Rishard Khan

The turn of 2021 brought much-need­ed promise in the fight against COVID-19. Just one day be­fore the year be­gan, the World Health Or­gan­i­sa­tion (WHO) gave its first vac­cine ap­proval on De­cem­ber 31, 2021. It ush­ered in nine oth­er such ap­provals over the year.

Us­ing this cri­te­ri­on, T&T would ac­quire enough vac­cines to ad­min­is­ter al­most two dos­es to every mem­ber of its pop­u­la­tion. De­spite this, the coun­try will end the year un­able to vac­ci­nate even half of its pop­u­la­tion even af­ter some six months of a mass vac­ci­na­tion cam­paign. T

Bumpy road to ac­quir­ing vac­cines

While T&T now has over 2.3 mil­lion dos­es of COVID-19 vac­cines in its ar­se­nal, it’s a favourable po­si­tion that looked al­most im­pos­si­ble at the start of the year.

The first dose to be ad­min­is­tered lo­cal­ly went to ICU nurse, Keisha Pre­vatt-Gomez on Feb­ru­ary 17- just two days af­ter the WHO ap­proved the Ox­ford-As­traZeneca vac­cine. It would be from a batch of 2,000 dos­es do­nat­ed by Bar­ba­dos.

Less than a week lat­er Prime Min­is­ter Dr Kei­th Row­ley would come to the na­tion with news that crushed the op­ti­mism of a few days pri­or amidst heavy op­po­si­tion crit­i­cism.

He re­vealed that small na­tions were be­ing over­looked by vac­cine man­u­fac­tur­ers due to a glob­al sup­ply short­age. It’s an is­sue he raised with the WHO dur­ing his time as CARI­COM chair, on be­half of the Caribbean re­gion. Adding to the dol­drum was an un­cer­tain ship­ment from CO­V­AX which the coun­try bought in­to last Sep­tem­ber with a US$1.5 mil­lion down­pay­ment.

Al­lo­cat­ed a first tranche of 100,800 As­traZeneca dos­es, the ship­ment would in­stead be de­liv­ered in three batch­es, the first of which ar­rived on March 30 - a month af­ter ini­tial­ly an­tic­i­pat­ed.

The In­di­an High Com­mis­sion­er would al­so join the gov­ern­ment in re­ceiv­ing heavy crit­i­cism from the op­po­si­tion and pub­lic af­ter it was re­vealed that oth­er is­lands ben­e­fit­ted from vac­cine do­na­tions from In­dia while T&T didn’t.

Blame shift­ed be­tween the Com­mis­sion­er for not ex­tend­ing the of­fer to T&T and to the gov­ern­ment for not ask­ing for a do­na­tion.

On April 13 In­dia would do­nate 40,000 dos­es of As­tra-Zeneca/Co­v­ishield. At the time, do­na­tions from oth­er coun­tries made up the ma­jor­i­ty of vac­cines in T&T.

Chi­na made the first large do­na­tion of 100,000 Sinopharm dos­es which lat­er led to T&T pur­chas­ing 1,000,000 dos­es from the coun­try.

As the year pro­gressed and the glob­al sup­ply short­age slow­ly re­solved, T&T was able to pur­chase sub­stan­tial dos­es through the African Med­ical Sup­plies Plat­form (AM­SP). How­ev­er, do­na­tions from coun­tries such as the Unit­ed States, Cana­da and oth­er Caribbean is­lands still formed a key sup­ply of vac­cines to T&T.

Employees from the manufacturing sector wait to receive the COVID-19 vaccine at the Trinidad and Tobago Manufacturing Association Mass Vaccination Centre, Divali Nagar Compound, Chaguanas, in June 2021.

ANISTO ALVES

Rough start to vac­ci­na­tions

The coun­try be­gan ad­min­is­ter­ing dos­es to the pub­lic in a na­tion­al vac­ci­na­tion dri­ve which, at the start, was dic­tat­ed by the less than a sat­is­fac­to­ry num­ber of jabs re­ceived. Giv­en the low num­ber of dos­es, the pro­gramme be­gan pri­mar­i­ly for health­care work­ers in Feb­ru­ary.

