Health, crime and crisis: the Pacific’s methamphetamine challenge

Podcast season one 2026

Akka Rimon 00:04
Welcome to the Pacific Wayfinder podcast, your guide to navigating the cross currents of security in the Blue Pacific continent.

Dr Nicholas Thomson  00:05

Bula, Bula vinaka, ni sa bula. Kia ora, and I hope you are all well. To all our listeners across the Pacific, and wherever you may be, you have joined the Pacific Security Colleges Pacific Wayfinder podcast series, and we are very, very fortunate today to be here with a couple of very special guests to kind of to discuss an issue, which is clearly gaining an enormous amount of attention, rightfully so, in the context of the Pacific, and that is the Pacific methamphetamine crisis. This is particularly a critical issue because it affects every part of society, and really speaks to those broader definitions of health and human security, and of course, subnational, national, and regional security architecture as well. So, before we go too far here, I’d just like to introduce my co-podcast guest today, and I’m joined by terrific colleague and friend over many years, Virginia Kamali, who is a the Pacific Island director, Pacific Program Director for the Global Initiative on Transnational Organized Crime, and we’re also joined by Jason, Dr. Jason Mitchell, who is the chair of the National HIV Task force in Fiji, in the Ministry of of Health and Medical Medical Services, and just on the back of this, you know, the reason we’re kind of, this is pertinent for the podcast today is that the Pacific Security College, and indeed myself, Dr. Nicholas Thompson, the health advisor at the Pacific Security College, in collaboration with with Virginia, have released a policy paper, part of our policy paper series, titled Turning the Tide, you know, working on Pacific’s methamphetamine crisis together. So, this is that provides the backdrop to where we are at. And before we go too far along, I’d like our two guests to introduce themselves and to kind of just give us a little bit of their own context in regards to methamphetamine in the Pacific, and why we would be sitting here talking about it, and kind of proposing some big structural ideas. So, first of all, to the you, Virginia, and an opening survey from you.

Virginia Comolli  02:18

Well, thank you very much, Nick. It is a pleasure to be joining you and Dr. Jason Mitchell on this podcast, and have been the opportunity to discuss such a topical and critical issue. I look at this from the perspective of transnational crime, and over the past few years, we’ve seen a transformation across the Pacific Islands regions in terms of the intensification and sophistication of transnational organized crime activities, and I would argue that the most transformative impacts of all has been the one of methamphetamine trafficking, which has multiple repercussions on all aspects of public and private lives for Pacific Islands, so I’m really, really glad we had the opportunity to put our heads together and come up with a roadmap, which will no doubt discuss in a minute on how to tackle this crisis going forward.

Dr Nicholas Thomson  03:16

Thank you very much. And Dr. Jason Mitchell, it’s a real pleasure to have you here. We understand just how busy you are, particularly now, but in general, and if you may give us some of your opening perspectives on methamphetamine, not only in Fiji, but what you’re kind of seeing is potentially lying ahead for the region.

Dr Jason Mitchell  03:35

Well, Nicholas, and great to be with you and Virginia on the podcast this afternoon. By way of background, I’m Fijian, currently leading Fiji’s STI, HIV, and Balkan virus response. Fiji has a very rapidly evolving HIV epidemic that is linked to risky behavior that is associated with intravenous drug use and methamphetamines, as Virginia and yourself have mentioned, is one of the most popular drugs that is currently being used in Fiji amongst intravenous drug users, but it’s the risky behavior that they’re involved with that is leading to the rapid rise of HIV infections and hepatitis C in our population. Somebody who’s worked in the Pacific with around HIV and STIs over 30 years. I am well aware of early signs of other countries starting to report increased rates of HIV infection beyond what they would normally see, and of course, some of those countries where CG was a number of years ago, where they were initially transit sites for transnational movement of drugs, and eventually the people in those countries will start using drugs, and that’s where sort of we come in from health, because it leads to a number of health issues that you know it’s important for us to respond with strong public health interventions. So maybe I’ll stop there. And hopefully we can talk a little bit more about some of the issues moving forward.

