democraciaAbierta: Opinion

The assassination of Haiti’s president may worsen its response to COVID-19

Haiti hasn’t vaccinated a single person yet. Poverty and vaccine hesitancy don’t help, but political instability will make everything worse

Rashmee Roshan Lall
9 July 2021, 12.00am
A street in the La Saline market, Port au Prince, Haití
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Jan Sochor / Alamy Stock Photo

The 7 July assassination of Haiti’s president Jovenel Moïse was the first such killing of a Haitian head of state since 1915. That distant tragedy precipitated the US invasion of Haiti, an occupation that lasted nearly 20 years. Moïse’s murder won’t trigger a similar response, but it could knock off course Haiti’s flailing attempts to deal with the COVID-19 pandemic.

Consider the reality of Haiti’s situation. The coronavirus pandemic may be receding in the US, but in Haiti, barely a two-hour flight away, the vaccination roll-out has not even begun. Haiti is the only country in the western hemisphere that has not vaccinated a single person against COVID-19. This grim statistic adds yet another doleful data point to what is already the poorest country in the western hemisphere.

Having lived in Haiti for three years and reported from there, I know how easy it is to blame Haiti’s state of chronic dysfunction for its lack of a vaccination drive. That is indisputably a factor, but it’s not the whole story.

By 6 July, the Dominican Republic – which shares the island of Hispaniola with Haiti – had administered 77.4 COVID-19 doses per 100 people. Move the computer cursor over to neighbouring Haiti on the vaccination map maintained by Our World in Data, an Oxford University project tracking the global pandemic, and the stark reality is spelled out. “No data” for Haiti, it says.

Instead, there is pandemic data of another sort. Between 3 January 2020 and 29 June 2021, 18,341 confirmed cases of COVID-19 and 415 deaths had been reported from Haiti, according to the World Health Organization (WHO). The toll is considerably smaller than in the Dominican Republic, which had 323,650 confirmed cases and 3,801 deaths during the same period.

However, that’s because of a demographic advantage rather than any strategic policy or competence displayed by Haiti’s government. More than half of Haiti’s 11 million population is younger than 25 – the youngest in the Caribbean – a lucky reality when faced with a disease that is rarely fatal for anyone under the age of 40. (The WHO figures are constantly updated; for the latest data, click here for Haiti and here for the Dominican Republic.)

But there is anecdotal evidence that, in the absence of any attempts to vaccinate Haiti’s people, case numbers are rising. A doctor in a hospital in Cap-Haitien, in the north of the country, says he is now seeing 15 to 20 cases every day. A controversial referendum on Haiti’s constitution, planned for 27 June, had to be postponed, at least partly because the authorities were forced to declare a new health emergency.

The UN secretary-general’s special representative for Haiti, Helen La Lime, recently told the Security Council she is concerned about worsening security and social conditions because of the surge in coronavirus cases and the “ever-growing polarisation of Haitian politics”.

No vaccine for politics

Politics has long been Haiti’s scourge, a dreadful affliction that has left it to lurch from one economic, health and public order crisis to the next. Instability has plagued the country since the overthrow of the despot ‘Baby Doc’ Duvalier in 1986.

Until his violent murder, President Moise had spent 18 months ruling by decree, having dismissed all but ten members of the 30-seat senate in the two-chamber legislature. Meanwhile, his opponents decried his alleged illegitimacy and his refusal to step down on 7 February, five years after the departure of his predecessor. Moise claimed that his five-year term began in February 2017, after a flawed election was re-run, and that he was entitled to stay in office until 2022.

Protests against Moise’s rule, which first broke out in 2017, paralysed the economy. His heavy-handed response to the protests arguably worsened an already dire situation. Gang violence has spiked in the past few months, displacing hundreds of families in poor neighbourhoods in the capital, Port au Prince, and deepening Haitians’ sense of insecurity. Elections, planned for September, were thought unlikely to settle anything because a council set up by Moise’s government to organise the poll was widely seen as partisan. Now, Moise’s assassination throws everything in doubt – including any vaccination roll-out.

