COVID-19 in Papua New Guinea: Economic and Social Impacts Insights from the fifth round of high frequency phone surveys Data collected in June 2022 Background High Frequency Phone Surveys • The fifth round of the high frequency phone survey (HFPS) interviewed 2,630 households in June 2022 on the socio- economic impacts of COVID-19, including employment and income, community trust and security and COVID-19 vaccination. It follows four rounds of surveys conducted from June 2020 to December 2021. • The previous round of the HFPS (round 4), found that recovery was weak in 2021, with household incomes falling, and highlighted persistently low COVID-19 vaccination rates. Context • While the third wave of COVID-19 was over by June 2022, PNG remains the least vaccinated country in the EAP region and could be vulnerable to future outbreaks of COVID-19. • The World Bank estimates that the PNG economy contracted by 3.5 percent in 2020 before returning to positive economic growth of 1 percent in 2021. Stronger economic growth is projected for 2022, of 4 percent. In particular, strong growth is projected for the extractive sector (6.8 percent). However, the trajectory of economic recovery remains highly uncertain. Source: Papua New Guinea Economic Update, Navigating a Fragile Recovery, February 2022, The World Bank. 2 Survey timing: after the third COVID-19 wave (June 2022) COVID-19 Cases and Vaccinations in PNG State of Emergency National Pandemic Act 100 5 90 4.5 R1 R2 R3 R4 R5 80 4 new cases per million / stringency index 70 3.5 people vaccinated% 60 3 50 2.5 40 2 30 1.5 20 1 10 0.5 0 0 March 2020 June 2020 September 2020 December 2020 March 2021 June 2021 September 2021 December 2021 March 2022 June 2022 data collection period new cases per million (smoothed, LH axis) stringency index (LH axis) people vaccinated (relative to population, RH axis) Note: The stringency index is a mean of nine measures of government response to lockdown, specifically: school closures; workplace closures; cancellation of public events; restrictions on public gatherings; closures of public transport; stay-at-home requirements; public information campaigns; restrictions on internal movements; and international travel controls. Higher measures indicate a stricter response. 3 Note: “People vaccinated” is relative to the total population and refers to people who received at least one dose. Note: A state of emergency was declared on March 20, 2020, with the first positive case of COVID-19; the National Pandemic Act 2020 was established as a more definitive response to the pandemic and delivered a response strategy detailing compliance with the Constitution Source: PNG National Department of Health, World Health Organization. Papua New Guinea: Coronavirus Disease 2019 (COVID-19) Health Situation Report #84. 02 August 2021. Period of Report: 26 July – 01 August 2021. Key findings There were signs of economic recovery with an increase in employment, but not household incomes: • Consistent with strengthening economic recovery in 2022, employment increased from December 2021 to June 2022, driven by growth in agriculture. The growth in jobs was restricted to rural areas and the informal sector. • Household incomes did not see any significant recovery. Most households had steady incomes over the six months to June 2022, but some rural and farming households reported falls in income. • Severe food insecurity fell and access to staple foods improved in the six months to June 2022, with less people having to reduce food or non-food consumption. COVID-19 vaccine hesitancy remained high: • COVID-19 vaccine hesitancy increased over the six months to June 2022. • While programs to reduce vaccine hesitancy remain warranted, incentives for vaccination may have limited potential to increase the vaccination rate. 4 Employment, incomes and food access Agricultural employment increased, but this did not result in increased household incomes. Food access improved. Work in rural areas increased between December 2021 and June 2022 Proportion of people that are working for Proportion of people that are working for income, by location income, by wealth status 90% 90% 80% 80% 74% 73% Percentage of population Percentage of pouplation 70% 68% 66% 70% 66% 69% 59% 65% 64% 65% 58% 60% 60% 59% 58% 51% 54% 53% 49% 50% 48% 50% 52% 45% 50% 40% 40% 45% 44% 37% 30% 30% 20% 20% Dec 2020 June 2021 Dec 2021 June 2022 Dec 2020 June 2021 Dec 2021 June 2022 Urb an Rural National Bottom 40% Mid dle 20% Top 40% Note: Vertical lines represent 95 percent confidence intervals. Note: The proportion of people in PNG who live in urban areas is relatively low, at around 13 percent of the total population. Note: “”work" is defined as any work for pay, any kind of business, farming or other activity to generate income in the past week. Source: Rounds two, three, four, and five of the World Bank high frequency mobile phone surveys. § Employment growth included the bottom 40 percent of the wealth distribution. 