Dr Nicholas Thomson  05:03

Oh, yes, I think we’re very, very lucky to have you both here. Virginia, you’ve been watching this for a number of years now, and I think a lot of us have kind of seen the emergence of synthetic drugs, and particularly crystal methamphetamine, the diversification of the different transnational organized crime groups, and whether they’re coming together or not. The particular just like you to just to maybe explore a bit more the particular vulnerabilities in the Pacific, and why, why the Pacific seems to be, you know, not only, you know, such a peaceful place, particularly from above, but, but now almost the the epicenter of of movement of narcotics.

Virginia Comolli  05:47

Yeah, thanks, Nick. Yeah, I mean, the changes over the past few years in the criminal landscape have been really incredible and very, very concerning for a very long time, the Pacific Islands have acted as transit points for drugs coming from Asia and Latin America, and that’s in for Australia and New Zealand, which, as we know, are very, very lucrative drug markets. If you want to sell your drugs, you definitely want to get a share of those markets, because these are the places where drugs are the most expensive, and so the Pacific Islands, being in the midpoint along those supply chains, of course, have been long used as transit points. What we have seen, however, more recently is how those countries, countries like Fiji, for instance, have actually started to develop their own domestic market consumptions, and this first started off because traffickers, foreign traffickers collaborating with local facilitators, had begun instead of paying them with cash, they would pay them in produce. So let’s say they were asking local collaborators to ship 20 kilos of methamphetamines, and they would say to them, well, you can keep five for yourselves. And then, of course, there wasn’t much of an understanding what to do with that, those those drugs, but that’s how they started to to enter the domestic markets, and how local people started to to use those those drugs. And for me, one of the transformative elements that really had made such a big difference is the growing influx of foreign criminal criminal groups, criminals from Southeast Asia, from China, and from and from the Americas, and indeed actually now the bulk of the methamphetamines are actually coming from the Americas, and the influx of these highly sophisticated, highly organized criminal actors that are also often involved in polycriminality, meaning that they are involved in different types of criminal activities, are now active in the Pacific, and not only that, they’re also collaborating. Traditionally, some of these groups would be rivals, would be competing over the control for the supply chain or drug markets, and now they’re working together, so this is just a business for them, of course. This is driven by financial profit, so they understand that they all have different strengths to bring to the table. So, you might have one criminal group that’s in charge of one segment of the supply chain for drugs, and and is collaborating with another one, will be responsible for another segment of that supply chain, and this is very problematic, because, of course, it makes it very hard for law enforcement to tackle them, and not to mention that there is also an overlap between the illicit and leases sectors, because it’s a common practice for for criminals to also hide their activities behind the facade of legitimate businesses, which are also handy for money laundering perspective, so really we’ve seen an increased number of criminal actors from from different foreign countries, more sophisticated techniques and methods for for smuggling and the collaboration among these actors, which in many cases have resulted in local law enforcement agencies being overwhelmed by all these criminal challenges.

Dr Nicholas Thomson  09:14

Thank you, Virginia. And I think when you reflect on the Pacific as a geographical region, we know very much, so that that it is an enormous blue ocean, and to try to run surveillance detection enforcement in such space is incredibly difficult. So, with that in mind, and this enormous availability, we, I’ll turn to Jason to kind of speak to maybe say four or five years ago, Jason, and what you were really worried about then versus what you’re clearly really worried about now, because Fiji itself has become the fastest growing epidemic of HIV in the world, and it’s largely driven by injecting. Drug use behavior, which we never thought we would see, to be completely honest, in the age of in the Pacific, having worked on injecting drug epidemics, particularly across Asia, we never particularly worried 20 years ago about the Pacific, and here we are, and I just maybe, if you got some insights into just how this was transitioning, and, and where you see things right now in the context of Fiji.

