COVID-19 Crisis and Vaccine Inequity: Caribbean Perspectives 

By Angelique V. Nixon and Alissa Trotz

May 24, 2021 (https://www.stabroeknews.com/2021/05/24/features/in-the-diaspora/covid-19-crisis-and-vaccine-inequity-caribbean-perspectives/print/)

It has been over a year (14 months) since the World Health Organisation declared a Global Pandemic due to COVID-19. Since then, we have witnessed alarming ways that existing global inequalities have increased – from rising unemployment and food shortages to disruption in supply chains to the economic fallout of lockdowns and halt in the tourism sector. For the Caribbean region as elsewhere, this has been a devastating time. But we got through 2020 (somehow), managing fragile economies and public systems (alongside climate crisis and rising gender based violence) containing COVID-19 spread through a variety of public regulations and lockdowns, as well as border restrictions and closures.

The most tourism dependent island nations grappled with impossible choices between public health and economic survival. Some countries opened borders as soon as they could – like the Bahamas (since July 2020 with a negative COVID-19 test and since 1st May 2021 all must be fully vaccinated) and the Dominican Republic (since April 2021 with a negative test). While Barbados never really closed borders (entry was possible with a negative test and quarantine), Trinidad and Tobago’s borders remained closed except for repatriated flights. Even with different approaches to borders, several countries were able to curb the spread of COVID-19 until recently. Now, with more contagious variants and lack of access to vaccines, many islands are in deep trouble. But how do we make sense of this continued crisis?

Infection numbers across the region have now peaked and doubled in the past few days/weeks with highest rates since the pandemic started being registered for Cuba, Guyana, Suriname, and Trinidad and Tobago. This past month, rising cases and deaths have been reported in these countries with highest peak rates, but also in the Bahamas, Barbados, Dominican Republic, Haiti, and Jamaica (Reuters COVID-19 Tracker / PAHO). While island nations and countries with smaller populations were managing the pandemic last year, we also know that countries across Latin America have not been able to contain the spread of COVID-19, with Brazil, Argentina, Chile, Colombia, Peru, and Mexico facing the highest rates of infections and deaths in the region. According to the Reuters COVID-19 tracker, “of every 100 infections last reported around the world, about 25 were reported from countries in Latin America and the Caribbean. The region is currently reporting a million new infections about every 7 days and has reported more than 31,621,000 since the pandemic began.” It should not be surprising then that Caribbean countries in South America like Guyana and Suriname would be impacted by more contagious variants given their proximity, fluid borders and the steady flow of migrants. The entire region has been in a deepening crisis since the start of the pandemic, but countries with larger populations have had a harder time (understandably) controlling the spread especially given the lack of access to vaccines. According to Pan American Health Organisation (PAHO) on 20thMay 2021, only 3% of people in Latin America and the Caribbean have been vaccinated.

Trinidad and Tobago was praised in May 2020 for managing the early months of the pandemic in a report by Oxford University evaluating country responses. The country was able to do this through strict and extensive lockdown measures and by keeping the borders closed with quarantine measures for repatriated nationals. The government invested in mitigation efforts with COVID-19 facilities, by keeping public sector workers paid and at home during lockdowns, and also providing relief and salary grants to those who lost employment during this time. At the time, some raised concerns about lack of testing and no serious attention to community spread. Nonetheless, the government maintained protective measures with slow openings, but received criticism for closed borders and leaving nationals abroad (even with approved exemptions for returning nationals and repatriation flights). But with proximity to South America, a population of nearly 1.5 million people and concerns about public health capacity to manage COVID-19, the government remained cautious and lifted internal restrictions gradually in late 2020. 

However, by early April, cases in Trinidad and Tobago started rising with clusters and the Brazilian variant and then exponentially by May – this in the context of vaccine distribution delays through COVAX. The first vaccines arrived in early April (33,600 through COVAX and donations from Barbados of 14,000 for frontline workers from their COVAX shipment). Vaccine rollout focused on frontline and healthcare workers, those over 60, and people with non-communicable diseases, and by late April, vaccines had run out and cases were rising. The government responded with a strict return to lockdown measures and eventually closed all but non-essential businesses, declaring a state of emergency and curfew which has just been extended to July 1.  Even with more vaccines arriving in small batches, to date, only 65,818 vaccines have been administered (first dose) with a small percentage having two doses – this means roughly only 2% of the population has been vaccinated. A recent donation of 100,000 doses from China arrived on May 19. Still with the healthcare system almost at capacity, the ICU full, and hospitals running out of beds, the crisis grows. In less than a month, Trinidad and Tobago went from single digit daily infections to an average of 508 per day and more deaths in the past month from COVID than for the entire previous year (including growing concerns about people dying without existing conditions).

