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Does Government have a Covid-19 Immunisation plan?

Listening to the post-Cabinet briefing on Wednesday, February 10th, it was encouraging to hear the Minister of Health saying the curfew will continue because of the situation at our borders and the dangerous threat posed by the new variants, namely the UK and South African strains.

I would have preferred to see the curfew start at 12.00 p.m. rather than 10.00 p.m., however the rational given by Minister Steele was a sound one. The decision of Cabinet to have the curfew remain as is, albeit with a slight amendment to the end time, must be applauded in light of the worsening situation with our neighbors.

Government must also maintain and strictly enforce strong entry protocols at the air and seaports in particular the requirement for a PCR test taken three days before travel and a second mandatory PCR test on the fifth day after arrival for all persons entering the island including tourists staying at hotels and villas.

Ambiguous information posted on various websites including official ones, should be amended to clearly reflect changes in the protocol.

Going back to the press briefing, I was disappointed in the acting Chief Medical Officer (CMO) pronouncement on what he considers a vaccination plan. At this stage the CMO should be able to outline a proper plan for mass immunisation not merely list categories of persons that are to be first in line to receive the first doses of the AstraZeneca vaccine now on island.

A plan is a detailed proposal for doing or achieving something. The plan should have a clear objective or set of objectives that are measurable. It should identify a list of activities and the resources required to implement them. The activities once implemented should contribute to achieving the stated objectives. The plan should have an overall aim or goal that should be achieved once the objectives are met.

Some of the components to be included in any mass vaccination plan are procurement and logistics, communications, preparation of infrastructure/vaccine sites, operations, surveillance and monitoring. For instance, the section on procurement and logistics should outline how the vaccines are to be acquired, transported to the island and then to the storage facility.

Similarly, the infrastructure section should detail the works to be done to get vaccination sites ready for inoculation. While operations would layout the process, identify resources human and otherwise to actually get vaccines in people’s arms. Critically important is the communications component that should identify a strategy for educating the population on the benefits of the vaccine and countering adverse information disseminated on various media platforms.

Likewise, surveillance and monitoring section should state how health authorities intend to monitor vaccinated persons for adverse reactions and to determine how fast and in what quantity the body is producing antibodies to the virus.

The Minister and his team must know a mass vaccination campaign is a complex process with distinctive moving parts working together. This is not a run-of-the mill exercise, it is an extraordinary undertaking with high stakes. The existing infrastructure used for immunising young children can’t handle such an exercise, there must be a proper Covid-19 vaccination plan in place to ensure a successful immunisation campaign. If one is not yet available, Cabinet should request one as soon as possible.

The CMO appears to suggest the ministry can use the infrastructure already in place to immunise children, however a mass adult vaccination program presents more challenges that must be planned for. The problems of people’s acceptability of the vaccine, decline in public trust and vaccine hesitancy are real and can’t be underestimated.

There must be a proper communications strategy to address these problems if the vaccine roll out is to be successful.

The Government of Barbados recently finalised its National Covid-19 Vaccination Plan along with an Operational Plan that would guide the actual inoculation exercise. A national Coordinator for the vaccination campaign was appointed in the name of Dr Elizabeth Ferdinand, a retired doctor.

Under the operational plan a number of facilities, including nine polyclinics, community centres and a few schools have been identified as vaccination centres.

The plan proposes establishment of special teams headed by senior health officers and smaller inoculation teams comprising eight to nine persons per vaccination site led by a public health nurse responsible for administering the vaccine.

The Barbados plan is well detailed – does Grenada have one? This is the question that must be asked to the Minister and his team. After listening to the press briefing on Wednesday last week, I didn’t get the sense there is a plan.

This is disturbing since the vaccination program is critical in laying the foundation for economic recovery.

Achieving herd immunity, in the shortest possible time that would protect the population from future devastating outbreaks and return society to some level of normality is of paramount importance.

With that being said – what is the overall strategy of government for fighting back against the virus apart from wearing mask, sanitising hands and social distancing? Is it to immunise over eighty percent of the population in the short order to achieve herd immunity or wait on PAHO/Covax phased schedule that would deliver vaccines in three batches over a twelve month period?

The island would not achieve herd immunity if it has to wait for twelve months to vaccinate eighty percent of its population. Additionally, huge segments of the population will be exposed to severe outbreaks of Covid-19 in particular the UK and South African strains if it has to wait that long.