But Haiti’s politics – for which there is no vaccine and, seemingly, no cure – cannot fully explain its current plight as the only country in the western hemisphere to have no COVID-19 doses to deliver to its people.

There is also the temptation to blame Haitians’ well-documented vaccine hesitancy, which has consistently meant lower immunisations against preventable diseases such as diphtheria and tuberculosis. Faced with a cholera epidemic in 2010 – the world’s worst in recent history – many Haitians responded with a magnificent burst of courage and illogicality. Mikwòb pa touye Ayisyen – a Haitian Kreyòl saying meaning that a mere microbe cannot kill Haitians – summed up the commonly held view.

After COVID-19 vaccines were developed and started to be delivered in many countries, videos began to circulate in Haiti claiming that there was a conspiracy to spread HIV/AIDS and malaria via the jabs. Justin Colvard, Haiti country director for the NGO Mercy Corps, noted that the rumours and disinformation included the belief that “COVID-19 was not real, and that if it was real, Haitians were invulnerable to it.” The parallels with the refusal to take cholera seriously were obvious. It was mikwòb pa touye Ayisyen all over again.

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The 7 July assassination of the country’s president, Jovenel Moïse, has thrown the country into disarray. Here’s what you need to know

Anti-AstraZeneca

But the Haitian government’s halting approach to vaccinating its people against COVID-19 may be about something else than irrationality or organisational missteps. Specifically, it’s about the Oxford-AstraZeneca vaccine.

Around the world, enough people have expressed concerns about the AstraZeneca vaccine to cause serious problems for vaccination roll-outs. Britain doesn’t like to acknowledge this fact because AstraZeneca was born at Oxford University (hence its name), but it’s certainly true in parts of England – as I have seen as a volunteer in vaccination clinics there over the past six months. It’s also true in France, Denmark, Italy and several other European countries.

In April, Haiti refused the 750,000 AstraZeneca vaccines it was offered for free under the COVAX scheme

It’s true in swathes of Africa, with Malawi blaming public doubt over the vaccine for its poor uptake and the need to destroy nearly 20,000 expired doses. It’s true in the US, which has not even licensed AstraZeneca for use. And it’s true in Haiti, which in April refused the 750,000 AstraZeneca doses it was offered for free under the WHO’s COVAX scheme for poorer countries.

Instead, Haiti asked for any other drugmaker’s vaccine – an impractical request because the country lacks a national ‘ultra-cold chain’, which limits the choice to AstraZeneca or the Johnson & Johnson vaccine, neither of which need to be stored at extremely low temperatures.

In May 2021, when a surge in coronavirus cases helped dull the Haitian government’s resistance to AstraZeneca, its request for the very doses it rejected could not be fulfilled because the Serum Institute of India (the world’s largest vaccine manufacturer) had production problems, and the global need was so great that vaccine makers in general couldn’t keep up.

About 130,000 doses of the AstraZeneca vaccine were supposed to arrive in Haiti in mid-June, but the Pan American Health Organization (PAHO) has admitted they are delayed indefinitely. On 21 June, the Biden White House promised 14 million doses for Latin America and the Caribbean, putting Haiti in line for much-needed relief. But by the end of the month, the US embassy in Haiti offered only a hopeful tweet about sharing more news soon.

Clearly, Haiti’s unvaccinated plight illustrates a larger issue: AstraZeneca’s brand equity. This vaccine, easy to store and use and cheaper than the alternatives, has been hit by wave after wave of bad publicity. The Oxford University scientists who developed it and the Anglo-Swedish pharmaceutical company that manufactured it – for no profit while the pandemic lasts – have done a poor job of communicating the facts. In the process, public trust in AstraZeneca has waned.

Shouldn’t Haiti’s unvaccinated plight as the pandemic rages be seen as the sum of many parts, rather than a symptom of its all too familiar malaise, of which the president’s assasination is a troubling flare-up?

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