Dr. Michael Tibbetts, MD
Updated December 14, 2020
The Cayman Government has announced that it will receive the first doses of the approved Pfizer/BioNTech vaccine in early January, 2021. This is great news and cause for celebration. These initial doses will be prioritized for the elderly, vulnerable and frontline healthcare workers. Given that the vast majority of deaths from COVID-19 occur in the elderly (>80% of deaths occur in the over 65 population and >40% of deaths occur in nursing home residents), the U.S. and U.K. are implementing similar plans, which will have the most immediate impact on reducing the mortality from COVID-19.
The Cayman Islands Premier Alden McLaughlin also announced that all incoming passengers will be required to show proof of vaccination if they are to avoid quarantine. This phase will commence after the most vulnerable residents and frontline healthcare workers are vaccinated (hopefully by March, 2021).
We detail below how a strategy that requires vaccination of all incoming passengers to avoid quarantine has significant limitations and is not the most viable path to reopen Cayman in the foreseeable future. Furthermore, a plan that requires pre-arrival testing and restrictions on visitors to approved resorts, restaurants and other attractions (an “enhanced movement quarantine”) will actually result in a much safer reopening plan.
To start, it will take the better part of 2021 for the vaccines to be distributed across the world. Even with widespread distribution most infectious disease experts believe that COVID-19 will not be eliminated from the planet.
The Cayman Island Chief Medical Officer, Dr. John Lee warned, “the discovery of a vaccine will not provide an immediate and total solution to the problems posed by COVID-19…Until successfully widespread global vaccination is possible, we will not be able to go back to a ‘pre-COVID-19’ freedom, so a new normal will be with us for some time.” 
While it sounds simple to require vaccination of all incoming passengers to avoid quarantine, the stated policy is simply not medically advisable or practically feasible at this time given the many unanswered questions about the COVID-19 vaccines.
There are at least 9 reasons why requiring vaccination of all incoming passengers as the basis of the reopening plan is not advisable:
The CIG’s announced plan does not address any of these important concerns. We are also not aware of any other countries that have announced a visitor reopening plan contingent upon incoming passengers being vaccinated to avoid quarantine.
In the words of one expert quoted in this Wall Street Journal article on December 8: “There’s not enough evidence to suggest that immunity passports are a good idea.”
We believe that an alternative pathway for stayover visitors to return and avoid quarantine should be provided once the most vulnerable Cayman residents, frontline and hospitality workers are vaccinated (hopefully by March, 2021). This pathway can include pre-arrival, on arrival and post arrival PCR testing and would actually be much safer than the proposed vaccination plan. The two key elements of the Reopen Cayman plan are pre-arrival testing which will reduce the rate of transmission by >80% as compared to 50% with the vaccine.
Additional measures such as sanitation protocols, a contact tracing app and limitations on a visitor’s movements to approved accommodations, restaurants and attractions (what some have called “enhanced movement quarantine”) would provide even greater protection of the community. With all of these strategies combined, this pathway will be many times safer than the approach reliant on vaccination!
The announced plan falls short of providing a path forward for the resumption of stayover tourism and the rebuilding of a key pillar of Cayman’s economy that affects the livelihoods of thousands of Caymanians. We believe that there are multiple options to a safe reopening to visitors that are not solely dependent on vaccination of all incoming passengers.
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