A Question of Protection: The Future of COVID-19 Vaccinations for Grenada

Written By: Central Health - Grenada

Vaccinations are important. They help prevent and control the spread of infectious communicable diseases and illnesses. However, numerous news reports have made it clear that once COVID-19 surfaced and spread rapidly around planet earth, causing over 12 million cases and over 500,000 deaths worldwide the race to develop a vaccine took off. Millions and millions of dollars are being invested into developing a vaccine to control the spread of COVID-19, even while the virus mutates. Notwithstanding, part of the process for verifying the effectiveness of vaccinations is to encourage humans to enroll in clinical trials. These facts raise two questions:

1.    What measures have been put in place to protect Grenadians from becoming ‘guinea pigs’ in an ill-intentioned scientists or individuals’ clinical trial?

2.     What reassurances will nationals be given regarding the source of the COVID-19 vaccination supplied to our region – considering our genetic makeup may be different from those tested?

As part of an ongoing online series entitled, “COVID-19 & Those Most at Risk,” Central Health – Grenada interviewed, public health practitioner E. Francis Martin (DR), MD., MPH., on the aforementioned concerns. 

Whereas Dr. Martin acknowledged that the vaccination protocol and schedule used in Grenada is guided by the technical support of PAHO/WHO, he made it very clear that currently there is an absence of legislation that deals with the protection of human sampling. “There is a concern for the region, in a sense that our small islands -  we don’t have strong legislation that speaks to the use of human sampling or use of human subjects for research purposes. So, I will make a blanket statement to say that because we have weak legislation for human sampling, a company can request to use the Caribbean as human subjects. It would be left up to the national governments and the public health and ministries to make a final decision on it,” said Dr. Martin

When asked by the Founder of Central Health – Grenada, Roslyn A. Douglas, MA, DTM whether Grenadians should have concerns about the source of the vaccine, Dr. Martin legitimized the question, stating that medications that work well for persons with one genetic makeup may not work well for another, “It is true that if your genetic sequencing puts you in a different gene pool, a vaccine that works in “A-area geographically,’ may not necessarily work in “B – geographical area.”

To watch the entire 10 minute interview segment visit Central Health – Grenada’s YouTube Channel – click here. 

For permission to publish this article email: centralhealthgnd@hotmail.com 

Opening Businesses & Borders: Here are some questions

By: Central Health - Grenada

Candid questions regarding the opening of businesses and borders can be found below.

The scientific terms are symptomatic, pre-symptomatic and asymptomatic. In layman’s terms, these are three ways a person can become infected from someone with COVID-19.  As piecemeal permission is being granted for the re-opening of businesses and eventually our borders, Grenadians really need to exercise caution. We do not have the all-clear for normalcy – not by a long shot. The fact remains, COVID-19 has killed more people globally in a shorter span of time than the flu. The main reasons are differences in incubation period, modes of transmission, rapid deaths, and plenty of unknowns due to insufficient time to study the virus.

Three ways get COVID-19: Without taking the necessary precautions, such as  wearing protective gear, hand washing, cleaning frequently touched surfaces, avoid touching one’s face with unclean hands and exercising physical distancing (6 feet), you can get the virus through contact with the following persons:

1. Symptomatic: You can contract the virus from someone exhibiting symptoms. 
2. Pre-Symptomatic: You can also get it from an infected person, which according to the World Health Organization (WHO) says the time between a person is exposed and when they first exhibit symptoms. 
3. Asymptomatic: You can also get it from someone who has it and is not showing any symptoms at all.

The problem with the latter, there has not been enough time to research how long they remain asymptomatic. So, for this mode of transmission we are truly operating blindly.

Johns Hopkins University & Medicine’s Coronavirus Resource Center reported that as of May 24, 2020 there have been 345, 036 global deaths caused by COVID-19. The World Health Organization (WHO) estimates that 290,000 to 650,000 people die of flu-related causes every year worldwide. This means from approximately December 2019 to May 2020  - roughly five months, COVID-19’s death record is already at 50%. 

In Grenada, from March until relative recently, everything came to a screeching halt. We needed to slow the opportunities for transmissions, as the health care system could not handle sudden mass illnesses. Who could forget the day Hon. Minister Nicolas Steele blew a complete gasket, when many at the beginning of this saga seemed flippant at the Ministry of Health’s warnings? That evening he sent us all to our rooms for two weeks – in the first instance. A pin could drop in Grenada and someone could hear it.

The strategy worked, although it was tough on many: efforts to balance shopping days; the pushing and shoving; the panic buying; walking with groceries on your back, for those that did not have transportation; and not able to access cash for several weeks. Nationals stuck at sea were eventually permitted to return home, after going through mandatory pre-cautions. You name it we went through the trial, errors and successes while leaning on ‘the science’. Grenadians emerged with zero deaths, to date.  Then, smiles started to fade rapidly because people were suffering economic hardship. For many their mantra is, “If I do not work, I cannot eat.” The fact is, no nation can remain cut off from the world indefinitely, but opening our borders means people are potentially bringing their germs and viruses with them.

As the nation attempts to take baby steps forward, some questions arise.

1.     What will be the screening process for travelers entering and leaving Grenada?

2.     What plans are in place to protect Grenadians from being used as guinea pigs for vaccine clinical trials?

3.     After borders are opened and should a second wave of cases hit our shores:

a.     Will the shutdown measures be repeated?

b.     What will be the phases?

