Nancy Solomon: You're listening to The Takeaway. I'm Nancy Solomon in for Tanzina Vega. As vaccine distribution ramps up in the US and in other high-income countries, many others have yet to receive any of the COVID-19 vaccines. In Haiti, where political instability and violence continues to rock the country, not a single dose of the COVID vaccine has been made available for its more than 11 million people. Here to explain why that is, is Jacqueline Charles, Caribbean correspondent for The Miami Herald. Jacqueline, welcome back to the show.

Jacqueline Charles: Thanks for having me.

Nancy: There seems to be a few reasons behind the delayed vaccine campaign in Haiti. Let's start first with the role of bureaucracy. What's causing the holdup there?

Jacqueline: Well, Haiti is a country that is known for its bureaucracy. Things normally move very slowly and other issues, but I think with this vaccine, there has been a number of issues that have been further feeding the slow-moving bureaucracy. Let's start with COVID. Haiti has somehow dodged the bullet so far on a high death toll. It's less than 300 deaths in the country, I think a little over 12,000 confirmed cases. Even though we recognize that they have problems in terms of testing, the reality is that you haven't seen in Haiti, what we've seen in Brazil, or even what we saw in Ecuador last year at the beginning, which is bodies on the ground, people being buried or even what we saw in Haiti 11 years ago with cholera.

Anecdotally, you're not seeing that there are a large number of people were dying as a result of COVID. Even in the hospitals, you're not seeing high hospitalization rates. In fact, a year after COVID, a number of COVID treatment centers that opened were closed, including one by Doctors Without Borders, which closed theirs three months afterward because people were just not coming to the hospital. If they were getting COVID, they were not getting severely ill, and somehow they were treating it.

The other factor that doctors believe it's because of the young population. More than half of the country's population is under the age of 30. I think over 50% is under the age of 25, but they're still stopped by this and they're still looking into it. I think that this reality in terms of the profile of the disease in Haiti has been feeding a side debate in terms of whether or not Haiti needs a COVID vaccination or a vaccine.

Also, there has been concern in Haiti among government officials about the AstraZeneca vaccine is what they've told me. There are two concerns for them. One, of course, they're watching reports about AstraZeneca, and the whole issue with blood clots and questioning how safe it is. We've seen reports which says it is safe, the benefits outweigh the risk in respect to this vaccine. At the same time, Haiti is a country that has struggled with vaccination, especially when it comes to children.

For them, it is much more efficient and easier to get somebody in the door for one shot rather than two shots. This push led to reports even in the Haitian press that said that the Haitian government, the Ministry of Health had turned down AstraZeneca. I spoke to the director-general he says no, they did not turn down their vaccine, but their ask is for GAVI and WHO to consider a one-shot vaccine. As we know Johnson and Johnson is available in the United States, but it has not yet been approved by WHO for emergency use, and therefore the only vaccine available to Haiti or any country right now through WHO through the COVAX facility, which is aimed at getting vaccines into the hands of poor and middle-income countries is the AstraZeneca vaccine.

Nancy: Jacqueline, you were talking about many of the reasons why the vaccination program hasn't gotten underway. What is the issue with cold storage? Is there the ability to store the vaccine if they were to get it from one of the companies that requires super low temperature?

Jacqueline: Well, yes, that is also a problem. We're talking about a country that is just not dealing with a governance issue today, but it has a number of other problems, and according to PAHO, the Pan American Health Organization, a lot of work has gone into helping Haiti prepare. Just to give you an idea of the problems, the cold storage issue, is that I think in February India which was providing vaccines AstraZeneca, their version of a Covishield to countries around the Caribbean and Latin America, they offered Haiti 10,000 doses, and Haiti had to tell them, "Hey, can you put that on hold because we're not ready."

The director-general says, "Listen, if we got these vaccines, and we didn't have the proper storage for the vaccine, then it would have expired in our hands, and then we would have been further criticized." A lot of work had to go into Haiti's preparation to receive this vaccine. What GAVI is saying just based on their timeline, the first date a half from Haiti confirmation that, "Okay, yes, we'll take the vaccine," was like March 9th. Then Haiti finally had a vote on March 16th where they agreed that the population needs to be vaccinated, and then they didn't inform GAVI until March 29th. What you see just is very slow-moving, slow-churning bureaucracy, yet they're still not fully prepared.

Nancy: Haiti is still seeing violence and political instability stemming from the 2015 election crisis. How does that further complicate the pandemic response?

Jacqueline: It does complicate it because what you have is a mistrust of the government, and so when COVID first appeared on the scene, you had a lot of people in Haiti who just really didn't believe that it was real. They felt that it was a ploy by the government to make money. Even today, I mean, the central question when we're thinking about vaccination in Haiti is how do you convince people to take a vaccine for a disease that they don't believe in?

When Haitians talk about COVID, they say, "Oh, it's just a little fever." There's this attitude towards this pandemic that we see that's ravaging in the US and ravaging elsewhere around the world, but in Haiti, it hasn't had that impact, and so it's a huge challenge. The government has been challenged in responding and in trying to convince people because of its own problems that it's had, the governance issue, the violence, the kidnappings. I think all of this is factored into the COVID response or lack thereof.

Nancy: What's been the US government's response, and what can the US government do to help?

Jacqueline: That's a very interesting question. The US government really has been for me absent on this whole COVID respond to me. Just a clear example, I mentioned earlier that Doctors Without Borders closed their COVID treatment center three months after they opened it. Well, the US provided ventilators after that fact. The ventilators to Haiti from USAID arrived after COVID centers were closing. It was not at the height of COVID when we were seeing some deaths in Haiti. There were concerns about whether or not Haiti would even be able to address a COVID outbreak in the country.

In terms of the COVID vaccine, the US really has been silent on this. This has really been pushed by the United Nations. They're the ones who have been providing testing kits. In fact, Haiti wanted to get some testing kits out of the United States, but remember, during the Trump administration, there was a lot of lockdown on products that were made in the United States, PPEs and other things, and so Haiti could not even access COVID testing kits from the United States in order for them to be able to test people for COVID.

Nancy: Jacqueline Charles is the Caribbean correspondent for The Miami Herald. Jacqueline, thanks as always for joining us.

Jacqueline: Thank you for having me.

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