Search

Summary: Background: We aimed to summarise the extent and nature of published research about eye health and eye health services in Pacific Island Countries and Territories since 1980. Methods: We searched Medline, EMBASE, Global Health and Cochrane Library to identify publications about eye health and eye health services in 22 Pacific Island Countries and Territories from 1 January 1980 to 26 January 2024. Study selection and data extraction were conducted by two reviewers independently. Findings: Of the 1610 publications identified, 180 were included. This research was most commonly conducted in Papua New Guinea (n = 52) or Fiji (n = 33) and focused on diabetic retinopathy (n = 29) or trachoma (n = 18), with few focused on cataract or refractive error. While eye health services research was common in the past, recent research focused on trachoma. The included research was largely undertaken and funded by people and organisations from Australia, Aotearoa New Zealand and the USA, though authors with Pacific affiliations is increasing. Interpretation: Few countries have up-to-date estimates of the prevalence of vision impairment or service coverage to enable evidence-informed planning. Increased effort is required to strengthen research capability to ensure research priorities in eye health are set by Pacific Peoples. Funding: The Fred Hollows Foundation New Zealand.

Background: In Solomon Islands, the retail food environment is an important food source, for instance, the dominant source of fresh fruit and vegetables for urban consumers is open markets. The effects of COVID-19 mitigation measures (such as restriction of human movement and border closures) in early 2020 placed food security at risk in many parts of the community. Of particular concern was the risk of price gouging in an already price-sensitive market. Aims: The study aimed to provide rapid and policy-relevant information on the pricing of foods in the urban food environment in Solomon Islands in the context of the unfolding COVID-19 pandemic. Methods: A vendor survey was conducted in July to August 2020 and repeated in July 2021 using a survey tool that collected information on type, quantity, and price of food on offer. Findings: We found price reductions among the majority of fresh fruit and non-starchy vegetables available. A trend of rising prices was reported for some other commodities, such as fresh locally caught fish. Conclusion: Our findings highlight the impact of 'schocks to the system' on food prices as a potential barrier or enabler to consumption of fresh foods purchased from urban areas – an important finding in a price sensitive market. The survey design was successful in collecting pricing data from the retail food environment during a time of external 'shock to the system'. Our approach is applicable to other settings needing a rapid survey of the external food environment. [ABSTRACT FROM AUTHOR]

Food security, in the context of a rapidly changing climate, is one of the most prominent global challenges facing human societies today. Pacific Island Countries and Territories (PICTs) are particularly vulnerable to the adverse effects of climate change, while facing additional stress from globalisation and increased supply chain disruption. This review aims to document our understanding of food system vulnerability to climate change in the region, and identify the existing studies that could inform policy and decision-making. The review also serves to discern the dominant focal areas of research, as well as where gaps exist for emerging research. Using keyword searches on the web, scholarly databases, and targeted organisational websites, we identified 104 studies published from 2010 to 2022 that looked at the impacts of climate change on some aspect of the food system in at least one PICT. We found that the majority of empirical research on climate impacts on food systems in PICTs focused on the biophysical components of food production rather than the complex interactions between the socio-economic and biophysical factors that make up food systems. An incomplete understanding of the impacts from climate change could result in maladaptation and an undermining of food system resilience. [ABSTRACT FROM AUTHOR]

Plain language Summary Globally, menarche is an important developmental milestone for females. Experiences of menarche and subsequent menstruation are embedded in socio-cultural norms and practices which can impact women’s ability to manage menstruation with dignity. This paper reviews social and cultural factors that affect the ability of women to effectively manage their menstrual health and hygiene (MHH) in Pacific Island Countries and Territories (PICTs). Peer-reviewed and grey literature were searched systematically, using the PRISMA extended scoping review methodology. Eleven studies met the inclusion and exclusion criteria: 10 qualitative studies and one mixed methods study. Included studies had been conducted in Melanesian (n = 9), Polynesian (n = 1) and Micronesian (n = 1) states of PICTs. Factors affecting MHH were identified and categorised using the Socio-Ecological Framework categories: biological; personal; interpersonal; environmental and societal. All 11 studies reported elements of societal and personal factors; ten studies reported evidence relating to interpersonal factors; nine studies reported elements relating to environmental factors; and two studies presented evidence linked to biological factors. MHH experiences of women in PICTs are shaped by socio-cultural norms and practices. These norms and practices need to be incorporated into sexual and reproductive health planning, programs and education in order to be relevant to diverse village and urban settings in PICTs.