4.     St. George’s University(SGU) says they will release a statement, however:

a.     What will the Grenadian employees be required to do to remain employed – as they interact with the students?

b.     What will the students be required to do, to protect employees?

5.     Outside of SGU:

a.     What measures will be put in place to protect staffers who may lose their jobs after voicing concerns about safety in the workplace?

b.     Can a hotline number be developed for employees to safely report when being forced to work outside of permitted hours, or their jobs being threatened for voicing concerns?

6.     What observations-measures have been put in place to ensure businesses, schools and other entities follow the health and safety regulations?

7.     If parents are uncomfortable returning their child to school:

a.     Will there be consequences for non-compliance?

b.     What systems will be put in place for cramped classrooms?

c.     If a parent chooses to Home School, will that be permitted?

8.     What measures will be put in place to protect teachers from students and vice versa?

9.     Other countries besides China are developing vaccines:

a.     What is the typical process for accepting and issuing vaccines?

b.     How long will it take for the approval process?

c.     Should Grenadians have concerns about the source of the vaccine will that be considered?

d.     Could a Grenadian be given the choice to accept or decline a vaccine based on source?

e.     Will the source of the vaccine be disclosed?

10.  Testing:

a.     Are there plans to test more than 1% of the population?

b.     The tests that are being used, which country sourced them?

11.  Bus drivers:

a.     Will the bus drivers be permitted to adjust their prices during this limited state of emergency?

b.     How will the sanitization of buses be monitored as they enter the terminal after trips?

It will be interesting to see if these questions are addressed. Equally interesting would be to find out what other questions citizens have at this time, and how can they get answers. During press briefings journalists can ask questions, but citizens have questions also.

For permission to publish this article email: centralhealthgnd@hotmail.com 

Cervical Cancer Is On the Rise In The Caribbean

By:  Roslyn A. Douglas, Founder of Central Health  - Grenada

According to Professor Sir Trevor Hassell President of the Healthy Caribbean Coalition (HCC) approximately six deaths per day in the Caribbean are caused by cervical cancer, and efforts are on the way to raise awareness.

Infection with high-risk human papilloma virus (HPV) is the main cause of cervical cancer. It is also the most common sexually transmitted infection (STI) globally. Low-risk classification of HPV generally can lead to benign lesions such as warts.  Similar to other STIs, high risk HPV is transmitted via unprotected oral, vaginal and anal sex, and can lead to cancers of the vulva, vagina, penis, or anus.  According to the Centers for Disease Control and Prevention HPV is so common that nearly all sexually active men and women get it at some point in their lives, “There are many different types of HPV. Some types can cause health problems including genital warts and cancers. But there are vaccines that can stop these health problems from happening.”

 

The President of HCC and its Manager - Maisha Hutton, recently travelled to Grenada and several other islands of the Caribbean, to speak with NGOs and Government officials to share their vision of reducing the number of deaths and disability from cervical cancer by promoting the Cervical Cancer Electronic Petition. “Once the petition is finished we are going to take the petition’s findings and take them to the heads of government. Because this petition really asks heads of government across the Caribbean to use the powers that they have to ensure that every woman in their territories has access to cervical cancer screening,” said Maisha Hutton.  HCC’s target goal for E-signatures is 50,000.  They are currently at approximately 9, 000. By press time just over 100 signatures have been received from Grenada. The Cayman Islands has shown the highest support with over 2000 signatures.

“Cervical cancer is the second commonest cause of cancer deaths among women.  That’s a very important thing to appreciate.  In fact annually over two thousand women in the Caribbean die from cervical cancer. That averages out I think about 6 deaths per day, from cervical cancer, throughout the Caribbean.  And the thing about it is that cervical cancer for the most part is preventable,” said Sir Hassell.  

Researchers from St. George's University, Department of Microbiology will present preliminary findings of a recently conducted study on cervical cancer in Grenada at the annual American Association for Cancer Research (AACR) conference in San Diego, CA, USA, April 5th-9th. Their research involved an in-depth analysis on cervical cancer and its associated mortality in Grenada from 2000-2010 and has revealed a higher mortality associated with cervical cancer than the current WHO estimates for the region. The study results are being prepared for publication at this time.

Two virgins having sex (oral and vaginally) with each other is the only guaranteed protection from high-risk HPV and any other STI. However as most individuals have had or will have more than one sexual experience, the usage of condoms and vaccinations given to virgin boys and girls can reduce the risk of infection. It however must be noted that these vaccines do not protect recipients from all HPV strains, only types 6, 11, 16, and 18, and condoms do not provide 100% protection from any STIs or pregnancy – they simply lower the risk considerably. Additionally, a person can obtain HPV from oral sex.

All sexually active women are encouraged to have pap smears as it is the best way to screen for cervical cancer.  A pap smear is a procedure in which a small medical brush/swab is inserted into the vagina so as to retrieve cells from the cervix.  The cells obtained on the brush/swab are then analyzed for abnormalities. 

Chief Medical Officer of the Ministry of Health Dr. George Mitchell confirmed that pap smears are available to all women who have reach the age of consent, “Grenadian women can access pap smears at our three (3) hospitals, six (6) health centers and 30 medical stations. Pap smears are also done privately throughout the country.”


Central Health - Grenada would like to thank Amy Baldwin, PhD, Associate Professor, Department of Microbiology, School of Medicine, St. George's University for providing technical expertise with this article.