Since 2006, the U.S. Navy has been conducting Pacific Partnership, a U.S. Defense Department forward readiness humanitarian aid program in the Asia Pacific Region. This program costs U.S. taxpayers roughly $20 million per mission. Captain Jesse Wilson, the 2011 mission commander sees responses to natural disasters in the Pacific as part of Pacific Partnership’s mission. They are a constant reminder that the United States must “be ready and trained to operate collectively and effectively with our partner nations throughout the Pacific.”
Over the past year there have been a number of significant natural disasters in the Pacific Region. In January, category 5 Tropical Cyclone Ian slammed into Tonga’s Ha’apai islands, destroying homes and taking down vital communications. Just over a year ago, the Solomon Islands suffered an 8.1 earthquake followed by a deadly tsunami that left many homeless and to this day still living in tent cities. This year, on April 4, the entire island of Guadalcanal experienced devastating flooding after days of rain dumped meters of rainfall on the island, causing rivers to swell and forge deadly new paths through villages. More than 20 percent of the Solomon Island population has been adversely impacted by this latest disaster.
The U.S. Navy and Pacific Partnership did not mobilize to assist with any of these disasters, despite significant on-the-ground logistical issues in delivering relief. This raises some questions: What is the commitment of the U.S. Navy’s Pacific Partnership to the Pacific Island region? And is the United States taxpayer getting true value for money?
Pacific Partnership came about in response to logistics problems experienced during the Indonesian tsunami response in 2004. The Navy rightfully recognized the need for multinational, coordinated and timely disaster relief to minimize human suffering, diminish economic consequences and mitigate security and instability issues in the effected regions. Every year since its inception Pacific Partnership has grown; today, it is a multinational exercise that includes the Australian, New Zealand and Japanese navies. Pacific Partnership conducts up to six two-week port calls during each three-month mission, during which pre-determined engineering programs are executed, health and dental clinics are held and public health and veterinary medicine education is provided.
While there is inherent immediate value to these visits and participating Naval staff work diligently to provide services, there is minimal sustainability to its efforts or meaningful measurable aid that comes from these exercises. The visibility, however, is great as the Navy utilizes its PR machine to get word and photos of their visits out to the public. Support in Washington for this program is big. Elected officials, State Department representatives and Military brass see Pacific Partnership as a major contribution to the health and wellbeing of the people of the Pacific Region. This is understandable as the program is one of only two U.S. government-funded global health programs in that region. While the majority of Naval staff participants return from these missions with a sense of accomplishment and humanitarian good, some—health providers in particular—see the need for more meaningful engagement.
Why Pacific Partnership was started in the first place has been questioned. Some speculate the increased U.S. interest in the region is to counter China’s growing military power or is a means to monitor potential insurgent activity. While there is little possibility that fragile Pacific Island states like Solomon Islands or Tonga will generate terrorist groups, there are complex issues unique to these least developed countries that render them at risk of failing following a natural disaster, economic downturn or internal civil unrest. A significant portion of their GDP comes from external aid, rendering them vulnerable to exploitation. For these reasons, the U.S. in concert with Australia and New Zealand needs to remain engaged, but to pivot the nature of this engagement for it to be more valuable in the region. Future Pacific Partnership missions must include programs that address disaster response and mitigation as well as support improved health care delivery to the people of the region. It must also combat the poaching of local doctors and healthcare workers by higher paying countries like Cook Islands and American Samoa through the creation of new supportive local work environment partnerships.
The partitioning of Pacific Partnership exercises in the Pacific Region needs to be considered so its delivery of goods are more effective and in line with the needs of the host country. For instance, there should be a true disaster response component to Pacific Partnership that mobilizes at a host country’s request. This can be accomplished by creating a more nimble Naval response team that can deploy rapidly in the event of a disaster or destabilization of an area, using all resources available to the Navy. This is vital to dealing with the difficult logistics of working and maneuvering in countries like Solomon Islands, with challenging undeveloped terrain, isolated outlying islands and rudimentary infrastructure that is vulnerable to even the most minor environmental impacts. Any relief effort in response to a disaster like the recent floods on Guadalcanal or more remote inhabited islands requires a land, sea and air approach, something the Navy does best with its amphibious warfare ships or landing platform/docks.
A comprehensive coordinated disaster effort involving the militaries of Australia, New Zealand and the U.S., demonstrated in past Pacific Partnership interoperability missions, can relieve unnecessary suffering, minimize negative economic consequences, stabilize a potentially explosive civil situation, and allow for soft power and visible goodwill. The quick restoration of infrastructure to a functional level by shoring up bridges, roads and utilities also allows subsequent relief efforts to proceed unhampered. Rapid control of a disaster zone can minimize civil unrest and a multinational humanitarian aid approach avoids hegemonic perceptions.
Pacific Partnership should strive to develop sustainable health development partnerships between multinational health providers, public health policymakers and host countries. A committed education partnership that delivers equipment upgrades and skills transfers to local health providers will allow for immediate and longer-term issues to be addressed. This type of approach is in contrast to the one-off way Pacific Partnership currently conducts its medical and dental clinics. It requires a team of specialists and public health doctors who commit to and pair with local providers, get to know the culture, environment and difficulties of providing health services and preventing diseases in a specific resource-limited environment. The Solomon Islands Living Memorial Project has accomplished this type of partnership with the Solomon Island doctors. On a shoestring budget, the program has helped doctors at the National Referral Hospital on Guadalcanal establish a very productive endoscopy program that is currently defining the burden of gastrointestinal disease in the country. Teaching visits occur twice a year, during which Australian and United States gastrointestinal specialists teach endoscopy skills. Between visits all partnership team members stay in contact by email.
Over the past thirty years Australia and New Zealand have traditionally been responsible for providing nearly all of the multilateral stability and development initiatives for their neighbors in the southern Pacific Region. Until recently, U.S. involvement in the South Pacific has been absent, despite commitments to the territories and commonwealths in the northeastern Pacific. The U.S. Navy’s Pacific Partnership has succeeded in shifting the U.S. sphere of influence and understanding to include the southern Pacific. This is a significant accomplishment. Eight years into Pacific Partnership’s history it is time to reassess the program, including its strengths and weaknesses. A version 2.0 of Pacific Partnership that provides disaster relief while building health capacity can help this program achieve a true global health leadership role.
Eileen Natuzzi, MD, MS, FACS is a public health surgeon and director of surgical education for the Solomon Islands Living Memorial Program, an educational partnership between health providers in the U.S., Australia and Solomon Islands.