In this blog, guest contributor and medical doctor, David Walcott explores issues surrounding Covid-19 vaccination in the Caribbean.
Vaccination is one of humanity’s most powerful tools in the fight against disease and disability, and has been around since the 1800s when the first vaccine was developed, contributing to global eradication of smallpox. Since then, these preventative tools have been instrumental in reducing the global burden of polio, measles, tetanus and many other diseases – yielding inestimable economic savings from disruptions in health, education and socioeconomic systems.
Immunization has been particularly important for economically constrained regions like the Caribbean, which do not have the financial reserve to withstand substantial disease burden and whose economic output is highly dependent on the health of its citizens. In decades past, many immunological scourges such as polio and tuberculosis have been controlled in the Caribbean and other developing regions by the invisible hand of immunization. In the greatest infectious threat in modern Caribbean history, vaccines represent not only a useful – but a vital – tool for regional self-preservation.
The Caribbean currently does not have sufficient levels of Covid-19 vaccination
Many regions in the world have responded aggressively to the need for citizens to become vaccinated, with a few countries having up 60 percent of their population fully vaccinated. However, in Latin America and Caribbean – the most rapidly ageing region in the world – the percentage of individuals fully vaccinated is relatively small, with estimates by PAHO of 1 in 4. Central American nations like Guatemala, Honduras, Nicaragua, and various Caribbean and South American countries still have persistently low rates of vaccination, which can be attributed to a combination of delayed decision-making, low levels of economic reserve and bargaining power, and suboptimal access to global supply chains.
Though all human beings should arguably have the right to benefit from scientific progress, our ability to do so is limited by economic and pragmatic constraints. Individuals in low and middle-income countries have always had lower access to medical breakthroughs, with profits on pharmaceutical product sales in such countries being significantly lower than within their more affluent counterparts. Access to these resources in such countries often depend on donor funding, which usually falls short of targets, particularly for small island-states like those within the Caribbean. These challenges with procuring adequate supply emphasize the importance of ensuring that, when available, vaccine uptake is optimized.
If we are unable to harness sufficient supply, we should surely drive sufficient demand
In addition to the palpable challenges with supply of vaccines, many countries unfortunately now face challenges with driving demand for Covid-19 vaccination – with high levels of vaccine hesitancy. In some countries, despite the inequitably high availability of vaccines, members of the general populus – and even healthcare workers – approach the vaccine with high levels of skepticism, fueled by conspiracy theories and disinformation. The health and economic challenges driven by the pandemic have now been superimposed by a pandemic of misinformation – often termed an ‘infodemic’ – that has stymied our ability to navigate towards a safe and effective exit.
Unfortunately, vaccine hesitancy rates in the Caribbean remain unacceptably high in response to the Covid-19 vaccine with surveys conducted over the last year between Trinidad, Cayman and Jamaica by the Johns Hopkins Centre for Communication Programs showing between 48-72% of individuals demonstrating an unwillingness to take the vaccine.
Thorough evaluation has been conducted through study of vaccines through clinical trials; e.g. the Pfizer-BioNTech, Moderna and Johnson vaccines have consistently shown over 85% effectiveness against severe illness. Not only are these vaccines effective against the original strain, but many have also been shown to be effective against new variants – such as the delta variant – a luxury which may not necessarily persist in the future as the virus continues to mutate. We must not miss the opportunity to let the vaccines of today prevent the unseen scourges of tomorrow.
The importance of this to our long-term socioeconomic viability is significant
Covid-19 posts a significant burden on our healthcare systems – with high levels of healthcare resources consumed by treatment and diagnosis of Covid-19. In addition to the human and physical resources that must be deployed towards managing this disease, the mental health burden and erosion in morale driven by managing Covid-19 poses grave threat to the long-term sustainability of our healthcare system. The limited bed and ICU capacity in small islands compromises the ability of the Caribbean to manage severe cases of Covid-19, and our region does not have the economic capacity to be able to withstand large burdens of severe disease.
In addition, the resource consumption tied to management of the pandemic generates collateral damage to other areas of our healthcare system that are naturally unable to access scarce resources that are shunted towards Covid-19. Given our high levels of noncommunicable diseases, already accounting for over 75% of regional mortalities, we do not have the luxury of making anything else a priority.
As small economies, sub-regions within the Caribbean are particularly sensitive to the interdependences of the healthcare system and the economy. In addition to healthy populations being able to generate greater economic output, restrictive health measures that are intended to stymie the persistent spread of Covid-19 have stifling effects on the economy. Lockdowns and curfews have been shown to significantly reduce economic output and small islands developing states and low-income economies have been shown to suffer the largest relative trade losses. Furthermore, our small-island economies are greatly dependent on tourism, and safe economies enjoy greater interest, patronage and earning from the tourist trade. Our fragile and emerging economies require as much economic engagement as we can muster.
We all have a responsibility in the path to an exit form this pandemic
As stakeholders of a regional community, we all – the public sector, the private sector, civil society, academia – have a responsibility to act in the regions’ long-term interest. The Caribbean must find a way to bring all local stakeholders influencing vaccine uptake together and convene their influence towards a common purpose. As much as our leaders must find ways to procure the resources we need, the pandemic will only be overcome if all parties, including civil society, work together to ensure the greatest levels of vaccine uptake. We each have a responsibility to ourselves, to our fellow man and woman, and to our nation. No one is safe until everyone is safe and it is time the Caribbean makes vaccines an unquestionable priority. Only in so doing can we return to the visions of optimism, economic growth and regional pride that we enjoy as a people “out of many one people”.