As the coun­try re­ceived more dos­es, the pro­gramme was ex­pand­ed to ad­min­is­ter jabs to oth­er seg­ments of the pop­u­la­tion.

On April 6 this was ex­pand­ed to in­clude the el­der­ly and those with co­mor­bidi­ties now that the coun­try had just re­ceived 33,600 AZ dos­es from its first ship­ment from CO­V­AX.

It would al­so be fur­ther ex­pand­ed to in­clude es­sen­tial work­ers. The sites, pri­ma­ry health cen­tres, were in­un­dat­ed by crowds but ac­cord­ing to the Min­is­ter of Health Ter­rence Deyals­ingh, peo­ple who did not meet the cri­te­ria showed up.

This group would shoul­der the blame for frus­tra­tions to get vac­cines. How­ev­er, in June the gov­ern­ment would bear the blame for a mass roll­out that saw hun­dreds turned away be­cause the sites weren’t able to ac­com­mo­date the rush.

Both the Min­is­ter of Health and Prime Min­is­ter Dr Kei­th Row­ley would of­fer pub­lic apolo­gies for the botched roll­out.

This led to the pri­vate sec­tor part­ner­ing with the Min­istry of Health to op­er­a­tionalise mass vac­ci­na­tion sites lo­cat­ed at the Di­vali Na­gar, Cen­tre Point Mall and the North­ern Acad­e­my for Per­form­ing Arts.

Each site had the ca­pac­i­ty to ad­min­is­ter thou­sands of dos­es per day. At the peak of vac­ci­na­tions in Ju­ly, these mass sites along with those op­er­at­ed by the re­spec­tive Re­gion­al Health Au­thor­i­ties and health cen­tres were av­er­ag­ing over 15,000 dos­es ad­min­is­tered per day.

Vac­cine hes­i­tan­cy/re­sis­tance

De­spite months of ed­u­ca­tion cam­paigns and a wealth of safe­ty da­ta, a sig­nif­i­cant por­tion of the pop­u­la­tion still isn’t con­vinced about vac­ci­na­tion, choos­ing in­stead to ab­stain.

Now, bare­ly 1,000 peo­ple are com­ing for­ward to take a dose.

The year will end with the coun­try yet to vac­ci­nate 50 per cent of the pop­u­la­tion.

As of Christ­mas Eve, on­ly 47 per cent of the pop­u­la­tion ac­cessed at least one dose of a vac­cine.

How­ev­er, glob­al­ly, an av­er­age of 58 per cent of the world pop­u­la­tion ac­cessed at least one dose.

One of the main con­cerns dri­ving hes­i­tan­cy and re­sis­tance lo­cal­ly is the vac­cine’s ef­fec­tive­ness and safe­ty.

How­ev­er, to date, some 90 per cent of COVID-19 hos­pi­tal­i­sa­tions and 96 per cent of deaths have been among the un­vac­ci­nat­ed. There have al­so been on­ly a few in­stances of ad­verse re­ac­tions to the vac­cine; four cas­es of vac­cine-in­duced throm­bot­ic throm­bo­cy­tope­nia (blood clots) fol­low­ing As­traZeneca, one case of my­ocardi­tis in a teen and one case of ana­phy­lax­is in a teen fol­low­ing the Pfiz­er jab.

None of the cas­es re­sult­ed in a fa­tal­i­ty and they are al­most sta­tis­ti­cal­ly neg­li­gi­ble against the back­drop of over a mil­lion dos­es of var­i­ous vac­cines be­ing ad­min­is­tered lo­cal­ly.

Prime Minister Dr Keith Rowley received his additional primary dose of the Sinopharm COVID-19 vaccine in November.

