‘Scary and disappointing’

Dr Swinburne Augustine, a research microbiologist and immunologist at the United States Environmental Protection Agency (EPA), has fought his share of battles.

A former soldier, he has been decorated for his role in the Grenada invasion in 1983 when he was a member of the Caribbean Regional Security System allied with US forces as well in the invasion of Panama in 1989 and the invasion of Kuwait in 1990, working as an airborne combat medic in the US army.

However, the Caribbean-born Augustine is facing what is arguably his toughest battle yet: the war against COVID-19. His research is being adapted for use in the fight against the pandemic – and vaccine hesitancy.

As an increasing number of people – both in the Caribbean and the US – openly express their unwillingness to take the vaccine, Augustine advises those who are not sure about its possible impact on their health to speak with their doctors.

“What they should do is ask for advice from the doctor that they trust, who takes care of them,” Augustine told The Gleaner, noting that some persons trust their doctors with everything except when it comes to the COVID-19 vaccine.

It is the same advice that Trinidadian nurse Jad Singh* gives to patients who aren’t sure if they should be immunized against the highly contagious and deadly virus. Trinidad and Tobago has recorded over 43,750 COVID-19 cases, and Singh has treated hundreds of them. He has seen over 1,250 die from the virus and has had to advise people who are worried about contracting COVID-19 yet have questions about the remedy.

“I will tell the patient, which I often do, ‘at the end of the day, this is your choice. If you want to take the vaccine that is up to you’,” he told The Gleaner. “I tell them it’s an individual decision. This is not a decision somebody else should make for somebody.”

REFUSE THE JAB

But Singh, a nurse for 18 years, and Augustine differ in one key, fundamental area. While the scientist is convinced that the quickest way out of the pandemic is to get the vast majority of the population vaccinated as soon as possible, Singh has flatly refused to join the queue for the shots in the arm.

Across the Caribbean, the authorities are facing a difficult conundrum as roughly half of the practising nurses and a significant number of doctors remain adamant that they won’t take the jab even as they remain in the front line in the fight against the pandemic.

A visibly annoyed Trinidad and Tobago prime minister, Dr Keith Rowley, lamented at a recent news conference that only 50 per cent of nurses there had been vaccinated, complaining that this was so even after he chose to give the 2,000 doses of AstraZeneca vaccine he received as a gift from Barbados in February to the health department because he felt the workers were at greater risk of contracting the virus.

“Those 2,000 doses went to the health department, such was our understanding that the health department, being in the front line handling infected people, handling the virus in their workplace on a 24-hour basis, that vaccination was their right to be allowed to work in that place to save the rest of us,” said Rowley. “So today, I must say I’m a little taken aback that vaccines being available, even choice of brand, and we only have an uptake of 50 per cent.”

Barbados and Dominica were the first English-speaking Caribbean countries to receive the COVID-19 vaccine after India’s prime minister, Narendra Modi, made gifts of 100,000 and 70,000 doses, respectively, to the two governments. Yet both continue to register low rates of vaccination among medical professionals, particularly among nurses.

It is not immediately clear what percentage of healthcare workers in Barbados are immunized, but in Dominica, the authorities revealed this week that while 63 per cent of doctors were fully vaccinated and another 10 per cent had had their first shot, a startling 70 per cent of nurses were unvaccinated, with only 27 per cent fully immunized.

DO NOT TRUST GOVERNMENT

It’s a “scary and disappointing” situation that plays itself out across the Caribbean, said Dr Carissa Etienne, director of the Pan American Health Organization (PAHO), who told The Gleaner that a recent survey found “significant hesitancy among nurses and doctors of the Caribbean”.

This pushback against the vaccines also comes as somewhat of a surprise to the PAHO boss mainly because of the region’s history with vaccines.

“For the entire region of the Americas, it is the Caribbean countries that have led the way in terms of elimination of these vaccine-preventable diseases, in terms of the level of coverage for all of these other vaccines. So I’m surprised by this copycat attitude all of a sudden,” she admitted.