Dr Jason Mitchell  10:34

there was evidence from the data that we can see the rates of HIV economically from HIV perspective, because you know we have full understanding of the epidemic currently in terms of the numbers, and we could see them from about 2022 that the numbers started to increase faster than what we were used to, but I’m mindful of how unreliable it might be to make it what was happening then, given we were just coming out of Covid, so perhaps you know if things were changing during Covid, maybe pre-covered, like most of the most people were relying on international reports to tell us what was actually going on in Dee Gene a couple of years back, and what we can see is that at some point in time, like the rate started to go up very quickly, so since 2019 up until the end of last year, 2025 increase in HIV infections in TG compared to these years. That’s really rapid, a rapid increase in cases being diagnosed in our country. Now, remember that cases diagnosed is only a fraction of people who you know actually have HIV, which is something we’ve always known since the beginning of the epidemic. People being diagnosed at just a fraction of the larger cohort of people living with HIV. So last year we had 2090 16 people diagnosed with HIV, compared to the previous year, which was 1583 cases, and the year before that was, you know, 416 so you can see how very rapidly, and so I think for us, we know something going on on the ground, and we’re just simply making sense of all of this linked to the transasta communal stuff that the business has talked about, you know, the criminality that currently in the country, the fact that we now have our own domestic markets for drug use, and that is reflected in our rates of food quality. Maybe one of the things that we probably don’t know a lot about is about how it’s affecting us in other areas of health, beyond HIV and hepatitis C, increase in people being admitted to our psychiatric hospital here as a result of drug-induced psychosis, or people with severe mental health crisis, and a lot of that is linked to drug use, much more than they’ve ever seen in the past. We know not, we know from our clinical colleagues that they’re seeing lots of very severe skin sepsis infections, blood-borne viruses, in addition to HIV, such as hepatitis C. We have outbreaks of hepatitis C in this country, but we don’t have a good sense of what, how big that is, and a lot of it is very much linked to the high-risk behavior that is associated with intravenous drug use, and so you know, I think we’re still in the early days of understanding a lot about this, and the numbers behind this, but certainly it is overwhelming our health system, and Fiji is not a poor country, but it’s certainly not a rich country, and we are feeding it in our health services.

Dr Nicholas Thomson  13:36

Yeah, I mean it’s a critical juncture in time, for sure, in terms of the epidemic itself, Jason, and of course the sequelae effects of unsafe injecting the skin lesions you’re talking about, and the comment around because of the epidemic in Fiji, and you’re right in that in the hot seat on this, in so many ways, you’re constantly kind of talking around the HIV epidemic itself, the need to for testing, for treatment, for for prep, for peer, peer intervention, for harm reduction, for this, for that, outside of, of, of the viral, the virus implications, just, you know, can you maybe just kind of reflect at the kind of the village level, the community level. What else are you seeing happening that is challenging your, you know, your local health and community leaders?

Dr Jason Mitchell  14:35

I think it’s the social impacts of people who use drugs and how those have an impact on families. A lot of what we know is really anecdotal. It’s the stuff that gets sensationalized and reported in the media. So, I don’t – I don’t propose to suggest what is actually going on on the ground, because I don’t actually know. I’m just like most people find out secondhand from whatever. The other people are telling us, but it’s, it’s sufficient enough to worry our traditional leaders in this country. The great companies have put it as one of the very important agenda items that they want to address as a group of people. Our leaders, our political leaders, who are elected into their positions, our prime minister and other ministers are concerned about it, because it is reflected in what their constituents are telling them, is a concern for them, you know, it’s I don’t know what came first, associate social issues leading to drug use, or drug use leading to social issues, whatever it is, it is a cycle that is one affecting the other and the other ones affecting the other, it makes people desperate, their use is pretty people desperate, making them, in addition to their high-risk drug use behavior, is making them engage for the need to get more access to drugs in other high-risk selling steps, for example, or using drugs in order to sell sex, and then it becomes a cycle.

