The anatomy of a comprehensive COVID-19 responseSunday, January 09, 2022
BY DR ORVILLE NEMBHARD
THE novel coronavirus pandemic swept ashore in Jamaica in March of 2020 in a manner reminiscent of Hurricane Gilbert. It has affected every parish and every single facet of life. COVID-19 disease is a national health disaster no different from a hurricane, and requires a response commensurate with its importance and impact.
The response to COVID-19 requires a whole-of-society response if we are to have any hope of returning to some sense of normalcy. A whole-of-society approach does not mean mere consultation. It goes well beyond that to providing guidance, communication, and coordination of plans so that key services can continue to be delivered. The stakeholders include business, trade unions, universities, religious and charitable organisations (non-governmental organisations [NGOs]). A whole-of-society approach also does in no way derogate from a Government's leadership of the management of a crisis. The alternative approach may be described as command and control in which the Government attempts to exercise complete control over all stages of crisis management – readiness, response, and recovery – without effectively or meaningfully engaging the private business sector and NGOs in these processes.
Health exists within a social, economic, and political framework. The health sector and the Ministry of Health and Wellness (MOHW) by itself cannot address all the factors required for handling this problem. To illustrate the point I made a presentation to an organisation aimed at addressing their vaccine-hesitant staff. A young male worker shared that he was willing to take the vaccine, but had concerns as to side effects. He pointed out that as a contract worker, he had no sick leave or health insurance and would lose income if he were to be absent from work. To the credit of the managers of the business, they immediately responded by saying they would honour sick leave if certified by myself as being vaccine-related by paying any staff so affected for days missed. In the last discussion I had with the management of that organisation, their staff are now largely immunised. This was a social and economic solution to a health problem resolved by dialogue and a willingness to compromise.
We need further engagements and support of this nature across all sectors of society. The MOHW has in the past shared that funding has limited their health education efforts. Equally in the past, when I worked in the ministry, the private sector was approached to donate some of their advertising slots to the MOHW. The messages would be created and approved by MOHW and tagged “brought to you by the MOHW and XYZ company”. Companies got bragging rights as good corporate citizens, MOHW got prime time slots free of charge, and the public got blanket advertising with approved messaging. A win-win if ever there was one. Corporate Jamaica can be further asked to produce and distribute branded cloth masks, thereby reducing the environmental burden of disposable masks and addressing the problem of non-compliance with mask-wearing due to the recurrent expense.
The private medical sector, through its islandwide reach of private practitioners, remains an untapped resource. Private practitioners remain some of the most trusted and credible sources of information on health matters. To date the MOHW remains, in my opinion, ambivalent at best and resistant at worst to COVID-19 antigen testing. What is the value of this test to the control effort? Humans are the source of spread of the novel coronavirus in much the same way as mosquitoes are the source of spread of dengue and ChikV (Chikungunya disease). National lockdowns and curfews are aimed at limiting the movement and association of humans so as to limit spread. COVID-19 antigen tests are able to identify individuals suffering from COVID-19 disease in minutes. People who test positive would be advised accordingly to limit spread and association. To extend the analogy, curfews are akin to a mosquito fogging exercise. Antigen testing is akin to householders clearing their environment of standing pools of water. Both have their value. Almost two years into the pandemic and nine months after the Jamaica National Agency for Accreditation (JANAAC) certified entities to perform antigen tests, the MOHW is still working on a protocol to certify and recognise practitioners who perform this test.
COVID-19 vaccines initially suffered from being unavailable. Now there is adequate supply, but accessibility remains problematic. Private practitioners have been brought to the table late in the day and with onerous conditions. For example, MOHW requires vaccines to be collected and returned daily, and further stipulate only medical doctors or registered nurses are authorised so to do. What special skill sets do medical practitioners and registered nurses have that make them the only suitable persons for vaccine collection and transport?
The private sector has been denied access to Pfizer vaccine. The reasons given have been the temperature storage conditionalities, the complexity of vaccine preparation, and the need for “in-person, face-to-face” training. Six weeks after the availability of the Pfizer vaccine, that training has not taken place. The Centre for Disease Control and Prevention (CDC) has online training videos relating to Pfizer vaccine preparation. Pfizer vaccine, whilst having some extreme temperature storage conditions, is also able to be stored for 30 days under the same conditions as polio, MMR, DPT, and chicken pox vaccines. In the USA, medical assistants mix and administer the Pfizer vaccine. Their medical training ranges from six to nine months. What is the skill sets which make the mixing and administration of the Pfizer vaccine only possible in the public sector in Jamaica and only by public sector employees? Did somebody say every vax counts?
Whilst I respect and applaud the MOHW and its staff in working hard, I do not feel they are working smart. One definition of management is getting things done through people. The approach by MOHW to COVID-19 seems to be one of trying to do it all by themselves. If we reframe the novel coronavirus pandemic as a national health disaster with a mandate for a multisectoral response led by MOHW, then perhaps the burden can be shared and the results made more tangible and timely.
Dr Orville Nembhard is a medical practitioner and pubic health specialist. He is one of the founding doctors of Health Plus Associates. He can be contacted at firstname.lastname@example.org