To take or not to take

The rollout of the government’s COVID-19 vaccination program comes as the internet churns out conspiracy theories faster than vaccines can be produced, and at a time when there is a significant level of distrust in vaccines and in the current administration, which is preparing for an election.

The Bahamas is not alone as it relates to the trust deficit issue.

In January, the Associated Press reported on a survey conducted by communications firm Edelman, which found that waning trust in governments and all types of media was threatening to limit the rollout of vaccines around the world, particularly in the United States.

In November, the UK’s Independent newspaper reported on the Kantar poll, which found that the number of people willing to be vaccinated against COVID-19 had shrunk in several major western countries — with distrust of government blamed for the hesitancy.

Only 31 percent of the public trusted Boris Johnson’s government as a source of reliable information on a COVID-19 vaccine.

In The Bahamas, the government started to administer the AstraZeneca vaccine on Sunday, as European countries were suspending AstraZeneca vaccinations amid reports of blood clots.

The Ministry of Health responded to concerns, saying that the vaccines received by The Bahamas last Wednesday are different from the batch reportedly used in the affected countries.

It said, “The AstraZeneca vaccine received by The Bahamas has met all of the requirements and standards outlined in the World Health Organization’s (WHO) pre-qualification system, which has provided Emergency Use Listing. The vaccine has also received Caribbean Regulatory System certification.”

Still, reports of France, Germany, Italy and Spain becoming the latest countries on Monday to suspend the use of the Oxford-AstraZeneca vaccine, coupled with skepticism towards government and health authorities, could negatively impact rollout.

Former Minister of Health Dr. Duane Sands said it’s important to pay close attention to both sides of the discussion. 

“What’s happening right now is we are getting what appears to be conflicting points of view. So you have a number of countries, most recently Germany, France, Italy [and Spain], which have suspended the AstraZeneca jabs, and they say temporarily, until they can investigate,” Sands told National Review.

“Simultaneously, you have the British saying that there’s no reason to suspend and then you have the International Society of Thrombosis and Haemostasis saying that there’s no reason to suspend.

“You have WHO saying that there’s no reason to suspend. So here we have a matter of significant concern, albeit small numbers of patients; and I can assure you that certainly from the medical point of view, this is being studied very, very closely to determine what is the safe and reasonable approach to this situation. And I don’t think that a final decision has been made particularly since we have just, just, just started the rollout of our vaccination program. So there is obviously positions on either side…”

Sands has called for a review of the AstraZeneca issue.

“And I believe that what is required is that we look at this in light of the concerns that have been expressed around the world and we make a decision as to which way The Bahamas will proceed,” he said.

“Obviously, we should get some input from our partners in the region, PAHO, WHO, etc. This is a process that ought not be a knee-jerk response. I don’t think that even Italy, France, Germany made a knee-jerk response (to suspend the vaccine rollout).

“Bear in mind that their decision came days after Denmark and other countries made the decision, so people will obviously be looking on and what they hope to see is that the process that we take is robust, it’s extensive, it’s objective, but most of all it is couched in what is the safe and appropriate approach for the people of The Bahamas.”

Sands did say he plans to take the AstraZeneca vaccine.

Yesterday, the European Medicines Agency, the European Union’s drug regulator, said there is no evidence that the AstraZeneca vaccine causes blood clots and urged governments not to halt the vaccine as coronavirus remains a critical threat.

The agency’s head, Emer Cooke, said, “We are still firmly convinced that the benefits of the AstraZeneca vaccine in preventing COVID-19 with its associated risk of hospitalization and death outweigh the risk of the side effects.”

The Bahamas is currently administering the 20,000 doses of AstraZeneca donated by the Government of India.

The prime minister has said 33,600 of the 100,800 doses of AstraZeneca The Bahamas has secured through the COVAX Facility are due to arrive in country by the end of the month.

In a release on the weekend, Caribbean Public Health Agency (CARPHA) said the batch of the AstraZeneca vaccine being used in the Caribbean is not the same one as the one now temporarily suspended in Europe.

“Adverse reactions that happen following immunization with any vaccine need to be fully investigated to rule out various factors, for example concomitant illnesses, progression of a disease, and batch assessment, before a final decision is made by the health authorities,” CARPHA said.

It said, at present, it cannot be determined whether there is a link between the vaccine and “reports of rare blood coagulation disorders in people who had received the vaccine”.

Still, concerns persist, even within the science community.

A senior Bahamian physician, speaking with National Review on Monday with no expectation of attribution, said while he wants to get vaccinated, concerns raised internationally about AstraZeneca give him pause.

Building trust

Worries about AstraZeneca due to reports of blood clots in some people who have received it in Europe is but one cause for vaccine hesitancy.

Even before such concerns arose, many people had determined they will not take the vaccine. 

Some believe COVID-19 vaccines have been “rushed” and have opted to wait a year or two to see how it will impact others first before taking it.

One businessman speaking with National Review yesterday, said, “There are still many chapters to be written in the story of COVID vaccines which will determine whether it is a drama, a thriller, or a plain horror show.”

While the very legitimate concerns many individuals have about COVID-19 vaccines ought not be dismissed, some people are buying into bizarre conspiracy theories.

A local pastor appearing as a guest on a popular talk show this week, for instance, said the vaccine will facilitate the emergence of a “new world order” and Bahamians ought not take it as it goes against the will of God.

With so much misinformation being spewed on the COVID-19 vaccine, building trust is vital to boost the numbers of Bahamians willing to get vaccinated.

