The Covid-19 pandemic had been ongoing for nearly a year when Dominica Prime Minister Roosevelt Skerrit took his first dose of the Oxford AstraZeneca vaccine during a live television broadcast on Feb. 24, 2021.
Though no Covid-related deaths had been reported in Dominica at the time, he urged the rest of the country to follow his example.
“Let us not wait for other countries to impose the requirement on us if we have to travel or we have to do business overseas,” he said. “But even for those of us who have no business traveling, it is for our own protection. Science has shown that it will help in the fight against Covid-19 and it minimises the opportunity for getting very ill and for death.”
In an unusual moment of unambiguous political unity in the eastern Caribbean country of about 74,000 people, Opposition Leader Lennox Linton later echoed Skerrit’s call.
“I put the vaccination that has emerged in response to this Covid-19 crisis as another gift of medical science, and so I am vaccinated, my family is vaccinated,” he said.
But most Dominicans didn’t take their advice. And in the ensuing months, many of them paid dearly.
Today, less than half the country has had a Covid shot, and health experts are still trying to understand the vaccine hesitancy that they say elevated the death toll and dramatically slowed the economic recovery.
In interviews with the Caribbean Investigative Journalism Network, health officials and others offered several reasons why Dominica and several of its neighbours resisted the needle much more adamantly than other countries in the Americas.
Some described clumsy education campaigns that didn’t reach everyone. Others pointed to a widespread distrust in messaging from the government and the independent media. Still others blamed a cultural preference for natural remedies or fear of a vaccine that was poorly understood.
But one issue cut across most other areas of concern: the misinformation and disinformation that swept the region during the pandemic via social media, WhatsApp and other messaging platforms.
Dr. Clive Landis, an immunologist at the University of the West Indies in Barbados, saw it coming early.
Even before the pandemic reached the Caribbean on March 10, 2020, he and other experts formed a task force at UWI to prepare. On Jan. 31, 2020, they held a sensitisation session.
“Even at that point, it was obvious that misinformation was already rampant,” he said. “And I just said, ‘Look, it’s very obvious that we’re facing two epidemics here. We are facing a viral epidemic, which is bad enough. But we’re also facing a misinformation epidemic.’ And it just got worse from there.”
Besides misinformation, which is spread innocently, Caribbean people were also bombarded in the ensuing months with disinformation, which is spread deliberately. And it continued when the vaccine became widely available in the region around April 2021.
In Dominica, Registered Nurse Glendora Telemacque saw the effects first-hand as she and her colleagues worked to educate the public about Covid and the vaccine.
“A lot of people had access to information that was shared on the internet with concerns and conspiracy theories,” she told CIJN. “A lot of people are also miseducated on the fact that there are different options of the vaccines, and people just run with the things that people tell them. … People chose to follow what they heard instead of getting the proper information.”
Claudia JnoBaptist, a fitness and nutrition coach in Dominica, also noticed this phenomenon. Although she said the government’s strong rollout strategy ensured that everyone had a chance to get a free vaccine, she observed residents growing increasingly afraid of the shot as falsehoods spread.
“They feel like there are some fatal consequences to taking the vaccine,” JnoBaptist said. “And a lot of social media reports have really encouraged that belief. And so it’s pushing more resistance on people to take the vaccine.”
Such misinformation was a global phenomenon during the pandemic. But it may have hit harder in the Caribbean, which soon proved particularly reluctant to get vaccinated.
In February 2022, the Pan-American Health Organisation issued an urgent warning, noting that 10 Caribbean nations were among the 13 countries in the Americas that had failed to reach the 40 percent vaccination rate recommended by the World Health Organisation for 2021.
Dominica was among them. And it has made limited progress since then: Even today, less than 46 percent of the population has taken one vaccine dose, according to global statistics maintained by the Johns Hopkins University.
That puts it eighth from the bottom on a list of 35 countries in the Americas.
And eight other Caribbean countries are also in the ten lowest spots: Trinidad and Tobago (53.91%); Suriname (45.65%); the Bahamas (44.28%); Grenada (39.26%); St. Vincent and the Grenadines (33.8%); St. Lucia (32.75%); Jamaica (28.77%); and Haiti (3.57%).
In 2021 UNICEF and USAID commissioned Caribbean Development Research Services to carry out a survey that examined vaccine hesitancy in Dominica and five other Eastern Caribbean countries.
