Dr. C. V. Alert, MB BS, DM.
Family Physician.
As far as health trends go, there is almost universal acceptance that, in the last few decades, we have moved from an era of communicable (infectious) diseases to an era of non-communicable diseases, the NCDs. Today it seems that the two eras are trying to see which can cause the most havoc and chaos, including deaths.
In the era of infectious diseases, slavery, war and colonization led to the global spread of contagious diseases, with devastating consequences. Human diseases such as polio, smallpox, tuberculosis (TB) and diphtheria circulated widely. These diseases caused substantial suffering and deaths. Improving sanitation and the development of effective vaccines became important tools in tackling this infectious disease pandemic, particularly in allowing many children to survive into adulthood.
Following this era of infectious diseases, we gradually moved into an era of chronic diseases, where the main causes of disease were no longer specific germs, but rather came from a set of ‘risk factors’ that persons brought onto themselves by their lifestyle habits : drinking, eating, exercise, smoking and even sleeping. Because persons can determine their participation in many of these activities, at least in theory the chronic diseases are potentially preventable. The pharmaceutical industry, on the other hand, saw a potential market of millions of persons, and funneled research efforts into producing the best new classes of drugs in an effort to reverse the ‘lazy and likerish’ habits that populations introduced into all stages of the human life cycle.
Thus diseases like obesity, heart disease, strokes, (many) cancers, and mental illnesses (although not commonly included in lists of chronic diseases) dominate our health landscape, filling our Emergency Departments, our hospital wards, our cemeteries and causing significant headaches in our Ministries of Finance. Caribbean Ministers of Health, in September 2008, participated in charting the “Declaration of Port-of-Spain”, ‘Uniting to stop the epidemic of NCDs’. And as a follow-up, earlier this month right here in Barbados, we have the 2023 SIDS Ministerial Conference on NCDs and Mental Health, leading to the Declaration of Bridgetown. [The cricket enthusiast around here can say when last we had so many declarations on Caribbean shores in the last 15 years]. The latter declaration promises to tackle the NCDs with the same ‘vim and vigor’ that the first declaration failed to deliver: Einstein’s definition of insanity may be applicable here.
Unfortunately we are also witnessing a resurgence of infectious illnesses, even while we seem to be ‘threading water only’ in our battle against the NCDs. In the last two decades we have witnessed a wave of severe infectious disease outbreaks, which have had a devastating impact on lives and livelihoods around the planet. The 2003 severe acute respiratory syndrome (SARS) outbreak, the 2009 swine flu pandemic, the 2012 Middle East respiratory syndrome (MERS) outbreak, the 2013–2016 Ebola virus disease epidemic in West Africa all resulted in substantial morbidity and mortality while spreading across borders to infect people in multiple countries.
These points to a possible new era of infectious disease, defined by outbreaks of emerging, re-emerging and endemic pathogens that spread quickly, aided by global connectivity and climate change.
In the Caribbean we were visited by Zika and Chikungunya, who (thank goodness) ‘huffed and puffed’ mainly, then Covid-19 came and (unfortunately) ‘blew the house down’.
Covid-19 had its most profound effects on the most vulnerable individuals in our communities: for Barbados this generally meant the large numbers of persons affected by one or more of the NCDs. Our last major epidemiology study, the Health of the Nation Study (published in 2015), identified large numbers of ‘unhealthy’ individuals as young as 25 years. We lack NCD National Prevention programs, and we struggle to adequately manage the medical conditions in those who have contracted the illnesses. Thus covid-19 located a fertile breeding ground.
Our initial attempts to ward off covid-19 – wash your hands, wear your masks and maintain social distances, seemed to provide little resistance to this virus. Modern science responded with the swift development of a number of anti-covid vaccines. Modern science did not anticipate that the anti-vaxers would put up as much resistance as the virus itself.
Persons who had no problems having their children receiving a series of childhood vaccinations over many years suddenly believed a variety of conspiracy theories to explain their refusal to take any of the covid vaccines. [While some countries are fearful of the increasing role of artificial intelligence, in some other countries there seems to be a decreasing use of normal intelligence].
When our Ministry of Health and Wellness (MOHW) decide to make local statistics available, we should see how many people here contracted serious covid, i.e., how many had to be hospitalized, how many died; how many were immunized vs those who declined immunization; and how many had an NCD. If the local experience is similar to other places that have produced their statistics, we should see that the benefit of vaccination outweigh the risks. And if this is the case, then efforts to protect the most vulnerable in our population, i.e. adults with chronic diseases and/or chronic disease risk factors would include offering vaccinations to these vulnerable individuals.
We know that, since Covid-19 arrived on our shores in February 2021Barbados has had 108480 known cases, and at least 596 deaths (and rising). We have not been told how many millions of dollars we have spent so far to fight covid, particularly for treating patients in inpatient facilities. We know that covid at one point shut down the whole country. We can safely assume that we cannot easily afford to do this over and over; we must plan for the future.
The current disease profile trajectory, and World Health Organization (WHO) projections, predicts that we can anticipate pandemics of increasing frequency and severity in the years to come. If this scenario materializes, we need to establish specific immunization protocols and programs, and vaccine access, to tackle these ‘licensed to kill’ diseases that will put us on their hit list.
No single vaccine provides 100% protection, or can even claim to be free of any possible side effects. When someone is vaccinated, they are very likely to be protected against the targeted disease. People with underlying health conditions that weaken their immune systems (such as cancer, diabetes or HIV), or who have severe allergies to some vaccine components, may not be able to get vaccinated. These people can still be protected if they live in and amongst others who are vaccinated. When a lot of people in a community are vaccinated the pathogen has a hard time circulating because most of the people it encounters are vaccinated. So the more persons that are vaccinated, this can slows the rampage of the virus through a community. This is called herd immunity. With herd immunity, unvaccinated people can still have some protection, thanks to those around them being vaccinated:. Vaccinating not only protects the vaccinated, but also offers some protection to those in the community who are unable (or unwilling) to be vaccinated.
We currently do not have an adult immunization policy, but available evidence suggests that we should have one.