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One Of The World's Poorest Countries Has One Of The World's Lowest COVID Death Rates

May 4, 2021
Originally published on May 7, 2021 10:19 am

Haiti has one of the lowest death rates from COVID-19 in the world.

As of the end of April, only 254 deaths were attributed to COVID-19 in Haiti over the course of the entire pandemic. The Caribbean nation, which often struggles with infectious diseases, has a COVID-19 death rate of just 22 per million. In the U.S. the COVID-19 death rate is 1,800 per million, and in parts of Europe. the fatality rate is approaching 3,000 deaths per million.

Haiti's success is not due to some innovative intervention against the virus. Most people have given up wearing masks in public. Buses and markets are crowded. And Haiti hasn't yet administered a single COVID-19 vaccine.

Dr. Jean "Bill" Pape says a combination of factors have kept the death rate so low.

Pape played a role similar to Dr. Anthony Fauci's in the U.S. The 74-year-old Haitian doctor served as the co-chair of a national commission in Haiti to deal with COVID-19, leading the country's effort to deal with the crisis. But the commission was dissolved earlier this year.

"The reason mainly is because we have very, very few cases of COVID," Pape says. The local health agency Pape heads, known as GHESKIO, actually shuttered its COVID-19 units last fall due to a lack of patients.

Last June, the country of 11 million was hit with a significant wave of infections. Hospital wards filled with COVID-19 patients. At the time, the country only had two places that could test for the virus, so the actual number of infections is unknown. Now, testing is far more available, but Pape says very few cases are detected each day.

"Sometimes it's two, sometimes zero, sometimes it's 20 cases," he says. "But we are not seeing a second wave, as we had thought would happen."

Pape says the country has pretty much gone back to the way life was pre-pandemic. Schools are open. Thousands of people packed the northern coastal Port-de-Paix for Carnival in February.

"Most people don't wear a mask," he says.

Not only have outdoor markets reopened; they were never completely closed.

Sheltering in place and working from home are luxuries most Haitians can't afford. As the poorest country in the Western Hemisphere, Haitians on average earn less than $2,000 per year according to the U.N. And most, Pape says, have gone back to work.

"Because if they don't work, they don't eat, their family doesn't eat," he says.

Concern about the pandemic is so minimal that this April, when the World Health Organization-led COVAX program offered Haiti a shipment of AstraZeneca COVID-19 vaccines, the government rejected it.

Dr. Jacqueline Gautier is on the national technical advisory group on COVID-19 vaccination.

She says ordinary Haitians and people in the medical community have heard reports of rare but severe side effects from the AstraZeneca vaccine in Europe, and they're in no rush to get that shot.

"Because COVID did not impact us as badly," she says, "people don't think it [the vaccine] is worth it actually."

Gautier is also the director of the St. Damien Pediatric Hospital on the outskirts of Port-au-Prince.

The pandemic may have had less of an impact in Haiti, she says, because it's a young country. The average age is 23. COVID-19 infections tend to be less severe in younger people. It's also possible, she says, that a significant number of people were infected by the virus last summer, showed no symptoms and built up immunity. Also houses tend to be open with plenty of ventilation – air flow can knock the pathogen out of the picture.

Whatever the reason, she says, COVID-19 hasn't become a daily concern for most Haitians.

"Also there are many other major problems the country is facing," she says. "So people don't see COVID as our major as a major problem for us. And who can blame them?"

The daily problems facing Haiti are many. There's poverty, political instability, wild fluctuations in the value of the local currency, corruption, armed gangs. Diarrhea remains a major killer of children.

"And kidnappings!" Gautier exclaims. "They are really a huge problem for the country."

So Gautier was fairly sure that Haiti had dodged the COVID-19 bullet.

Then she saw the catastrophic COVID-19 wave in India, coming after a span of time when it seemed the country had been spared the worst of the virus. Now she worries that a deadly surge may be in Haiti's future, too.

"We don't know," she says. "This disease, it is full of surprises."

Copyright 2021 NPR. To see more, visit https://www.npr.org.

STEVE INSKEEP, HOST:

About a year ago, NPR global health reporter Jason Beaubien was working on a story about a rise in COVID cases in Haiti. At the time, he called up that country's version of Anthony Fauci, the veteran physician Dr. Jean "Bill" Pape, to find out how things were going. And Pape said how worried he was.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

JEAN BILL PAPE: I've lived through the AIDS epidemic, TB, cholera, malaria. This is the most difficult epidemic we have to deal with.

INSKEEP: Given that concern from a year ago, this story is remarkable. Haiti has not only bounced back from the pandemic, it has one of the lowest death rates from COVID in the world. Here's Beaubien.

JASON BEAUBIEN, BYLINE: Starting last spring, Haiti was hit with a serious wave of COVID infections. Hospital wards filled with patients. The country only had two places that could test for the virus. So how many people actually got infected is unknown. But these days, testing is far more available. And now, Dr. Pape says not many cases are being detected each day.

PAPE: Sometimes it's two. Sometimes it's zero. Sometimes it's 20-something cases. But we are not seeing a second wave as we had thought would happen.

BEAUBIEN: The 74-year-old doctor says the country has pretty much gone back to the way life was pre-pandemic. Schools are open. Thousands of people packed Port-de-Paix for Carnival in February.

PAPE: Most people don't wear a mask.

BEAUBIEN: Not only have outdoor markets reopened, many of them never closed. Sheltering in place and working from home are luxuries most Haitians can't afford. As the poorest country in the Western Hemisphere, Haitians, on average, earn less than $2,000 per year, according to the U.N. And most, Pape says, have gone back to work.

PAPE: People continue working for the majority because if they don't work, they don't eat. And the family doesn't eat.

BEAUBIEN: Concern about the pandemic is so low that when the World Health Organization-led COVAX program offered Haiti a shipment of AstraZeneca vaccine in April, the government rejected it. Dr. Jacqueline Gautier is on the national technical advisory group on COVID vaccination. She says ordinary Haitians and people in the medical community have heard about the reports of rare but severe side effects from the AstraZeneca vaccine in Europe. And they're not in a rush to get that shot.

JACQUELINE GAUTIER: And because COVID, after all, did not impact us as badly, so people don't think it really is worth it, actually.

BEAUBIEN: In fact, as of the end of April, the COVID death tally is only 254 in a country of 11 million people. Gautier says the pandemic may have had less of an impact in Haiti because the average age is 23. And infections tend to be less severe in the young. It's also possible, she says, that a significant number of people built up immunity to the virus last summer. Plus, houses tend to be open with plenty of ventilation. Whatever the reason, she says, COVID isn't a pressing concern for most Haitians.

GAUTIER: And also because there are many other major problems the country is facing. So people don't see COVID as a major problem for them. And who can blame them?

BEAUBIEN: Because the list of daily problems facing Haiti is long. There's poverty, political instability, wild fluctuations in the value of the local currency, corruption, armed gangs.

GAUTIER: And kidnappings are really a huge problem currently for the country.

BEAUBIEN: Until recently, Gautier was fairly sure that Haiti had dodged the COVID bullet, that this was going to be one crisis where Haiti actually got lucky. But then she saw what's happening in India and how variants can change the pace and intensity of an outbreak.

GAUTIER: We don't know. We don't know. This disease is full of surprises, right?

BEAUBIEN: Gautier now worries that, like India, another deadly surge may be in Haiti's future, too.

Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.