PORT AU PRINCE, AUGUST 5, 2021 (MIC) -
By : Cyrus Sibert
The assassination of President Jovenel Moïse on July 7 momentarily overshadowed fears associated with the impact of COVID-19 on the people of Haiti. However, an increase in infections, a high incidence of hospitalisations and a rising death toll have injected a greater sense of urgency into both official and community actions to address the pandemic.
The virus had initially been slow in affecting the Haitian population, but the arrival of the Brazilian (Gamma) variant earlier this year dramatically changed the dynamic and the official response to the virus.
Additionally, and despite continued scepticism, general vaccine hesitation - having turned back an initial COVAX supply - has turned to a programme of action that has witnessed the vaccination of 11,209 Haitians by the first week of August.
On May 14, there was a public announcement of the discovery of 2 new variants in Haiti, the figures then stood at 274 deaths, 13,520 confirmed cases, 1,955 hospitalised, 12,437 recovered and 67,019 tests conducted.
However, by July 30, the figures stood at 563 deaths, 20,326 confirmed cases, 4,961 hospitalized, 14,802 recovered and 101,640 tests.
That has since been an increase in deaths of 289 (49%) and confirmed cases of 6.806 (0.67%) over a three-month period.
Haiti recorded its first two cases on March 19, 2020. One year later, the head of the National Public Health Laboratory and the GHESKIO Centre, Dr William Pape, announced that “the coronavirus pandemic is on the decline in Haiti. There was no second wave. No case for 3 months.”
He surmised that Haiti was a rare case in the Caribbean. Additionally, the Chairman of the Scientific Committee against COVID-19 in Haiti announced the closure of the 3 GHESKIO centres for the care of infected people. (See report of March 2021)
New cases are now increasingly facilitated by ongoing political and social tensions and accompanying public demonstrations at which very few precautions against the virus are being observed.
The shortage of petroleum products is also causing crowding at gas stations, even as protests following the assassination continue. Despite numerous deaths in record time, some of whom are important, influential, and well-known personalities, there continues to be little mask wearing or social distancing in public spaces.
At the end of May, Dr Yolène Surena, prominent head of Civil Protection, died of COVID-19. In June, Mr René Sylvestre, president of the Supreme Court of Haiti died following complications associated with the virus.
Before these developments, several senior officials were infected at the birthday party of the influential Director of the National Old Age Insurance Office (ONA), Mr Chesnel Pierre, who did not survive either.
Well-known teachers, professors, and political figures such as the former Senator of the Grande-Anse Department, Mr Maxime Roumer, succumbed to COVID-19.
It was hoped that this upsurge in COVID-19 will raise public awareness of the seriousness of the disease and the extent of the danger. But, with few exceptions, public behaviour has not changed for the better.
In the festivities sector, the managers of musical groups have cancelled performances originally scheduled for the summer period. The very popular Tropicana and Septentrional orchestras have published a note to this effect. The most popular religious festivals were also celebrated without the customary festivities.
There has also been considerable confusion at several state institutions following the July 7 assassination. Ministry of Health, Dr Marie Gréta Roy CLÉMENT has retained his post and, with it, a level of control over management of the pandemic.
As a consequence of growing concerns over the impact of the virus and its variants the Haitian government reversed an earlier decision to refuse offers of vaccines. Additionally, there is considerable anxiety related to the possible arrival of the Delta variant that has infected high numbers of patients in the nearby United States of America.
The vaccination campaign
On July 14, Haiti received 500,000 doses of the Moderna mRNA-1273 vaccine as a donation from the United States through COVAX.
Upon receiving the vaccines, Minister Clément declared: “The Department of Public Health and Population expresses its gratitude to the United States Government for this gesture of solidarity and mutual aid. These vaccines will be administered free of charge to the Haitian population.”
“This donation is part of the U.S. government's plans to increase COVID-19 immunisation coverage in other countries around the world, counter new waves of infection and prioritize immunisation of health workers and other vulnerable populations in neighbouring countries who need vaccines.”
The US government has pledged to donate some 12 million doses of the vaccine to countries in the Caribbean and Latin America.
