By Kevin E. Lunday*
The United States is a Pacific nation. By its history, geography, and shared culture with other Pacific islanders, the United States is an integral member of the community of nations that make up Oceania. U.S. leadership in Oceania remains vital during the ongoing COVID-19 global pandemic, especially as the Delta variant spreads and a resurgence of COVID-19 among unvaccinated populations threatens a prolonged crisis of disproportionate impact in the region. As the United States seeks to strengthen its commitment to global vaccination efforts, it should place immediate emphasis on increasing vaccine delivery and administration, supported by broader health aid and investment, to the Pacific islands throughout Oceania.
Expanding and accelerating U.S. development aid could have a significant impact on improving response to the ongoing crisis and preventing retreat on development progress. This is not simply about advancing U.S. interests in competition with Beijing’s efforts to provide vaccine and health aid, although today everything is filtered through the lens of strategic competition between the United States and the People’s Republic of China. This is about meeting U.S. responsibility as a Pacific nation.
In the face of a worsening pandemic, coupled with enduring security challenges for Pacific Island nations, U.S. strategic leadership is needed to ensure governance, security, and stability in a region that includes the United States.
Covid-19 in the Indo-Pacific
The pandemic’s effects in the Pacific islands, in terms of deaths and hospitalizations, was significantly mitigated until recently by aggressive government quarantine and containment measures, including severe travel restrictions. These emergency measures, which brought major economic burdens because they restricted travel, tourism, and trade, were largely successful until mid-2021 in preventing potentially catastrophic, widespread community transmission as governments moved to distribute and administer COVID-19 vaccines starting at the end of 2020.
There is growing consensus now, however, that these severe travel restrictions are not economically sustainable over the long-term. Any herd immunity is elusive in the face of viral variants and lagging vaccine rates in most Pacific Island nations. Recently, the accelerated spread of the Delta variant in the Pacific, with much higher transmissibility rates, threatens to prolong and worsen the crisis by increasing the risk of hospitalizations and deaths among the unvaccinated.
Widespread, sustained, and aggressive vaccination among the peoples of Pacific island nations, supplemented by mitigation measures, is the way these peoples and governments will endure and eventually emerge from the crisis. They cannot do it alone. Achieving this goal requires significant support from major allies to aid in supplying governments with safe and effective vaccines, overcoming challenges to logistics, reaching remote and distributed populations, supporting limited medical infrastructure, and overcoming significant vaccine hesitancy.
The United States was quick to begin the delivery and administration of vaccines in Oceania. As soon as vaccines were made available and approved for emergency use by the Food and Drug Administration in December 2020, the U.S. prioritized among its early efforts the vaccination of Americans in the State of Hawai’i and the U.S. territories of Guam, American Samoa, and the Commonwealth of Northern Mariana Islands. In January 2021, honoring the special defense and security relationship with the three States in Free Association (“Compact States”), the U.S. began delivery of vaccines to Palau, the Republic of the Marshall Islands (RMI), and the Federated States of Micronesia (FSM).
In June 2021, the President announced the U.S. commitment to global vaccination efforts, pledging 80 million doses through the COVAX program under the World Health Organization (WHO) arm of the United Nations, with part of 16 million doses donated to Asia that would include the Pacific Islands. Several weeks earlier, at the Pacific Island Leaders Conference at the East-West Center in Honolulu, the U.S. Secretary of State said the U.S. was committed to assisting Pacific communities to recover from the pandemic, both through vaccine donations and helping devastated island economies rebuild in a way that is sustainable and inclusive.
More recently in August 2021, the President spoke in a recorded video address to the Pacific Island Forum (PIF) Leaders Meeting in which he said the United States would donate “half a billion” Pfizer/BioNTech vaccine doses to the COVAX international vaccine sharing program and that some of that donation will flow to the Pacific. The President also told the PIF Leaders Meeting that the United States was “not attaching any conditions or strings to these doses – this is about saving lives.”
The United States is providing other health aid to Pacific Island nations during the pandemic, such as personal protective equipment and supplies, strengthening laboratory systems, activating case-finding and event-based surveillance, and providing technical experts for COVID-19 response and preparedness. U.S. allies Australia, New Zealand, Japan, and France, have their own vaccine programs to assist Pacific Island nations, both through COVAX and existing bilateral aid programs, as well as providing other health aid.
Four Ways to Stronger Regional Leadership
The Pacific Island nations need reliable allies, especially in crisis. The U.S. has signaled that it intends to take more than a transactional approach to global vaccinations and that it will meet the challenge to be a global strategic leader in combating the pandemic. As such, U.S. leadership in Oceania must be clear, persistent, and enduring.
Acknowledging that the U.S. actions over the past 150 years both in the Pacific and with its peoples have at times been complicated and even controversial, it has also been a history of protection and liberation from oppression by coercive and conquering powers dating back to World War II. Moreover, the increasing diversity of the U.S. population remains one of the United States’ greatest and most unique strategic strengths. Today, the Americans who are Pacific islanders by residence, birth, or cultural ties (Polynesians, Micronesians, and Melanesians) are essential to that vibrant strength.
