As the Pacific grapples with a deadly measles outbreak originating in New Zealand, some of the region's smallest states are seeing their health systems put under increasing strain before the disease even reaches their shores.
Already, measles has spread to Fiji, Tonga and Samoa.
Health authorities in Samoa say they have registered seven deaths suspected to have been caused by the measles virus.
Now, there are fears its spread to other countries in the region could be only a matter of time.
"There's no reason why measles can't come here. We have 20 flights a week from Auckland," said Josephine Aumea Herman, the Cook Islands Health Secretary.
In the Cook Islands, there are too many visitors to screen for the disease and officials are reliant on advice from New Zealand, she added.
A family of three, who recently arrived from Auckland, had been quarantined after they were flagged by New Zealand officials, but the group were resisting instructions, Dr Herman said.
"They are not fully understanding the importance of quarantine."
There were strong rates of immunisation in the Cook Islands and preparations were underway to deal with a potential outbreak, she said.
"We're hoping we can hold."
In Niue, health authorities are even more stretched.
The only hospital is out of measles' vaccines and waiting on a delivery from UNICEF, according to the Acting Health Secretary, Edgar Akau'ola.
"It's the people who come from overseas we are worried about. Everyone here on the island is vaccinated at an early age," he said.
In Tokelau, only reachable by boat from Samoa's capital Apia, health authorities are so worried they have been screening every passenger disembarking in the atolls, according to the territory's top public servant.
"There is also a check on everybody to make sure that the vaccination is up to date," said Tino Vitale, the General Manager of Tokelau's government.
"This is scary and I think that's why they are taking a cautious approach," he said, adding that all people living in Tokelau have been immunised.