Dr Nicholas Thomson  16:03

Yeah, and so just as I asked Jason, there, Virginia, the bigger picture, the broader health surveillance, the need for that, that the fact that this is being talked about at the highest levels of leadership, both in Fiji and beyond, of course, around the region. Can you also maybe reflect from your experiences and conversations around, you know, what local law enforcement are seeing in the local communities, and and what they’re saying, and what they’re saying that they need.

Virginia Comolli  16:30

Yes, as Dr. Jason was mentioning, so the impacts on communities are very, very significant, and from a law enforcement perspective, there is also an increase in all other crime types, and be not organized crime, but assaults and thefts and robbery. You just need to talk to a taxi driver in Fiji, and he will tell you that chances are they’ve been assaulted, they’ve been robbed by someone who was trying to feed their addictions, so this has, of course, repercussions for community, community trust, community, community cohesion, to the point that my understanding is that some communities have introduced some bylaws to try and encounter some of these effects on their communities, whereby if you are known to be a drug user, you’re being kicked out. These, however, one could argue that there can be quite problematic responses, because if someone who is already a vulnerable person, a drug user, all of a sudden is ostracized from their community, they’re on their own. So, what’s going to happen to them? They might become homeless women or girls might turn to sex work to support themselves, so in a way that is displacing the problem really without fixing it, unless those individuals have access to forms of support, but I guess these measures that have been introduced, and we may agree or disagree with their effectiveness are symptomatic of the fact that everyone from police policy circles, health, of course, or civil societies, traditional governance structures, everyone is trying to do something about the drug crisis in Fiji, in particular, because there is a recognition that the problem has escalated to two levels never seen before, with really repercussions rippling across so many aspects of life.

Dr Nicholas Thomson  18:37

Yeah, no, absolutely, and I think in many ways, it’s kind of what you know drove, drove, you know, you and I, and, and our colleagues to kind of put forward this, you know, the paper that was, that was released by the Pacific Security College, of which you’re a co-author, you know, turning that, you know, turning the tide together, and this idea that, that while we have, you know, methamphetamine and drugs more generally recognized in Pacific Island Forum leaders meetings, recognized in heads of health meetings at a regional level, being recognized versus what do we do next is really the step, and I think we’ve proposed some ideas for that, and Virginia, before we kind of trying to go too far, I was wondering if you might kind of reflect and kind of lay out what some of those big ideas are in the policy paper, and then we might ask Jason to, as someone from the outside of the production of the paper, to see what he thinks and how we might go about it, so Virginia, first, maybe just as a co-author, which was a pleasure. If you could, could lay out what we’re, what we’ve been calling for.

Virginia Comolli  19:48

Of course, I think really cognizant of what we said just now, you know, all these wider implications. It’s really, we, our starting point was that we needed to. Bring all these different stakeholders together, if we wanted to really design approaches that are sustainable, are likely to succeed in the fight against this methamphetamine crisis, so relying on existing mechanisms in terms of regional organizations and structures, declarations, and also the regional strategy to counter transnational crime, we put forward the idea for a Pacific Islands Forum led regional summit on health and security implications of methamphetamine use and trafficking, and in our paper we really wanted to lay down the road map on how to get to that summit, and the summit would be a bring together reinforcement policy, health, civil societies, churches, NGOs, traditional traditional leaders, and in laying up a roadmap on how to get there, we really looked at the importance of strengthening the regional evidence base in terms of better understanding patterns of prevalence and use of methamphetamines and other synthetic drugs, the getting a better understanding of trafficking routes, any existing prevention and treatment and harm reduction responses and their effectiveness, but also engaging in dialog with with with multiple sectors of societies, in engaging with civil society actors, youth groups, traditional leaders, churches, and really learning from existing grassroots level approaches that might be there. It might be helpful in responding to two drugs, and really then feeding all this evidence into existing and upcoming regional meetings of heads of health, the Pacific Islands Chiefs of Police, and other, you know, relevant for forum across the region, and then gathering all this information and use it to build the agenda for these regional summit on methamphetamines, and then we don’t want that summit, of course, just to be a talking shop, we actually wanted to use the conclusions coming out of that summit to then lead to the design of a regional strategy against synthetic drugs. Well, against actually, I should say, against methamphetamines, but then we wanted to be flexible enough to be able to be implemented in the case that other synthetic drugs get introduced into the into the region, so really this is a whole of society regional approach and cross sectoral approach, and I guess just the fact that the three of us are on the on this podcast talking about this, and we of course look at this problem from our different professional perspectives really talks to speaks to the fact that this is an issue that really requires the engagement of different sectors and perspectives in order to really develop effective responses.