Summary: Despite positive trends in many indicators, there remains an unacceptable burden of preventable maternal, newborn deaths and stillbirths every year.This paper provides an overview of the maternal and perinatal outcomes across 22 Pacific Island Countries and Territories, including Papua New Guinea. We highlight some unique challenges and provide examples of initiatives in three of the larger countries to contribute to safer childbirth.There are high maternal and perinatal morbidity and mortality rates in many of the countries, although reliable data are limited. There are currently no data relating to the burden of intrapartum-related maternal and perinatal morbidity or stillbirth or the quality of intrapartum care. Varying definitions across countries for perinatal indicators mean that meaningful comparisons are difficult and unreliable. There is need for midwives and other maternal and newborn health providers to improve maternal and newborn indicators as countries advance towards the 2030 Sustainable Development Goals.

The article presents a scoping study which examined the social and cultural factors affecting the ability of women in Pacific Island Countries and Territories (PICT) in managing their menstrual health and hygiene (MHH). Topics include the inclusion of experiences of menarche and subsequent menstruation in the social and cultural beliefs, norms and practices of people worldwide, and the factors affecting MHH like interpersonal, societal and environmental factors.

Summary: The Pacific Island Countries and Territories (PICTs) have experienced the coronavirus disease (COVID-19) pandemic in different ways and with different timelines, with some experiencing large outbreaks leading to high levels of morbidity and mortality with significant strain on health systems, while others have had no local transmission or delayed transmission until after vaccine rollouts started. Regardless of COVID-19 trends, the pandemic has had a large impact on the social, political, and economic landscape in the Pacific, the effects of which are still being understood. However, the pandemic has also put renewed focus and investment into public health systems and provided an opportunity for the PICTs to build on existing systems and recent capacity strengthening to improve public health in the Region. Funding: Leila Bell was supported by an Australian Government Research Training Program (RTP) Scholarship. Other funding sources had no role in paper design, data collection, data analysis, interpretation, or writing of the paper.

Diarrheal diseases have been known to cause death in many children below the age of five years, and rotavirus infection represents a major health problem in the world today, particularly in developing countries. The recent outbreak of rotavirus gastroenteritis in Samoa led to the introduction of her debut national immunization program on rotavirus vaccination for infants. Despite the introduction of anti-viral and anti-emetic drugs as of the containment approaches towards the virus, risk factors, preventive measures and public health preparedness against rotavirus infection are poorly understood in Samoa. This review aims to use available evidence on rotavirus literature to elucidate and map preventive strategies for the recently emerged rotavirus infections in Samoa. We conducted a search strategy using online medical literature databases and retrieval systems. A designated set of keywords such as rotavirus, gastroenteritis, outbreak, risk factors, containment measures, vaccination and Samoa were inserted in electronic databases to retrieve articles. The databases included PubMed, Google Scholar, MEDLINE, Scinapse, and EBSCO host. Findings from this review addressed the impact of rotavirus infection, associated threats and other preventive measures. Introducing useful health frameworks in pursuing possible methods such as improved water quality, exclusive breast feeding, improved laboratory diagnostics and outbreak surveillance, may be essential in addressing alternate approaches towards containment of the disease in Samoa and other Pacific Island Countries and Territories.

Background: We aimed to summarise the extent and nature of published research about eye health and eye health services in Pacific Island Countries and Territories since 1980., Methods: We searched Medline, EMBASE, Global Health and Cochrane Library to identify publications about eye health and eye health services in 22 Pacific Island Countries and Territories from 1 January 1980 to 26 January 2024. Study selection and data extraction were conducted by two reviewers independently., Findings: Of the 1610 publications identified, 180 were included. This research was most commonly conducted in Papua New Guinea (n = 52) or Fiji (n = 33) and focused on diabetic retinopathy (n = 29) or trachoma (n = 18), with few focused on cataract or refractive error. While eye health services research was common in the past, recent research focused on trachoma. The included research was largely undertaken and funded by people and organisations from Australia, Aotearoa New Zealand and the USA, though authors with Pacific affiliations is increasing., Interpretation: Few countries have up-to-date estimates of the prevalence of vision impairment or service coverage to enable evidence-informed planning. Increased effort is required to strengthen research capability to ensure research priorities in eye health are set by Pacific Peoples., Funding: The Fred Hollows Foundation New Zealand., Competing Interests: JR, LH PS and APM report a grant from The Fred Hollows Foundation New Zealand to support the conduct of this study. No other author has a conflict to disclose., (© 2024 The Authors.)