6 § Men and women reported similar increases in employment between December 2021 and June 2022 (not reported in charts) This increase was driven by agriculture… Proportion of people that are working for Proportion of people that are working for income, by sector income, by formality 50% 70% 45% 60% 54% 40% 39% Percentage of population Percentage of population 35% 50% 44% 30% 30% 26% 38% 37% 25% 40% 25% 23% 24% 30% 20% 22% 15% 20% 14% 17% 11% 10% 10% 9% 3% 10% 5% 3% 2% 1% 0% 0% Dec 2020 June 2021 Dec 2021 June 2022 Dec 2020 June 2021 Dec 2021 June 2022 Agriculture Industry Services Formal Informal Note: Vertical lines represent 95 percent confidence intervals. Note: “”work" is defined as any work for pay, any kind of business, farming or other activity to generate income in the past week. Source: Rounds two, three, four, and five of the World Bank high frequency mobile phone surveys. § Work in both the industry and services sectors have remained steady, while agricultural work increased 7 § Formal work remained steady while informal work has increased in the last year …but household incomes were still not recovering Change in total household income in Proportion of households that is ‘very worried’ the six months to December 2021 and about their finances over the next month in the six months to June 2022 60% 100% 90% 50% 43% 80% Percentage of households Percentage of households 70% 40% 60% 30% 50% 27% 40% 21% 20% 30% 17% 20% 10% 10% 0% 0% June 2021-Dec 2021 Dec 2021-June 2022 Dec 2020 June 2021 Dec 2021 June 2022 Stopped entirely Reduced Stayed the same Increased Source: Round four and five of the World Bank high frequency mobile phone surveys. Source: Rounds two, three, four, and five of the World Bank high frequency mobile phone surveys. § Less than one percent of households reported income had stopped entirely between December 2021 and June 2022. 8 § Rural households and households in the bottom 40 percent were more likely to be very worried about their finances over the next month. For households with falling incomes, the main driver was falling agricultural incomes Of households with lower total income from Of households with stable or increased income from December 2021 to June 2022 - change in common December to June 2022 - change in common income income sources sources Family farming, livestock, fishing Family farming, livestock, fi shing Non-farm family business Non-farm family business Assistance from family within country Assistance from family within country Wa ge employment Wage empl oyment Income from properties, investments Income from properties, i nvestments 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Percentage of households Percentage of households Stopped Reduced Stayed the same Increased Stopped Reduced Stay ed the same Increased Source: Round five of the World Bank high frequency mobile phone surveys. Source: Round five of the World Bank high frequency mobile phone surveys. Income types reported by less than 4 percent of households and are not included in these charts Income types reported by less than 4 percent of households are not included in these charts • Family farming, livestock and fishing is the most common source of livelihoods 9 Falling incomes were also more common in rural areas Change in total household income between Change in individual adults’ labor income December 2021 and June 2022 from December 2021 to June 2022 100% 100% 90% 90% 80% 80% Percentage of households Percentage of population 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% National Urb an Rural Highland Islands Mo mase Southern Bottom Mid dle Top 40% National Urb an Rural Highland Islands Mo mase Southern Bottom Mid dle Top 40% 40% 20% 40% 20% Location Region We alth Location Region We alth Stopped entirely Reduced Stayed the same Increased Stopped entirely Reduced Stay ed the same Increased Source: Round five of the World Bank high frequency mobile phone surveys. Source: Round five of the World Bank high frequency mobile phone surveys. Note: “”labor" is defined as any work for pay, any kind of business, farming or other activity to generate income in the past week. . § Incomes of both rural households and rural labor were more like to be falling than household and labor incomes in urban areas 10 § Individual labor incomes for men and women were similarly likely to have fallen (not reported in chart) Access to basic foods increased… Households attempting to purchase Of households attempting to buy staple food staple food