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St. Kitts and Nevis Covid-19 vaccine rollout success

The COVID-19 pandemic continues to affect countries around the world with the number of cases and deaths increasing daily.  Since May 2021, St. Kitts and Nevis a dual-island nation in the Caribbean with a population of 53,192 has also experienced two major surges in COVID-19 cases. According to the data received through PCR tests, as of October 25, 2021, there have been 2,637 confirmed cases of COVID-19 with 21 deaths. 

As of October 25, 2021, 50,045 vaccines have been administered, 76.6% have received one dose and 24,197 or 72.1% are fully vaccinated. The goal is to have 33,037 adults fully vaccinated which is 80% of the population and 4,800 children, the total population of 12–17-year-olds.

Building upon past practices and strong leadership

The Covid-19 vaccination coverage rate in St. Kitts and Nevis is high.  This has been credited to very robust implementation strategies, including the fact that the Covid-19 vaccination strategies were built upon a very solid general vaccination program in the country.

Historically, St. Kitts and Nevis has a successful record of having a high vaccination rate.  In terms of childhood vaccination, the overall rate is between 96-97%, so they would have built upon that platform when rolling out the Covid-19 vaccines.  Some of the contributing factors to the successful Covid-19 vaccination rollout include:

• A strong health system with an all-hands-on deck approach to management of the pandemic;
• Support from partners such as the Pan American Health Organization (PAHO), Caribbean Public Health Agency (CARPHA), the European Union, and countries like the United States of America, Taiwan and India, who first assisted with acquisition of Covid-19 vaccines;
• The Prime Minister of St. Kitts and Nevis, Hon Dr. Timothy Harris played a very important role in the rollout and success of the program. This was a key strategy in terms of people seeing the leader of the Federation coming on board.

He led, advocated, pleaded and he urged.  He was always there to provide the necessary support, financial investment, and human resources, he was there at all times, he must be commended for the astute and excellent leadership provided.  One looks toward their leaders in terms of decision making, he has advanced the benefits of the vaccination.

Arrival of Covid-19 vaccines

Like most countries in the Eastern Caribbean, Oxford AstraZeneca was the first Covid-19 vaccine to arrive in St. Kitts and Nevis.  On February 22nd, 2021, 70 persons on St. Kitts were the first to vaccinated from the batch of 2,000 doses of this vaccine, donated by the Government of Dominica.   Amongst the first persons vaccinated were the Hon Dr. Timothy Harris, Prime Minister and the Cabinet, and Dr. Cameron Wilkinson, Chief of Staff at the Joseph N. France Hospital. 

The population was well informed about the arrival and administration of the vaccines and the benefits of vaccination, through various social media platforms and daily briefings.  The ‘Roll Up 2 Roll Out’ vaccination campaign was well on its way.  Seventeen (17) health clinics administer the vaccines on weekdays, with no appointments required.  In late March it was reported that over 50 medical doctors, more than 90 percent in the Federation took their first dose of the AstraZeneca. 

On April 7, 2021, St. Kitts and Nevis received 21,600 doses of Covid-19 vaccines through the COVAX Facility, a global effort between the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance Gavi, the United Nations Children’s Fund (UNICEF), the Pan American Health Organization (PAHO) and the World Health Organization (WHO).   

In early June 2021, with the first batch of vaccines due to expire by month end, the mass vaccination campaign was stepped up with health centres extending opening hours to accommodate more persons.  The turnout was encouraging, during the period June 24-30, 2021, 7,068 persons received their first dose, while 6,628 their second dose.  All this was achieved amid Government mandated limited days of operation and full weekend lockdowns due to community spread and spiralling cases between mid-May and early July.  Despite the strict movement of persons, clinics remained open to facilitate the process.  

Several weeks prior to the arrival on August 11, 2021, of 11,700 doses of the Pfizer vaccine, a donation from the United States of America, the Prime Minster notified of the second vaccine option and the roll out to commence on September 1, 2021. 

