Jamaica needs vaccines!

I feel our little island of Jamaica is in an extremely vulnerable place at the moment.

We need more vaccines. Vaccine inequity, which he of the furrowed brow – Dr. Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) – has spoken about so many times, is real. For many developing countries, including our own. The point is that COVID-19 quickly evolved from being a purely health issue to a socio-economic issue. At that point, the Prime Minister and other Ministers started repeating the mantra, “Balancing lives and livelihoods.”

The problem is, the virus does not care one jot about our livelihoods. So, despite the best juggling efforts of our Government (and no doubt others) it carries on and dashes our best-laid plans. To quote Dr. T:

“Vaccine inequity is the world’s biggest obstacle to ending this pandemic and recovering from COVID-19…Economically, epidemiologically and morally, it is in all countries’ best interest to use the latest available data to make lifesaving vaccines available to all.”

https://www.who.int/news/item/22-07-2021-vaccine-inequity-undermining-global-economic-recovery

And now, we can assume that we have the Delta variant, the latest weapon in COVID’s little bag of tricks, according to Minister Christopher Tufton.

Tomorrow evening at 6:00 p.m. Prime Minister Andrew Holness will tell us what new measures (longer curfews? more restrictions on gatherings? etc) will be imposed. Since we have a severe shortage of vaccine, what else can he do?

Here is our latest situation, meanwhile (as of Saturday, July 24). The number of new cases has been increasing daily.

We have heard all about anti-vaxxers. I am a pro-vaxxer – for the sake of my own health, and that of my family, my friends, my neighbors, my country, and Planet Earth in general. What choice do we have? My husband and I are one of the five per cent or so who have been fully vaccinated, but we are not taking any chances. We wear masks, we sanitize, we social distance. And, mostly, we stay home. Oh, and by the way…

I had to look up “Hib.” It is “a bacterial illness that can lead to a potentially deadly brain infection in young children.” Full name: Haemophilus influenzae type b

The Ministry of Health and Wellness briefings are an exercise in reading between the lines. I always get the feeling that the Government officials who are briefing us are not giving us the full story; they are living in both the past and the future, and we pick up what we can from the present. They are privy to information that we may not have (YET) and they may also be reporting a situation from two weeks ago. On April 29 – just about three months ago – the briefing included a warning about the Third Wave, which I wrote about here. At the time, COVID was looking pretty much “under control,” thanks to curfews. However, I duly noted the somewhat nervous body language and the Chief Medical Officer’s comment three months ago:

“We have seen larger health systems than ours collapse because of COVID.”

Three months later, we seem to be in a darkening place. A sort of fog descended on me as I listened to last Thursday’s press briefing (July 22) – the first in three weeks.

Not a very encouraging picture.

Here are a few things that struck me:

5,153 nurses and midwives are engaged in the public health system. “They lead the charge” on several fronts, Minister Tufton noted. The Minister met with the Nurses Association of Jamaica, as last week was Nurses Week.

However, I had noted earlier in a radio interview with Dr. Melody Ennis (when pressed by the journalist) that only 60 per cent of health workers are (fully?) vaccinated. It was suggested that more nurses than doctors were as yet unvaccinated. I have also heard (a few times now) that quite a few nurses are active “anti-vaxxers.” How can this be? What did they learn at nursing school?

Of other priority groups for vaccination, numbers also seem depressingly low according to Dr. Ennis. About half of our police force is vaccinated; the Jamaica Defence Force is higher. Less than half our teachers are vaccinated (does this bode well for the already doubtful back to school plans in September?) and only 25 per cent of the elderly group is vaccinated. I heard that “younger people are telling their older relatives not to take the vaccine.”

“We are moving in the wrong direction and that is cause for concern,” said Minister Tufton. The seven-day average positivity rate from tests was 9.8 percent, and moving up.

259 (33 percent) of our communities have COVID-19 cases.

Hospitalization is increasing daily – from 199 to 251 last week (that is, the number of suspected as well as confirmed COVID cases).

Our case fatality rate is 2.3 percent. Is that good? I think it is rather average.

The age groups 20 – 29 and 30 – 39 encompass most cases, but older people are much more likely to die. More women are confirmed to have COVID-19 but significantly more men have died than women.

