Border screening is an essential component of COVID-19 testing strategies in Vanuatu

In their Personal View, Belinda Hengel and colleagues¹ 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.² 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.¹ 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, 2020.³ 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).⁴ 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,⁵ 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.² 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.