A Perspective on The COVID-19 Vaccine Challenge: Access or Attitude?

By Dr. Ron Sookram –  Academic Director, The UWI Arthur Lok Jack Global School of Business

28 October 2021

Reading Time: 7 minutes

Twenty months and counting, the COVID-19 pandemic continues to be as headstrong as it was at the very beginning. Countries have implemented various mitigating strategies to address the spread of the virus. These have ranged from the mandatory wearing of masks to full-scale lockdowns including the closure of national borders. Globally, an estimated 244 million persons have been recorded as being infected while at least 4.95 million persons have died from the virus (Our World in Data, Oct. 21). In addition, the global economy significantly contracted leading to the deepest economic recession in nearly a century (OECD, Oct. 2021).

Facilitating Accessibility

Several medical experts considered the development of vaccines and thus the inoculation of the world population as the best option to effectively reduce the spread of the virus to a level that is manageable. In addition, many business and political leaders reasonably assumed that vaccination was needed to return life to some form of normalcy and certainly economic recovery. With unprecedented pace, at least 6 types of  COVID-19 vaccines became available with the approval of the World Health Organisation (WHO) by early 2021.

Prior to the successful development of these vaccines, world leaders recognised that if appropriate steps were not taken, the availability of the vaccines will not necessarily guarantee access to poorer or lower-income countries and peoples of the world. This resulted in the COVAX procurement initiative which was expected to guarantee fair and equitable access to vaccines for all people in all countries. As stated by Seth Berkley, CEO of Gavi, the Vaccine Alliance, in September 2020,  COVAX is “the world’s largest and most diverse portfolio of COVID-19 vaccines, and as such represents the world’s best hope of bringing the acute phase of this pandemic to a swift end.” (Berkley, September 2020).

To a large extent this goal of COVAX has not been achieved. According to the Financial Times (25 Oct. 2021), less than 3 per cent of people in low-income countries have received at least one-dose compared with three quarters in richer nations. COVAX has delivered about 400m doses out of a yearly projection of 1.4bn. On the other hand, through bilateral and multilateral agreements, wealthier nations have bypassed COVAX and engaged vaccine manufacturers directly. These rich countries are now in the phase of rolling out booster shots which will also prevent numerous persons from low-income countries from getting their first shots. The Financial Times concludes that the consequences of this situation are “far-reaching, as insufficient inoculation in poorer regions could lead to a rise in cases and the emergence of more virulent strains, and hold back the global economic recover.”

Officials from the WHO have reported that just 37% of people in Latin America and the Caribbean have been fully vaccinated against COVID-19, almost half the rate of Canada as emerging economies struggle to access the life-saving vaccines (WHO, Oct. 2021).  Further, Director of the Pan American Health Organisation (PAHO), Dr. Carissa Etienne, indicated a general lack of vaccine availability as the main factor restricting immunization rates in both regions. The PAHO Director further elaborated that disparities in vaccine distribution are especially stark in Jamaica, Nicaragua and Haiti where less than 10% of the population has received a full series of COVID doses. The inequities in access is certainly a critical contributory factor that partly explains the low vaccination rates in both regions.

Response to getting Vaccinated

Vaccine hesitancy however is also impacting the low vaccination rates in the Caribbean region.  Most English Speaking Caribbean countries were fortunate to obtain vaccines from both COVAX and other sources (for example, donations from India, USA, and China) yet their vaccination rates remain low. Even among middle-income Caribbean countries such as Barbados and Trinidad and Tobago vaccination rates are below 50% despite the availability and access to vaccines. The table below shows the status of the percentage of population that has been fully vaccinated as of 25 October 2021 among a sample of Caribbean countries:

Source: Our World in Data, COVID-19 vaccine Statistics Data, 25 October, 2021

It is striking to note that with the exception of Anguilla, no other English Speaking Caribbean country has been able to fully vaccinate over 50% of its population. Trinidad and Tobago, Jamaica and Barbados, considered to be the more advanced economies in the region, have been unsuccessful in surpassing this threshold. While these countries are slowly reopening their economies, with attempts to create safe zones for the vaccinated in some cases, the majority of their populations remain unvaccinated.

 Admittedly, vaccine hesitancy is complex because people delay or refuse vaccination for many reasons. However, it is reasonable to assume that the region’s low vaccination rate is partly a result of the communication and legal strategies employed by leaders in government and health. Although their common intention is to encourage citizens to get vaccinated, the impact has been opposite. There are persons who consider the approach as infringing on their constitutional rights.

