The transboundary spread of infectious diseases is one of the greatest threats to global health security and the International Health Regulations (IHR 2005) which binds countries to “prevent the international spread of disease.” The Caribbean Region is characterized by many small, diverse populations of varying levels of development, surveillance and laboratory capacities, close, interconnected, porous borders, vulnerability to disasters and climatic change, high dependence on tourism, and a myriad of public health threats, including infectious diseases (endemic, emerging, or re-emerging). These all impact on the Region’s capacity to prepare for and respond to public health threats that transcend national boundaries, and thus global health security. This is further exacerbated by the COVID-19 pandemic since March 2020, that has devastated economies worldwide and is one of the society’s greatest threats.
Travel and tourism are crucial to the Caribbean as it is one of the world’s most prominent air and cruise travel destinations, with over 55M visitors in 2019. However, high and increasing numbers of visitors to the Caribbean, which bring so many economic benefits also increase the health, safety, and security risks to local and visitor populations and bring different health, social, and environmental challenges. This has been evident through the introduction and spread of new and re-emerging diseases such as SARs, Norovirus, H1N1, Chikungunya, Zika, and recently, COVID-19 which is devastating tourism dependent economies. A key element of increasing capacity for disease prevention and control is core surveillance systems that can detect public health issues in real time and providing information that allows for a timely, coordinated response. Given that the number of visitors to the Caribbean exceeds that of its residents, enhancing surveillance systems to capture public health threats and emergencies in both local and transient (visitor) populations, and track disease spread across international boundaries is critical to achieving global health security.
Climate change poses a grave challenge to the Small Island Developing States of the Caribbean. In the past five years, there has been an increase in the frequency and intensity of tropical storms and hurricanes. Powerful hurricanes, such as Irma (2017) and Dorian (2019), devastated the Caribbean countries, killing hundreds, causing island-wide damage and placing immense strain on the delivery of health, food security, and other basic services. Climate change has also fuelled changes in the distribution of mosquito borne vector borne diseases (VBDs), by altering the behaviour and breeding patterns. Consequently, the Caribbean witnessed outbreaks of Chikungunya in 2013 and Zika virus in 2016. Changing temperatures significantly influence the ecology and transmission of foodborne pathogens across the food chain. Outbreaks, such as non-cholera Vibrio spp., have shown positive correlations with increasing air and sea surface temperatures.
The Region has been affected by epidemics of cholera, human immunodeficiency virus (HIV), dengue fever, Chikungunya, Zika, foodborne diseases (FBDs), antimicrobial resistant organisms, influenza A(H1N1), and recently, the SARS-CoV-2 (COVID-19) pandemic. Such public health emergencies continue to cause illness and death throughout the Region and incur significant burdens on vulnerable and marginalized individuals and communities. They have imposed enormous financial burdens on societies and highlighted the fragile nature of public health and emergency response infrastructure within the region, especially in laboratory, surveillance, and workforce capacities. The revised IHR 2005 have been a key driver in international efforts to strengthen global health security. However, the success of the IHR 2005 relies upon the capacity and performance of national and regional public health systems to address public health threats before they become global health emergencies. All 26 Member States (CMS) of the Caribbean Public Health Agency (CARPHA) requested an extension to June 2016 for implementation of the IHR (2005) core capacities. Subsequently, WHO determined that IHR capacities should be achieved along a continuum of goals.
While the region has made some progress in implementing IHR (2005), significant gaps remain. In the recent IHR country self-assessment for the period 2019/2020, only nine CMS submitted States Parties Annual Reports to the 73rd World Health Assembly. Most countries scored between 60-80% in-terms of surveillance capacity, with two countries reporting below 50% and only one at 100% capacity. Within the Region, a mean score of 62% was reported for human resource capacity. Of the nine mentioned CMS, one reported less than 50%, and only two at 80% and above. Points of entry for the same CMS had a mean score of 58% with five having a score less than 50%.
The complex challenges faced with the myriad of infectious diseases in the Caribbean Region necessitate multi-faceted, integrated, sustained, and harmonized efforts across multiple sectors, with regional and international partners, public health agencies, and other key stakeholders supporting MS to advance towards strengthening public health systems, capacity, and security.
Weakened and inefficient public health systems throughout CMS broaden the gap in responding to public health concerns in a timely, effective, and thorough manner. Across the Region, similar challenges are faced related to its public health systems, including lack of human resources, under-resourced laboratories, inadequate health technologies, insufficient information systems, deficient institutional and organizational capacity, and inadequate financial resources for the implementation of IHR (2005) core capacities. Furthermore, the absence of critical surveillance, epidemiological and geographic information systems, operational real time visitor surveillance for both air and sea arrivals, cohesive communication networks, and optimal participation of non-health actors further worsen the performance of public health systems within CMS. These factors leave the Region vulnerable to public health threats, especially infectious disease outbreaks, that can jeopardize regional and global health security.
Enhanced strategies are required to strengthen workforce capacity, bolster public health surveillance and response systems, improve laboratory systems, and improve overall public health diplomacy. These are key in enhancing the quick detection and reporting of pathogens as well as preventing and reducing the effects of infectious disease outbreaks, including its sequelae on morbidity, mortality, economic stability, and reputational damage.
This project is an important priority for CARPHA in its ongoing response to COVID-19 and its continued efforts to strengthen systems at regional and national level, as well as to address some of the most challenging problems facing national and regional public health leaders. The type of public health incidents and emergencies faced in the Caribbean region can vary from infectious disease outbreaks, disasters from natural threats to mass gathering events, chemical or radiological incidents. CARPHA plays an important role in contributing to the regional emergency responses to these significant public health events. Some of these activities covered by CARPHA include providing staff to be part of the rapid response deployment teams to provide advice on disease prevention and control strategies in outbreak and epidemic situations; coordinating health input for emergencies in countries after the impact of natural disasters i.e. provision of medical staff and supplies, environmental health assessment, water quality monitoring, and management; providing laboratory support to outbreak investigations to confirm aetiology and monitor trends; and providing support for specific planning for food safety and security.
Furthermore, the Agency’s responses are governed by its all-Hazard Emergency Preparedness and Response Plan (EPRP) which establishes the organizational framework for the activation and management of CARPHA’s activities in preparing for and responding to incidents/events having public health, or health care implications throughout the region, or that threaten the continuation of the Agency’s services. This plan details the detection, preparedness, and response arrangements within CARPHA to a public health event within the Caribbean region.