Covid-19 involves security, social, economic, humanitarian and communications elements, among others, and responding to this crisis requires measures that go beyond the health response. This is one of the initial lessons learned from national responses to the Covid-19 pandemic from the Caribbean Community (Caricom) region, says Ronald Jackson, Executive Director of the Caribbean Emergency Management Agency (CDEMA).
During January 2020, Caricom’s emergency management community huddled together virtually to examine the implications of a Covid-19 outbreak in the Caribbean. This early action was to allow the region to activate early measures to either prevent or suppress the presence of Covid-19 in the region. The urgent and initial step was aimed at getting the region to figure out its game plan, given the following considerations:
- Pre-existing state of the health care facilities in the Region
- The pre-existing socio-economic context of the Caricom
- The low to medium level emergency preparedness that has characterised the region in the best of times.
This short reflection therefore seeks to examine whether the desired outcome was achieved. As we look back some three months after that first huddle, and just under two months after the first reported Caribbean case,we are seeing variability in the results with an overall positive trending of collective success rates as all governments seek to flatten the curve. There are, however, outliers and variations in rates of spread and rates of recovery. What could this be attributed to? What lessons have we learned from the experiences of those who saw cases before us and from among our own neighbouring countries in the region?
Leaders all over the world have been forced to make difficult decisions between a full-on application of policies to suppress the spread of the virus, which to some, appears oppressive, or policies that seek to balance a health response with keeping some semblance of the economy afloat. In fact, one Head of State expressed the view that: “Saving lives was his priority as it was always possible to recover the economy, but it was impossible to recover lives.”
Whatever the approach, it is clear that the decisions need to be risk informed, backed by the science and a clear understanding of the social context in each state, along with the level of preparedness and capacity of national emergency management systems to deal with the challenge.
More importantly, the policy approach needs the full support of the private sector, the local communities and civil society as a whole if they are to be successful in delivering the desired outcome in the shortest possible window of time. While there was support provided by these sectors, the consistency this support emerged as a concern given the uneven application of social distancing guidelines and work from home protocols. This is likely to have an effect on the efficacy of the of the policy action.
An observation of the national responses in the Caribbean suggests that the National Emergency Management Systems (National Emergency Operations Centre, Specialised Teams, Emergency Support Functions and decentralised operational elements including community response units) have not been fully leveraged to take on the wider implications of this public health crisis, despite many governments evoking National Disaster Management Legislation to provide the legal basis for the management of the crisis.
This reasons behind this may be varied, however one clue lies in the existing protocols in place for managing a pandemic. A quick audit of a sample of six out of 18 national pandemic plans revealed that only one reflected a whole-of-government approach, while the others were mostly structured around a health sector response. In the one case where the plan reflected a comprehensive response and coordination arrangement the national mechanism was still under-utilised. This initial finding has prompted further close examination of the response to Covid-19 to begin to identify some of the early lessons. These include:
- Border closure in a region such as the Caribbean needed to be co-ordinated and enacted at the same time. If only one or two countries close their borders to international travel (ie from areas experiencing high numbers of Covid-19 cases) but remains open to regional travel, then those Caricom States that have open borders to international travel create a high probability for cases to be imported intro – and transmitted across – the region.
- Comprehensive responses must be designed and planned to meet the policy decisions in order to achieve the desired outcomes (a flattening of the curve). Observations suggest that the curfews instituted (whether 12 or 24 hours) did not appear to have adequately considered existing and varied social and economic contexts.
- Public perception of this crisis must first be considered and understood. There is class-based, or demographic based, response to the guidelines stipulated by the government. The needs and conditions of those who have lost their income because of the massive economic slowing or shut down caused by the outbreak and live, daily updates must be considered in instituting the partial or full curfews. Individuals living in high density and low-income communities require social support mechanisms to cope in the midst of these hard measures.Such support mechanisms must treat possible psychosocial challenges in order to reduce the potential for domestic violence and other negative behaviour brought on by high stress and oppressive conditions.
- National disaster management mechanisms were not comprehensively engaged in the response. Responding to this crisis requires measures that go beyond the health response. This crisis involves security, social, economic, humanitarian and communications elements, among others. These emergency support functions are all contained within national emergency response systems and must be integrated into the planning and co-ordinating efforts to ensure efficiency in the state, private sector and civil society response to the challenges. The community disaster management infrastructure must be integrated into the response plan to aid in managing social distancing arrangements, as well as providing welfare and relief to the worst affected,working in tandem with emergency relief and welfare committees.
- Inventory and capacity of national stockpiles needs to be revisited. The early stages of the crisis revealed that across the region the national emergency stockpiles did not have adequate health-related equipment and resources. This is an area that was already under-resourced for dealing with traditional hazard events such as hurricanes, floods and earthquakes. New and emerging threats pose novel challenges in the management of the emergency response and will require a rethink of what is kept in stock and what level of financing is required to ensure an acceptable level of readiness for all types of hazards, including public health emergencies. The occurrence of MERS, SARS, Ebola, Zika and Chikungunya all suggest that the recurrence of public health crisis and pandemics are now permanent features of our hazard landscape.
These observations suggest the need for deeper examination to inform improved strategies for the management of epidemics and pandemics. The immediate goal must be to ensure a greater level of pandemic preparedness that is efficient in the delivery of response and mitigation services.
Though these lessons are very preliminary, it is hoped that they can still help to shape the ongoing Caribbean response to the Covid-19 crisis.