A time might come when the Jamaican Government will not be able to spend dollars for doses, health officials have warned.

As new COVID-19 variants create mischief in public health and the necessity of vaccination becomes clearer with each hospitalisation and death, the Medical Association of Jamaica (MAJ) is cautioning that it is likely the Government mightbe challenged in terms of continuing to cover the cost for COVID-19 vaccines.

“The vaccines are not free; I know the governments are the ones who are footing the bill. The Government has put a lot of money in it. I know there may come a point where they may not be able to sustain the payment for these vaccines. So for example, if we need booster shots, they may not be able to. They may not be able to afford to go on. I know the drug companies are not doing it for free. Somebody is paying. Whether it is the American Government, the British Government or the Jamaican Government, it is being paid for,” Dr Leslie Meade, president-elect of the MAJ told the Jamaica Observer in an interview.

“We know that there is going to come a time when we will have spikes ever so often. And if so, we may need, from time to time, either booster shots, or persons who may not have gotten shots before will need to get the vaccine. We don’t know when that time is. It could be tomorrow… it could be years from now. And we don’t know how long these governments are willing to foot the bill for it. The Government will make that decision,” he added.

In agreement, general physician and family practitioner Dr Nagendra Babu Chandolu told the Sunday Observer that it’s only a matter of time before a price is affixed to COVID-19 vaccines.

“Countries are starting to have a minimum requirement that people who want to travel to their country must be vaccinated. In the future, there is going to be more demand for vaccines. As for now, the manufacturing companies are doing the production but still giving for free because the Government support is there. But later on, automatically, all these big institutions have to sell the product,” he said.

Chandolu, who is originally from Andhra Pradesh, south India, has been operating in St Mary for the last seven years. He said if Jamaica gets to a place where the COVID-19 vaccines become mandatory, that will be another push towards paying for the jab.

“It’s better if people go quickly and get it now and utilise the free service. People saying ‘I want the Pfizer’ or ‘I want this one’ are actually making demands for that product. It’s creating a hype for the product. It’s marketing. We have to look at all those things. If it becomes mandatory, we will have to spend money. No government will be giving it free lifelong. That’s my belief. It’s very hard for some companies to maintain that free service. I believe once you’re giving anything free, there is no value for the product.”

But Meade said it’s ideal that Jamaica achieves herd immunity so that the country doesn’t get to that point where the vaccines become “so much commercialised”.

“Once we’ve gotten to herd immunity and get the numbers down and it’s under control, then we will see whether or not this is something that will have to go on our vaccine regime, or if the Government will say that individuals will need to foot the cost. But it will be a public health decision – whether the Government thinks it would be for the greater good to ensure there is greater access to the COVID-19 vaccine or if it would be something left up to the individual to choose whether to take it or not,” said Meade.

Occupational and public health specialist Dr Alverston Bailey told the Sunday Observer that the “hypothetical” concept of paying for vaccination would be related to the anticipated need for the COVID-19 vaccines and people’s willingness to purchase them.

“I’m actually thinking in terms of the vaccines being available to the private sector and then those who can afford it would not have a problem purchasing it. This scenario I think will occur if vaccines are required annually like the flu vaccine. The flu vaccine is given free by the Ministry of Health to its workers but it’s also bought by citizens through the private sector, which makes it easier to acquire.

“The purchasing of vaccine is essentially a norm as we are right now. The private sector buys childhood vaccines and also the flu vaccine, to be given to who actually require it. So, theoretically, in the future when the booster doses of vaccines are necessary, then there’s a strong possibility that we’ll have so much vaccines around that it will be available through the private sector for persons to purchase it in order to be vaccinated.”

Bailey further reasoned that if people are given the option to vaccinate themselves through the private sector, it could significantly decrease the overcrowding seen at vaccination sites across the island.

“It might actually enhance the vaccination effort if persons are given an opportunity to pay for it. But in this instance, they will have to access the vaccine through their private doctors. So theoretically, if we need a booster and the Government gives permission to the private sector to deliver the vaccine, then persons might be willing to pay for it because it will be easier to access with less challenges.”

On the downside, Bailey said the costs for the vaccines would be exorbitant.

“It will have to be. You have to recognise that there’s still a serious vaccine shortage around the world. What could theoretically happen if vaccines are available for sale is that it could seriously impact on the equity issue. The wealthy will access the vaccines and the poor will not be able to afford the vaccines and will have to rely on the Government for vaccination. There lies the problem in terms of having vaccines for sale. There are some advantages and disadvantages,” he argued.

That said, Meade told the Sunday Observer that he believes it would be in the Government’s best interest to continue footing the bill for the vaccines, so there can be “ready and easy access” for all sectors of the society.

“We have seen the ravages of COVID now and if we leave it up to individuals to make a decision, then we will be back here sooner than later. So I am a proponent, if needs be, for the Government to continue to cover the cost for COVID-19 vaccines. We are seeing long-term problems from COVID. That’s what we call the long haul of COVID. Even though it’s primary a virus that affects the lungs, we’re seeing where it’s also affecting a host of organ systems – whether it’s the central nervous system which includes the brain, heart, kidney, liver,” he said.

Meanwhile, Bailey argued that as long as COVID-19 vaccines remain difficult to access, they will be regarded as a commodity in high demand.

“In the classical scenario of supply and demand, it will be costly to acquire the vaccine because of limited supply. And so, the Government might be concerned about the questions of equity and distributive justice if the wealthy get vaccinated and the poorer members of society do not. The bulk of our populace is not wealthy.”

He added, however, that if third doses of vaccines become available, he believes it would be reasonable if the Government charges to administer the shot.

“By the time the third doses are due, many persons would still not haven gotten even the first dose. So, if you really want to access the third dose, I think it would be reasonable to say to persons ‘You’re going to have to pay some premium price for this.’ That to me would be one of the best justifications for charging persons who might express an interest in obtaining a third dose. But for the time being, with limited supply, I think selling would not be the just thing to do at this time.”