Dr Nicholas Thomson  23:17

Absolutely, thank you, Virginia and Jason, when you kind of, when you, you’ve kind of worked your way through, through, through the paper, which you know is not, not a, it’s not long, it’s not kind of difficult, we kind of, you know, put forward, you know, this, this idea that you know, if we can kind of bring the two security and health major regional platforms together to kind of oversee, you know, the gathering and the learnings from across national and sub national, across the Pacific, and you sit there in your position, Jason, in the midst of of what’s going on, you yourself, you know, you sit in in cross agency meetings, particularly with law enforcement, not only about drugs policy, but about, you know, harm reduction interventions as well. And I think you’re in a really unique position to see, okay, guys, if you want to, you want to do this. How do you? I’ll give you some perspectives from Fiji about what it’s like to bring health and security and civil society together, and maybe some of the challenges, and then, and then maybe some reflections about what, what we might be able to learn if we are able to, you know, to work with with stakeholders to, you know, bring this together for 2027 regional summit.

Dr Jason Mitchell  24:36

Thank you, Chris. I am, I’m more and more every day, the more work I do around crime and its impacts on health, the importance of both the two different sectors working together, but I can’t imagine, like, just our learnings from Covid, the police work, you know, and other. Law enforcement agencies were very much part of the response, because they all had – we all had a role to play, but with regards to the drug situation and its impact on health, we’re in completely different schools. So, because we’re having conversations about legal protections for us as public health workers to introduce harm reduction, which includes needles and syringes. We’re having to talk to people we would normally not need to talk to about public health interventions, but we are asking for permission to do something which, in their view, is considered aiding and abetting in a crime. And from our perspective, public health people, we see what we’re trying to do as simply a public health intervention to prevent infections from from occurring, and in our view, looking from our pieces of legislation that sit under health, such as the Public Health Act or the HIV Act, there are sufficient provisions in there that allow us to do these things, but it seems to clash with what our law and justice and our law enforcement agents are actually needing to uphold from their perspective, so what we’re having to do is there’s two parallel systems. We’re speaking to the leadership on both sides, so me, as a policy person on behalf of the ministry, are speaking to people on law enforcement, law agencies, and helping them understand the need for these climate action interventions. So suddenly the top people are talking, and they all agree that we should be working together, but the people at the bottom are still not aware that they need to be in line. We need to all be on the same page with regards to the programs we need to introduce, so we are starting to recognize that we all need to be on the same page on the health side, and from more injustice and more enforcement, but throughout from the top of the hierarchy all the way down to those who are in the field, and right now that’s not happening. We are still, we agree in principle that we need to work together. We agree in principle about the need for our public health interventions, and they agree in principle that they need to let go on certain things, so that we can do our public health work, but in reality they just can’t imagine how that will, how that will happen in practice, because they themselves need to uphold certain things, certain pieces of legislation, and provisions of those legislation, and I think we’re going to continue to clash until we’re all on the same page from the very top all the way down to implementation, and I think that’s where