The vaccination campaign began with trials in several cities across the country. As at July 23, five vaccination sites were available in the Haitian capital and its surroundings.
On July 29, the MSPP announced 10 vaccination centres at University Peace Hospital (Delmas), Saint Damien Hospital (Tabarre 41), Gheskio IMIS (Tabarre 41), Geskio INLR (Blvd Harry Truman, Port-au-Prince), Juvenat / FONDEFH Community Hospital (Port-au-Prince), Justinien University Hospital (Cap-Haitien), OFATMA Hospital (Cap-Haitien), Sainte Thérèse Hospital (Hinche), Saint-Michel Hospital (Jacmel), and Fort-Liberté departmental hospital (Fort-Liberté).
The vaccines are being offered free of charge on a “walk-in” basis at most centres except Gheskio IMIS in Tabarre where an appointment is necessary.
On July 27, 2021, a pre-vaccination campaign trial activity was launched in the city of Cap-Haitien.
On this occasion, the Moderna vaccine was administered. In less than an hour, 20 people were vaccinated. The elderly and medical personnel were the first to receive their doses.
Rhudnie Angrand is the campaign manager within the North Department of Public Health Directorate. She said that 2000 doses were available at that venue.
The MSPP is in phase 1 of vaccination which means elderly people, people at risk and healthcare workers have the option of receiving two doses of Moderna within an interval of 28 days.
Two sites are available in Cap-Haitien for the trial test of July 28, 2021: Hopital Justinien and OFATMA.
The Ministry of Health with support from UNICEF and PAHO/WHO had installed on a solar energy refrigeration system combined with generators to allow for vaccines to remain at a stable temperature until the injection phase.
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| Northern Haiti vaccination campaign manager, Rhudnie Angrand, receives her shot in Cap-Haitien. (Photo by: Cyrus Sibert) |
Three sites at Cap-Haitien and Milot are also operational, and a team has been set up to monitor the vaccinated people.
Ms Angrand said in an interview that “to deal with scepticism and anti-vaccine resistance, there will be an awareness campaign. Meetings with opinion leaders, clerics, the media, journalists, community leaders to raise awareness about COVID-19 and the importance of getting vaccinated.”
All workers in public administration, private companies, and banks will receive a form to this effect.
At the campaign launch on July 27 were leading figures such as Phel Casimir, Chief Prosecutor at the Court of Appeal; senior journalist Gérard Maxineau; footballer and sports instructor Ricardo Magloire, and Dr Chérubin Wilton.
They all agreed that the availability of vaccines on Haitian soil was a major development. There are some who have travelled to the United States at costs of up to US$1,500 in order to be vaccinated.
This was the case of Dr Turenne Calil, Head of Department at the Hospital, whose mission is to encourage his colleagues to be vaccinated.
“I have already been in contact with at least seven infected patients without knowing it. It was after the lab tests that I was able to realise the risks I was exposed to. So, I decided to go to the United States to get the vaccine,” he said.
“It cost me a fortune, an unforeseen trip and a lot of wasted time. Today, it’s an opportunity to have this programme in Haiti. There, within our reach. You should take advantage. Because COVID-19 is extremely serious! People are dying.”
Dr Chérubin Wilton thinks that this virus has already killed more than 6,000 people in Haiti. From his experiences, because of economic difficulties, myths and beliefs of all kinds, people rarely consult a doctor or a health centre to address the symptoms of this disease.
“Clearly, there are no statistics for the traditional medicine sector that people primarily refer to for fever, flu, headaches. There is also self-medication. As a last resort they go to the hospital,” he concluded.
Dr Calil has however advised that educating the population about the disease and vaccines is a major priority. He also sees signs of a positive reaction to the vaccine.
“People will understand eventually,” he said. “In the United States an average of 11 vaccines are usually required to admit a child to school. In Haiti, the American Embassy imposes an important vaccine requirement for obtaining a residence visa.”
He pointed to the fact that “locally, children receive lots of vaccines before the age of five. So, vaccination is present in our life, it has always protected us.”
Dr Calil added: “These are the same companies that produced the vaccines of yesterday that are supplying those of today. The resistance to COVID-19 vaccines is just the effect of a global trauma that will eventually disappear.”
