The Potential Effect of the Coronavirus Pandemic on Haiti

A Latin America Bureau report we contributed to this week noted that, at the time of writing, there were thankfully no recorded cases of Coronavirus in Haiti. Notwithstanding, an outbreak would undoubtedly pose a considerable threat to the densely populated country which has all-too-recent memories of how devastating an outbreak of infectious disease can be.

Haiti is already battling 160,000 cases of HIV, is home to the highest rate of tuberculosis in the Americas, and has only been free of new cholera cases for one year. This is after a catastrophic nine-year epidemic when United Nations soldiers from Nepal infected Haiti with the disease in October 2010, leading to 10,000 deaths and sickening close to 100,000 people. The Zika and Chikungunya epidemics have also had a detrimental impact on Haitian healthcare system in recent years.

The Moïse government has already announced sweeping travel restrictions in and out of the country. Albeit porous, the authorities have agreed to close the main border entry points with the Dominican Republic. With a strong tourism industry, the DR has already announced 11 cases of the virus introduced by foreign tourists to the island.

A Coronavirus outbreak would pose an unimaginable threat to fragile healthcare systems that depend on external agencies. It would exacerbate the ongoing political crisis that continues to weaken internal health infrastructure.

With all this in mind, the potential for Coronavirus to spread in Haiti with devastating consequences is overwhelming. 

WHAT WE KNOW

• Coronavirus is very infectious. The average person with coronavirus will transfer the virus to an average of 2 to 2.5 others (WHO 6th March).
  
• In Haitian cities, and especially in Port-au-Prince, people live in close proximity. An outbreak, without social distancing measures, could therefore spread very quickly.
  
• The WHO estimates that the mortality rate of Covid-19 is between 3-4%. The risk is exacerbated for the elderly and those with underlying health conditions and non-communicable diseases. For example, people with HIV and tuberculosis are high risk, and both of which are particularly prevalent in Haiti compared with the Caribbean region as a whole. Respiratory infections are already one of the biggest causes of premature death in Haiti, and has the highest rate of tuberculosis in the Americas. As of 2018, 160,000 Haitians were living with HIV.
• Haiti has restricted most travel into Haiti. The best chance to prevent the spread of coronavirus (or at least slow it down) is containment; to minimise the chance of somebody bringing the virus into a country or region, and then quickly identifying and isolating any persons who have Covid-19 before they transmit the virus. Many governments have, in the past few days, restricted travel across borders. Haiti has too – flights from Europe and Canada have been suspended, and the border with the Dominican Republic has been officially closed. At the time of writing, the Dominican Republic has had 21 confirmed cases of coronavirus and one fatality.
• Haiti’s health systems are currently very fragile. Less than one in ten Haitians have proper access to regular healthcare. The cholera epidemic of 2010 is a stark example of how quickly an epidemic can spread with only a very weak public health infrastructure against it; this known weakness makes the UN’s crime of introducing the disease all the more severe. The cholera epidemic also highlights Haiti’s recent experience in mobilising against a deadly infectious disease. There have been no new cases in cholera for over a year now. A recent Guardian article has noted Haiti’s response to cholera across communities and organisations as “an object lesson in dealing with a public health crisis.”
• However, that is not to say that Haiti’s public health system is more resilient than it was a decade ago. Haitian healthcare is still insufficient, sustained by NGO activity, and since 2018, Haitian healthcare has been further weakened as a result of the inertia of the Moïse administration in the wake of the massive Petrocaribe protests against his government. Healthcare workers have joined the protests in recent months, in particular because crucial medical supplies have been running out. Haiti’s health system remains particularly vulnerable to an outbreak of the proportions seen in Europe.
  
• Haiti needs a cooperative, national effort. Dr Émile Hérald Charles, former director of the Ministry of Public Health and Population, has called for a “coherent, synergistic and unitary” response to the virus. He told AlterRadio that Haiti has the necessary expertise to mount a national response, but warns that “there are not enough resources disseminated [throughout Haiti] to provide an answer to this health attack,” arguing that “public authorities must appeal to community organisations” if the effort is to stand any chance.
  
• Preparation campaigns are underway. On Monday 16th March, acting Prime Minister Joseph Jouthe has launched a new information campaign to raise awareness about the virus and coordinate media response in keeping the public well-informed about the spread of the virus and containment measures. The National Federation of Mayors of Haiti are launching a street cleaning and awareness-raising campaign with similar aims next week. NGOs such as Partners in Health are working with regional public health bodies to prepare for a rise in cases, and grassroots and diaspora groups are disseminating hygiene information materials in Kreyol online.

WHAT WE DO NOT KNOW

• How much coronavirus is affected by climate. There is much yet unknown about coronavirus and about the illness it causes (Covid-19). Notably, we do not yet know to what extent, if at all, the rate of transmission is affected by climate. There has been much speculation about whether coronavirus will struggle to spread in tropical, humid conditions, fuelled by its current overwhelming prevalence in temperate countries in the Northern Hemisphere during winter 2019-20. However, it is simply too early to confirm whether a country like Haiti with a humid tropical climate will therefore see a slower spread. Moreover, studies of the 2009 H1N1 “bird flu” found that, although there was a significant seasonal effect in the spread of the virus, the biggest driver for transmission was the fact that there was no natural immunity; there is no natural immunity for the coronavirus that causes Covid-19 in any population.
  
• How much border restrictions/closures will affect Haitian life. Haiti is a country that, due to decades of dictatorial extraction and foreign meddling, has come to rely heavily on the world outside for its supply chain. Stipends and support from Haitian diaspora in the USA, France, and Canada form a significant part of the economy. The land border with the Dominican Republic is now officially closed, but questions remain as to how effective this measure will be, and how severely this will affect the Haitian economy.
  
• Why exactly travel to/from the USA is continuing, and if it will lead to transmission. Travellers from the USA are to be screened on arrival, but the government’s decision not to close the border to the country stands out, as the coronavirus epidemic in the USA is severe, and cases of Covid-19 are far more prevalent than in Canada, for example. The reasons the Moïse administration has done this may be because of the prominence of US businesses and NGOs in Haiti, the importance of the US diaspora, or Moïse’s continuing desire for a close allegiance with President Trump.
  
• How, if implemented, social distancing will affect Haiti. Social distancing measures, if they come, would undoubtedly affect the informal economy that plays a significant part in city life. Haitians have been gathering on the streets of cities in numbers for months, and in Port-au-Prince for a year-and-a-half, demonstrating against Moïse and the Haiti he has come to represent. A significant outbreak of coronavirus will affect the protests, and it will affect the nature of Moïse’s ongoing suppression of them.

WHAT’S NEXT

• As symptoms can often take days to manifest, and testing equipment is rare, we do not know for certain if Haiti is still free of coronavirus. There is an anxious wait for the first positive test, but voices in Haiti are calling on Moïse to take urgent steps to ensure a containment strategy. In recent days, the government has taken more strident steps, but there is still much work to be done to best prepare Haiti for the entry of coronavirus.
  
• Like all nations, Haiti’s response to the pandemic, and the manner in which coronavirus will affect Haiti, is contingent on current and antecedent societal factors. The steady erosion of Haitian infrastructure due to decades of extraction from predatory elites, disaster capitalists and exploitative NGOs, added to the exhaustion from the continuing social and political crisis revolving around Moïse, leaves Haiti especially vulnerable if coronavirus gains a foothold.