Five weeks after countries across Latin America and the Caribbean began receiving COVID-19 vaccines from a World Health Organization-backed alliance, Haitians have yet to receive a single dose.
Preexisting health infrastructure shortcomings, lack of planning, logistical delays and concern from health authorities about the safety of the two-dose AstraZeneca shots being supplied by the international community have delayed the country’s vaccine campaign from starting.
“We are all working hard with the government of Haiti, the Ministry of Health and other stakeholders so that Haiti can receive vaccines as soon as possible,” said Dr. Ciro Ugarte, director of health emergencies for the Pan American Health Organization, the WHO’s Americas branch.
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Haiti is among 10 countries in the Americas that will receive vaccines at no cost through COVAX, an initiative to provide COVID-19 inoculations to countries that would otherwise have difficulty getting them. The nation of more than 11 million already struggled to administer routine vaccines and provide basic health care before the pandemic. Now those hurdles are coming into sharp relief as the country tries to get a COVID-19 vaccine campaign off the ground.
Bureaucratic holdups are also adding to the delay — some say, unnecessarily.
A high-ranking official involved in Haiti’s vaccine distribution plans, who spoke on condition of anonymity because he was not authorized to discuss the work underway, said the country is treating the COVID-19 shots like any other vaccine shipment when it requires an expedited, special import authorization. Other countries have allowed emergency procedures and quick authorizations to get the vaccine.
PAHO spokesman Daniel Epstein said Haiti has not yet completed all the regulatory steps to authorize the import of the AstraZeneca shots. It also only recently completed several legal and administrative processes required by COVAX and vaccine producers.
“There are some administrative and legal processes regarding decisions that were made just a few days ago,” Ugarte said. “We need to complete the processes so that Haiti can receive vaccines.”
The country is so far behind in preparing for the shots that even when offered free vaccines through India earlier this year, the government asked that they be sent later, an official said.
In February, India offered Haiti 10,000 doses of Covishield, the India-produced version of the AstraZeneca vaccine, as part of the nation’s efforts to ship vaccines to low and middle-income countries in the region. But the country wasn’t ready to store and administer the shots, and ended up asking India to hold off and try sending them again later, Dr. Lauré Adrien, the director general of Haiti’s Ministry of Public Health and Population confirmed to the Miami Herald.
Adrien said that without a well-established vaccination strategy and proper storage it “just didn’t make much sense” to accept the donation at the time.
“We would end up with 10,000 doses that would have been expired and need to be destroyed,” Adrien said. “We had to postpone it to a later date in time for us to assure good use of this precious but perishable gift.”
The country also raised concerns about storage and conservation of COVID-19 vaccines with Gavi, the Geneva-based public-private vaccine alliance that is leading COVAX with the WHO.
As part of its first shipment from COVAX, Haiti is slated to receive 756,000 doses of the AstraZeneca vaccine. The doses will arrive by the end of May if all the requirements are fulfilled, Epstein said. The shipment would fully immunize around 3% of the total population, with priority given to frontline health care workers and people who are at highest risk of suffering complications from the virus. But that shipment is currently delayed. The main Indian supplier, the Serum Institute of India, recently decided to halt exports of AstraZeneca shots, which could further slow the vaccine rollout.
Dr. Jarbas Barbosa, assistant director of PAHO, said Haiti, Bolivia and Nicaragua are all seeing a delay in AstraZeneca vaccine shipments after the major Indian supplier announced this week that it will be prioritizing India’s domestic needs over vaccine exports as cases surge. Barbosa and a spokesman for Gavi said officials are in talks with India’s government to quickly resolve the issue.
“It’s important to guarantee that these contracts can be fully accomplished so that we can have the vaccines being delivered to all of the countries,” Barbosa said Wednesday during a weekly call with regional journalists on the situation of COVID-19 in the Americas.