“The major reasons given by respondents for being unvaccinated are that they do not trust the vaccines which they believe were developed too quickly; they do not know what is in them; they are worried about possible side effects, and that it is their choice (and they choose not to vaccinate),” the CADRES report found.
Effects of Hesitancy
This vaccine hesitancy proved deadly for many in Dominica and other Caribbean countries, according to Dr. Joy St. John, the executive director of the Caribbean Public Health Agency (CARPHA).
“What we saw is that among the people who were in the hospitals and dying, most of them — I mean, 90 percent or more of them — were not immunised,” she said. “And so what happened with Covid-19, especially among older populations or vulnerable populations with underlying comorbidities — chronic diseases, diseases that cause issues with the functioning of the immune system — we saw that among those groups, especially if they were not immunised, they were not surviving a case of Covid-19.”
This story played out in Dominica after the first Covid-19 death was announced in August 2021. Health officials said the great majority of the 74 people who died with the disease were unvaccinated, though the government hasn’t provided a precise percentage.
Later in the pandemic, the lower vaccination rates also delayed countries’ economic re-opening. For the smaller tourism-dependent countries like Dominica, the result was catastrophic, according to Landis.
“We had all of our eggs in one basket, at least for most countries. … Everyone has got one basket and it’s called tourism. And tourism was shut down,” he said. “And so what you have, you have [gross domestic product] losses which are unprecedented.”
Many small Caribbean countries saw GDP losses up to around 20 percent, according to the immunologist.
“Outside of war, you don’t get a GDP loss of 20 percent,” he said, adding, “Normally if you have like a half percent loss of GDP, your central banker is having a nervous breakdown. We had a 20 percent. I mean, it’s unprecedented. There’s never been anything like it. And that just killed the Caribbean’s economy going forward. And that will have repercussions for years to come where whole advancements that were made in human development are going to fall back.”
Dominica didn’t fare as badly as some of its neighbours, but its GDP contracted about 11 percent in 2020, recovering only 3.7 percent in 2021.
Entertainer and entrepreneur Milva Bellot was among the many Dominicans who were hit hard during that time. In early 2020, she had just finished setting up her snackette, Unique Cuisine, at the Dominica State College.
But shortly after she launched her business, the pandemic was declared and the country was forced into a shutdown. She immediately lost her investment, she said.
Her entertainment work didn’t fare much better.
“On the artistic part of it, movements, obviously during Covid, was null and void,” she said. “You couldn’t really do videos or your work how you’re expected to or how you wanted to. So the progress that you would have had in the two years due to the shutdowns were gone. … So it’s been a tough couple of years, but we are getting through it.”
In part because of her own experience, Bellot got the Covid vaccine.
“I’d rather be safe than sorry,” she said.
Besides health considerations, she explained, vaccination made it easier for her to travel and collaborate with other people without fear of getting extremely ill.
She also encouraged other Dominicans to get vaccinated, but she found many of them to be reluctant.
She wasn’t the only one who felt her message was falling on deaf ears. Professional communicators were struggling too.
Journalist Garvin Richards, who works at the Dominica Broadcasting Station, complained that he had to compete with self-proclaimed “health experts” who were poorly informed but prolific on social media.
“There were a lot of conspiracy theories going around, and a lot of people opt in to be … the social media doctors. Many people are on the internet with unbalanced information,” Richards said. “So that was my biggest challenge, honestly, you know: trying to get everyone to take heed of the relevant information from the authorities.”
He has faced similar challenges with other types of coverage in the past.
“In Dominica, when we have weather situations, for example, everyone becomes an overnight weather expert, and they choose not to take the information from the relevant authorities,” he said. “So that was one of the biggest challenges.”
Telemacque, the nurse, said Dominicans often follow the advice of popular personalities in the country rather than health experts or the news media. And those personalities were often divided on the topic of vaccinations.
St. John said the misinformation problem in the Caribbean also may have been exacerbated by the relatively late arrival of the pandemic and the vaccines.
Much of the world, including the United Kingdom, United States and China, were administering vaccines by the end of 2020. They didn’t reach much of the Caribbean until April 2021, when the COVAX Facility made them more widely available.
By the time the doses arrived, stories already were swirling about the adverse side effects experienced by a relatively tiny number people who took the vaccine — many of whom had underlying conditions, St. John noted.