Pacific Island Countries and Territories (PICTs) are experiencing a Diet-Related Non-Communicable Disease (DR-NCD) health crisis(1). Increasing rates of DR-NCDs such as Type 2 diabetes and cardiovascular disease have been linked to dietary transitions and increasing food insecurity in the region(2). Anthropogenic climate change has also been identified as a significant threat to food security in PICTs(3). Additionally, the impacts of the COVID-19 Pandemic have been identified as both a contributor to food insecurity in the region and as an opportunity to transform PICT food systems and reduce rates of DR-NCDs(4). Yet, the drivers of dietary change, food security and agricultural practices in peripheral PICT communities are not well documented or understood. To determine how these drivers may change in the future and the impacts this may have on Pacific peoples, a deeper understanding of the historical and contemporary drivers of change is necessary. The aim of this scoping review was to collate existing information to improve this understanding, by mapping key factors evident in the literature that underpin the links between DR-NCDs and food security with a focus on women in PICT peripheral communities, to better clarify the challenges, working definitions and conceptual boundaries in the research area. The review maps where research has been conducted geographically and how the links between DR-NCDs and food security in PICTs have been investigated over time and identifies projections and suggestions for the future. The scoping review was conducted in accordance with a pre-defined protocol available online(5). A total of 476 peer-reviewed sources and 126 grey literature sources were identified by the initial search criteria. Two independent researchers completed title/abstract and full text screening using Covidence, and data extraction using a data extraction tool. The resulting data was quantified in table format, with common themes and ideas presented qualitatively. Sources spanned all sectors of PICT food systems with a heavy focus on production from fisheries and agriculture. Most PICTs were represented in the findings. Many drivers of change within food systems were identified, some of which included the impacts of anthropogenic climate change, the COVID-19 pandemic, and urbanisation. The drivers impacted all four pillars of food security, and many were directly or indirectly related to dietary and lifestyle changes associated with DR-NCD risk factors. This data is accompanied by an interpretation of results and a narrative summary. These results provide a useful platform to further explore the drivers of dietary change, food security, agricultural practices and DR-NCD's in this region. [ABSTRACT FROM AUTHOR]

Highly processed and energy-dense foods are contributing to the high and rising rates of non-communicable diseases and nutrient deficiencies in Solomon Islands. Non-communicable diseases currently cause 69% of deaths in Solomon Islands, and the rate is rising, fuelled in part by limited health system capacity to treat these conditions. Solomon Islands also has the highest reported undernourishment rate in the Pacific. Recent decades have seen several factors change the food and economic environment in Solomon Islands. Importantly, rural-to-urban migration has caused a disconnect between urban residents and access to land and home gardens. This study aimed to examine the complexities of nutritious food access in urban Solomon Islands. Data were collected from 32 women in Honiara, the islands' capital, using a novel survey instrument. There were 3 important findings: (1) the dominant influencers of the diet patterns described by participants in this study were food affordability and access to land on which to grow it, (2) all participants experienced food insecurity, and (3) reported diet patterns reflected unhealthy diets which were particularly high in processed and sugary foods. These findings suggest a need for improvements in the food environment in Honiara. [ABSTRACT FROM AUTHOR]

Introduction: Standard measles control strategies include achieving high levels of measles vaccine coverage using routine delivery systems, supplemented by mass immunization campaigns as needed to close population immunity gaps. Areas covered: This review looks at how supplementary immunization activities (SIAs) have contributed to measles control globally, and asks whether such a strategy has a place in Pacific Islands today. Expert commentary: Very high coverage with two doses of measles vaccine seems to be the optimal strategy for controlling measles. By 2015, all but two Pacific Islands had introduced a second dose in the routine schedule; however, a number of countries have not yet reached high coverage with their second dose. The literature and the country reviews reported here suggest that a high coverage SIA combined with one dose of measles vaccine given in the routine system will also do the job. The arguments for and against the use of SIAs are complex, but it is clear that to be effective, SIAs need to be well designed to meet specific needs, must be carried out effectively and safely with very high coverage, and should, when possible, carry with them other public health interventions to make them even more cost-effective.