- Establish a small interagency Federal task force (E.g., Pacific Islands Health Task Force)
First, the United States should immediately establish a Pacific Islands Health Task Force to unify and coordinate Federal government efforts from the U.S. Agency for International Development (USAID), Departments of State and Defense (and include coordination of efforts from Departments of Interior, Health and Human Services, and Veterans Affairs for the U.S. territories and Compact States). This would position the executive branch to focus leadership and resources on vaccination and other health aid, while enabling more effective oversight and assessment of efforts.
The Pacific Islands Health Task Force would be led by an experienced U.S. diplomat and seconded jointly by a senior USAID official and detailed senior U.S. military officer, and would report to the USAID Administrator. The task force would be staffed with a small group of select experts in pandemic response, public health, and international development, and would leverage the National Security Council to ensure unified effort across cognizant Federal departments and agencies.
- Adopt more ambitious vaccine targets with Pacific Island nations
Next, the United States should build on existing international vaccine sharing commitments by setting and filling more ambitious bilateral vaccine allocation, delivery, and deployment targets with each of the Pacific Island nations, starting with the Compact States. U.S. vaccine targets should aspire to achieve a 75% population vaccination rate in the host-nation, depending on host-nation government targets and timelines. U.S. vaccine targets and sharing should continue to be planned in coordination with efforts of other major regional allies (Australia, New Zealand, France, and Japan) and recognize planned COVAX vaccine distributions.
- Rapidly deploy Health Emergency Action Response Teams (HEART) to the Pacific
Third, the United States should rapidly form special mobile medical teams comprised of civilian, private sector, and military healthcare professionals, logisticians, and key support technicians to deploy in support of Pacific Island governments and healthcare workers to deliver and administer vaccines. HEART teams, organized and directed to deploy by the Pacific Island Health Task Force, would operate under the direction of the U.S. embassy and in coordination with the regional USAID officer and U.S. Indo-Pacific Command.HEART teams would integrate with and support host-nation healthcare teams. Recognizing the significant challenges to U.S. domestic healthcare workforce capacity, the U.S. government needs to leverage other sources to create these deployable mobile medical teams. Sourcing should include military medical personnel from each of the U.S. armed forces that operate in the Pacific (including the U.S. Coast Guard), public health officers from the Federal government, allied military medical personnel from the Australian Defence Force and New Zealand Defence Force, and medical personnel from private-sector and non-governmental organizations.Additionally, the teams should include U.S. National Guard medical personnel for those Pacific Island nations assigned to National Guard Bureau State Partnership Program (i.e., Wisconsin National Guard for Papua New Guinea, Nevada National Guard for Fiji and Tonga). When possible, mobile military medical teams should include U.S. members who are Pacific islanders.
The deployable mobile military teams could also leverage the Department of Defense for transportation, logistics, and support, resourced by USAID and the Department of State programs. Beyond vaccinations, the mobile medical teams, working with the U.S. embassy and host-nation government, could identify and assess opportunities for additional health assistance and development aid related to health security for follow-on action.
- Increase health diplomacy engagement with Pacific Island people
Fourth, the U.S. government should increase public diplomacy and global engagement efforts to advance education and understanding of health prevention and vaccination among Pacific island peoples, while combating foreign state and non-state propaganda and disinformation aimed at undermining U.S. vaccination and health aid efforts.The highly competitive information environment has become more so in the pandemic, and the effectiveness of vaccination campaigns and other public health efforts depends on the ability to effectively and persistently communicate accurate information across the information spectrum while addressing malign efforts to use the information environment to undermine U.S. efforts and policies. This is especially important to combat disinformation that undermines confidence in the proven safety and efficacy of U.S.-provided vaccines.
These actions, necessary in the near term, must be reinforced by broader, persistent U.S. investment in diplomacy, foreign aid, and security assistance for Pacific island nations, as described in the U.S. Interim National Security Strategy. There have been policy and legislative initiatives in this area, but they have yet to gain sufficient traction. For example, the Boosting Long Term Engagement in the Pacific (BLUE Pacific), H.R. 7797, would increase U.S. diplomatic presence throughout Oceania; encourage full U.S. participation in regional governance forums; and authorize $1B in economic development and assistance. Policy experts have suggested similar expansions of U.S. commitment to Oceania, urging, for example, that the U.S. offer new special defense and security bilateral agreements, similar to the existing Compacts of Free Association (with Palau, FSM, and RMI), to smaller Pacific Island nations.
Need for Responsible State Behavior by Others
There is another actor involved in efforts to vaccinate in the region whose recurring use of coercive economic and development aid to further its own interests signals that its vaccine distribution efforts are transactional, typically with strings attached. Efforts by the Peoples’ Republic of China (PRC) to produce and distribute vaccines globally as part of their planned “health diplomacy” are still gaining momentum, hampered by a diminished vaccine efficacy relative to other, available vaccines.