Office of the Prime Minister

Nic­ki Mi­naj con­tro­ver­sy

The hes­i­tan­cy and re­sis­tance gov­ern­ments glob­al­ly are chal­lenged with was not aid­ed when Unit­ed States-based Tri­ni-born rap­per Nic­ki Mi­naj took to Twit­ter in Sep­tem­ber claim­ing her cousin’s friend in Trinidad had swollen tes­ti­cles af­ter be­ing vac­ci­nat­ed. The Min­istry of Health dis­missed the claim af­ter an in­ves­ti­ga­tion un­earthed no such in­ci­dent. How­ev­er, the in­ter­na­tion­al celebri­ty’s tweet had be­come vi­ral with many oth­er users cling­ing to her word as the truth.

The dwin­dling num­bers have led peo­ple to call for manda­to­ry vac­ci­na­tions and while the Prime Min­is­ter said it’s an op­tion avail­able to the gov­ern­ment, it’s not one they’re ready to im­ple­ment yet. Le­gal minds such as se­nior coun­sel Mar­tin Daly has al­so pub­licly stat­ed that there are le­gal grounds for such a mea­sure to be im­posed.

Since the out­break be­gan the gov­ern­ment has used re­stric­tions to de­lay the virus’ spread to buy time for the pop­u­la­tion to get vac­ci­nat­ed. The ma­jor­i­ty of the pop­u­la­tion’s re­luc­tance to do so was a wrench in the gears of the gov­ern­ment’s ap­proach to con­trol­ling the pan­dem­ic.

Had the vac­cine up­take con­tin­ued at the rate of 15,000 dos­es per day as in Ju­ly, all el­i­gi­ble mem­bers of the pop­u­la­tion could have been ad­min­is­tered at least one dose by Sep­tem­ber/Oc­to­ber 2021.

Now the gov­ern­ment has shift­ed to us­ing the large stock of dos­es as boost­er shots for all those al­ready ful­ly vac­ci­nat­ed to op­ti­mise pro­tec­tion now that the Omi­cron vari­ant is pos­si­bly spread­ing among the pop­u­la­tion.

Re­stric­tions & safe zones

On May 15, the gov­ern­ment im­posed one of the strictest re­stric­tions for the pan­dem­ic - a State of Emer­gency (SoE). Since the virus ar­rived in the coun­try on March 12, there were sev­er­al calls for an SoE to be im­ple­ment­ed.

Un­til then, the Prime Min­is­ter had dis­missed such a move which he be­lieved had more far-reach­ing con­se­quences than ben­e­fits at the time. How­ev­er, with the par­al­lel health­care sys­tem fac­ing al­most cer­tain col­lapse un­der the post-East­er surge the ham­mer dropped.

While busi­ness­es weren’t as re­strict­ed as done dur­ing the first “lock­down”, the SoE im­posed re­stric­tions on in­di­vid­u­als. It al­lowed for a cur­few to be im­posed and grant­ed ex­tra pow­ers to the de­fence force. The SoE al­so out­lawed pub­lic con­sump­tion of al­co­hol. It would be ex­tend­ed and last un­til No­vem­ber 17. Dur­ing the time, at least 1,986 peo­ple were ar­rest­ed for breach­ing the cur­few.

How­ev­er, every pe­ri­od of re­stric­tions took a toll on the econ­o­my. In Oc­to­ber, the gov­ern­ment op­er­a­tionalised the Safe Zone ini­tia­tive. It came with the ad­mis­sion of the Prime Min­is­ter that the virus is here to stay and it was time to learn to live with it.

The Safe Zones func­tion var­ied de­pend­ing on who you asked. For some, it was a ban to pre­vent the un­vac­ci­nat­ed from recre­ation­al ac­tiv­i­ties. For oth­ers, it was a priv­i­lege that al­lowed re­spon­si­ble mem­bers of the pub­lic who got vac­ci­nat­ed to be al­lowed to re­turn to some sem­blance of nor­mal­cy.

A man walks past the closed RRM Plaza, High Street, San Fernando, in April following the new COVID-19 restrictions.

