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Required Vaccination of Visitors is Not the Most Viable Path

 

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.

 

Widespread vaccination will take time

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.” [1]

 

Requiring vaccination of all incoming passengers has pitfalls

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:

  1. The safety and efficacy of the vaccines has NOT been studied in children and teenagers under age 16. The clinical trials for teenagers only recently began and the studies for children under 12 will not commence until 2021. The CIG’s stated vaccination policy will prohibit children and teenagers under age 16 from entering the Islands without quarantine until the late summer of 2021 at the earliest.
  2. The safety and efficacy of the vaccines has NOT been studied in pregnant women. Therefore, pregnant women will not be advised to be vaccinated and could not enter the country without quarantine.
  3. The safety and necessity of vaccinating previously infected individuals (20-30% of US population) is NOT known.  It is not yet known how long immunity from previous infection will last and whether those individuals even will require vaccination.  This data will not be available for many months. As a result, 20-30% of the US population may be excluded from visiting.
  4. The duration of immunity from the vaccines is NOT known. We don’t know if immunity will last 3 months (the duration of the clinical trials) or 30 years.
  5. The relative efficacy of the vaccines compared to one another is NOT known. Therefore, whether a specific vaccine(s) will be required is NOT known (e.g. Pfizer/BionNTech vaccine with 95% efficacy versus Astrozeneca/Oxford with 70% efficacy).  The risk that a person is infected with COVID-19 would obviously be much higher if they had the Astrazeneca vaccine versus the Pfizer vaccine.
  6. It is NOT known whether someone that is vaccinated can also be a carrier of the virus. According to the co-founder and CEO of the firm BioNTech Ugur Sahin, the Pfizer/BioNTech vaccine will only reduce transmission by 50%. As the article notes, “This puts something of a dampener on vaccination being the key to the safe resumption of international travel. At this stage, we also don’t know how long immunity will last for those vaccinated with the Pfizer/BioNTech vaccine. But as the trial will continue for several more months, some of this data should become available in 2021.”
  1.  The UK Government has no plans to formally issue immunity passports to vaccinated individualsor to make getting the shot mandatory according to Nadhim Zahawi, the British government’s vaccines minister. The CIG’s stated policy would be out of step with the UK Government and Public Health England.
  2. There may be legal pitfalls in differentiating between vaccinated and non-vaccinated individuals including data protection, privacy rights and forgery.
  3. There are many individuals who oppose vaccination for ethical or religious reasons and would thereby be excluded from visiting. Only about half of Americans surveyed in early December, 2020 will be willing to get the vaccine.

 

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.

 

[1] https://www.caymancompass.com/2020/08/21/covid-19-the-race-for-a-vaccine-is-just-the-start/

 

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Dasher
Dasher
2 months ago

Good information for consideration- what are your multiple ideas to safely open the island? Please provide and share your solutions.

RAHAMADULLA
RAHAMADULLA
2 months ago

Precautions make better results for today and fruits we will get in future .There is a end in every studies.puplic need to do more safety practices now.pray for Cayman and rest of the world.

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