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Devastating floods over Easter sparked a coronavirus outbreak in Timor-Leste that now threatens to rage out of control. Australian aid has helped, but the nation desperately needs more vaccines and medical supplies. By Max Opray.

Covid-19 surges in Timor-Leste

Health workers collect samples during a Covid-19 testing drive in Dili, Timor-Leste’s capital, this week.
Credit: EPA

Dr Joshua Francis had never seen anything like it. The Darwin-based infectious diseases physician at the Menzies School of Health Research is used to tropical downpours, but the biblical rains of the Easter weekend in Timor-Leste were something else entirely.

“I woke up to the most extraordinary driving rain all of the Saturday. Rain like I’d never seen: a flooded front yard and a dawning realisation of the devastation,” he tells The Saturday Paper.

“No power, no internet, roads all cut out, so we had to send somebody to the lab to check it out.”

That lab is the National Health Laboratory, the epicentre of the Covid-19 testing effort for Timor-Leste, and it was totally flooded.

To say this was poor timing is to put it mildly. The island nation was in the midst of its first real Covid-19 outbreak after more than a year of remarkable success keeping the virus at bay.

Come Easter Sunday, Francis and his team were shovelling out mud from the lab while at the same time trying to analyse Covid-19 tests.

It was the first day back in the lab for Timorese microbiologist Nevio Sarmento, who paused his PhD in Darwin to return to help with the effort to contain the rising cases of Covid-19 in his homeland.

“I remember we had the PCR [polymerase chain reaction] tests running on one side, and the mud-shovelling on the other,” he says. “It did affect our productivity.”

Sarmento is under no illusion about the relationship between the devastating floods and the current coronavirus crisis gripping the nation.

The floods, which killed 44 people and displaced thousands, forced the Timor-Leste government to lift a strict lockdown imposed to contain the initial outbreak. This necessary loosening of restrictions allowed the virus to spill out into regional areas.

“The water destroyed a lot of houses, a lot of displaced people had to go to emergency shelters with up to 2000 people in one shelter, which allowed for transfer [of the virus] much more easily,” Sarmento says. “We’re now seeing the evidence of the spread that began then.”

Almost 200 positive cases a day are now being detected, in a country of just 1.3 million people.

As of May 23, there were 5816 confirmed cases. The true number, however, is believed to be far higher.

Dr Rui Maria de Araújo, a former prime minister of Timor-Leste and the head of the country’s Covid-19 response, tells The Saturday Paper the positive tests likely capture only a fraction of the scale of the outbreak.

“It is estimated that in Dili, the capital of the country, alone we have about 50,000 infected people, but we are only able to detect 5 to 6 per cent,” he says.

Authorities have worked to contain the outbreak to Dili, but a growing number of cases are starting to appear in regional areas such as the municipality of Bobonaro, in the far west of the country.

Of tests done in the week leading up to May 23, 17 per cent returned a positive result.

Asked what Timor-Leste most urgently needs, Araújo is succinct: “Vaccines, vaccines, vaccines.”

Baseline projections by the Covid-19 International Modelling Consortium indicates Timor-Leste’s outbreak will peak in July, and that about 60 per cent of the population will get infected.

But if Timor-Leste is able to aggressively roll out vaccines in the next two months, that infection rate drops to 37.5 per cent, which would mean a halving of expected hospitalisations and deaths.

The urgency is not lost on Francis and the team at the National Health Laboratory.

“Timor-Leste faces the unusual experience of its first wave of Covid-19 at the same time as rolling out the vaccine,” he says. “It’s a race against time.”

As of May 22, more than 55,000 doses of AstraZeneca vaccine have been administered but two doses are needed per person, with a significant wait between each one.

In early April, the country secured 28,000 doses from the Covax initiative, which seeks to supply Covid-19 vaccines to low-income countries. Australia sent an additional 40,000 doses in May.

Francis says that with 1300 people trained to give vaccinations in Timor-Leste, the country could be administering up to 40,000 doses a day – the only issue is sufficient supply.