The increase in anthropogenic CO 2 emissions over the last century has modified oceanic conditions, affecting marine ecosystems and the goods and services that they provide to society. Pacific Island countries and territories are highly vulnerable to these changes because of their strong dependence on ocean resources, high level of exposure to climate effects, and low adaptive capacity. Projections of mid-to-late 21st century changes in sea surface temperature (SST), dissolved oxygen, pH, and net primary productivity (NPP) were synthesized across the tropical Western Pacific under strong climate mitigation and business-as-usual scenarios. These projections were used to model impacts on marine biodiversity and potential fisheries catches. Results were consistent across three climate models, indicating that SST will rise by ≥ 3 °C, surface dissolved oxygen will decline by ≥ 0.01 ml L −1 , pH will drop by ≥ 0.3, and NPP will decrease by 0.5 g m −2 d −1 across much of the region by 2100 under the business-as-usual scenario. These changes were associated with rates of local species extinction of > 50% in many regions as fishes and invertebrates decreased in abundance or migrated to regions with conditions more suitable to their bio-climate envelope. Maximum potential catch (MCP) was projected to decrease by > 50% across many areas, with the largest impacts in the western Pacific warm pool. Climate change scenarios that included strong mitigation resulted in substantial reductions of MCP losses, with the area where MCP losses exceeded 50% reduced from 74.4% of the region under business-as-usual to 36.0% of the region under the strong mitigation scenario. [ABSTRACT FROM AUTHOR]

Introduction:Standard measles control strategies include achieving high levels of measles vaccine coverage using routine delivery systems, supplemented by mass immunization campaigns as needed to close population immunity gaps. Areas covered:This review looks at how supplementary immunization activities (SIAs) have contributed to measles control globally, and asks whether such a strategy has a place in Pacific Islands today. Expert commentary:Very high coverage with two doses of measles vaccine seems to be the optimal strategy for controlling measles. By 2015, all but two Pacific Islands had introduced a second dose in the routine schedule; however, a number of countries have not yet reached high coverage with their second dose. The literature and the country reviews reported here suggest that a high coverage SIA combined with one dose of measles vaccine given in the routine system will also do the job. The arguments for and against the use of SIAs are complex, but it is clear that to be effective, SIAs need to be well designed to meet specific needs, must be carried out effectively and safely with very high coverage, and should, when possible, carry with them other public health interventions to make them even more cost-effective. [ABSTRACT FROM PUBLISHER]

The diverse geographic, demographic, and societal factors in the Pacific Island Countries and Territories (PICTs) have contributed to unique epidemiological patterns of HIV, syphilis, and hepatitis B. Transmission can be during pregnancy, at the time of birth or via breastfeeding for HIV, and can have long-term adverse outcomes. Given the similarities in prevention of mother-to-child transmission of these infections, coordinated interventions for triple elimination are used. This systematic review has evaluated the peer-reviewed literature, grey literature, and global databases to assess the availability of data to report against elimination targets in the WHO Regional Framework for the Triple Elimination of Mother-to-Child Transmission of HIV, Hepatitis B and Syphilis in Asia and the Pacific 2018-2030. The secondary objective is to report on progress towards these targets. The findings show that none of the PICTs are on track to achieve triple elimination by 2030. Amongst the limited publicly available indicator data, there is suboptimal coverage for most indicators. It is important that there is an increase in availability of and access to antenatal care, testing, and treatment for pregnant women. Increased efforts are needed to collect data on key indicators and integrate reporting into existing systems to avoid extra burden., Funding: Leila Bell was supported by an Australian Government Research Training Program (RTP) Scholarship, Australia. Funding sources had no role in paper design, data collection, data analysis, interpretation, or writing of the paper., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Margaret Hellard received investigator-initiated funding from Gilead Science and AbbVie unrelated to this work. Jess Howell received investigator-initiated funding from Gilead Science unrelated to this work and is a Gastroenterology Society of Australia (GESA) Liver Faculty member was voted Chair for 2023. The authors also acknowledge the support to the Burnet Institute provided by the Victorian Government Operational Infrastructure Support Program. Jane S Hocking received a fellowship from National Health and Medical Research Council which funded partial salary paid to the University of Melbourne., (© 2023 Published by Elsevier Ltd.)

