This is a series of reports by the AALL FCIL-SIS Latin American Law Interest Group and Latino Caucus in a project monitoring COVID-19 legal responses in the Latin America and Caribbean region.
By Yasmin Morais
On September 16, 2021, Marcelo Rodriguez, Foreign and International Law Librarian at the Daniel F. Cracchiolo Law Library, James E. Rogers College of Law, University of Arizona, and the founder of Law Librarians Monitoring COVID-19, welcomed participants to the fifth panel called Accessing Resources and Information During the Pandemic (CARICOM, OECS, PAHO) in a series of 8 webinars for the Conference on Access to Information: Latin America and the Caribbean (CAI:LAC).
Moderator, Janette Bulkan thanked Marcelo and welcomed everyone. She then invited Dr. Carleen Radix to tell participants more about the OECS, what the acronym means, and her role in the organization.
Dr. Radix described the OECS as a regional grouping of Caribbean states that came together in 1981. Its membership comprises most of the English-speaking eastern Caribbean states and two French-speaking territories. They share a common currency, and they are also a part of CARICOM. She is the Head of the Human and Social Division which is made of up several units including Health and Education, and in this role, she provides oversight for the Pool Procurement Service.
In answer to the question of What is CARICOM? Dr. Karen-Gordon Boyle informed the session that CARICOM was formed on July 4, 1973, through the Treaty of Chaguaramas with the four original member states of Barbados, Guyana, Jamaica, and Trinidad and Tobago. Twenty countries are now a part of CARICOM, with fifteen being members and five as associate states. She also noted that CARICOM continues to work for better trade relations with Europe, Africa, and Asia based on the Cotonou Agreement of 2000. The Cotonou Agreement is a treaty between the European Union (EU) and the African, Caribbean, and Pacific states (ACP). Dr. Gordon-Boyle is the Program Manager of the Health Sector Development Unit. With respect to health, CARICOM plays a coordinating role and works closely with PAHO and the Caribbean Public Health Agency (CARPHA) in shaping policies relating to health and development and bringing Ministers Health in the region together.
Dean Chambliss, who is the Sub-Regional Program Director of PAHO, advised that PAHO has been in existence since 1902 and will soon be celebrating its 120th anniversary. The organization is both a public health agency as well as a regional office for the World Health Organization (WHO). PAHO maintains country offices in the region.
OECS Pool Procurement Service (PPS) for Covid-19
Dr. Radix shared that the OECS PPS was established in 1986 and is a self-financing mechanism for small states to secure medications and medical supplies. As a result of the pooling, over eight hundred products were procured for hospitals and health centers across nine OECS states. The overall benefits of PPS are: reduction in prices, sharing of information/capacity, and the building of supply chains.
Since the pandemic, PPS was put in high gear due to limited market availability and governments in the region competing for supplies. PPS allowed member states to obtain supplies of critical response items, quickly. The Caribbean Disaster Emergency Management Agency (CDEMA) and CARICOM/PAHO also partnered in this effort.
CARICOM’s Negotiations with the African Union for Vaccines
Dr. Gordon-Boyle discussed CARICOM’s partnership with the African Union with respect to the negotiation of prices and vaccine supplies, largely due to the Cotonou Agreement. With the goal of achieving herd immunity of 90%, CARICOM worked to be considered a part of the AU’s negotiation. She noted that it was difficult in the early stages for CARICOM to negotiate vaccine prices, and how more developed states benefitted early on, and even had surplus, while smaller states had a deficit of supplies. To date, CARICOM’s negotiations resulted in the acquisition of up to 466,500 doses of the J & J vaccine, from a company in South Africa, with up to three million doses available to be accessed, funds permitting, because of the African Vaccine Acquisitions Task Force.
She also explained that the J & J one dose vaccine proved useful in efforts to reach indigenous communities in Guyana and Suriname, for example because of the transient nature of these populations, many of which are located hundreds of miles from townships. There was the concern that it would be harder to locate them for follow-up doses for vaccines requiring two doses, so the J & J vaccine was ideal for this situation.
