Caribbean nations are preparing to distribute their first Covid vaccine doses in the coming weeks and months. Much planning and coordination is necessary to ensure that the Caribbean population totalling approximately 44 million is vaccinated quickly, efficiently and equitably. Political leaders and other decision-makers have an important role to play in this task, which requires ethical commitment and action, especially since they “bear different ethical burdens than the ordinary citizen, particularly in their responsibility to make rules and impose policies that affect the lives of entire nations and peoples” (Perkins and Landis 2020). The Government of Jamaica presented its vaccination plan to Parliament in January of this year; among its priority listing for the first 50,000 vials are government officials who are placed first on the list ahead of health care workers and other vulnerable groups.
This brief interrogation of this prioritization of government officials questions the fairness of this treatment being afforded such officials and facilitating them – in Jamaican parlance – “buorin in di lain/boring in the line”. Jamaicans have a socio-cultural practice of largely ignoring queues and heading to the top of the line (“boring”) or refusing to even form queues, for example, to get on the bus. Indeed, it is normal to see people “bonglin’ bonglin’ op/bungling bungling up”, as we say, as they rush to be first, causing a bottleneck, often defeating the purpose of the bonglin and disenfranchising those who were first and had formed a line. “Buorin in fronta di lain/boring to the front of the line” seems to be at play in the devised distribution plan of vaccinations which prioritises government officials, who do not meet the criteria of vulnerability outlined by the very WHO Guidelines they claim guided the drafting of the Vaccination Plan.
The Jamaica Vaccination Plan
The Vaccination Plan is entitled, “Interim Vaccination Logistics: From the Vial to Arm” (Ministry of Health and Wellness 2021). It divides the vaccination of the population in three phases with the first phase comprising eight or nine groups. Of some concern, a group entitled DCS (Department of Correctional Services?) is omitted from one list, “Delivering the Vaccines – Who will Get First”). Phase 1 is identified as the “Vulnerable Group”. See Table 1 below:
|Health Care Workers||15,987|
|Jamaica Defence Force (JDF) (the Army)||10,046|
|Jamaica Fire Brigade (JFB)||4,000|
|Jamaica Constabulary Force (JCF) (the Police)||15,021|
|Persons working in Early Childhood, Primary and Secondary Education Institutions||11,832|
|Passport and Immigration Agency||650|
|Department of Corrections (DCS)||9,667|
Table 1: Phase 1 – Vulnerable Group
Source: Ministry of Health and Wellness 2021
Notably, the Phase 1 list is not numbered but is presented four times; in three of the four cases, Government Officials are placed first. This can be read as an implied prioritising of Government Officials in the delivery of vaccines. The Government Officials group is composed of persons such as the Governor General and his wife (2), Cabinet Ministers (23), Members of Parliament (63; this double counts as this figure includes some members of the Cabinet), Senators (18; again, double counting as some members would have been included in the Cabinet.), Heads of Ministries and Agencies (165), Judges (100), Service Level Public Sector Officers (5000) and Parish Counsellors, i.e., local government officials (40; this undercounts the number as there are 228 parish councillors. On what basis are some excluded, making some more equal than others?).
Phase 2 is titled “Essential to Economic Activity” and lists other public sector workers and workers from industries such as tourism, transportation and agriculture. The General Public is included in Phase 3.There does not appear to be any attempt to include or specify vulnerable groups like prisoners, persons in state institutions, the homeless or the homebound.
The Plan identifies the WHO SAGE Values Framework for Allocation and Prioritization of COVID-19 Vaccines as the major source for its Vaccination Principles of human well-being, equal respect, national equity, legitimacy and reciprocity. Equal respect seeks to “ensure that non-discriminatory practices are incorporated in vaccination allocation and deployment by allowing equitable vaccination distribution to various groups within the society despite their socio-economic background and religious groups” (Ministry of Health and Wellness 2021). It is questionable whether equal respect is actually on display with the prioritising of Government Officials (including members of parliament representing all parties) in vaccine delivery, particularly when vulnerable groups like prisoners and the homeless are not even accounted for. The over and undercounting is of concern; even if this is an error, it is a troubling one.
In Defense of Prioritising Government Officials
The Minister of Health and Wellness has defended Government Officials being top priority on several fronts: 1) WHO and PAHO guidelines; 2) the need to protect the three branches of government (Parliament, Senate and the Judiciary) so they could make decisions and policy for the good of all; 3) the exposure of this group based on their interaction with the public (Selfish Leadership in Vaccine Distribution 2021). However, the latest WHO SAGE Roadmap for Prioritizing Uses of COVID 19 Vaccine in the Context of Limited Supply (November 2020), which builds on the WHO SAGE Values Framework utilised in the Vaccine Plan, does not envisage Government Officials as a Vulnerable Group. Indeed, it posits priority based on membership in one of three vulnerable groups: 1) Health workers at high to very high risk of becoming infected and transmitting SARS-CoV-2 in the Community Transmission epidemiologic setting; 2) Sociodemographic groups at significantly higher risk of severe disease or death such as the elderly or people with comorbidities; 3) Social/employment groups at elevated risk of acquiring and transmitting infection because they are unable to effectively physically distance – such as, the incarcerated or those living in overcrowded conditions. With the exception of those members who may be elderly or suffering from significant comorbidities, it is, therefore, difficult not to conclude that to include Jamaican Government Officials in the Vulnerable priority Group goes against the very WHO Values Framework they reference, which states clearly, as indicated in the WHO SAGE Roadmap:
As outlined in the Values Framework, there must be no tolerance for personal, financial or political conflict of interest or corruption in the prioritization of groups to have access to COVID-19 vaccines. In all cases, decision-makers must be able to publicly defend their decisions and actions by appealing to reasons that even those who disagree can view as reasonable, and not arbitrary or self-serving. Countries should ensure that individuals are not able to use their social, financial or political privilege to bypass country-level prioritization. (WHO SAGE Roadmap 2020, 12)
It may therefore be advisable that the Jamaica Vaccine Implementation Plan be revisited and the en masse grouping of Government Officials be removed from the Vulnerable Group so that the currently scare vaccines can be made available to truly vulnerable populations, several of whom appear to have been forgotten, as they lack the power or privilege to buor in fronta di lain.