Limited resources are one of the major constraints in effective disease monitoring and control in developing countries. This paper examines the pig and poultry market chains of four targeted Pacific Island countries and territories (PICTs): Fiji, Papua New Guinea, Solomon Islands and Vanuatu and combines them with a risk pathway analysis to identify the highest risk areas (risk hotspots) and risky practices and behaviours (risk factors) of animal disease introduction and/or spread, using highly pathogenic avian influenza (HPAI) and foot-and-mouth disease (FMD) as model diseases because of their importance in the region. The results show that combining a market chain analysis with risk pathways is a practical way of communicating risk to animal health officials and improving biosecurity. It provides a participatory approach that helps officials to better understand the trading regulations in place in their country and to better evaluate their role as part of the control system. Common risk patterns were found to play a role in all four PICTs. Legal trade pathways rely essentially on preventive measures put in place in the exporting countries while no or only limited control measures are undertaken by the importing countries. Legal importations of animals and animal products are done mainly by commercial farms which then supply local smallholders. Targeting surveillance on these potential hotspots would limit the risk of introduction and spread of animal diseases within the pig and poultry industry and better rationalize use of skilled manpower. Swill feeding is identified as a common practice in the region that represents a recognized risk factor for dissemination of pathogens to susceptible species. Illegal introduction of animals and animal products is suspected, but appears restricted to small holder farms in remote areas, limiting the risk of spread of transboundary animal diseases along the market chain. Introduction of undeclared goods hidden within a legal trade activity was identified as a major risk pathway. Activities such as awareness campaigns for pig and poultry farmers regarding disease reporting, biosecurity measures or danger of swill feeding and training of biosecurity officers in basic animal health and import-associated risks are recommended to prevent and limit the spread of pathogens within the PICTs. [ABSTRACT FROM AUTHOR]

The Pacific is characterised as a region for the purposes of many international interventions and assistance programmes. Representatives of Pacific States participate in regional fora to build a strategic and unified approach to development. Regionally, bilateral trade agreements impact upon strategies to regulate alcohol imports. Policing and customs initiatives are increasingly supporting prevention of illicit drug production and trafficking, and model laws have been proposed to achieve consistency in enforcement. The aim of this commentary is to provide a response for policies using the case of alcohol and other drug research in the Pacific Islands Countries Territories. This commentary undertook a review of the current literature for regional developments for alcohol and other drug use in the Pacific Island Countries Territories region. A total of 14 articles were used in this article. The publication date for the articles used in this review ranged from 1997 to 2011. The findings of the review found that there should be a co-ordinated approach for adopting alcohol and other drug approaches. Furthermore, there should be a co-ordinated regional response with the inclusion of targeted domestic programming that will meet the needs for the Pacific Island countries and territories. Countries in the Pacific Island territories are characterised by varying degrees of political stability. Without stable government and democratic process, it is likely to remain difficult to develop consistent and effective legislation and policy for implementation of successful alcohol and other drug programmes. We found that there is a lack of robust and current data for alcohol and other drugs in Pacific Island countries and territories. Further research funding is needed to build the limited knowledge of alcohol and other drug substance use. [ABSTRACT FROM AUTHOR]

Despite positive trends in many indicators, there remains an unacceptable burden of preventable maternal, newborn deaths and stillbirths every year. This paper provides an overview of the maternal and perinatal outcomes across 22 Pacific Island Countries and Territories, including Papua New Guinea. We highlight some unique challenges and provide examples of initiatives in three of the larger countries to contribute to safer childbirth. There are high maternal and perinatal morbidity and mortality rates in many of the countries, although reliable data are limited. There are currently no data relating to the burden of intrapartum-related maternal and perinatal morbidity or stillbirth or the quality of intrapartum care. Varying definitions across countries for perinatal indicators mean that meaningful comparisons are difficult and unreliable. There is need for midwives and other maternal and newborn health providers to improve maternal and newborn indicators as countries advance towards the 2030 Sustainable Development Goals., Competing Interests: We declare no competing interests., (© 2022 The Author(s).)