PAHO COVAX Facility
Mr. Chambliss shared details on PAHO’s COVAX initiative, which is like the OECS response, except that it covers the entire hemisphere. PAHO provides pool purchasing of vaccines and COVAX provided partial quantities for the Caribbean. PAHO also acts as a knowledge broker and provides technical support in delivering health care both for communicable diseases and other non-COVID services. PAHO also provides evidence-based data and policy recommendations on COVID. He mentioned that one of the main challenges of PAHO was in helping countries in the region manage non-communicable diseases during the pandemic and with the overwhelming demands of COVID-19, it was difficult for the region’s public health systems to maintain continuity.
The Importance of Communication and Initiatives Launched During COVID
The moderator then asked the panelists about the importance of communication and what were some of the challenges due to COVID. Dr. Radix noted that both the WHO and PAHO were sources of information on COVID and spoke about one initiative that was launched in June 2020 by the OECS, namely OECS Link. OECS Link, an interactive short series, reached out to ask young people to share on social media what was happening during the pandemic. A technical expert was also included to provide further information. OECS also used both French and English creoles in four member states to communicate widely. Another initiative was the OECS’ Yes Program, involving schools. Students interviewed teachers and discussed events unfolding during the pandemic.
Dr. Gordon-Boyle elaborated further on CARICOM’s communication initiatives and strategies. CARICOM relied on WHO, PAHO and CARPHA as the sources for technical information related to COVID-19. She noted that the Caribbean Public Health Agency (CARPHA) was an implementing agency and they had done a study on vaccine hesitancy. Based on their findings, they developed videos of persons who took the vaccine and their experiences of having no side effects. CARPHA also hopes to eventually develop a campaign aimed at vaccine hesitancy based on the study.
In response to the moderator’s question on how PAHO has used its knowledge of non-communicable diseases to address COVID, Mr. Chambliss said he wanted to focus on the mental health aspect of non-communicable diseases. He advised that PAHO, in collaboration with the Caribbean Development Bank (CDB), used a campaign related to mental health and coping strategies called Stronger Together, which was launched before the pandemic and later adapted to COVID-19. It is aimed at adults and children and the focus is on achieving strong mental and psycho-social health. He stressed the importance of resilience, and helping people who need information, support, and training in individual countries.
With respect to the question of what’s next for the OECS in dealing with COVID-19, Dr. Radix pointed out that no one anticipated the pandemic and the unfolding story of COVID-19, and that for the Caribbean, it has been a significant blow. We had the benefit of seeing the virus come from across the world and that we could try to anticipate our response. However, the region has learned from other countries and has prepared systems. The challenges are that although vaccines are now available, there is hesitancy, as well as new waves of infection with the highly transmissible Delta variant. The impact on the region’s economy is significant, especially relating to tourism and travel. There needs to be a balance as we move forward to deal with the health system and the economy. The struggle continues as the numbers are increasing with the variants. As in the rest of the world, our health systems are overwhelmed. It will require all hands on deck now, and the vaccine is our biggest tool in our toolbox.
Dr. Gordon-Boyle, in responding to what is next for CARICOM in getting the economy moving and keeping people safe, indicated that it has been over a year since member states have been dealing with lockdowns and other pandemic-related issues. The hope is to get back to normal. She advised that CARICOM has been working on policies to help countries reopen responsibly, and that while some of the policies were regional in nature, they could be adopted. Some of these policies relate to quarantining, and evacuations related to volcanic activity and countries have been receptive to the policies. They had to develop draft policies that are regional in nature that can be adapted and adopted and tweaked by countries to meet their needs. She also mentioned the issue of mandatory vaccine and that,the WHO prefers working with people as opposed to mandatory vaccination. Dr.Gordon-Boyle also shared CARICOM’s concern on how overwhelmed the healthcare workers and systems are and that it is critical to slow the rate of spread of the virus. The Caribbean has done well compared with some countries in terms of hand washing and mask wearing for example. CARICOM wants to encourage immunization as an effective tool.
PAHO – What Are the Lessons Learned Regarding Sovereignty and How Has PAHO Maneuvered in Relation to the Vaccine?
