Floyd Morris | What of COVID-19 vaccination for persons with disabilities in Jamaica?
The Government of Jamaica (GOJ) is currently implementing its COVID-19 vaccination programme. The programme is being implemented amid growing shortage of the COVID vaccines on the international market as selfish developed countries move to purchase all they can for their population. Such a situation has left developing countries in a precarious position, as they experience exponential growth in deaths and infection relating to the virus.
Developing countries are the domicile of the majority of persons with disabilities across the world. The World Health Organization (WHO) projects that there are over one billion individuals, or 15-17 per cent of the global population, living with a disability. Of this figure, over 800 million, or approximately 80 per cent, reside in developing countries. These individuals are regarded as the world’s poorest and are marginalised from mainstream society.
The marginalisation of persons with disabilities comes about due to them having poorer health outcomes, lower levels of education, limited employment opportunities and entrenched negative attitudes from members of society. All of these factors contribute to persons with disabilities being poor and thus marginalised from mainstream society. Oftentimes, these individuals are forgotten from any developmental initiative. And, even when they are remembered, they are placed at the back of the queue.
I have been tracking public discussions in Jamaica on the roll-out of the GOJ’s COVID-19 vaccination programme and have listened attentively as to who should be first in line to receive the vaccine. In the conversations, individuals have conveniently pointed to the guidelines postulated in the United States of America’s Center for Disease Control (CDC) on the prioritisation of individuals for the COVID-19 vaccines. I use the word ‘conveniently’ because I have heard references to the different groups who should be included in the early phase of the vaccination programme and nothing is said about persons with disabilities. The CDC guidelines make it pellucid that persons with disabilities should fall in groups 1a or 1b of the vaccination programme, and this would be dependent on the nature and circumstances surrounding the person with the disability. For example, if the person with the disability has a comorbidity or is a senior citizen, then that individual should be in group 1a. The guidelines also make provisions for caregivers of the person with disability to be included in the early phase as well. Thus, anyone who is responsible for providing assistance or support for a person with disability should be included when that person with disability is being vaccinated.
Here is where I believe the inattentiveness to persons with disabilities from the COVID-19 vaccine programme begins. No one knows the extent of the population of persons with disabilities in the island, and when this is conflated with their caregivers, the population increases considerably.
The population census of 1991 indicated that 111,114 individuals in the island had a disability. The 2001 census indicated that there were 162,860 individuals with a disability and the 2011 census, which saw a change in the questions on disability due to the introduction of the Washington set of questions on functioning, indicated that just over 70,000 individuals demonstrated that they had a disability in the island. Questions continue to be raised about the accuracy of the 2011 census results in Jamaica where persons with disabilities are concerned, since it is recording a significant decline in the population of persons with disabilities, in a society where violence, motor vehicle accidents and non-communicable diseases such as hypertension and diabetes are pre-eminent contributory factors to disability.
The COVID-19 pandemic makes it more imperative for us to have more credible data on the population of persons with disabilities. Specifically, there is a need for a proper database of the population of persons with disabilities so that we can have a strategic and targeted development of this marginalised population. Without credible data, it is just difficult to plan and execute programmes such as the COVID-19 vaccine initiative. The best starting point, therefore, is to use the WHO estimate of 15-17 per cent of a developing country’s population being persons with disabilities. Applying this to Jamaica would mean that approximately 459,000 individuals would have a disability.
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) states that persons with disabilities include those who have a long-term physical, mental, intellectual or sensory impairment which, in interacting with various barriers, may hinder their full and effective participation in society on an equal basis with others. Emanating from this indicative reference of who are included as persons with disabilities are eight primordial categories of disability. These are blindness or visual impairments; deafness or hard-of-hearing; physical disabilities; mental illness; intellectual disabilities; speech disabilities; learning disabilities, and neurological disorders.
Space and time would not allow for me to expound on each category. However, it must be noted that these types of disabilities have their unique and distinctiveness. Thus, they will require particular treatment and focus in the vaccine implementation.
In this roll-out, the varied stakeholders have to be conscious of the global environment that we are operating in. It is an environment that has moved away from the antediluvian welfare and medical models of disabilities. The focus is on the social and rights-based models of disability. Health workers in Jamaica, for example, have been schooled under the medical model of disability and there is always the temptation to focus on the disease affecting individuals with impairments.
For the vaccination of the COVID-19 pandemic, emphasis has to be placed on the social and human rights of persons with disabilities. Because, it is societal barriers that have served to restrict the efficacious participation of individuals with impairments in society on an equal basis with others. These individuals are human beings and, therefore, are subject to the inalienable rights luminously adumbrated in distinct international human rights treaty, of which the Convention on the Rights of Persons with Disabilities is most appropriate for the current discourse.
The following, therefore, are some issues that the GOJ must take into consideration, bearing in mind the global mantra of persons with disabilities, “Nothing about us, without us.”
1. To mobilise a local team of individuals who have a lucid understanding of the community of persons with disabilities. These should include individuals for and of persons with disabilities.
2. Government should seek to have the various agencies of and for persons with disabilities assisting in identifying the whereabouts of these persons with disabilities.
3. Social workers, community health aides, parish councillors and other community-based workers in the governmental system should be mobilised to assist in identifying the location of persons with disabilities who want to be vaccinated.
4. The Adventist Disaster Relief Agency (ADRA) and Red Cross should be brought on board to assist with the mobilisation of persons with disabilities who are interested in the vaccination programme.
5. The GOJ should engage in an aggressive public education programme to specifically target and explain to persons with disabilities the importance of getting the COVID-19 vaccine.
6. The GOJ should engage the use of a mobile clinic to take the vaccination programme into rural communities where there are large population of persons with disabilities.
7. Transportation support should be mobilised to assist those persons with disabilities who need assistance to be transported to the vaccination centres.
8. Provisions should be made for the caregivers of persons with disabilities to be vaccinated simultaneously.
As one of the global experts on disability, I am making myself available to the GOJ for guidance and support on this important issue. Disability is a rights-based issue and we must ensure that the rights of these individuals to healthcare are fully respected. We should ensure that these individuals are fully included in all aspects of the vaccination initiative, and I am prepared to do whatsoever I can to assist the GOJ reach my brothers and sisters with disabilities who want to take the vaccine.
Senator Dr Floyd Morris is the director for the University of the West Indies Centre for Disability Studies. Send feedback to firstname.lastname@example.org