Editorial | Fiddling with lessons

Some things do not require a lot of money to get done. Documenting the lessons learnt from an event and codifying how to respond should it recur is among them. All this requires, at most, is concentrated effort.

That is why this newspaper is, to say the least, flabbergasted that Jamaica has not documented the lessons learnt from the chikungunya virus epidemic that hit the island nearly a decade ago. The same thing applies to the Zika virus, from which several thousand Jamaicans suffered in 2016 and into 2017.

It may be too late, at this stage, to gather and collate information from those episodes, except by combing through relatively old files and now dusty records. Which would not have the same efficacy tapping into people’s experiences in the immediate aftermath of events.

Jamaica, or at least the island’s health authorities, seem on course to make the same mistake with respect to the COVID-19 pandemic, which is now morphing into an endemic disease.

The health minister, Christopher Tufton, must ensure that does not happen. He also owes the country an explanation for the previous shortcomings, as well as say who has been, or is to be, held to account for these failings. In doing so, the minister cannot extricate himself from responsibility.

Chikungunya (chik-V) and the Zika virus are spread through bites from the Aedes aegypti and Aedes albopictus mosquitoes, the same ones that transmit dengue fever and are found in Jamaica.

The chikungunya virus, for which there is no vaccine, leaves its victims with fever, joint pains, headaches and, sometimes, swelling and rashes. The symptoms usually last a few days, or up to a week. However, many people, especially those with other conditions, have complained that it often exacerbated their other ailments.

MAJOR OUTBREAK

In 2014, there was a major outbreak of the disease in the Caribbean and parts of Latin America, the first significant occurrence outside Africa and Asia. Jamaica was in the grip of the disease. Indeed, the Jamaican health authorities, on the basis of a 2016-2017 study, concluded that 80 per cent of the island’s population contracted the virus.

“Almost half of the people in Jamaica said they had chikungunya,” Dr Karen Webster-Kerr, the government’s epidemiologist, said at the 2018 release of the survey’s findings. “Of that (number), when we look at the case definition in terms of how many persons had fever and severe joint pains, only 24 per cent would have fit the case definition. However, when we did the test, eight out of 10 persons were infected with chikungunya.”

Many people still claim to carry lingering effects of the virus. This ought to make chikungunya a significant public health concern. Given the absence of a vaccine for the virus, another epidemic could recur.

The same, too, could happen with the Zika virus, whose outbreak in Jamaica – though not as expansive as chikungunya – was sufficient for the health authorities to advise women against becoming pregnant during the epidemic. One of the effects of the disease in some pregnant mothers is microcephaly, a condition in which babies are born with small heads, affecting brain development.

Zika infections are also associated with an increased incidence of Guillain-Barré syndrome, an immune system disorder that damages nerves, causing weakened muscles and, sometimes, paralysis.

Happily, as distressing as the chikungunya and Zika viruses were, and the havoc they wrought on people’s bodies, they did not kill many Jamaicans.

COVID-19 has. More than 3,000 Jamaicans have died from the disease since the island’s first COVID-19 death in March 2020.

CONTAINED SPREAD

Vaccines, other drugs, and new treatment protocols have, over the past year, contained the spread of the coronavirus that causes COVID-19, as well as deaths from the disease. But experts warn that it is entirely possible that new strains of the virus could emerge, weakening the efficacy of current vaccines and treatments.

In the circumstances, it is good sense that Jamaica’s health authorities should not only have documented lessons learnt and best practices from those outbreaks, but use that information to create contingency plans, ready for activation should the viruses return.

Yet, we have been told by the office of the auditor general, after a recent performance audit of the health ministry, that it did not happen for any for the last three epidemics that hit Jamaica.

The ministry did prepare management plans and protocols of chik-V and Zika, “however, we found no evidence that MOHW (Ministry of Health and Wellness) did an assessment and documented the lessons learnt from these health emergencies and incorporated post-event reviews to aid in responding to future health emergencies”, the auditor general said in the report.

Added the report: “An evaluation of the lessons learnt from the COVID-19 pandemic has not yet been conducted. MOHW indicated that a ‘formal assessment and documentation of the lessons learnt and how these lessons learnt from the COVID-19 pandemic are to be implemented to effectively prepare and respond to future health emergencies has not been undertaken’.”

The health ministry might not have the budget to finance its medium- and long-term strategic plans. That, however, is not an argument to be made for failing to document lessons learnt and best practices to be applied next time.