Training of personnel

On July 22 and August 20, 2021, PAHO provided virtual training to national immunization programs in the Caribbean sub-region for the receipt, deployment, and administration of the Pfizer vaccine, to over 200 and 100 participants respectively.  The second training focused on clarifying questions and addressing gaps in information on all elements of use, storage and associated WHO recommendations for Pfizer vaccine.  Additionally, on August 5, 2021, PAHO conducted a question-and-answer session specifically for the Expanded Program on Immunization (EPI) team in St. Kitts and Nevis, where concerns about Pfizer vaccination techniques were clarified.

Since some issues and concerns are better addressed in person, the Ministry of Health requested technical support from PAHO to facilitate the increased roll out, assess the cold chain management and vaccine administration practices, especially since it is now being administered to children ages 12 -17 years. 

A team of two (2) PAHO experts visited the country from September 27 – October 1, 2021, during that period the team:

• Discussed the issues of vaccine hesitancy with staff
• Provided information on the Pfizer vaccine and its administration to children
• Reviewed the Events Supposedly Attributable to Vaccination or Immunization (ESAVI) protocols and data capture for surveillance and to discuss with Pediatricians.
• Shared Strategic Advisory Group of Experts/World Health Organization (SAGE/WHO) recommendations for Pfizer vaccination
• Facilitated a discussion forum to address concerns that health care workers (HCWs) may have regarding Pfizer vaccine and vaccination
• Strengthened capacities for the delivery of COVID-19 vaccine – Pfizer
• Discussed PAHO technical assistance to strengthen ESAVI Surveillance

The team held training sessions and interviews with HCWs, vaccinated clients were also interviewed, visits were made to the Central Medical Stores and some health clinics to observe vaccination sessions and how vaccines are maintained.  Discussions were held with Pediatricians and the Surveillance team, and data management systems reviewed.

	Dr. Judy Nisbett, Medical Officer of Health in Nevis was a participant in the training.  She commented “The training session went very well; it introduced some new points.  In general, it was a refresher for the nurses, they were able to get some of their questions answered and to address some of the causes for hesitancy.		“The training was very informative, the questions and queries we had were answered and we feel more comfortable now going forward,” said Ms. Deslyn Tyson-Whyte, Community Nurse Manager, Nevis.

In the interviews with vaccinated clients, they were asked about their reasons for making the choice to be vaccinated.  These are some of the responses:

• A 17-year-old female was motivated because of a job offer that required her to be vaccinated.
• A male business owner stated he had been encouraged by his physician and he felt that it would impact negatively on his business if he wasn’t vaccinated.
• The father of a 14-year-old female said that he and his wife had researched the PAHO and WHO websites and after discussing with their two children, the decision was made.

Dr. Darlene Omeir, PAHO/WHO Advisor for Family and Community Health applauded the vaccination coverage of the Federation of St. Kitts and Nevis and said, “the Federation has already surpassed the PAHO/WHO global vaccination requirement.”

Dr. Milton Britton Barillas, PAHO/WHO Technical Advisor for COVID-19 Roll-Out said, “research have shown that there are minimal adverse reactions. The safety of the vaccines has shown that there are more benefits than adverse reactions. For our children in the Federation, the best advice that I can give, that PAHO/WHO can say is to take the vaccine.”

The Minister of Health, Honourable Akilah Byron-Nisbett thanked PAHO for their support and expressed gratitude for the team visiting during the current pandemic.  She welcomed the recommendations made by the team and noted the suggestion regarding providing an information brochure to children and adults which also congratulated them on receiving the COVID-19 vaccine.

In providing a review of the mission Dr. Omeir, said that staff are committed, dedicated and knowledgeable on the use of Pfizer vaccine, clinics clean and compliant with public health protocols, vaccination sessions conducted in a very orderly manner, and the vaccination e-registry was very user friendly.  She also noted the high demand for vaccines and that the public valued health care workers.

In a subsequent meeting with Dr. Delores Stapleton-Harris, Permanent Secretary, she said “Part of the success of the mission was a strong focus on the administration of the Pfizer vaccine in particular.  We found that there was much hesitation relative to the young children between the age group of 12-17 years.  The consultants would have engaged with nurses and persons at the health centers and they would have provided valuable information on the Pfizer vaccine for children.  We found that there was much hesitancy but subsequent to the engagement our uptake has been gaining momentum. 

Source:

https://www.paho.org/en/stories/st-kitts-and-nevis-covid-19-vaccine-rollout-success