Prof Terrence Forrester
Director of SODECO (Centre for Solutions for Developing Countries), University of West Indies, Kingston, Jamaica
International Affiliate Member, Koi Tū: The Centre for Informed Futures
The eruption of this viral (COVID-19) pandemic at the start of 2020 has spectacularly disrupted virtually every aspect of life when considered at global, national, institutional, community, household and individual levels. The status quos for social, cultural, religious and economic functioning have been rapidly swept aside by the imperatives to protect lives and the social order. As a direct consequence, almost all customary ways of pursuing any end within these and other major spheres of our societies were held in abeyance while the world huddled, suffered, feared and died. Now towards the end of May 2020, most societies are emerging from these constraints but with different attitudes and aspirations around whether we will, or indeed should return to the original status quo, or whether many key areas of life will be permanently altered. And, of course, there is much discussion about what immediate and longer-term consequences might be attendant. The precarious circumstances drive the demand for clear answers, many of which lie in the predictive realm surrounded by clouds of uncertainty. And if massive changes are required then the concern arises, to what extent might they be acceptable to the public? In Jamaica, the unfolding of this societal crisis has perhaps provided salutary lessons drawn from how the public has so far responded to the perception of an existential threat associated with COVID-19.
Jamaica and the English Speaking Caribbean, like Taiwan, New Zealand, and South Korea, has weathered the initial viral onslaught with significant, yet not massive nor disabling disruption. The strategy for effectively managing the national epidemic in Jamaica, caused by this novel infectious agent introduced into an immunologically naïve population, was based on fundamental public health principles. The approach emphasized surveillance through existing sentinel sites such as border checks, and case presentations to clinics, health centers, and hospitals in both the public and private health sectors. This surveillance was coupled with robust contact tracing capabilities that have been retained in the public health service through aggressive and sustained programmes to control the ongoing HIV/AIDS pandemic, as well as in the Jamaican setting, preventing malaria from reestablishing itself in an endemic form through travel related reintroduction of the malaria parasite into a permissive environment.
This focus on surveillance, case identification and contact tracing that has been retained as a functional public health asset, and the deep knowledge and know-how of practitioners on the ground and throughout the successive hierarchical levels of the central Ministry of Health made the adoption of a contact tracing approach feasible and successful. Simultaneously, as transpired in countries throughout the world, the central government coordinated the parallel races to prepare for massive numbers of patients needing quarantine and in-hospital intensive care that required building additional hospital capacity, providing required inputs from PPE, new intensive care facilities, supervised quarantine facilities sometimes requiring repurposing of buildings such as sports arenas and empty hotels, and of course testing capability and capacity. All this required agile and coordinated team action and such was evident from the visible and active involvement of the Prime Minister leading an all of Government approach, the special active leadership roles vested in the Minster of Health, the Chief Medical Officer and Chief Epidemiologist, plus their support staff. Academia, private sector, media and policy communities were tasked to support the effort by obtaining, analyzing and rendering coherent all relevant information including WHO, PAHO, and local live public health data streams.
In late May we are observing an apparent plateau in the epidemic locally, with cases just over 500, and low numbers of sporadic reported new cases. At this time new cases are principally Jamaican nationals who had been working in the cruise industry and are now being repatriated. These individuals likely have a high probability of being infected, and appropriate strategies for arrival at the border, testing, quarantine and release into the general population are being observed. However in parallel there is the newly begun process of opening up the society, including churches, businesses, public transportation, recreation facilities etc. Schools will remain closed until September, with instruction and examination having been moved rapidly on-line. Strategies to minimise risk of infection spread are communicated through public education messages, and there is a supportive presence of public health inspectors and law enforcement personnel operating in the public space. In parallel the Ministry of Health has ramped up its capacity to detect new cases, trace contacts, quarantine and manage the expected mini eruptions of cases.
A few things stand out. First, the apparently instinctive response to turn to science and science advice as a principal source of evidence and information to inform policy and action in order to manage this crisis was evident among policy makers as well as the public, perhaps suggesting that trust in science is widespread at multiple societal levels and existed prior to the emergency. Second, the public attitudes made evident via media coverage, social media vox pop streams, and observed behaviours, show a society that clearly understood in a functional sense the issues surrounding what is meant by the current best evidence, and the inevitable changes in understanding with the evolution of knowledge, and thus the need to adjust responses and messaging.
When understandings changed, there was hardly a murmur about experts being trustworthy and dependable nor not knowing what to do, but instead a mature acceptance that the best science at any moment was exactly that. This comfortable relationship of the public with the scientific process is enormously valuable for planning future strategies of risk communication and it also suggests that our concerns about low capabilities in science literacy in a society where secondary education is not universal and tertiary enrolment is about 27% have probably been unfounded. Although inequality is significant in Jamaica, with a pre-COVID estimate of poverty of 19% and although levels of crime and violence are high, there was overt demonstration of trust in representatives of the constabulary and the armed forces, who managed the restrictions on movement and gatherings through curfews, localised lockdowns and promotion of social distancing. Again this outturn speaks to social cohesion, a vital undergirding for coordinated social response to existential threats.
Lastly, if the common perception of distrust or ignorance of science, inability to cope with changing evidence, and distrust of security forces representing the state were indeed accurate depictions of opinion pre-COVID, then perhaps the society has a sophisticated common understanding and different instinctual responses to the perceptions of business as usual versus those required in the face of massive threat that modulates these contexts within which behavioural responses take place. We should aim to better understand the handoff from one perspective to the other, as we will probably need to proactively manage them.