The Trinidad and Tobago government and public officials have focused on the public with calls for people to be responsible and stay home (as Prime Minister Rowley infamously said “don’t jackass de scene”). This has justified the state of emergency powers, the curfew, and disciplinary actions through increased policing and fines (which disproportionately impacts poor and working class people especially those doing informal work). But what we have talked less about is the larger context of vaccine shortages and explaining clearly to the public why we are in this mess of global vaccine inequality. The Prime Minister finally addressed this in the state of emergency press conference, but still with a main focus on personal responsibility. The media has inflamed existing vaccine skepticism, which has likely increased fears about whether or not to get the jab. This is a problem globally but has even greater ramifications in small populations and where there are vaccine shortages.

While Trinidad and Tobago was running out of vaccines, Guyana has access to far more vaccines and has admirably embarked on a national vaccination drive, with the Minister of Health Dr. Frank Anthony announcing that some 180,000 people had received their first dose of a vaccine, and over 45,000 the second dose (because of deals outside of COVAX secured through China and Russia). There is no lockdown, with officials pointing to the dire situation in Trinidad to make the case that there is no clear evidence that it works. But even here in Guyana, where the curfew (10:30 pm to 4 am) is not properly or evenly enforced, where cases and fatalities are rising (according to yesterday’s Stabroek News, the country “recorded over 2,500 new COVID-19 cases for the month and over 50 more deaths”), and where there is no official confirmation that variants of concern are driving these numbers (it remains unclear what the problem is with getting samples on a plane to the Caribbean Public Health Agency testing facilities in Trinidad and Tobago, which as far as we understand has never stopped testing for variants), officials are also still having trouble getting people vaccinated, and face deep-seated skepticism. Given colonial legacies of medical testing that leak into contemporary patterns of distrust, Caribbean countries could have invested more time in meaningful public education campaigns that are seen as non-partisan and that are led by and centred on communities, instead of top down roll out plans, or the discipline and punishment approaches to regulation and public health that have manifested in some countries in the region.

While vaccine development and clinical trials completed in late 2020 brought hope for the new year, concerns about vaccine distribution and access were immediate – from the World Health Organisation to public health researchers expressing similar warnings against vaccine nationalism. Wealthy countries (namely the United States, Canada, the UK and European Union member states) began securing vaccines for their populations (through direct deals with vaccine companies) while poor and middle-income countries signed onto COVAX (the global vaccine sharing plan run by the WHO) – which placed countries on a list determined by infection rates and availability. What experts feared would happen did happen – as wealthy nations secured way more than their share of vaccines and undermined the COVAX mechanism’s plan for more equitable distribution. Moreover, COVAX was dependent upon vaccine manufacturers in India, and when that country became overwhelmed by a deadly second wave with record COVID-19 infections and deaths in March, they had to prioritise their own vaccine distribution.

By March, vaccine rollout across Europe and North America (even with challenges) reduced the rates of infections, while much of the world – i.e. the Global South – saw infections rise, more contagious variants, and lack of vaccine access in the context of economic hardships and delicate public healthcare systems. This has been a devastating combination with cases and deaths increasing in 2021 in our region’s second and deadlier wave. Public health experts have been calling for vaccine justice (which includes sharing of technology and materials for production) and more equitable distribution of vaccines globally (for the greater good). And they have applied pressure to wealthy nations to donate vaccines to countries in the Global South, with the United States and European Union recently promising donations of their surplus vaccines. And Pfizer and BioNTech just announced that they will provide 2 billion doses of COVID-19 vaccines to middle- and low-income countries (at cost) over the next two years.

Now we wait on more donations and future COVAX shipments and remain in various degrees of lockdown and/or curfews to manage this ongoing crisis. Thus far, aside from the COVAX shipments, vaccine donations have come from India and China and from fellow Caribbean nations (even with limited supplies, Barbados and St Vincent and the Grenadines donated to Trinidad and Tobago). But what we should also be doing is working to develop regional solutions — to secure vaccines as a CARICOM bloc for example, and to work closely with Cuba which is developing its own vaccines — a few of which are in final trials. A recent article published in the online newsletter CARICOM Today: The Latest from the Caribbean Community, notes that “[t]he Pan-American Health Organization (PAHO), the hemispheric arm of WHO, has been monitoring this process and seems to be optimistic that Cuba will be the first country in Latin America and the Caribbean to produce a national vaccine.”. Why not place explicit emphasis on our regional support for and solidarity with Cuba through a unified voice (supported by calls from PAHO for greater regional vaccine production)? This is one of our own Caribbean countries that is possibly on the cusp of developing an effective vaccine, a country for whom universal access to health care is understood to be a question of justice, driven by people and not profits. When will we turn to greater South-South collaborations/partnerships and reliance upon each other, starting with our own region? What can we do to foster our South-South relations and trust to build solidarity and resilience in ourselves? We continue to hope and call for our Caribbean survival to be rooted in regional investment and solidarity.

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