Key Pandemic Lessons For Caribbean Countries

by Terrence W. Farrell

Last July, senior regional public health scientists and officials assembled in Trinidad, under the banner of CARPHA, to discuss regional health security and lessons learnt from the pandemic. Photo courtesy CARPHA.

The COVID-19 pandemic has had severe impacts on every economy and society globally, not least those here in the Caribbean. Economic life was disrupted by lockdowns and restrictions on mobility, and our tourism-dependent economies fared the worst. Health systems and personnel were placed under extreme pressure, and the psychological toll will be felt for years to come, especially on the elderly and those whose families lost loved ones, in an untimely manner, to the disease.

The World Health Organization (WHO) has not yet declared that the pandemic has ended, although it has indicated that the ‘end is in sight’. Around the world with few exceptions, restrictions have been or are being swiftly removed. Even the most highly restrictive countries, Australia and New Zealand, have recently re-opened their borders. 

The pandemic is not over, but the sentiment is that we are in a different place compared to a year ago. Essentially, this is because (1) two out of three persons globally have been fully or partially vaccinated, though in low-income countries, the vaccinated population is only 21%; (2) some proportion of the unvaccinated have had the disease and recovered and have therefore acquired some degree of natural protection; and (3) Omicron BA1-5, the current dominant strains of the SARS-Cov-2 virus, while more contagious, are less likely to cause severe illness requiring hospitalisation, and hence fewer deaths.

Questions surrounding the origins of the SARS-Cov-2 virus have now been settled with zoonotic transmission at the Wuhan market in China as the likely point of initial spread. The next pandemic could happen at any time and arise from anywhere. Governments and organisations are distilling the lessons from the pandemic. 

The Lancet COVID-19 Commission has issued its lessons for the future report. It is therefore vital that our necessarily-open Caribbean countries capture the key lessons for the region from the experience and begin to plan seriously for the next challenge whenever it comes and take concrete actions now in certain areas to be better prepared.

Emanating from the experience of the pandemic, there are five lessons which the region needs to learn and to act on: (1) the high incidence of Non-Communicable Diseases (NCDs); (2) vaccine hesitancy; (3) digitalisation; (4) manufacture of vaccines and novel therapies, and (5) enhanced regional cooperation in all these areas. 

The Region’s High Incidence of NCDs Exposed 

For reasons well-documented in the regional medical research, the Caribbean has long experienced a high incidence of non-communicable diseases (NCDs), including asthma, ischemic heart disease, obesity, diabetes and hypertension. With the onset of the COVID-19 pandemic, it was quickly realised that those more likely to succumb to the virus were the elderly with these co-morbidities especially diabetes and hypertension. 

At the end of August 2022, Trinidad and Tobago’s deaths from COVID-19 reached 4,144 from 178,964 confirmed cases. Only 7% of deaths were persons who had been fully vaccinated. Despite its ‘parallel health care system’ for COVID-19 patients, Trinidad and Tobago’s deaths appear to be higher than those reported by other Caribbean countries. This prompted the formation of a committee into clinical outcomes which reported in February 2022. That report found that 68% of the decedents had one or more co-morbidities.

It may well be that the other Caribbean countries had similar outcomes, but were not captured in the number of deaths reported. There has been recognition globally that both cases and deaths from the virus have been under-reported, especially in low-income countries. 

Attempts have been made to measure ‘excess deaths’ since the onset of the pandemic - that is deaths over and above those projected assuming normal conditions. These estimates are subject to wide margins of error. 

The Economist has used sophisticated statistical techniques to estimate ‘excess deaths’. In the case of Trinidad and Tobago, their ‘central estimate’ is just 7% higher than reported deaths. However, in the case of Jamaica, their central estimate is 122% higher, for Guyana 149% higher, and for Saint Lucia, 58% higher, while the central estimate for Barbados is actually 50% lower than the deaths reported there. 

Even acknowledging the wide margins of error, these estimates, taken together with the data from the Trinidad and Tobago clinical outcomes report, suggest that the high incidence of NCDs in our region’s populations, combined with low vaccination rates, contributed to the number of deaths observed.