Prime Minister Dr. Hubert Minnis and his wife, Patricia, Minister of Health Renward Wells, and the special health advisor to the prime minister, Dr. Merceline Dahl-Regis, were all vaccinated before the cameras on Sunday, in an effort to boost confidence in the vaccine.

After she was vaccinated, Dahl-Regis acknowledged that vaccine hesitancy is a real concern.

“It’s global,” she said. “It’s not only here. You have a lot of misinformation circulating – example, the association of AstraZeneca and thromboembolism. In two patients. Twenty-six million took it. Two patients.

“Now, they’ve established that it is unrelated to the vaccine. But the hesitancy is really related to misinformation.”

In what bordered on being dismissive, she added, “There are many more people who want to take it than the supply that we have. So, those who want it can get it.”

Local officials will need to do more to allay the fears of the public over the vaccine.

On the issue of trust-building, Sands said, “At this point, obviously there are questions and I think what’s most important is transparency not just to talk it, but to show it – because there is so much misinformation and disinformation floating around and so many conspiracy theories and so on and so forth, that you can’t just ram this through.”

Having Dahl-Regis – a respected figure in the health field and a reassuring presence in our pandemic response – before the cameras being among the first to get vaccinated was an important move in building trust.

Hugely unpopular political figures like the prime minister and the health minister are not likely to have as broad of an impact on efforts to encourage confidence in the vaccine.

Consultation

In addition, their attitudes toward healthcare professionals and lack of consultation on rollout do nothing to foster trust.

Ahead of the arrival of the vaccine, the heads of the three major healthcare unions in the country said they had received no information from the government on how the rollout of the COVID-19 vaccine will take place.

Up to Sunday, union leaders reported that consultation had still not happened.

Wells said on Sunday “the most important persons” were consulted.

“The reality is the Ministry of Health has been driving this process,” the minister said when asked to respond to the union leaders saying they had not been consulted.

“The most important persons in this process are those persons who have always been a part of the vaccination process, which is the Ministry of Health immunization department that has been leading the charge in regards to immunization in this country, in general. This is not new. This is something that The Bahamas has been doing for probably 180 years.

“The first vaccination bill, the bill that we still use today to vaccinate folk, was passed around April 6, 1860. That’s how long we’ve been vaccinating people in The Bahamas.

“The reality is the Ministry of Health, with its very creative, innovative, bold, passionate individuals who are part of that technical team, along with the vaccination committee, has put together a fantastic vaccination program for the Bahamian people, and it was one born in what we have done in the past from our experiences and we will continue to move forward.”

It was pointed out to him that those stakeholders who expressed concerns are consultant physicians and nurses.

Wells responded, “Many of those individuals are a part of the Ministry of Health; and so at the end of the day, their colleagues who are also a part of the Ministry of Health, who have the requisite training who are also the individuals with the same kinds of degrees. And so, again, we have been through this process on a number of occasions in vaccinating the Bahamian people, in vaccinating the public, and we are moving forward in that vein.”

The health minister seems to miss the point that we are facing a once-in-a-lifetime pandemic. To minimize the importance of healthcare professionals in the vaccine rollout process is insulting and raises questions about his grasp of the role the various healthcare professionals are playing at this time.

The prime minister, who was asked last Wednesday to respond to the unions, did not offer a better response.

He evaded the question altogether.

Minnis said he is more concerned about getting the vaccine out to the public “so that we can get back to normalcy as quickly as possible”.

Yesterday, Nurses Union President Amancha Williams told us her organization has yet to hear anything from the government on the vaccination process. Williams said she has been getting calls from nurses but is unable to answer their questions.

It’s incredible that the government has sent out a release, accompanied by photographs, of the COVID-19 Vaccine Consultative Committee’s meeting with the Bahamas Christian Council to discuss the vaccine rollout, but has yet to engage key stakeholders in the health sector.

We note, too, that the Christian Council president is a member of the vaccine committee, but there is no representation from any of the healthcare unions.

There is certainly nothing wrong with engaging the religious community on this most important initiative, but the lack of respect, dismissive attitude toward stakeholders in the health sector and haughty approach to the handling of the vaccine rollout is most unfortunate, especially given that frontline workers are the priority group for vaccination.

On Monday, Sands spoke of the importance of engaging stakeholders and being transparent in addressing the public’s concerns on the AstraZeneca vaccine.

“It has to be done in a loving, open way where [you] deal with concerns that people have by education, by answering questions, by answering questions again and again and again,” he said.

“By going to look for answers that [you] didn’t think were necessary and settling sometimes on a case by case basis, the concerns that people raise.

“I also think it’s important that we engage the critical stakeholders, the general nursing and physician bodies primarily because they are the ones who engage people every single day with the informed consent for how to manage their diabetes, how to manage their blood pressure and how to vaccinate their children (no reference to the COVID vaccine here).

“…All of these things are within the day-to-day purview of the clinical teams, which is not to say that other people shouldn’t be involved, but the general healthcare teams have to play a critical-point role, be out front if this vaccination program is going to be successful.”

As it continues the vaccine rollout, the government should recognize the importance of building trust among the public. This includes engaging stakeholders at every level, and launching a sustained education program with credible individuals in the health sector being available to answer questions and give information.

Being dismissive of healthcare workers and others with a stake in the outcome is not a productive approach; neither is stating that there are more people who want to take the vaccine than the amount of vaccine we have, so those who don’t want to take it just should not take it.

We all stand to benefit from a successful vaccine program. Likewise, we all stand to lose from a botched process. 

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