Hanover and Westmoreland have the highest rate of COVID-19 – new cases. People are not following protocols, and they are holding more events at home (funeral services are being held in homes because churches are too strict) and parties are being held in remote areas, to avoid detection. Why are the highest rates per population so high in the western parishes?

Minister of Health and Wellness Christopher Tufton addressing the July 22 press briefing. He was calm but appeared tense and unsmiling.

“I am prepared to say that should assume that the [Delta] variant is here,” said Minister Tufton, although there has been no evidence from the samples we have been sending out for testing…yet. “Something is happening”… He referred to travel (but “it’s not about tourism”) especially from the UK and the U.S.

He also reminded us that even if you are vaccinated “you can still get the virus.” He used this argument to stress that we should all continue to observe protocols and not become complacent. It is “becoming more and more a distinct possibility” that complacency among the vaccinated will set in, he noted.

The Chief Medical Officer reported on how things are being managed in terms of hospital beds (we have only added about 150 new beds). “We have had a sudden increase…quite a big jump,” she said. There may well be a quick rise in the curve of beds available.

Since our peak in March, we have sometimes had no people on ventilators. In the last couple of days, we have seen more people on ventilators and using high flow nasal oxygen (which keeps patients off ventilators but uses “a significant amount of oxygen.”) The CMO rather worryingly mentioned oxygen supplies several times but noted increased capacity has been put in place (first 200, then 800 cylinders). Consistency of supply is key.

We have 108 ventilators on the island.

The reproductive rate (“R” rate) is climbing. It is over 1, which we didn’t want. Our vaccination levels are too low to have any effect on transmission, noted Dr. Webster Kerr, Chief Epidemiologist.

Jamaica also needs personnel, especially those trained in critical care.

There is also a challenge with human resources, again, according to the CMO. Critical care staff are needed to monitor ICU beds “and we are short in this area,” she added. We continue to do contact tracing but again, there’s a staff shortage. We are already somewhat stretched in all areas, it seems. And we need more critical care staff.

A fourth field hospital will be delivered and set up in the next few days at May Pen Hospital, courtesy of the U.S. Southern Command. There are already three at Spanish Town, Falmouth, and St. Joseph’s in Kingston.

We have just 5,000 hospital beds in total… General occupancy in some hospitals is going above 85 percent.

Two Senior Medical Officers contributed to the briefing: Dr. Baker from the National Chest Hospital (which has 42 beds with piped oxygen), and Dr. Derek Harvey from Cornwall Regional Hospital. They both put a brave face on things. “We were looking forward to doing more elective surgeries again, but realize that may have to go back on hold,” said Dr. Harvey, almost wistfully. “We pray that we don’t have a severe wave,” said Dr. Baker. There is a need for critical care staff.

Now, vaccination…

“We would have loved to be far more advanced in our vaccination efforts, but it has not been for a lack of effort” from those negotiating and even asking for donations. Per capita, Jamaica is “at the tail end” of vaccinations in the Caribbean, said Minister Tufton – this is painfully true. However, the Minister of Foreign Affairs and others have been working tremendously hard.

“It has been a real challenge based on limited quantities and increasing demand.”

The Ministry’s policy is to ensure that vaccines are safe and it is sticking to that policy.

He is “very hopeful” – the British High Commissioner has made promises for “fairly substantial” amounts.

We should have more news next week on the Johnson & Johnson vaccines from South Africa – delayed by the unrest there – which we have paid for.

“We have seen so much uncertainty”… The situation with vaccines has been something of a soap opera – a saga full of unexpected twists and turns, and often ending in disappointment.

The most likely policy on vaccines, once the larger shipments come in, would be to “open up” to all who qualify aged over 18; greater outreach in communities (something which makes so much sense); and engaging stakeholders, including the private sector. He is aiming – all being well – to have 800 – 900,000 people vaccinated by the end of September. This would be 51 percent of the targeted population (not our entire population of course).

Read all of the above. What kind of picture does it paint? I see a picture of a Jamaica perched on the edge of a precipice, with dangerous seas and sharp rocks below. Maybe sharks. We are teetering on the edge.

Whether people are “hesitant” or not…we need more vaccines.

Jamaica needs vaccines. This is a plea.