items in June 2022 items, share that was able 100% 100% 100% 98% 100% Share of households able to buy corresponding 90% 80% 97% Share of households (%) 95% 93% 70% 94% 60% essential food items (%) 50% 90% 91% 40% 30% 86% 20% 85% 86% 10% 0% 80% Islands Islands Islands Momase Momase Momase Southern Southern Southern National National National Highlands Highlands Highlands 75% Staple starches Staple protein Fruits & vegetables June 2021 December 2021 June 2022 Staple starches Staple protein Fru its & vegetables Yes, able to purchase No, not able to purchase Source: Round five of the World Bank high frequency mobile phone surveys. Note: People who did not attempt to buy staple food items were excluded from all analyses. Note: Dotted vertical lines indicate 95 percent confidence intervals. Source: Round one-five of the World Bank high frequency mobile phone surveys. § Access to staple starches, fruits and vegetables significantly increased from December 2021 to June 2022 § Shares of households that were attempting and able to access staple foods were all very high in June 2022 across 11 provinces …and severe food insecurity decreased Households that experienced food insecurity over the 12 months to December 2021, 35% and over the 12 months to June 2022 30% Share of households (%) 25% 15% 20% 14% 25% 14% 12% 16% 23% 23% 24% 15% 21% 10% 13% 14% 13% 14% 12% 5% 7% 5% 5% 5% 5% 0% December 2021 June 2022 December 2021 June 2022 December 2021 June 2022 December 2021 June 2022 December 2021 June 2022 Urban Rural No children 0-5 Children 0-5 National Location Family structure Severe food insecurity Moderate food insecurity Note: “Hungry but didn’t eat” was not collected, so FIES was measured using seven indicators. According to the Food Insecurity Experience Scale (FIES), moderate food insecurity is indicated by there being “a time when they ate less than they thought they should because of a lack of money or resources”, while severe food insecurity is indicated by going “without eating for a whole day because of a lack of money or resources”. Source: Round five of the World Bank high frequency mobile phone surveys. § While severe food insecurity decreased, moderate food insecurity has increased over this period 12 § Food insecurity is a widespread problem affecting households in rural and urban areas, and with and without children Fewer households were eating less or taking children out of school, while more were drawing down on savings… Consumption based coping strategies that Financial coping strategies that changed, changed, December 2021 - June 2022 December 2021 and June 2022 Reduced the number of children attending school Spent from savings Reduced food consumption Received cash or borrowed from friends or family December 2021 Reduced non-food consumption Received government assistance December 2021 June 2022 June 2022 0% 10% 20% 30% 40% 50% 0% 10% 20% 30% 40% 50% Share of households (%) Share of households (%) Note: Coping strategies that remained stable between December 2021 and June 2022 are excluded from the chart, but are listed at the bottom of Note: Coping strategies that remained stable between December 2021 and June 2022 are excluded from the chart, but are this slide. listed at the bottom of this slide. Note: Horizontal dotted lines at end of bars are 95 percent confidence intervals. Note: Horizontal dotted lines at end of bars are 95 percent confidence intervals. Source: Rounds four and round five of the World Bank high frequency mobile phone surveys. Source: Rounds four and round five of the World Bank high frequency mobile phone surveys. § Consumption reducing strategies were being used less, while strategies to increase finances available for consumption, were being used more. Spending and consuming more, could be a sign of future optimism. 13 § Other strategies continued to be used, such as “ “found ways to earn more money” and “delayed making re-payments”. …but looking ahead, feelings about the economy were mixed Proportion of households reporting much better or much Anticipated state of the economy in June 2022, for worse economic outlook over time one year ahead 60% 100% 90% 50% 80% Share of households 40% 70% Share of households 60% Mu ch better 30% 50% Somewhat better About the same 20% 40% Somewhat worse 30% Mu ch worse 10% 20% 0% 10% December 2020 June 2021 December 2021 June 2022 0% Survey Date National Ma le Female Urb an Rural Bottom 40% Much/somewhat better Much/somewhat worse HH Head Location We ll-b eing Source: Round five of the World Bank high frequency mobile phone surveys. Source: Rounds two, three, four, and five of the World Bank high frequency mobile phone surveys. § Nearly 30% of female-headed households reported that the economy would be somewhat better