Border screening is an essential component of COVID-19 testing strategies in Vanuatu
Authors: Caroline van Gemert, Posikai Samuel Tapo, Kalkie Sero, Len Tarivonda, Philippe Guyant, Tessa B. Knox, Matthew Cornish, Vincent Atua, Geoff Clark, Melissa Binihi, Wendy Williams, George Junior Pakoa, Michael Buttsworth, Jimmy Obed, George Worwor, Nelly Ham
Journal: The Lancet Infectious Diseases (2021)

In their Personal View, Belinda Hengel and colleagues1Hengel B Causer L Matthews S et al.A decentralised point-of-care testing model to address inequities in the COVID-19 response.Lancet Infect Dis. 2020; (published online Dec 23.)https://doi.org/10.1016/S1473-3099(20)30859-8Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar note that geographical dispersion of small populations across islands and other rural and remote settings presents a key barrier to COVID-19 testing access, and they present a decentralised COVID-19 point-of-care testing model based on in-community testing of suspected (symptomatic) cases. The model is based on point-of-care testing using a rapid, fully automated, self-contained, qualitative RT-PCR test for SARS-CoV-2 detection using single-use cartridges.2Becker MG Taylor T Kiazyk S Cabiles DR Meyers AFA Sandstrom PA Recommendations for sample pooling on the Cepheid GeneXpert system using the Cepheid Xpert Xpress SARS-CoV-2 assay.PLoS One. 2020; 15e0241959Crossref Scopus (24) Google Scholar Hengel and colleagues note that several Pacific Island countries and territories already have GeneXpert platforms in use for tuberculosis management within provincial-level and national-level health services.1Hengel B Causer L Matthews S et al.A decentralised point-of-care testing model to address inequities in the COVID-19 response.Lancet Infect Dis. 2020; (published online Dec 23.)https://doi.org/10.1016/S1473-3099(20)30859-8Summary Full Text Full Text PDF PubMed Scopus (38) Google Scholar The proposed model is relevant to settings where there is widespread community transmission. However, it is less relevant in the absence of community transmission. The Pacific Island nation of Vanuatu (population 290 000, 83 islands), similar to many other Pacific Island countries and territories, has experienced border cases only—that is, cases identified in managed quarantine facilities—and has not experienced community transmission of SARS-CoV-2. COVID-19 testing via the GeneXpert platform became available in May, 2020.3Williams W, van Gemert C, Mariasua J, et al. Experiences in COVID-free Vanuatu: initial establishment of surveillance and challenges of no in-country testing and Tropical Cyclone Harold, January–April 2020. Western Pac Surveill Response J (in press).Google Scholar Test procurement is through the regional Joint Incident Management Team (coordinated by the WHO Representative Office for the South Pacific), and test allocation to Vanuatu comprises approximately 3% of the population (8400 tests ordered).4WHO Representative Office for the South PacificCOVID-19 Joint Incident Management Team. Health sector preparedness & response: external situation report #31.https://www.who.int/docs/default-source/wpro-documents/dps/outbreaks-and-emergencies/covid-19/jimt_covid-19_external_situation_report31.pdf?sfvrsn=2ca92d36_3Date: 12 November–10 December 2020Date accessed: January 15, 2021Google Scholar Due to the limited number of tests available, and reflecting the epidemiological scenario of border cases only, Vanuatu has adopted a testing strategy that prioritises efficient and targeted resource use rather than decentralised testing. It is focused on retaining sufficient laboratory testing supplies to use in the event of community transmission, as targeted active case finding through laboratory testing of close and casual contacts is central to the control of community transmission. The highest priority group for testing identified in the laboratory testing strategy is symptomatic individuals who meet the WHO case definition,5WHOPublic health surveillance for COVID-19: interim guidance.https://www.who.int/publications-detail-redirect/who-2019-nCoV-surveillanceguidance-2020.7Date: Aug 7, 2020Date accessed: August 10, 2020Google Scholar followed by asymptomatic testing of international arrivals in managed quarantine facilities on days 5 and 11 after arrival. Asymptomatic testing is done in pooled batches, whereby multiple samples are combined and tested as a single unit.2Becker MG Taylor T Kiazyk S Cabiles DR Meyers AFA Sandstrom PA Recommendations for sample pooling on the Cepheid GeneXpert system using the Cepheid Xpert Xpress SARS-CoV-2 assay.PLoS One. 2020; 15e0241959Crossref Scopus (24) Google Scholar A total of 2297 individuals were tested in Vanuatu by the end of 2020, among which the specimens for approximately 2213 individuals (96%) were tested via pooled testing in pools of up to 6:1, resulting in a saving of approximately 1800 test units to date. Vanuatu has successfully demonstrated that a small Pacific Island nation can use innovative strategies to effectively manage the use of limited testing resources. We declare no competing interests. Download .pdf (.13 MB) Help with pdf files Supplementary appendix A decentralised point-of-care testing model to address inequities in the COVID-19 responseThe COVID-19 pandemic is growing rapidly, with over 37 million cases and more than 1 million deaths reported by mid-October, 2020, with true numbers likely to be much higher in the many countries with low testing rates. Many communities are highly vulnerable to the devastating effects of COVID-19 because of overcrowding in domestic settings, high burden of comorbidities, and scarce access to health care. Access to testing is crucial to globally recommended control strategies, but many communities do not have adequate access to timely laboratory services. Full-Text PDF