While Latin America and the Caribbean continue to be a hotspot for COVID-19 infections, accounting for more than half of all global deaths reported over the last week, Haiti so far has been spared the worst of the pandemic. There have been less than 300 reported deaths, and 12,840 confirmed infections. In comparison, the Dominican Republic, located on the same island and with roughly the same number of people, has registered 3,369 deaths and over 255,000 infections.
The low number of cases, despite overall poor compliance with protective measures like wearing masks and avoiding large gatherings, such as Carnival and almost weekly mass anti-government protests, has surprised doctors. Though some attribute the low number of reported infections to the country’s fairly young population (more than half are under the age of 25), no one is completely sure if that’s the reason the pandemic has been relatively mild there.
Beds designated to treat infected patients have remained largely empty and COVID-19 treatment centers like one opened by Doctors Without Borders/Médecins Sans Frontières in Port-au-Prince closed after only months of operation due to a lack of patients. Plans to turn local soccer stadiums into over-sized hospitals also were scratched.
All of this, along with deep mistrust of the government, a widespread belief that the virus isn’t anything more than “a little fever,” and the stigma attached to those who get it, have sparked a debate within the country about whether vaccines are even needed.
“From an epidemiological point of view, we do not need the anti-COVID vaccine. It is not a public health hazard now. I do not know about later on,” said Dr. Ronald Laroche, who runs a network of low-cost healthcare clinics and hospitals in Haiti that provide COVID testing. “Our problems right now are maternal mortality, infant mortality, malnutrition.”
Nonetheless, the government is proceeding with ensuring that the proper infrastructure needed to administer the shots is in place after officials agreed that people do need to be vaccinated, said Foreign Minister Claude Joseph.
Haiti asked Gavi to consider changing the AstraZeneca vaccine in light of reports out of Europe that the manufacturer’s shots could pose a blood clot risk, but never refused the inoculation, Adrien, of the health ministry, said.
The European Medicines Agency has said it found “a possible link” between the AstraZeneca vaccine and “very rare cases” of blood clots. But the benefits of getting vaccinated still outweigh the risks, it said.
Throughout the pandemic, Haiti has had to rely mostly on PAHO for test kit donations. The government did set aside some money to purchase protective equipment, ventilators and other medical equipment, but a human rights research center later accused the government of embezzling $1 million in funding, part of $34 million in contracts the government disbursed with no oversight. The allegation was recently mentioned in a U.S. State Department human rights report.
Haiti health ministry officials did not respond to questions about the alleged misappropriation.
Even before the COVID-19 vaccine, Haiti faced challenges with its immunization system that in the past has prevented it from acquiring certain vaccines for free because it failed to meet minimum standards for assistance.
The government reported that 79% of all children had been inoculated against diphtheria, tetanus and pertussis in 2018, the last year for which data is available. Gavi, however, reported the number was in fact considerably lower, at 64%. To be fully immunized, children must receive all three doses of the vaccine before their first birthday.
DTP3 vaccine coverage is considered a valuable benchmark in assessing immunization performance.
Adrien said the ministry has been following reports about unusual blood clots and the recent deaths of seven people in the United Kingdom after getting the AstraZeneca vaccine and is concerned. In asking Gavi to consider providing an alternative shot, he said officials should also weigh the difficulty of administering two doses in a country with widespread transportation and communications issues, a population hesitant over vaccines in general and an overall relaxed attitude toward COVID-19.
“We thought that a vaccine to be administered in a single dose would be more accommodating to the country,” he said.
For now, however, the only single dose vaccine, by Johnson & Johnson, has not yet been authorized by the WHO for emergency use. If Haiti wants those vaccines, the country will have to pay for them.
A spokesman with Gavi said discussions are ongoing with the Ministry of Health in Haiti to address safety concerns in relation to the AstraZeneca shots. The Caribbean nation has provided requested technical details on administrating the shots, but an agreement outlining legal liabilities has not yet been signed, the official said.
“COVAX and its partners continue to work with governments to address any challenges that may arise so that health systems are ready for widespread deployment as further doses become available,” the spokesperson said.