Dr Nicholas Thomson  27:25

we are, Jason. It’s a, it’s a cautionary tale, and I think you know, as a public health person myself, and working on the on the HIV epidemic among stroke users across Asia, you know, between say 2002 1015 and 15, you know, there’s some real parallel lessons in what you’re saying, and I might just kind of lay out very quickly some of those, those things, and the similarities across the Mekong, that you know, Thailand, Lao, and Cambodia, we saw a significant increase in the availability of methamphetamine, in that case, it was tablets. Now it’s, it’s crystal, same thing, you know, confronting society, you know, cohorts of of young drug users, you know, the media, you know, this person’s done this, this person’s done that. The political leadership comes in over the top and says, fine, we need, we need to be tough here, you know, a war on drugs, and, and we see it go really quite the other way, and you know, we’re sitting there trying to find avenues to work with young people, or drug use, to find out, you know, can we do this, what would work for you, at the same time the broader society is clashing over over the fundamental philosophy of drugs and their use, and you know what I, what I, what I learned there was that the overwhelming popularity of a tough on drugs approach from national government, you know, really, really took us down a difficult road, which was okay. Well, let’s let’s arrest, let’s, let’s put people through the justice system and into prisons. Now our prisons are full, so what are we going to do? Well, we’re going to build drug treatment centers, you know. So, so the difference between a prison and a four world drug treatment center back in those days was was not much, you know, young people, particularly who are at high risk of all sorts of of of health behaviors and implications, particularly in a closed setting like a drug detention center, and really at the end of the day, really really getting nowhere, the supply didn’t stop, and I think so. Alongside that, that Jason, we, you know, what do you do, right? And you sit there in academia, or you sit there in the Department of Health, and, like, okay, well, the police have got no interest in this. The guys right up there in the top of health need more evidence. So let’s see how we can build evidence, and so in that case we were able to kind of join forces with the narcotics boards across the different countries and say you guys need evidence, not only about the trafficking, we need evidence to around the health and how you, how people were using, so we could design interventions that were community led and community informed, and it kind of led to a maturing of those, those relationships. It doesn’t make it easier, but I think it led to a maturing, and so you know, one of the things that we call for in the paper, Jason, is this idea that in Fiji we have this, you know, rapidly evolving HIV epidemic. We have needle sharing that is driving it, to the best of our knowledge. We’re not seeing that in some of the other countries, and so, but that doesn’t mean we won’t. But it also means, well, what is happening there? What is distressing them? Are there sexual risks? Are communities breaking down? Are young people being arrested? Are they contemplating compulsory drug detention centers, and so we speak for this need to collate subnational and national kind of evidence, and just wondering from your experience, Jason, how might we, how might we go about that in the Pacific? If you’re speaking at a regional forum on health, how would what would you, what would you be saying right now from your position and your experience?

Dr Jason Mitchell  31:26

Well, as a public health person, like I feel one of the, one of the, one of the weaknesses, particularly in our particular area of health, which is HIV and other blood-borne viruses, is we are not very, we’re not very active, we’re not very good at looking at what is going on with regards to the epidemic. We don’t dig into the numbers sufficiently enough to understand what is what is causing the increase in numbers, and like I’m only purely speaking from a public health perspective, I’m saying this because I think there are signs that some other countries are starting to show increases in HIV that are beyond what they would normally, and this is where Fiji was almost five years ago, and we should have looked into numbers, and we should have immediately responded with good public health programming to address the new risks and vulnerabilities that were our population was being exposed to. Now, the reason why I’m harping on and on about this at the Pacific level is because I work across the region as well, and through some voluntary work that I do, and I can see that some countries, which would have had a low HIV epidemic, is starting to show increases of infections, and the alarm bells that are, of course, going on, going off in my wood, because this is what happened to Fiji a number of years ago. Our countries are developing, certainly a country like Fiji, it’s, it’s, it’s, it’s, it’s developing very quickly, and people are needing to work long hours, you know, like I worked in Southeast Asia as well, and a lot of our drug users were using drugs because of the type of work that they were doing the long hours, the very horrible underground work in really horrible conditions, and drugs was a way to survive that. And for many of our patients who are HIV positive or hepatitis C positive, that are drug users, a lot of them are started off taking drugs just to cope with work, just to cope with the social issues that they were dealing with, and so we have lots of social issues that are driving this epidemic, these epidemics of HIV, and I think they are leading to other social issues and a lot of other health issues, but our systems are just not catching, just catching up fast enough, and so I feel like I think a lot of what you, you’re doing in terms of the criminality side of things, and crime, I think it’s crossing over, and it’s impacting the social, social issues, and leading to health issues as well, but I don’t think there’s sufficient capacity in our countries to address a lot of this,