Kristian De Silva

Ei­ther way, it was a sort of mid­dle ground be­tween a life of re­stric­tions and a full re­open­ing of the econ­o­my as the gov­ern­ment, like all oth­ers glob­al­ly, tried to bal­ance lives with liveli­hoods.

Un­der this ini­tia­tive bars, restau­rants and cin­e­mas were able to re­turn to pro­vid­ing in-house ser­vice to ful­ly vac­ci­nat­ed cus­tomers. Bars did not have this al­lowance since Au­gust 2020.

The move re­sult­ed in a brief in­crease in vac­ci­na­tions but it has since dwin­dled. But with the pos­si­bil­i­ty of the Omi­cron vari­ant cir­cu­lat­ing among the pop­u­la­tion, the Prime Min­is­ter ex­tend­ed the Safe Zone ini­tia­tive to in­clude the pub­lic ser­vice.

The move saw an uptick in vac­ci­na­tions but on­ly time will tell if it was able to boost vac­ci­na­tion lev­els im­pact­ful­ly.

Shaky herd im­mu­ni­ty?

As vac­ci­na­tions be­gan lo­cal­ly, the Min­istry of Health had one goal in mind - to vac­ci­nate enough of the pop­u­la­tion to sup­press the spread of the SARS-CoV-2 virus which caus­es COVID-19.

Min­is­ter of Health Ter­rence Deyals­ingh set a tar­get of around 70 per cent of the pop­u­la­tion. How­ev­er, vari­ants of con­cern such as Gam­ma, Delta and now Omi­cron since emerged, each with pro­gres­sive­ly in­creased lev­els of trans­mis­si­bil­i­ty and an abil­i­ty to evade im­mu­ni­ty - whether nat­ur­al or vac­cine-in­duced.

Health ex­perts glob­al­ly be­lieve these fac­tors would now push the goal post for herd im­mu­ni­ty up to 90 per cent of a pop­u­la­tion need­ing to be ful­ly vac­ci­nat­ed.

“What is the ef­fec­tive vac­ci­na­tion rate that will help to ex­ert max­i­mum con­trol? We used to think in terms of oth­er dis­eases 85 per cent, 80 per cent. I would say the high­est we can go... which means per­haps over 90 per cent,” pub­lic health diplo­mat and epi­demi­ol­o­gist, Dr Far­ley Cleghorn pre­vi­ous­ly told Guardian Me­dia.

How­ev­er, in T&T, on­ly rough­ly 78.6 per cent of the pop­u­la­tion (1.1 mil­lion of 1.4 mil­lion) is el­i­gi­ble to be vac­ci­nat­ed un­der the cur­rent na­tion­al vac­ci­na­tion frame­work which is based on WHO guid­ance.

While this fig­ure will still of­fer in­creased pro­tec­tion over the dis­ease- that’s as­sum­ing every­one el­i­gi­ble gets vac­ci­nat­ed. Those el­i­gi­ble to get vac­ci­nat­ed is ex­pect­ed to grow with time as the WHO ap­proves dos­es for broad­er cat­e­gories of peo­ple such as for chil­dren un­der 11.

Armed with her protective gears a nurse is seen testing visitors amidst raising covid-19 cases through out the country at the St Clair Medical Centre, corner of Elizabeth and St Clair Avenue,Port-of-Spain in April.

ABRAHAM DIAZ

A Look to 2022

The new year will un­doubt­ed­ly bring new chal­lenges in the coun­try’s COVID-19 fight, how­ev­er, it could al­so bring some promise. Al­ready the ma­jor­i­ty of re­stric­tions have been lift­ed with beach­es be­ing re­opened short­ly be­fore Christ­mas and the bor­ders re­opened since Ju­ly. But while there are few­er re­stric­tions in place, COVID-19’s threat is alive and well. Un­til any fur­ther de­vel­op­ments with the virus, vac­cines or ther­a­peu­tics, the proven ways to pro­tect against in­fec­tion is ad­her­ence to pub­lic health guide­lines and vac­ci­na­tion.