“If you’re given hundreds of millions of vaccines, you are going to have some unfortunate people who will have side effects,” she said. “It does not mean that everyone will get them. But because there was so much focus on Covid-19, there was so much reporting in the traditional media and on social media about Covid side effects, people got scared. So these were some of the issues behind hesitancy.”
Conspiracy theorists, she added, fed off the few stories of adverse reactions and whipped up irrational fear on social media. Many of them spread blatant falsehoods, such as claiming erroneously that the vaccines would impact fertility or harm children, she said.
“There were campaigns that spoke about a lot of foolishness: that the vaccine was a way of getting a chip into your body so you can be tracked,” she said. “However, because we walk with cell phones — some of us have two — each of those cell phones has a chip that you’ve been tracked by for years.”
Telemacque agreed that the delay in vaccine availability likely exacerbated the misinformation problem. Many Dominicans, she noticed, changed their minds about the vaccine after getting the first dose and never returned for the second. She believes that conspiracy theorists were largely to blame.
“Generally, it was available to the population; it was easily accessible,” she said. “However, I think that because of the time and space between getting vaccines that were available, and the options, some people did not go back for the other shot. That was one of the things that hindered people from getting both doses of the vaccine — the complete dose.”
Though the government operated a thorough vaccine awareness campaign, she said, residents didn’t seem to be getting the education they needed to make a good decision about the shots.
“People had a lot of questions. And I think the questions were left unanswered for the most part. Because people were meeting me on the streets in my uniform, asking, ‘Nurse, do you think I should take the vaccine? What are the side effects?’” she said. “Those types of questions need to be addressed next time we have an event. People will need to be more informed of the options of care, such as the vaccination process.”
‘Approach it Head-on’
In the future, St. John said a stronger response is needed to combat misinformation across the region. To that end, she implored health agencies to be more assertive.
The sources of misinformation and disinformation, she said, must be made uncomfortable, and agencies should select public relations officers and other representatives who are competent to speak and write on such matters.
“You have to approach it head-on. And you have to be intense in your communications. In other words, you need to really get ahead of it,” she said. “And every time some strange thing is said, attack it with vigour based on the science, based on the evidence. You have to counter that misinformation and disinformation from every angle. That means every media platform uses people who are trusted in the community.”
Media organisations, she said, also play an important role in combating falsehoods. But like public health agencies, they are often underfunded, she added.
“In the future, what we need to do is to be ready with messages, like a template, and then plug in different pieces of information that will evolve as the disinformation evolves. That demands some funding,” St. John explained.
She added that governments also must work to build trust by forging honest relationships with their populations.
“Trust in governments and trust in health services is one of the most critical requirements for any sustained health response and sustained health-seeking behaviour,” she said. “So it’s critical, and it’s a delicate thing and it must be treasured and maintained. We must be truthful with our populations.”
Messages also need to be distributed with agility and speed, she said.
“We have to realise that we are stronger when we work together, not just within countries but across countries within our region,” she added. “Those are some of the things that CARPHA has learned.”Telemacque, the nurse, said existing media coverage in Dominica could also be improved with factual updates presented more regularly after each major newscast. She added that it is also important to keep in mind that many elderly Dominicans rely on their radios instead of cable television or the internet.
Despite the challenges, St. John said she believes the region is gaining ground in the fight against disinformation and misinformation about Covid-19 vaccines.
To help, the CARPHA communications team has been coordinating capacity building and working as a repository for Caribbean-specific messaging campaigns, she said. Such efforts, she added, will help ensure that evidence-based information goes out in the form, language and dialect that will best reach the population.
Her optimism appears to be borne out by a follow-up survey carried out by CADRES last year that compared vaccine hesitancy in six Eastern Caribbean countries in 2021 and 2022.
“All the countries in the survey were less likely to be vaccine hesitant in 2022,” the survey report stated.
On a scale of one to ten, the vaccine hesitancy in the respective countries dropped between half a point and 1.3 points, with Dominica dropping nine-tenths of a point, according to the report.
Dr. St. John has high hopes that this trend will continue.
“Let us hope that the foundation that is being built, this strategy of using the regional approach, will bear fruit,” she said.
This reporting was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunization in the Caribbean, in partnership with Sabin Vaccine Institute.