Mr. Chambliss noted that earlier, many Caribbean countries did well prior to vaccine due to public health measures until the Delta variant. This has led to increased cases. Central and South America have different issues. Vaccine rollout has also been only partially successful due to issues of supplies, demand, and misinformation and varies a lot across Caribbean states. Supply of vaccines has now opened up and most countries have adequate supplies. PAHO’s main role is to provide evidence-based data through public service announcements to ensure.accurate health information. Vaccine coverage is the most effective effort, and the challenge has been to promote this.
Dr. Radix responded to the question on what is the major takeaway for the next pandemic? She pointed out that the region is not a stranger to shocks, being the region described by some as the most disaster-prone are in the world from hurricanes, earthquakes, volcanos, re-emerging epidemics, and outbreaks of Dengue and new diseases such as and Chick-V and outbreaks of Yellow Fever. She also shared that the Caribbean has a good history of vaccines and was the first region to eradicate other diseases and we have strong immunization and public health measures, and we need to remember this and go back to basics. We need to work together. There is also good collaboration among states. Those would be the major lessons.
CARICOM Challenge of COVID in Haiti and Other Lessons Learned Over the Last Eighteen Months
Dr. Gordon-Boyle reiterated that every member state has experienced COVID-19, and every state is sovereign. and have experienced COVID. She confirmed that Haiti took a while to administer vaccines and was the last member state to do so. Their government has a right to do what they want for their people. She stated that CARICOM does not dictate to individual governments and the final decision is up to the member state but rather we can only support them. Haiti is now on board, and they will also be able to access the three million doses of vaccines previously mentioned. There is also potential support from the World Bank and the Caribbean Development Bank (CDB) to make loans available to countries that do not have the cash to meet their needs. So, there are several initiatives out there.
Among the other challenges experienced across the region are: mental health issues and needs, fears and worries regarding COVID, lockdowns and the attending loneliness. There is the stress of daily living with this disease that cannot be seen. There are people who are stressed about being locked up in a house with children and other issues, while others have the problem of being under lockdown alone and going crazy. She shared an example of someone writing to CARICOM regarding the economic impact of the pandemic. Member states need a social net, and the economic impact of the pandemic must also be remembered. Food and shelter are dire needs.
The moderator also made the point that there is also the possibility of a lost generation of students who have had to miss school.
Challenges of Language, Size, and Mainland Versus Islands
Mr. Chambliss mentioned that strong health systems are an answer to these challenges. Across the region there is the issue of the ability of health systems to manage. They need to be well-funded, and emergency preparedness and response require improvement. The challenge is to continue to build capacity to prepare for and manage future epidemics or pandemics. Other needs are people’s access to primary healthcare up to tertiary level, universal healthcare, and new investments in digital health products to share information in a timely manner.
At this point in the presentation, there was a chat question from audience member, Patricia Bisnott on whether there has been mobilization of CSOs and faith-based organizations. The following responses were provided to the question:
Dr. Radix: These organizations play a vital role and have always played a vital role with health and are strong partners for the health of communities with respect to education. For example, diabetes and hypertension, cancer organizations doing screening and education as an extension of the health system. We need to engage and make better use of these organizations, especially in relation to getting the message out such as taking vaccines, for example. They are also strong partners for mental health. Yes, there is a significant role and yes, we could be doing more with these organizations.
Mr. Chambliss: Partnerships with civil society organizations are critical across the Caribbean. We have some very strong civil society partnerships. PAHO must be neutral and cannot advocate but these organizations can. They are critical in the vaccine effort. Faith-based leaders are effective since people listen to those they trust, particularly in view of misinformation throughout the Caribbean.
Dr. Gordon-Boyle: I agree with my colleagues. There is need for an entity to work with them. They can be a part of the problem or a part of the solution, for example the misinformation and hesitancy among some faith-based groups. Faith based organizations have a reach in the community and when they do not believe in vaccines, they are a part of the problem. We need to work with them and try to understand their hesitancy. We also need the participation of the police and other multi-sectoral agencies.
There are examples in Guyana where faith based organizations have had success in administering vaccines and some have taken the bull by the horn. Humanitarian organizations such as The Lions and Rotary Clubs have also helped with sanitation such as installation of sinks and promoting hand washing. We have had ad hoc response and this needs to be organized, and our response must be multi-sectoral. Social services must be on board in turning this epidemic around. We need a governing body to make sure what needs to be done is done. Enforcement is critical. Some countries have systems that are approaching breaking point and CARICOM has to avert it, especially with immunization.