Dr Etienne surmised that a lack of understanding among some in the medical field of the mRNA technology used to create the COVID-19 vaccines was to blame for the level of hesitancy.

However, vaccine-hesitant healthcare workers told The Gleaner that a lack of trust in governments and insufficient information about the vaccines, along with a feeling that they were being pressured to take the jab, were at the root of the problem.

“I do not trust this government,” stressed Heidi Jackson*, a nurse at a COVID-19 facility in Dominica. “I am also afraid of getting the side effects, which for now are unknown. Who’s to say a few years down the line whatever is in the vaccines won’t affect me greater than the COVID-19 itself? Unless I can get some concrete answers, I will not be taking the vaccine. My job entails saving people’s lives, and I start with mine first.”

In a rather important symbolic gesture, a public health nurse, Marcia Thomas-Yetman, was the first person in Jamaica to receive the coronavirus vaccine back in March. Since then, there has been a less-than-spectacular increase in the number of healthcare workers taking the jab.

Jamaica’s health ministry reported recently that 65 per cent of healthcare workers had taken the first dose, and just over 40 per cent had taken the second shot. It was not immediately clear how many among those were nurses or doctors although the uptake among doctors is said to be “high”, and the Nurses Association of Jamaica recently reported that 70 per cent of its members had received the COVID-19 vaccine.

And even though the numbers in Jamaica are better than in other English-speaking Caribbean countries, the issue of trust remains a concern, according to Dr Sherridene Lee of i-doc Concierge Wellness Services Limited in Montego Bay, St James.

“I think in general, in terms of the Caribbean, or even the US, I think the problem in taking the vaccine is lack of trust in our leaders,” the 33-year-old double-jabbed doctor told The Gleaner. “I think the big problem is how the vaccination is being done and not the vaccine itself.”

The trust issues being experienced currently were not unpredictable. Back in February, The Sunday Gleaner reported that a survey of 33,000 people in 20 countries conducted by the US public relations and marketing consultancy firm Edelman last October and November, had found “an epidemic of misinformation” and “widespread mistrust of institutions”, with governments and media among the least trusted.

The Sunday Gleaner also reported at the time that this lack of trust also extended to the vaccination programmes, with a significant number of people indicating that they had no intention of taking the jab, based on a global survey on trust conducted by Imperial College London between November last year and mid-January of this year.

While doctors and nurses were not identified in those surveys, it has become clear that a large percentage of them share the sentiments of the general public, who are unsure and untrusting.

TRUST THE PROFESSIONALS

The authorities across the region can begin to earn back some of this lost trust by trusting these very health professionals, suggested Dr Lee.

“You can’t say to a doctor, ‘go take a vaccine and lead by example’ if the doctor is asking various questions that are not being answered. So I think more of the medical community [need to be] invited into talks and our opinions and our voices heard, and [there needs to be] a real conversation about the vaccines and the way forward,” argued the young doctor.

“It’s not that they don’t trust the vaccine itself. I don’t think they trust the process, not of making the vaccine, but the rationality behind how they’re doing the vaccination.”

Still, there are those in the nursing profession, like B. Samuel of Dominica, who believe in the many conspiracy theories about the vaccine that are shared on social media.

“I’ve done enough research to know that this vaccination is just another scam by the pharmaceutical companies, and I will not be putting it in my system,” Samuel, who has been a nurse for 11 years, told The Gleaner.

“Many [patients] find it surprising that I am a healthcare worker and don’t believe in this vaccination, but before I am a healthcare worker, I am a human being who still has freedom of choice and the right to have a say in what goes into my body.”

Arguments such as these are perplexing to Dr Augustine, the EPA research microbiologist and immunologist, who was a nurse for 14 years before he became a scientist.

“If you are a medical professional and you are against vaccination, then that is not the profession you should be in,” asserted Augustine. “You are doing a disservice to your patients, to the public, and you’re doing much harm to the scientific and medical community.”

*Names changed to protect identity.

editorial@gleanerjm.com