In normal times, NCDs have significant negative economic and social impacts. They lower worker productivity, increase the cost of primary and secondary health care, including the cost of medication, and contribute to the high costs of caring for persons with disabilities- amputations, strokes - resulting from these ‘lifestyle’ diseases. 

Regional health ministries are well aware of these impacts and that they need to be addressed by changes in diets and exercise. The COVID-19 pandemic has underscored even more the need to address the problem of NCDs across the region.

Vaccine Hesitancy 

Once vaccines became available from early 2021, Caribbean countries pushed to acquire them as quickly as possible through COVAX and other facilities, with the expectation that acceptance and uptake by the population would be swift. By the third quarter of 2021 most Caribbean countries had been able to source vaccines from the USA, China, Russia, and some small amounts through COVAX. 

However, vaccine hesitancy was stronger than anticipated. Hesitancy had been observed in the United States and even in countries like the United Kingdom and western Europe where vaccine acceptance and uptake were high. However, suspicion and arguments against vaccination were widespread in the Caribbean region.

The data on the current (August 2022) status of vaccination indicate that uptake has plateaued. None of the Caribbean countries has attained even the global average of 68%. While Singapore is at 92% fully or partially vaccinated, and the UK and Norway at around 80%, Guyana is at 60%, Barbados, 58%, Trinidad and Tobago, 49%, St. Lucia, 33% and Jamaica, 29%. 

The large differences in uptake do not reflect vaccine availability since effective vaccines became generally and easily available by early 2022. Caribbean governments have put in a variety of facilities to deliver vaccines and several ways of communicating to citizens and residents how they can get access.

The explanations for the relatively low level of uptake must await the socio-psychological research which ought to be conducted to explore demographic, educational, gender, ethnic, and other factors which may have influenced uptake. 

Observation and anecdotal evidence suggest that vaccine hesitancy is not primarily a matter of levels of education. Well-educated persons count themselves among those unwilling to be vaccinated. Suspicion of the vaccines and their putative side-effects, alleged to be unseen and long-term, seems to have been an important influence, while the power of social media in disseminating misinformation cannot be discounted. 

Public demonstrations and declarations by prime ministers and ministers of health were clearly not sufficiently persuasive, reflecting the fact that Caribbean societies evince low levels of trust in its politicians and public officials. The research and the crafting of strategies to improve uptake are important if we are going to prepare adequately for the next pandemic. In addition, that work may well inform how we can address NCDs as well.

Digitalisation 

The pandemic response required swift policy making and implementation. Governments had to procure personal protective equipment (PPE), vaccines, implement lockdowns using legislation including states of emergency, and institute travel restrictions. Because infected persons could be asymptomatic, testing and contact tracing were given high priority. With remote work mandatory for many sections of the labour force and with remote schooling, connectivity as well as suitable smart devices and applications at homes became critical. It was also useful to know where, when and how people were moving around. 

Countries with well-developed IT infrastructures and already digitalised were able to quickly roll out good applications for test reporting, contact tracing, immigration entry and passenger location, and online schooling. Private sector firms were able to extend online shopping and delivery to restaurants and supermarkets. Google, Apple and other location services permitted estimates of people movements and the identification of ‘hot spots’.

Caribbean societies came to appreciate the width and depth of the digital divide. While broadband connectivity was in place and mobile penetration fairly high, it was soon discovered that many mobile devices were not smartphones, and many school children did not have connectivity at home or did not have appropriate devices for receiving lessons. 

When borders were reopened, the digital forms for entry were in some cases not well designed, requiring the scanning and uploading of documents which challenged some travelers already burdened by testing requirements. 

Moreover, the submission of digital forms did not obviate the need for the physical documents to be presented or manual re-entry of the same data. Caribbean private sector firms were able to respond quickly in respect of remote working and some attempts were made to implement online ordering and ‘curbside pickup’ since the systems for home delivery and mobile payments are not well-developed.

The pandemic has clearly shown the extent of the digital divide, not only in respect of high-speed connectivity, but more importantly, in terms of rapid application development and the people and systems needed to support digital transactions, including logistics and delivery, and payments.