Dr Nicholas Thomson  33:58

we, we paint a fairly, dare I say, you know, grim is one word, but it feels like we’re right on the point here of, I mean, crisis does not seem, you know, over an over description of what, what we, what we collectively see happening, not only Fiji, but, but in the region, I think what we would, of course, what we would like to see is if there was, you know, no methamphetamine coming through the Pacific, and the Pacific was, was able to be as it has always been, you know, the wonderful cultures and closeness, and you know, and people really, you know, being able to really have senses of community, and I think you know the insidious nature of this particular drug really kind of breaks down a lot of those senses. The, you know, a friend of mine once said that, you know, Nick, drug policy is really, you know, like the hamburger with the lot, you know. You have a public health pragmatic perspective, you have a religious perspective, you have an ethic perspective, you have a kind of a morals perspective, and everyone feels that feels the need to kind of get their bit in there, but at the end of the day we really need to go where the evidence evidence is, and I’m glad you know you mentioned Jason, the COVID, you know, COVID time, the COVID period, because that was a time where you know the Pacific Island, you know, the leadership, you know, invoked a bit of COVID declaration and opened up the, you know, opened up the coordination to the humanitarian pathway, and I remember talking with police, you know, across the region about that time, and they were so enthused about, you know, what they had been able to do, you know, they were playing a role in public health, you know, they were doing social distancing work, they were doing this, they were doing that, and you know, unfortunately, you know, HIV has been a platform for so many issues, access to medicine, human rights, you know, stigma, etc. etc. And again, we’re asking HIV to be the platform to say, “Oh, hang on a second, you guys, if we don’t kind of bring these things together and work together, you know, we will, you know, wind up with an epidemic, but not just an epidemic, we’ll wind up with communities that that are fundamentally challenged. So I think we, you know, we can see these things, and we want to bring this idea of coordinated Pacific leadership across these health and law enforcement and community perspectives, and let us hope we can get there, and we will work as closely as we can with all of you to make that happen. If we, if we were to sum it, and we know how much work you do, Jason, we see you all over in meetings all the time, particularly the one this week, I think, saying that was going to cost $150 million a year just to treat people at this rate in Fiji, if they have HIV, and that is an enormous amount of money to find every year. So, so with those challenges, and, and the, and the politics of responding, you know, what would you like to see, and I’ll ask you both, where do we go from today to avert what could be in the next five years. So, Virginia, first to you.