Yet the PRC continues to scale up international vaccine deployment, including to Pacific Island states (E.g., Solomon Islands, Papua New Guinea, Kiribati) where a gap exists and it has significant political and diplomatic interests. The international community, including the United States, needs China to be successful with vaccine production and distribution for its own population, and to responsibly participate in global vaccine efforts. However, the U.S. must continue to call out Beijing if it attempts to leverage or weaponize vaccine distribution as it has done coercively with other prior foreign assistance under its One Belt, One Road initiative.
The U.S. should immediately increase targeted vaccinations, other health assistance, and development aid to the Pacific islands, employing a unified, focused Federal response that leverages the interagency and allies for leadership, diplomacy, coordination, medical aid, and communications.
COVID-19 is not the only crisis facing Pacific island nations; it is just the most immediate and pressing one. Oceania also faces longer-term challenges with rising sea levels due to climate change that threaten diminishing inhabitable land; overharvesting of precious fish stocks due to illegal, unreported, and unregulated fishing by distant water fishing fleets; and foreign malign influence that threatens governance and regional stability.
Continued U.S. leadership is needed to address these challenges, which are also significant challenges for the U.S. But first, the U.S. must address the most immediate crisis of the pandemic. The elevation of public health, global health engagement, and health security to pivotal national and regional security priorities is one way of doing this. As a Pacific nation whose identity as a people is bound to others in Oceania, leadership and action now is a clear imperative.
The views expressed in this article are the author’s alone, and do not necessarily reflect the official position of the DKI APCSS or the United States Government. September 2021
*Rear Admiral Kevin E. Lunday, U.S. Coast Guard. The views expressed in this article are the author’s alone, and do not necessarily reflect the official position of the DKI APCSS or the United States Government.
 Oceania consists of the central and southern Pacific Ocean, comprising Polynesia (including Hawaii), Melanesia, Micronesia, Australia, and New Zealand. Oceania includes Guam, the Commonwealth of Northern Mariana Islands, American Samoa, and the Compact of Free Association (COFA) states Palau, Federated States of Micronesia, and the Republic of Marshall Islands.
 COVID-19 – the Pacific response: 9 September – Policy Forum.
 Boe Declaration on Regional Security – Forum Sec.
 COVID-19 – the Pacific response: 9 September – Policy Forum.
 In some states, such as Papua New Guineau, there is longstanding suspicion of vaccines in certain areas, made worse by the spread of disinformation about COVID-19 vaccines. Health workers face death threats as COVID-19 vaccine hesitancy takes hold in PNG – ABC News; Curb the Infodemic: Vaccine hesitancy, misinformation and confusion – ABC International Development.
 News Releases from Department of Health | Thousands of COVID-19 Vaccines Arrive (hawaii.gov); 7,000 vaccines arriving | Guam News | postguam.com; American Samoa starts Covid-19 vaccinations | RNZ News. In addition to vaccines, the United States government passed the American Rescue Plan Act, which provided between approximately $450- $500 million in pandemic-related relief to each U.S. territory, depending on the population of the territory. The American Rescue Plan Act, Section 9901—The Coronavirus State Fiscal Recovery Fund (congress.gov).
 U.S. ships COVID-19 vaccines to Pacific island nations | ShareAmerica.
 FACT SHEET: Biden-Harris Administration Announces Allocation Plan for 55 Million Doses to be Shared Globally | The White House
Statement by President Joe Biden on Global Vaccine Distribution | The White House
 Pacific Islands Conference of Leaders Concludes First Day of Virtual Meeting – Pacific Islands Development Program (eastwestcenter.org)
 Biden Pledges ‘No Strings’ Pacific Pandemic Support | World News | US News
 The_Pacific_Islands_Fact_Sheet_on_COVID-19_Assistance_-_final_Aug_2020.pdf (usaid.gov).
 Australian support for COVID-19 vaccine access in the Pacific and Southeast Asia | Indo-Pacific Centre for Health Security (dfat.gov.au); NZ ready to provide $75m for Pacific and global COVID-19 vaccination support | Unite against COVID-19 (covid19.govt.nz).
 Biden to Call for Summit on Global COVID Vaccine Supplies | Voice of America – English (voanews.com).
 Global Engagement Center – United States Department of State.
 NSC-1v2.pdf (whitehouse.gov).
 See Text – H.R.7797 – 116th Congress (2019-2020): BLUE Pacific Act | Congress.gov | Library of Congress
 See. How the US Can Protect the Sovereignty of the Smallest Pacific Islands – The Diplomat
 Blinken denounces China’s ‘strings attached’ vaccine diplomacy – Nikkei Asia.
 China’s Vaccine Diplomacy Stumbles in Southeast Asia – The New York Times (nytimes.com).
 China’s Sinopharm COVID-19 vaccine launches in the Pacific – ABC News.
 China Is Weaponizing the Belt and Road. What Can the US Do About It? – The Diplomat.