Manufacture of Vaccines and Novel Therapies 

The pandemic also showed up how dependent on the developed world Caribbean countries are in responding to a major health crisis. While our health systems, managerial and clinical, generally responded well, the resolution of the crisis required the availability of PCR and later rapid (lateral flow) testing and access to vaccines. 

The Caribbean Public Health Agency (CARPHA) was able to respond to the initial demands for PCR testing until the equipment and technology became more widely available and deployed within the private sector. The biotechnology firms and universities in the more developed countries, as well as Russia and China, were able to respond remarkably quickly in designing and producing both traditional and MRNA vaccines, and the regulatory agencies to quickly approve their emergency use. Other countries, Singapore for example, were very early on, able to develop rapid tests for the SARS-CoV-2 virus.

The ability to manufacture vaccines and novel therapies is not beyond the capabilities of the region. Given resource constraints, it will require focusing on specific areas for research and development, collaboration with extra-regional laboratories and universities, and appropriate incentives for one or more regional firms to acquire the requisite technologies and manufacturing processes. 

Regional Cooperation

From the onset of the pandemic CARICOM and its various arms engaged in mounting a regional response to the crisis. These related to testing and vaccine distribution through CARPHA, vaccine procurement, food security, digital transformation, and national security. 

The University of the West Indies (UWI) formed a COVID-19 Task Force and several of its academic staff in virology and genetics played important roles in analysing developments with the virus, and communicating with the public. However, vaccine procurement lacked solidarity. Some countries were prepared to use only WHO-approved vaccines while others were not. Chinese-made vaccines were supplied in significant quantities in some countries and hardly at all in others.

The supply chain challenges posed by lockdowns and the threat to regional food security, exacerbated by the ongoing Russia-Ukraine conflict, seem to have galvanised the desire for enhanced cooperation in agriculture which must now be sustained by implementing a supporting policy framework across the region. Guyana’s incipient oil boom has generated opportunities which have attracted the regional private sector in their pursuit, in the process bringing to the fore the issues of local content policies and the free movement of skilled labour.

CARICOM needs to push beyond functional cooperation which has worked reasonably well to enhanced production integration and free movement of capital and labour in the context of a revived CARICOM Single Market and Economy (CSME) process. It also needs to pursue well-defined regional projects such as biotechnology ventures and vaccine manufacturing, increasing access to digital devices and applications and improving application development capabilities in the public sector, as well as focused research on vaccine hesitancy, NCDs and other hidden disabilities.  

The region has much work to do if it is to be prepared for the next health crisis as well as to recover ground lost over the last three years in promoting growth and advancing sustainable development.

ABOUT THE CONTRIBUTOR

Terrence W. Farrell obtained his Ph.D (Economics) in 1979 from the University of Toronto, and also holds an LL.B (London) degree and the LEC from the Hugh Wooding Law School. A former Deputy Governor of the Central Bank of Trinidad and Tobago, he has worked for regional companies in Information Technology, Insurance and Media. He is admitted to practice law in Trinidad and Tobago, and is also a Certified Mediator. He is a Fellow of the Institute of Banking and Finance of Trinidad and Tobago, a Member of the Chartered Institute of Arbitrators and a member of the Caribbean Corporate Governance Institute.  

Over the past 30 years, he has served as a director of various state-owned companies, statutory corporations, public listed companies and private companies in Trinidad and Tobago, Jamaica, St. Lucia, and the United Kingdom.  

He is currently a director of Republic Financial Holdings, TATIL, and TATIL Life as well as several private companies. 

He has served on government-appointed committees addressing various public policy issues, including the Vision 2020 Core Group (2003), the Task Force on the Future of BWIA (2006), the State Enterprise Review Committee (2016), the Economic Development Advisory Board and the National Tripartite Advisory Council (2016-2017). 

He has published several scholarly articles in Economics, and has authored three books — Central Banking in Trinidad and Tobago (1990), The Underachieving Society: Development Policy and Strategy in Trinidad and Tobago, 1958-2008 (2012) and his latest book We Like It So? The Cultural Roots of Economic Underachievement in Trinidad and Tobago was published in February 2017. He has also co-edited Caribbean Monetary Integration (1994).