Virginia Comolli  37:34

Yeah, well, as you said a moment ago, this is a very grim outlook, but also I’d like to look at silver linings here, if it’s at all possible, and see this as a window of opportunity, because the crisis has gotten so serious, and now there is a genuine understanding across sectors, across countries, that something really needs to be done, and so we really need to capitalize on that momentum, so I think it was very positive, just in April, for instance, at the joint heads of Pacific Security, where actually transnational crime and drugs featured very prominently. I was also very pleased to hear that the next Pacific Islands Forum leaders meeting, that is coming up later in the year, transnational crime and drugs will be a key priority for discussion, and you could also argue that the first ever regional transnational crime summit happening in May, actually it was conceived primarily acknowledging that this crisis did what the drugs issue has reached crisis level, so actually, so much is happening across the region, and I think we really need to capitalize on those efforts and put our heads together and move forward, and ensuring that that disconnect that Dr. Jason was mentioning earlier about between leaders understanding what needs to be done and actually on the ground front line are still unsure about approaches that disconnect is no longer there and actually we have some harm reduction oriented approaches that are also in built into law enforcement responses, because we really need both sides of the story, and I know it’s a massive cliche, but I think in this, in this context, this really is applicable, that we cannot arrest our way out of this problem, is not about arrest, it’s not about how many kilos or tons we seize, because we know there will always be more coming through, we need to make our communities in the Pacific and our systems in the Pacific more resilient to withstand the harmful impacts of drug and other forms of criminality and other societal harms.

Dr Nicholas Thomson  39:58

Well said, Jason, Dee. If you had five minutes at that, the leaders’ meeting, what would you be suggesting from your perspective?

Dr Jason Mitchell  40:06

I am one of the biggest challenges I have is to remind people of two things: we’re dealing with human beings here, and we as public health people need to be seeing our patients and our communities as communities of people who have human rights, and that is fundamentally the approach that I take from all the work that I do. I’m saying this because, with the greatest attention being given to the crisis of drugs in this region, it has led to some serious heavy-handedness in terms of the underground work of our law enforcement policy makers in the country that are really putting a lot of pressure on people who are ready, as Virginia already pointed out, already vulnerable and already at risk, and we’re making their lives so much harder, and it’s making us, who are trying to mount an effective public health response, extremely difficult, because we can’t find the people we need to find who are to benefit from this great public health interventions that we are spending the limited resources we have to invest in, they’re not benefiting from it because they are being treated as criminals and they go underground, and we’re seeing that a lot of that here, and I think one of the things that I would like to remind our leaders, of course, if I’m given the opportunity to talk to them, is that at the end of the day it’s about the people that we care for, and we need to have a level-handed, caring approach to addressing this as a community together, and it cannot be just one group of people and all health groups of people doing things. We have to all be on the same page, working together with a common goal of addressing the needs of our community holistically and using human rights best practice. Because at the end of the day, once we lose sight of the humanness in each other, we will not come back from that, and I think we have seen enough examples in this region of what happens when we treat each other as criminals rather than human beings that are deserving of fairness, kindness, and good public health interventions.

Dr Nicholas Thomson  42:17

Incredibly wise words, Jason and Virginia, and I think you both, you know, placing placing human rights at the center of of public health, placing placing human rights at the center of of security, yeah, really is, is, and particularly, and we acknowledge the Pacific is really leading this kind of expanded concept of security, the Boy Declaration lays out that these non-traditional issues – climate, human security, food, water – the basics really are the cornerstone of the society, and therefore the security of the society. So the architecture is there, that the frameworks are there, and the philosophies are there. It’s just, can we turn them on ourselves, and can we be the best versions of ourselves for every person in society. And I would like to thank you both, and and to hope that it’s a kind of call for some of the ideas that we’ve put forward today, and it’s certainly in the paper that if we can form, and you know, Jason’s experience is central to this. If we can form national co-led committees, you know, police, civil society, and health, can we gather evidence? Can we bring that to the table? Does it also help socialize the issues across society. Can we bring media on board, so that it’s not just sensational, but it’s educational and pragmatic. And so let us not forget that all, and you made the very good point, Jason, that you know if we keep talking about crises, we’re not going to work our way out of it, essentially. So, you know, thank you so much for bringing a human perspective, both of you, to today’s podcast, and no doubt that the three of us will continue to work together, and we will continue to do whatever we can to support the work of health and human rights, and indeed security across the Pacific, so vernacular to you both, and I look forward to seeing you all again soon.

Dr Jason Mitchell  44:30

Thank you,

Virginia Comolli  44:31

thank you, thanks,

Dr Nicholas Thomson  44:33

Thank you.