In a press conference on May 5, Australian Health Minister Greg Hunt said the federal government was able to provide countries such as Timor-Leste with vaccines in the wake of the decision to advise against AstraZeneca use for under-50s in Australia due to the remote risk of blood clots.

“That does create a flexibility for Australia to provide extra assistance to our friends and neighbours who may be facing vaccine shortages,” he said.

However, the advice given by the Australian government and others on AstraZeneca has created some uncertainty for Timor-Leste, where 90 per cent of the population is under the age of 54.

“It raised a lot of questions among the population about why the vaccine is right for Timor if it is not right for other places,” says Francis. “There is a different balance of risk, however, with the current outbreak, so the risks of Covid-19 outweigh any risk from the vaccine.”

Australia is prioritising Timor-Leste and other Pacific nations in its vaccine distribution plans. But it has simultaneously obstructed efforts to remove patent restrictions on Covid-19 vaccines, which would allow poorer countries to access generic versions.

Nevertheless, Araújo says the support offered by Australia across all aspects of the Covid-19 response so far is appreciated.

He expressed gratitude for Australian support in medical supplies, testing reagents and in construction of infrastructure for quarantine and treatment. “One thing is needed more from Australia: more doses of the AstraZeneca vaccine,” he says.

Beyond the vaccines, aid offered by Australia so far includes 84 medical oxygen canisters.

As with so much of Australia’s dealings with gas-rich Timor-Leste, though, fossil fuel companies are never far away from the action.

A helicopter co-funded by the federal government and gas giant Santos helped deliver medical supplies around the island to aid the flood and Covid-19 response.

There is also the matter of vaccine diplomacy, with China pledging 100,000 units of its Sinovac vaccine to the country as it competes for influence in the Asia–Pacific region.

Pat Conroy, Labor’s shadow minister for International Development and the Pacific, told The Saturday Paper that the Morrison government “should listen and act accordingly to any requests for support and assistance from the Timor-Leste government”.

He added that Australians owe Timor-Leste a debt of gratitude over the thousands that died in World War II due to “reprisals by Japanese soldiers for their assistance to Australian soldiers”.

Timor-Leste’s youthful population does confer one significant advantage as its outbreak worsens: a lower risk of death from the virus.

As of May 26, 14 deaths have been linked to the virus, although fatalities lag weeks behind still-rising case numbers.

Since March 1, there have been 135 people hospitalised due to the virus.

Most infections have been recorded among younger Timorese, with vaccine efforts targeting older people and those with one or more diseases or health conditions, particularly in Dili where most cases so far have been recorded.

Sarmento cautioned, however, that the death toll needs to be reviewed.

“We haven’t retrospectively reviewed causes of death because of the situation on the ground, and there are Timorese with comorbidities, including high rates of malnutrition,” he says.

“Fortunately, my family, many of them have comorbidities like high blood pressure, but those family members have been vaccinated and are eagerly awaiting their second dose.”

Adding to the urgency of the vaccine rollout is the difficulty of stricter lockdown measures for the Timorese population.

As Francis notes, lockdown is a radically different proposition for the average Australian compared with the average Timor-Leste resident.

“A strict lockdown in Australia means me and my family stay at home and order groceries and takeaway to our door,” he says.

“In Timor-Leste a family like mine with four kids, they also live with their grandparents and extended family so there might be 20 people in the house. They can’t get things delivered, so have to go to the market – and there’s one market for rice, and another for vegetables and so on.”

Francis, like many on the ground in Timor-Leste, takes care to emphasise that his call for a vastly accelerated vaccine distribution effort is not a criticism of what has been offered by Australia thus far.

“The Australian government has been incredibly supportive,” he says. “I’m only asking for more because more is what is needed.”

This article was first published in the print edition of The Saturday Paper on May 29, 2021 as "Covid-19 surges in Timor-Leste".

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Max Opray is Schwartz Media’s morning editor and a freelance writer.