Lack of guidelines on control of pediculosis in the Solomon Islands led to a search for relevant evidence on head lice in the Pacific Island Countries and Territories (PICTs). The aim of this search was to systematically evaluate evidence in the peer reviewed literature on pediculosis due to head lice (Pediculus humanus var capitis) in the 22 PICTs from the perspective of its value in informing national guidelines and control strategies. Methods PubMed, Web of Science, CINAHL and Scopus were searched using the terms (pediculosis OR head lice) AND each of the 22 PICTs individually. PRISMA methodology was used. Exclusion criteria were: i) not on topic; ii) publications on pediculosis not relevant to the country of the particular search; iii) in grey literature. Results Of 24 publications identified, only 5 were included. Four related to treatment and one to epidemiology. None contained information relevant to informing national guidelines. Conclusions Current local evidence on head lice in the PICTs is minimal and totally inadequate to guide any recommendations for treatment or control. We recommend that local research is required to generate evidence on: i) epidemiology; ii) knowledge, attitudes and practices of health care providers and community members; iii) efficacy of local commercially available pharmaceutical treatments and local customary treatments; iv) acceptability, accessibility and affordability of available treatment strategies; and iv) appropriate control strategies for families, groups and institutions. We also recommend that operational research be done by local researchers based in the PICTs, supported by experienced head lice researchers, using a two way research capacity building model. [ABSTRACT FROM AUTHOR]

Pacific Island biodiversity has a notorious record of decline and extinction which continues due to habitat loss and degradation, invasive species, overexploitation, pollution, disease and human-forced climate change. In terrestrial systems, these global and local pressures are more acute because of relatively small land to sea area, high endemism and poor adaptations to resist predation. Regional policy and learning frameworks exist to combat biodiversity loss and environmental degradation, but implementation remains patchy across the 22 Pacific Island countries and territories (PICTs) within Oceania. PICTs are challenged by small, under-resourced government departments, limited data, and strong political will for rapid economic development at the cost of ecological sustainability. In this synthesis of the special issue, we identify the challenges and opportunities for biodiversity conservation on Pacific islands. We identified bright spots of implementation occurring through regional initiatives, knowledge-sharing networks, and community-based management. The challenge looms large, given the relatively small-scale efforts compared to the core drive for development of natural resources which continues to pervade island communities. Five key initiatives promise improved conservation effectiveness: 1) alignment of national biodiversity strategies to the Aichi Targets, under the Convention on Biological Diversity; 2) increased engagement with local communities to promote wise stewardship and local environmental monitoring; 3) dissemination of best practice guidelines for management through learning networks; 4) cost-benefit analyses that drive investment in biosecurity and invasive control; and 5) implementation of integrated island management that accounts for the multiple synergistic benefits of ecosystem management (e.g., climate adaptation, disaster risk reduction, improved health). [ABSTRACT FROM AUTHOR]

Highlights: [•] Knowledge gaps need to be identified for conservation and management. [•] A consistent metrics is needed to guide a gap analysis. [•] A quick spatial approach based on mapped geomorphological richness is presented. [•] A gap analysis is conducted for Solomon Island. [ABSTRACT FROM AUTHOR]

The Pacific is well known for producing tsunamis, and events such as the 2011 Tōhoku-oki, Japan disaster demonstrate the vulnerability of coastal communities. We review what is known about the current state of tsunami risk management for Pacific Island countries and territories (PICTs), identify the issues and challenges associated with affecting meaningful tsunami disaster risk reduction (DRR) efforts and outline strategies and possible ways forward. Small island states are scattered across the vast Pacific region and these states have to varying degrees been affected by not only large tsunamis originating in circum-Pacific subduction zones, but also more regionally devastating events. Having outlined and described what is meant by the risk management process, the various problems associated with our current understanding of this process are examined. The poorly understood hazard related to local, regional and distant sources is investigated and the dominant focus on seismic events at the expense of other tsunami source types is noted. We reflect on the challenges of undertaking numerical modelling from generation to inundation and specifically detail the problems as they relate to PICTs. This is followed by an exploration of the challenges associated with mapping exposure and estimating vulnerability in low-lying coastal areas. The latter part of the paper is devoted to exploring what mitigation of the tsunami risk can look like and draw upon good practice cases as exemplars of the actions that can be taken from the local to regional level. Importantly, given the diversity of PICTs, no one approach will suit all places. The paper closes by making a series of recommendations to assist PICTs and the wider tsunami research community in thinking through improvements to their tsunami risk management processes and the research that can underpin these efforts. [ABSTRACT FROM AUTHOR]