When it comes to Phel Casimir, the solution is simple: “You have to help your body to defend itself. We do it by eating good food, drinking water, playing sports, and getting vaccinated.”
Despite these previous encouraging comments, the sceptics are not far off. Two young women who requested anonymity told us that they will not take any vaccines. “Because Haiti has no luck with foreigners.”
“They don't like us,” one woman said. “So, if they give us a vaccine, it’s to our misfortune. These great powers do not like the Haitians. We intend to strengthen their immune system by natural means and prefer to run the risk of infection.”
There are also others who prefer to stand back and observe, and some, like one hospital janitor who said it is the confidence in those in charge that drives him to be vaccinated.
“This hospital has always taken care of me from the moment I was born,” he said. “I trust the health officials. Resources are scarce, but they do what they can. You can blame them for anything, but they would never launch a vaccination programme if they did not have the guarantee that it is good for the population”
Meanwhile, since June 23, the Ministry of Public Health has authorised the private sectors to import vaccines and has set up an accelerated administrative procedure to facilitate importers.
The ministry has however reserved the right to supervise private vaccination centres and shut them down if necessary. But, so far, no private operator is operational in Haiti.
There is also no special vaccination programme for schoolchildren before the start of the school year. Angrand explained that there is no vaccination for minors yet. The priority remains the elderly, people at risk, healthcare workers, and medical personnel.
Following a request for information of MIC to the Communication Department (media@gavi.org) of GAVI (The Vaccine Alliance) https://www.gavi.org, the following details have been provided regarding the links between Haiti and this institution. Given the importance of this correspondence in terms of information on the issue, we have chosen to include it in this text:
The Minister of Health of Haiti signed the COVAX Vaccine Request form on December 15th, 2020, indicating Haiti's willingness to receive COVID-19 vaccines through COVAX.
Related legal agreements, including an annex to the Vaccine Request form were signed by Haiti's Minister of Health and Minister of Finance on March 17, following extensive review by the country's institutions and specific authorisation by the Prime Minister’s Council.
These documents were shared with COVAX on March 29, clearing the way for COVAX to deliver vaccines to Haiti. Delays since then have been related to an inquiry from the MSPP about the possibility of sending an alternate vaccine due to high levels of vaccine hesitancy in the population as well as AstraZeneca global supply constraints.
These logistical challenges have been addressed by resorting to donations of doses, channelled through COVAX, by countries that have already procured and received supplies.
In addition, the country needed to finalise critical readiness needs related to vaccine deployment, mainly concerning indemnification and liability requirements of the suppliers, which also extended timelines.
As at July 14, a total of 500,000 Moderna doses had arrived in the country, donated by the U.S. Government through COVAX. These are the first doses the country has received. In addition to vaccine doses, Gavi approved technical assistance requested by the country in December 2020 and April 9 this year.
This is being managed through WHO and UNICEF to support activities under the National Vaccine Deployment Plan (in the amount of US$743,987).
Cold Chain equipment support is also provided through COVAX to support vaccine storage capacity at national and regional levels (US$350,000). This was approved on May 26. Haiti is also eligible for further support for COVID vaccine delivery in the country through the recently approved Covid-19 Vaccine Delivery Support /CDS.
While COVAX ensures that Haiti has access to vaccines, their distribution is ensured by PROMESS, the “Essential Medicines Program” of the Republic of Haiti which was created in 1992, during the embargo period.
PROMESS is a PAHO/WHO programme in Haiti. Its objective is to ensure the availability and accessibility of essential drugs and quality medical devices for public and private non-profit medical institutions in the country.
It is this programme that ensures the storage and distribution of vaccine doses depending on availability and the distribution strategy. PROMESS is founded and operates with financial contributions from the World Bank, bilateral (France, Switzerland, Holland, USAID, Canada) and multilateral (UNICEF, UNFPA, European Commission). These partners are members of the Programme Management Committee which is chaired by the Ministry of Public of Health of Haiti. https://www.paho.org/fr/haiti/promess-programme-medicaments-essentiels
There nevertheless continues to be pervasive resistance to receiving the vaccine. Among the major factors are religious beliefs and mistrust of the international community.
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