Dear Editor,

The United States Virgin Islands has been luckier than good in managing the COVID pandemic compared to other U.S. insular territories and competing Caribbean tourist destinations, but now faces a problem with vaccine hesitancy that must be confronted.

The crowning achievements to date in COVID management are the following:

First, despite ranking as the 10th highest cumulative infection rate per 100,000 jurisdiction in the Caribbean region, COVID-related hospitalizations have never threatened critical care capacity. Less than eight COVID-related hospitalizations occurred at any given time, far below the 52 Intensive Care Unit (ICU) bed capacity.

According to MJS & Associates, as of March 28, the USVI had 2,710 cases per 100,000 residents, much less than St. Barts, Aruba, Bonaire, Curacao, Turks and Caicos, Puerto Rico, and St. Maarten, but worse than the Dominican Republic, Bahamas, Jamaica, Cuba, the Cayman Islands, Dominica, St. Lucia, the British Virgins Islands and St. Kitts and Nevis.

Second, the requirements to have a COVID negative certificate or a positive antibody test for entry into the territory seems efficacious in minimizing travel-related cases of COVID. In contrast, temperature screening protocols used earlier on, combined with a laxness in monitoring persons who were supposed to be self-quarantining, failed to prevent asymptomatic infected persons from entering.

Third, the vaccination rate currently exceeds many other larger Caribbean tourism destination competitors such as the Dominican Republic, Jamaica, and the Bahamas; islands that either due to financing constraints, procrastination or inability to secure donations of vaccines early on are now caught having to wait for the United Nations or the largesse of some donor nation.

Comparing vaccine rates

When comparing vaccination rates, the USVI, along with a handful of small states and territories, are outperforming for the most part many larger, independent states, according to Our World in Data. Small states and territories are favored for two reasons: First, colonial powers are paying the tab for the vaccines in their far-flung dependencies. Second, by virtue of having small populations and landmasses, it is operationally easier to distribute the vaccines.

Among the countries ranked by vaccine doses administered for 100 residents, according to Our World in Data database, as of March 24, Gibraltar, an English territory at the tip of Spain with a population of 33,140, had the world’s highest vaccination rate (159.8.). Others in the top 10 were Israel (113.2.); Seychelles (96); United Arab Emirates (75.6); Chile (47); United Kingdom (45.9); Maldives (41.62); Bahrain (39.9); USA (38.3) and Malta (35.2). What is notable among this group of 10, is that six are small states and one is a dependent of the U.K.

The USVI vaccination rate was not independently reported since it considered part of the U.S., but it was calculated to be 36.63 per 100, using raw data found in the same Our World in Data database. Consequently, the USVI is easily among the better-performing globally, and surpassed only by the Cayman Islands in the Caribbean region.

However, when the USVI is compared to the U.S. mainland, the country with the highest absolute number of vaccinations, and the other four U.S. insular territories that all benefit from the enormous amount federal resources allocated to vaccination programs, it is tied with Puerto Rico for last place on a percent share of the population basis. Whereas the U.S. mainland, with a population of 331 million, is boasting a full vaccination rate (two doses) of 15.7 % as of March 28, the USVI is at 12.13%. The other insular territories are 19-20.5% range while Puerto Rico is at 12.28%.

Vaccine utilization

More troubling for the USVI is the relatively low vaccine utilization rate. According to the Kaiser Family Foundation website, as of March 29, the USVI had only administered 64.4% of vaccines delivered, which is below the nationwide average of 83.5%.

Since the USVI is the only American jurisdiction with open adult eligibility for vaccines without residency requirements, the territory has a vaccine hesitancy problem. Should more targeted outreach programs, especially to the non-English immigrant communities and young people, be tried? Should mobile clinics be dispatched to low-income areas or worksites? Should public authorities, the clergy, respected educators, and prominent persons from the most vulnerable subgroups blitz social media and the multitude of talk radio shows that exist and preach the virtues of getting vaccinated?

For the pandemic to end, approximately 75% of each country’s population/territory has to be inoculated, for example, herd immunity. In the USVI’s case, about 62,000 persons above the age of 16 need to be vaccinated. With 12,993 fully vaccinated, we still have a way to go. Let us make smallness work for us and quickly achieve herd immunity. We have been lucky so far. Let us not tempt fate with the new variants of COVID that are more transmissible and cause more severe illness.

The local population has a profile that makes it vulnerable to COVID disease, such as high median age, high rates of obesity, hypertension, diabetes, cardiovascular disease, low incomes and multigenerational housing. If local residents do not get vaccinated in large numbers, we will be unwittingly giving birth to a new industry: vaccine tourism.

— Mark Wenner, St. Thomas