or much better 14 § Urban areas are slightly less optimistic than rural areas, though economic outlooks were similar for all wealth quintiles Health care access, COVID-19 & vaccination Most people could access healthcare when they needed it. But COVID-19 vaccine hesitancy increased. Most people could access healthcare when needed Share of households that needed and accessed Share of households that needed and accessed 25% urgent care in the past month routine care in the past month 25% 20% 0.9% 20% 4.5% 1.1% Share of households Share of households 15% 15% 10% 18.6% 10% 17.1% 16.0% 5% 5% 0.3% 0.1% 1.2% 5.4% 3.5% 2.2% 0% 0% June 2021 Dec 2021 June 2022 June 2021 Dec 2021 June 2022 Urg ent care needed, accessed Urg ent care needed, not accessed Routine care needed, accessed Routine care needed, not accessed Note: The figures above represent cross-sectional data from round four and round five. Note: The figures above represent cross-sectional data from round four and round five, Routine care includes Note: Vertical lines represent 95 percent confidence intervals preventative care Source: Round four and round five of the World Bank high frequency phone surveys Note: Vertical lines represent 95 percent confidence intervals Source: Round four and round five of the World Bank high frequency phone surveys § Only one-fifth and six percent of households had sought urgent and routine healthcare in the past month, respectively, with very few households reporting access issues. 16 COVID-19 was recognized as an infectious disease, though some thought of COVID-19 as a hoax What is COVID-19? What does the COVID-19 vaccine do? 70% 70% 60% 60% Percentage of population Percentage of population 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% Infectious disease Other health problem Don't know Hoax/conspiracy Reduces severity Don't know Stops you from getting Does nothing COVID-19 Note: Vertical lines represent 95% confidence intervals. More than one option was able to be selected. Note: Vertical lines represent 95% confidence intervals. More than one option was able to be selected. Source: Round five of the World Bank high frequency mobile phone surveys. Source: Round five of the World Bank high frequency mobile phone surveys. § Despite extensive public health campaigns, 30 percent of people still don’t know what the COVID-19 vaccine does. 17 Most people did not want a COVID-19 vaccine COVID-19 vaccination intentions For those who did get vaccinated - reason for vaccination 100% 60% 8% 17% 50% 80% 36% Percentage of population Percentage of population 40% 60% 60% 51% 30% 32% 40% 20% 18% 19% 20% 23% 10% 12% 7% 4% 2% 5% 6% 0% 0% June 2021 December 2021 June 2022 Reduce symptoms of Reduce chance of Reduce chance of Needed for work COVID-19 should I get getting COVID-19 passing it to others Vaccinated Planning to get vaccinated it Not sure Not planning to get vaccinated Unaware of vaccine availability in PNG Note: Vertical lines represent 95% confidence intervals. More than one option was able to be selected. Note: The vaccination rate is relative to the adult population (18+). Source: Round five of the World Bank high frequency mobile phone surveys. Source: Rounds three, four, and five of the World Bank high frequency mobile phone surveys. § While awareness of COVID-19 vaccines has increased, so has vaccine hesitancy. Most people who got vaccinated did so to reduce COVID-19’s risk to themselves and to others. Only 17 percent of vaccinated people cited 18 recommendations from family or friends as a reason for getting vaccinated. The main reasons for vaccine hesitancy were worries about side effects and distrust of vaccines Reasons for vaccine hesitancy Reasons for not trusting vaccines 100% 90% Percentage of population not sure about / not Percentage of population not sure about / not planning to get vaccinated, who don’t trust 80% 80% 70% planning to get vaccinated 60% 60% vaccines 50% 40% 40% 30% 20% 20% 10% 0% December 2021 June 2022 0% Family and friends don't trust Don't trust pharmaceutical/drug Don't trust government Wo rried about side effects Don't trust vaccines Don't think vaccines will work vaccines companies Note: Vertical lines represent 95% confidence intervals. More than one option was able to be selected. Note: Vertical lines represent 95% confidence intervals. More than one option was able to be selected. Source: Round five of the World Bank high frequency mobile phone surveys. Source: Rounds four and five of the World Bank high frequency mobile phone surveys. § Many people distrusted vaccines because their friends and family distrust vaccines. Distrust of pharmaceutical 19 companies is also widespread. Health clinics remained a trusted source of COVID-19 vaccine information Most