The moderator posed the question on whether the new norm will be digital healthcare, telemedicine, or virtual care and panelists gave the following responses:
Dr. Radix: This is something we have been looking at as small island states. Our populations are small. The health systems were often overwhelmed even before COVID. Telemedicine has been used to bridge the gap. COVID-19 accelerated these things that we had been thinking about. How do we bring the specialist in and get the patients out? Dr. Gordon-Boyle asked about where is our reserve. We have a reserve in our diaspora, but we are not engaging them. How do we create these virtual systems to engage the diaspora? I want to mention one thing that is being done virtually. This is what we call a Virtual Tumor Board, which is a multi-disciplinary team for cancer. This was created to bring specialists together virtually. As small states we only have few specialists that we can bring from abroad. Cancer cases can be discussed, and the resources across the islands. We can make plans based on what we have across countries. This is a pilot program.
Dr. Gordon-Boyle: Since 1989, the Caribbean had suggested that we should have a regional licensing board. We still do not have this in place. The free movement of physicians and nurses across the region would help, particularly if one country is in dire need and this would be at the policy level agreement and for Caribbean heads of government to approve the policy. The diaspora has a pool could also assist, and Ministries of Foreign Affairs and ambassadors might need to reach out to make this happen. We need to look at the Caribbean Association of Medical Councils (CAMC) and CAMC needs to be ratified, so that is another possibility.
Mr. Chambliss: Telemedicine has existed but it is very fragmented. We have seen interesting examples in telemedicine, especially in The Bahamas due to its many islands. There are successful best practices but not in a systematic way. There are some successful best practices to build on. The Caribbean must be able to pool its resources and sends personnel across borders mainly because of the economies of scale.
While the moderator waited for questions from audience members, she mentioned the work and successes being done at the University of Guyana with respect to reaching indigenous populations and getting the message out, particularly work being done by the Amerindian People’s Association. She asked whether we should be doing more in creole languages.
Dr. Radix: In the Caribbean, we are story tellers and orators, and we speak to each other based on our history of sharing information. She noted that mask-wearing, social distancing and speaking with each other mainly online now, have affected our communication. What is important is meeting people where they are, and we need to use our ways of communicating.
Dr.Gordon-Boyle: One size does not fit all. In the United States there are many cultural groups, and one group has had historical distrust of the health system. The challenges for indigenous groups are language and seclusion. However, a bigger challenge is locating them or physically reaching them due to the transient nature of these groups. That is why the J & J vaccine has been a godsend for this group. It is not known if indigenous groups have been more hesitant of vaccine than other groups. This would be an interesting study. There is also a huge cost in reaching them. Another challenge is maintaining the vaccine’s cold temperature over the long distances to reach indigenous communities.
Indigenous populations are also put in jeopardy by gold miners and loggers, etc. in Suriname and Guyana, with the spread of disease by these groups and the impact on indigenous populations.
Dr. Radix: We should continue to use public health measures from the past. This conference has been interesting. We must work together. This is key, and we have been doing this as a region. We need to continue to use the public health measures we have used in the past. Most islands now have three options for vaccines, so we need to get vaccinated. We also need to keep the conversation going, particularly with respect to mental health. We will have to try to do everything to get us out of this pandemic.
Dr. Gordon-Boyle: COVID-19 has reminded us that the world is now a village. No one is safe until we are all safe. She urged everyone to get vaccinated since we don’t want to overwhelm our fragile health system.
Mr. Chambliss: He expressed thanks for the opportunity to serve on the panel. The silver lining is that nothing in living memory has shown us the economic impact of diseases and we need to ensure that the health sector is strong for economic prosperity. Economic concerns often drive policy. Hopefully the Caribbean region and the world will learn from it and that we cannot ignore the health sector and how important health is to economic prosperity.
The moderator thanked all the panelists, stating that we have learned a lot and it has been a rich and wide-ranging conversation. She indicated that the next panel would be discussing Brazil, and again expressed thanks for the thoughtful and wide-ranging responses. She also thanked Marcelo Rodriguez and the group of librarians for these sessions and shared that recording of the session will be available.