providing funds for MPs to spend on local projects.
None of this went on health service delivery.
There was a famous drug corruption scandal.
The resource boom was over, and revenue was falling.
Health budgets were cut (after inflation, by 9 per cent between 2013 and 2017).
Then prime minister Peter O’Neill introduced a “free healthcare” policy at the start of 2014.
Health facilities were discouraged from charging user fees, their most reliable source of revenue. Analysts warned at the time that this would weaken the health system.
Meanwhile, Australia was reorienting its aid to PNG over this period away from service delivery.
Whatever the questions around the accuracy of PNG’s immunisation data, there is plenty of evidence that immunisation rates had deteriorated to crisis levels prior to the Covid-19.
Controversies over the Covid-19 vaccine will only make the general immunisation task that much harder.
We can debate whether PNG is a failed state.
But this is a clear case where the State has failed its people.

Data from World Bank World Development Indicators. Measles and DPT coverages are reported in relation to two year olds; hepatitis B in relation to one year olds. The DPT and hepatitis B vaccines are now combined in PNG so the two series have converged. Health budget data from WHO.

Disclosure: This research was undertaken with the support of the ANU-UPNG Partnership, an initiative of the PNG-Australia Partnership. The views represent those of the authors only.


Stephen Howes is the Director of the Development Policy Centre and a Professor of Economics at the Crawford School

Kingtau Mambon is an economics tutor at the University of Papua New Guinea School of Business and Public Policy