trusted source of COVID-19 vaccine Groups that could change people's minds information about the COVID-19 vaccine 80% 40% Percentage of population not sure about / not 70% 35% planning to get vaccinated (%) Percentage of population 60% 30% 50% 25% 40% 20% 30% 15% 20% 10% 10% 5% 0% Dec-21 Jun-22 0% Health clinic Newspaper Family and friends Family and friends Health workers Religious leaders Note: Vertical lines represent 95 percent confidence intervals. Note: Health workers includes, doctors, nurses, pharmacists and other health workers Note: Vertical lines represent 95 percent confidence intervals. Source: Round five of the World Bank high frequency mobile phone surveys Source: Rounds four and five of the World Bank high frequency mobile phone surveys. § Family and friends can also help to change minds about the COVID-19 vaccine, which suggests that convincing one person to get vaccinated could lead to others getting vaccinated too. § A third of households had visited a healthcare facility in the past 12 months, so health clinics may potentially be a 20 good avenue for promoting COVID-19 vaccination. Few vaccine hesitant people would get a COVID-19 vaccine for a reward Would you be interested in Would you be interested in Would you be interested in participating in a program that participating in a program that participating in a program that gave free tickets to the Digicel cup gave food vouchers worth 100 gave 30kg of rice to vaccinated to vaccinated people? Kina to vaccinated people? people? 9% 7% 11% 91% 93% 89% No Yes No Yes No Yes Source: Round five of the World Bank high frequency mobile phone surveys. Source: Round five of the World Bank high frequency mobile phone surveys. Source: Round five of the World Bank high frequency mobile phone surveys. § This was true irrespective of whether rugby tickets, food vouchers, or bags of rice were used as incentives. 21 § These results were relatively constant across gender, geographic, and wealth breakdowns. Acknowledgements and further information Core Team: Darcey Johnson, Darian Naidoo*, Chris Wokker, Jeffrey Woodham, and Kexin Zhang Extended team: Rochelle Se Yun Eng, Ritika Khandelwal, Lydia Kim, and Elene Metreveli Task Team Leaders: Utz Pape* and David Gould Practice Manager: Rinku Murgai *For inquiries please contact Utz Pape (upape@worldbank.org) and Darian Naidoo (dnaidoo@worldbank.org) The team gratefully acknowledges the Australian Department of Foreign Affairs and Trade, for financing the data collection and analysis. References World Bank. 2020. Papua New Guinea High Frequency Phone Survey on COVID-19 : Results from Round 1. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/34907 License: CC BY 3.0 IGO. World Bank; UNICEF. 2021. Papua New Guinea High Frequency Phone Survey on COVID-19, December 2020 to January 2021. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/35585 License: CC BY 3.0 IGO. World Bank. 2022. COVID-19 in Papua New Guinea: Economic and Social Impacts, Insights from the fourth round of high frequency phone survey, Data Collected in December 2021. World Bank, Washington, DC. © https://documents.worldbank.org/en/publication/documents- reports/documentdetail/099615007192235150/p1772220ce9399095094bc0ed4900ca2f0d 22 Annex: Survey methods • Data was collected using a phone survey in June 2022, with a sample size of 2,630. Implementation was led by Digicel in Port Moresby. Each interview took around 15-25 minutes. • The high attrition was expected because it is common to ‘cycle’ SIM cards in Papua New Guinea. To maintain sample size number, new households were added in each round to replace the dropping households. • Given the difficulty contacting people towards the bottom of the wealth distribution, weights have been applied to increase their representation in the results presented. Attrition (refers Proportion of respondents from each wealth decile, Household Date collected to the last rounds one to five sample size round) HFPS R1 HFPS R2 HFPS R3 HFPS R4 HFPS R5 DHS 30 Round one Jun/Jul 2020 3,115 NA share of observations (unweighted %) 25 Dec 2020/Jan Round two 2,820 67.4% 20 2021 15 Round three Jun/Jul 2021 2,533 86.3% 10 5 Round four Nov/Dec 2021 2,714 67.0% 0 1 2 3 4 5 6 7 8 9 10 Round five Jun 2022 2,630 54.9% decile of wealth index 23 Note: Bolded months are those when most data collection occurred, and are the months used as the shorthand to refer to Note: Yellow bars reflect that, if phone survey respondents perfectly represented the wealth distribution, 10 percent of respondents would each round in this presentation. be from each wealth decile. The proportions in the chart have been weighted. Source: 2016-18 DHS and Rounds one to four of the World Bank high frequency mobile phone survey