The Pacific Island Countries and Territories (PICTs) have experienced the coronavirus disease (COVID-19) pandemic in different ways and with different timelines, with some experiencing large outbreaks leading to high levels of morbidity and mortality with significant strain on health systems, while others have had no local transmission or delayed transmission until after vaccine rollouts started. Regardless of COVID-19 trends, the pandemic has had a large impact on the social, political, and economic landscape in the Pacific, the effects of which are still being understood. However, the pandemic has also put renewed focus and investment into public health systems and provided an opportunity for the PICTs to build on existing systems and recent capacity strengthening to improve public health in the Region., Funding: Leila Bell was supported by an Australian Government Research Training Program (RTP) Scholarship. Other funding sources had no role in paper design, data collection, data analysis, interpretation, or writing of the paper., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Margaret Hellard received investigator-initiated funding from Gilead Science and AbbVie unrelated to this work. Mark Stoové received consultancy funding from Gilead Sciences and received investigator-initiated funding from Gilead Science and AbbVie unrelated to this work. The authors also acknowledge the support to the Burnet Institute provided by the Victorian Government Operational Infrastructure Support Program., (© 2022 The Author(s).)

While categorized as Small Island Developing States, South Pacific Island nations are the custodians of major ocean areas containing marine resources of high commercial and environmental significance. Yet, these resources are threatened by climate change, overfishing, Illegal, Unreported and Unregulated (IUU) fishing, as well as habitat destruction. The study, carried out in the early stage of the interdisciplinary research project SOCPacific (https://socpacific.net), aims to: a) identify the main policies on which fisheries management is currently based in the South Pacific, particularly in Fiji, New Caledonia and Vanuatu; b) investigate the evolution over time of key issues covered in these policies and related to coastal and/or offshore fisheries sectors; c) trace disconnections on the matter between legally binding instruments and non-binding strategies. A list of more than 200 documents relevant to regional fisheries management was gathered and separated into legally binding instruments and non-binding strategies. Legal instruments focused more on offshore issues (tuna fisheries and IUU fishing) and increasingly covered IUU fishing issues, confirming that tuna fisheries have an established hard policy arena. In strategies pertaining to coastal fisheries, community involvement appears as a key topic and a clear overall trend towards increasingly addressing climate change was spotlighted. Sustainability, community involvement, climate change, and food security issues are more covered in strategies than in legal instruments. Topics mostly addressed in relation to coastal areas are not substantially covered in legal instruments, suggesting that establishing binding measures might not be deemed as beneficial as strategies in coastal fields. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a critical global health threat with a disproportionate impact on low-income and middle-income countries (LMICs) due to their higher burden of infections, reduced laboratory surveillance infrastructure and fewer regulations governing antimicrobial use among humans or animals. While there have been increasing descriptions of AMR within many LMICs in WHO's Western Pacific and South East Asian regions, there remains a paucity of data from Pacific Island countries and territories (PICTs). The PICTs represent 22 predominantly middle-income countries and territories with a combined population of 12 million people and 20 official languages, spread over hundreds of separate islands spanning an area corresponding to more than 15% of the earth's surface. Our paper outlines the present state of the evidence regarding AMR in PICTs-discussing the present estimates of AMR and their accompanying limitations, important drivers of AMR, as well as outlining key priorities and potential solutions for tackling AMR in this region. Significant areas for action include developing National Action Plans, strengthening laboratory surveillance systems and educational activities targeted at both healthcare workers and the wider community. Ensuring adequate funding for AMR activities in PICTs is challenging given competing health and environmental priorities, in this context global or regional funding initiatives such as the Fleming Fund can play a key role., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Climate change presents significant challenges to modelling and managing aquatic resources. Equilibrium assumptions common in many modelling approaches need to be replaced by formulations that allow for changing baselines and integration of ongoing changes and adaptations by species, ecosystems and humans. As ecosystems change, so will the ways humans use, monitor and manage them. Consequently, adaptive management loops and supporting tools deserve more prominence in the management toolbox. Models are critical tools for providing an early understanding of the challenges to be faced by integrating observations and examining possible solutions. We review modelling tools currently available to incorporate the effect of climate change on marine and freshwater ecosystems, and the implications for management of natural resources. System non-linearity can confound interpretations and hence adaptive management responses are needed that are robust to unexpected outcomes. An improvement in the ability to model the effects of climate change from a social and economic perspective is necessary. The outputs from ‘end-to-end’ and socio-ecological models can potentially inform planning, in both Australia and the Pacific region, about how best to build resilience to climate change. In this context, the importance of well directed data-collection programs is also emphasised. Lessons from this region, which is advanced with regard to modelling approaches, can guide increased use of models to test options for managing aquatic resources worldwide. [ABSTRACT FROM AUTHOR]