Surging Covid-19 cases in Guam are threatening to overwhelm the island’s healthcare system, while rapidly spreading infections across Papua New Guinea and new clusters in French Polynesia following the resumption of tourism have sparked fears of uncontrolled outbreaks in the Pacific. The Pacific region is still the least-infected in the world – several countries remain Covid-19 free – but there are troubling surges across countries with fragile health systems ill-equipped for large numbers of infections. Emerging too, is an early trend of ‘vaccine diplomacy’, with regional powers seeking to exert political influence through promises to help Pacific nations - otherwise likely at the back of the queue - secure access to a vaccine when one becomes available. The US secretary of defense Mark Esper, made a flying visit across the Pacific this week, condemning China’s “malign activities” in the region, and seeking to buttress American influence. But Esper’s rapid Pacific visit has also exposed the serious risk of inbound travel after a member of his advance team to the US unincorporated territory of Guam tested positive for Covid-19. Guam has now recorded 1,287 infections, and 10 deaths, with scores of infections traced back to US military personnel serving on the island, as deployments continued throughout the pandemic. The aircraft carrier USS Theodore Roosevelt docked in Guam in March, unloading sailors in the midst of a mass outbreak of Covid-19 on board. The 1,156 infections from the ship are not counted in Guam’s domestic total, but Guam officials have publicly detailed nearly 200 military cases on the island, including 35 airmen who went to local restaurants, raising concerns about military personnel as vectors for the virus. “We are in very dire straits. We are in very desperate times. Our island right now is sick,” Guam’s governor Lou Leon Guerrero said, extending the public health emergency for Guam until the end of next month. “As we operate on Guam with our fragile healthcare system, this is it being stressed to the limit,” Dr Felix Cabrera, a member of the governor’s physicians advisory group, said. “It’s going to get worse before it gets better.” Esper had earlier told the president of Palau – a country with which the US is re-negotiating its compact of free association – that the US would help secure it Covid-19 vaccines, when one became available. “I am confident we will have a vaccine by the end of year: of course, we will share it with our friends and partners and with you, that will make a difference,” Esper said. Australia and New Zealand have also committed money towards securing vaccines for the Pacific region. China has offered priority access to five south-east Asian countries if and when its vaccine is available, and has reportedly already tested a vaccine on its nationals leaving China to work in the Pacific region. With its tourism industry essentially shuttered, Palau’s economy has been devastated by border closures. Palau’s president, Tommy Remengesau Jr said US troops could fill the tourism void. “We love to have you in Palau…please, tell your friends and tell your families that Palau is the best place for R-and-R and the US military always gets our warmest welcome.” In PNG, the Pacific’s largest country, the number of infections has jumped from single figures two months ago, to 453, with five deaths. Cases have spread from the capital Port Moresby to half of the country’s 22 provinces. But fewer than 16,000 tests have been undertaken across the country since the start of the pandemic - a tiny fraction of the country’s nine million population - and the virus is almost certainly far more widespread and running unidentified through communities. A lockdown of Port Moresby was lifted after a fortnight and domestic travel has been resumed. Papua New Guineans have been urged to adopt the ‘Niupela Pasin’ - the new normal - of living with Covid: practising social distancing, wearing face masks, and washing hands. Prime minister James Marape said PNG would not go back into lockdown, despite the surging number of cases. “Covid-19 not only affects us health-wise but also economically,” he said. “That is why we will not have another lockdown. We must adjust to living with the Covid-19… we will not shut down our country again”. The French territory of French Polynesia re-opened to tourists on 15 July. At that time there had been no new infections since the end of June, and just 62 for the whole pandemic. The territory now has 397 confirmed cases. There have been no deaths, but several Covid-19 patients have been hospitalised and a small number are in intensive care. A cluster of infections has emerged from a dinner party held at a Papeete restaurant at the end of last month. And 51 out of 71 members of a French police mobile squad - some of whom were at the party - tested positive to Covid-19 on their return to France. Some in French Polynesia have called for the reintroduction of mandatory quarantine for international arrivals, but this has been refused by the territory’s government and the French High Commission, which said long-term isolation was not viable for the territory.