For example, the Covid-19 Transparency Advocacy Group of Trinidad and Tobago (CTGATT) was established to “advocate the sovereignty of the human being and the right to choose what we put into our bodies” (c19-transparency-tt.org). The CTGATT is seeking for the government to recognise the rights of individuals to decline taking the vaccine and to also consider alternative solutions to the pandemic. This suggests that the approaches to be used by our leaders must demonstrate that citizens’ right to choose whether to be vaccinated is not being infringed and, at the same time, clearly outline the reasons why vaccination might be the most appropriate option to managing the pandemic.

Further, a significant number of persons do not believe that the COVID-19 vaccines are safe. The speed in which these have been developed and approved as well as their associated side-effects are key issues contributing to vaccine hesitancy. Similarly, the communication strategies employed by our leaders need to address these issues in an easy-to-follow and unambiguous manner.

Moreover, a simple but possibly a major contributory factor to the situation, is the fact that many people are afraid of needles. Associate Professor of Psychology, Meghan McMurthy (2021), indicated that for about 1 in 10 people, this is a reality, and it has impacted the COVID-19 vaccine campaigns. For example, a COVID-19 poll showed that of Canadians who did not plan being vaccinated or were not sure, six to seven per cent had delayed previous vaccinations because of needle fear (McMurthy, 2021). Consequently,  a fear for needles can lead to escape behaviour resulting in a delayed decision to get vaccinated. Our health related authorities should then consider how help can be provided to such individuals.

In general, it must be made clear that COVID-19 vaccines are there to protect individuals from getting severely ill from the virus as well as to avoid the emergence of new variants or strains. Vaccination is considered the quickest and safest option in getting countries back to some form of normalcy. The ongoing appeals by Health Ministers, Chief Medical Officers, Prime Ministers and other leading figures for citizens to get vaccinated have not worked. More effort has to be made to find innovative ways to combat misinformation or fears related to vaccination.  Dr. Etienne (PAHO) has also called for vaccine distributors to bring doses directly to communities, transportation to vaccination clinics and clearer communication on the safety and effectiveness of current vaccine options.

Impact on the Economy

The pandemic’s impact on the region’s economies are obligating governments to take relief measures such as tax cuts, tax deferrals, grants to households and businesses. In addition, governments have had to increase funding for health infrastructure, medical equipment and personnel. These  measures were initially based on emergency conditions when a long-term solution to the pandemic was unavailable. Governments are unable to sustain these measures and will soon be forced to phased them out. These relief responses according to IMF Acting Director, Nigel Clark,  “come at a price to economic stability and the pandemic is still around even though vaccines are available” (CMC Oct. 2021). The implication is that the longer these emergency measures are kept the more painful the economic recovery will be. In short, improved health conditions are essential for the region’s economic recovery.

How Can Business Leaders Help?

The business community can play an important role as well. No business was left untouched by the pandemic and the effects are ongoing. However, the pandemic did not only affect the bottom line, it also prompted fundamental changes in the way business operate. In many cases the decisions made during the pandemic will facilitate long-term success and financial stability. Nevertheless, the safety of employees and customers depends on containing the virus. Any employees or customers who get sick can have a direct impact on operations and bottom-line (HealthPartners, 2021).

Where restrictions have been lifted companies are trying to navigate issues associated with vaccinated and unvaccinated employees. Most companies have made unvaccinated employees absorb the testing costs for COVID-19 as a compromise to mandatory vaccination requirements.  However, based on the large number of unvaccinated people there is a high probability that there can be the emergence of new COVID variants or outbreaks, and with it forced reintroductions of lockdowns.

At any rate, businesses are reopening and will desire to stay open. For this to happen, the vaccination rate needs to significantly increase. Business leaders can help their employees understand how the decision to get vaccinated can have a positive impact on the business as well as the country. At the same time business leaders need to explain to unvaccinated employees how they could put others at risk. Quoting HealthPartners , “there is a strong case to be made that vaccinations can help ensure that your business is a safe place for people to work and for customers to spend their money.”

The large quantity of available information from diverse sources have created confusion and distrust among people. People are possibly looking for a source they can trust. Business leaders can use this as a great opportunity to help the vaccination rate. According to the 2021 Edelman Trust Barometer business is the most trusted institution at the moment. This is largely a result of the behaviour of business during the pandemic stepping up with measures to keep employees safe and employed. On this basis of trust business leaders can be involved in the conversation about vaccination, providing valuable support in demystifying the safety of vaccines and correcting the widespread misinformation and consequently, combating vaccine hesitancy and scepticism.

By aligning the message with that of leading experts at the government or health authority levels, while also personalizing communications, business leaders can strengthen their employees’ confidence in the vaccine and willingness to get vaccinated.  By an understanding that being vaccinated is the safest and quickest way to get to the new normal, where we have the best protections in place to keep people and business safe and healthy, we can encourage people to get vaccinated. This is arguably a winning approach because by impacting the vaccination rates your business would also benefit.