“The vaccine is critical to these plans – it reduces the risk of Covid-19, but also restores confidence among planners and politicians that Covid-19 can be controlled,” he added. “It’s the one big thing the islands are hoping for in order to open borders and permit travel.”

The US is leading immunisation efforts in Palau, the Federated States of Micronesia, and the Marshall Islands, sovereign states that rely on Washington for their defence under a Compact of Free Association, with vaccinations expected to begin within weeks.

For other Pacific islands, the timetables for immunisation are less clear.

Last week, New Zealand’s foreign minister Nanaia Mahuta said NZ$75 million (US$53 million) would be allocated for the roll-out of vaccines in Tonga, Samoa, and Tuvalu, as well as the country’s dependent territories of Tokelau, Niue, and the Cook Islands. In October, Australia announced A$500 million (US$377 million) in funding over three years to support immunisation in the Pacific and Southeast Asia.

Support for the region is also expected to come from Covax, a World Health Organization-backed initiative established to ensure access to vaccines for lower-income countries, although it remains unclear how its supplies of vaccines will be allocated or if they will meet demand.

Professor Fiona Russell, a member of the expert advisory group for the immunisation effort at Australia’s Department of Foreign Affairs and Trade (DFAT), said timetables for vaccinations in many island nations had yet to be finalised and would require careful coordination between the WHO and agencies including Unicef, DFAT, New Zealand’s Ministry of Foreign Affairs and Trade (MFAT), the ADB, and the World Bank.

“Countries are still figuring out how to coordinate partners,” she said. “It’s a busy space and essential that it is coordinated.”

Russell said immunisation would face significant challenges, including vaccine storage and distribution, determining priority for vaccinations in populations with high rates of diabetes and obesity, and requirements for legal protection for vaccine manufacturers.

“Covax will cover Covax vaccines, but vaccines from other sources will require the government or partner to indemnify,” she said.

Anti-vaccine sentiment could be another potential hurdle, according to Dr Tess Newton Cain, project lead for the Pacific Hub at the Griffith Asia Institute in Brisbane.

From 2019 to earlier this year, a major measles outbreak in Samoa cost 83 lives, after vaccination rates plunged following the deaths of two infants due to improperly administered vaccines.

“There needs to be a fair amount of education done prior to introducing [vaccines] to the general population in the Pacific,” Newton Cain said. “As we saw in Samoa, it only takes one misstep for the community to lose confidence in this sort of product and process.”

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Henry Ivarature, Pacific Fellow at Australian National University’s Crawford School of Public Policy, said he expected immunisation in many islands not to get under way until well into next year.

“Access and affordability are the two issues Pacific leaders have raised about Covid-19 vaccines,” he said. “For many Pacific states, we could be looking at the second quarter of 2021, rolling out towards the end of the year.”

Despite their isolation and small populations, Pacific Island nations have become a focal point for a growing competition for influence in the region among China, the US, Australia and New Zealand.

The four countries have in recent years each ramped up aid and loans to the region, with Australia and New Zealand announcing a “Pacific Step-up” and “Pacific Reset”, respectively, focused on greater engagement with the region.

Tuvalu, Nauru, Palau and the Marshall Islands are among Taiwan’s 15 remaining diplomatic allies. Solomon Islands and Kiribati made high-profile switches of diplomatic recognition to Beijing last year.

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China has not announced any specific commitments to provide vaccines to the Pacific Islands, although vice foreign minister Zheng Zeguang last month told a virtual summit that Beijing was committed to developing and distributing a vaccine as “a global public good, as part of its contribution to vaccine accessibility and affordability in developing countries, including Pacific Island countries”.

“Part of the New Zealand and Australia generosity is not wholly altruistic; they are aware that Covid-19 in the Pacific is a risk to New Zealand and Australia,” said Tukuitonga, who is also Associate Pacific Dean at the University of Auckland.

“In any case, it’s a good foreign policy position consistent with New Zealand’s reset agenda.”