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What is even more frightening is the sober assessment of Professor Dr. Sharron Peacock, Director of the Covid-19 Genomics UK Consortium, the surveillance program monitoring how the virus is adapting and mutating that the UK strain is going to sweep the world in all probability.

Currently, the UK variant known as B.1.1.7 has been found in seventy countries around the world according to the New York Times. With that in mind a more prudent strategy would be to vaccinate as quick as possible eighty percent of the population.

With the constraints of the Covax facility, the Prime Minister responsible for Science and Technology in Caricom should ‘think outside the box’ and lobby his colleagues in the region to agree on a future joint procurement of the Novavax and Johnson and Johnson vaccines that would soon apply for emergence use authorisation, and buy additional doses of AstraZeneca vaccine to be able to vaccinate eighty percent of the Caricom region’s population.

This is not time to be going ‘hat in hand’ waiting on Covax type facilities to provide free vaccines. The Prime Minister must use funds from the National Transformational Fund (NTF) to purchase vaccines and get it in the hands of the population as soon as possible in light of the fast changing situation with the virus and the need to return to some level of normality that would create the conditions for economic recovery.

The Minister appears to suggest during the press briefing that the number of days for quarantine could be reduced for vaccinated visitors. This is ill-advised and laid bare his poor level of understanding of the emerging trajectory of mutated strains and how they impact the efficacy of current vaccines.

The percentage of the population needing to be vaccinated to achieve herd immunity depends on how cantagious the virus is and the effectiveness of the vaccine towards it. Using just the AstraZeneca vaccine would require eighty percent of the population to be vaccinated for herd immunity, assuming there isn’t a spread of the UK or South African strain among the population.

Scientists in the US investigating mutations of the virus may have just found an even more contagious strain which would further complicate the current situation. Since the jury is still out on whether even the highly efficacious Pfizer/BioNTech and Moderna vaccines are effective at preventing infection, the utterances of the minister is reckless to say the least.

However, it highlights the eagerness on the part of government to return to risky short term tourism at the behest of large foreign owned hotels. Rather than preside over development of a well thought-out strategy and Covid-19 immunization plan, his thinking appears to be on making entry protocols more complaisant to short term tourism.

In the absence of a strategy to achieve herd immunity in the shortest possible time and a Covid-19 immunisation plan, a ‘cap in hand’ approach to acquiring vaccines, and a fast mutating virus, the AstraZeneca vaccine with its relatively lower efficacy may not help the island to achieve herd immunity or protect the population from the South African strain.

Because herd immunity is the only sustainable strategy to prevent the virus from over-running the population, Government must act now to get regional support for a joint procurement effort to get the Johnson and Johnson and Novavax vaccines along with AstraZeneca to immunise the population against the Covid-19.

Procuring two or three vaccines with varying degrees of efficacy towards the original and new strains is the best option at this time. The region should not depend solely on AstraZeneca because it’s effectiveness against the South African strain is in question and its overall efficacy is sixty two percent.

This means that a higher percentage of the population would have to be immunised to get to herd immunity and there would be no protection against the dreaded South African strain that has already begun to spread around the world. This is not good for a country heavily dependent on tourism.

The press briefing not only laid bare the absence of a national Covid-19 vaccination plan, but also lack of a strategy that would guide the fight against the virus now that vaccines are available. It is high time the minister and his team give serious consideration to these matters and stop the ‘knee- jerk reaction’ approach to policy making and planning.

The situation with Covid-19 mutations are changing so fast, ‘foolish folly’, must not be allowed to repeat itself after the short term tourism debacle. As new more deadly variants of the virus continue to spread around the world, an effective vaccine strategy and immunisation plan is urgently needed to protect the island from future outbreaks.

These variants can prevent countries from achieving herd immunity as they become more contagious requiring more people to be vaccinated and interfere with vaccines efficacy, that is its ability to prevent illness and infections.

Going forward there needs to be a strategy that would utilise a portfolio of two or three high efficacy vaccines, approved by WHO and manufactured by reputable pharmaceutical companies, along with the one from AstraZeneca to build herd immunity and lay the foundation for economic recovery.

The ball is in the government’s court, let’s see how they would play it.

Special Correspondent

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