March 27, 2020

Dear CARICOM Heads of State and Government,

I write on behalf of the Board of Directors, members, volunteers, and technical staff of the Healthy Caribbean Coalition (HCC) at this time of crisis—the COVID-19 pandemic—firstly, to represent and re-emphasise the particular vulnerability of those living with non-communicable diseases (NCDs), especially older persons, and to highlight the need for proactive responses to the threat posed by the pandemic to this group, including provision for their care and treatment; secondly, to recognise and commend the significant efforts being made by you, the leaders of your respective countries, in your response to the pandemic, and to offer the support of the NCD civil society movement; and thirdly, to encourage consideration, even at this early stage, of the possible legacy of this pandemic, especially as it relates to addressing the NCD epidemic.

NCDs and COVID-19
It is estimated that in most Caribbean countries 4 out of every 10 adults has one or more NCDs. Most of the global data from the pandemic shows that NCDs were the most common co-morbidities of COVID-19 in the older age group with the highest mortality. The Caribbean, with its high prevalence of NCDs and many elderly people, represents a region exceedingly vulnerable to the more serious complications of the pandemic.

Given the significant number of Caribbean people living with NCDs (PLWNCDS), we are asking CARICOM governments to implement the following population-based measures, which will safeguard both people living with NCDs and the general population, including health care workers. These include: 

• the closure of all borders to all cruises and flights, with the exception of flights with returning residents, essential medical specialists, nurses, and other categories of health and health-related professionals;
• the closure of non-essential businesses and the implementation of curfews for non-essential workers and other members of society;
• the prohibition of all social gatherings;
• the implementation of strong quarantine and isolation measures;
• promoting and enforcing disinfection protocols of public spaces such as, although not limited to, grocery stores, pharmacies, communal residences, public transit, and airports;
• promoting proper hand and respiratory hygiene;
• expansion of testing to identify and track emerging local transmission;
• institution of mechanisms to ensure that all people living with NCDs have access to at least 3 months’ supply of essential medicines from public and private pharmacies, supported by a public advisory to stockpile these medications;
• implementation of measures to ensure access to healthy foods;
• and activation of social protection packages to protect citizens from financial hardship.. 

Multi-sectoral response to COVID-19
We are conscious that many of these steps have already been taken by one or more countries in the region. We in civil society are of the view that more needs to be done to safeguard the health of PLWNCDs, and we are prepared to assist in what must be a multi-sectoral, whole-of-society response. The HCC, with its 100+ civil society organisation members across the region, has strong patient networks and communication platforms, which can be leveraged to ensure, as much as possible, that no one is left behind. In the coming weeks and months, in support of national and regional responses, the HCC will focus our education and advocacy on the following five key areas: increasing knowledge about Covid19 and NCDs; promoting access to and consumption of healthy foods; promoting access to essential medicines for PLWNCDs; promoting good mental and physical health; and engaging young people.

NCD legacy of COVID-19
Finally, Honourable Heads of State and Government, the inter-relationship between pandemics such as COVID-19 and socio-economic development is readily demonstrated by the acute and dramatic adverse health and economic outcomes. The mutually adverse relationship between NCDs, which account for 8 out of 10 deaths regionally, and their antecedents and associations, such as climate change, social and economic determinants, and unhealthy eating, among others, is less obvious, but no less important. 

We therefore recommend that, as a legacy of COVID-19, health be given priority in all policies, with true policy coherence among sectors leading to nutrition and physical activity policies for healthier schools; fiscal policies that make the healthy option the more affordable option; agriculture and trade policies that prioritise food security and enable Caribbean people to eat what they grow, in preference to unhealthy imported foods, fast foods, or quick-serving foods; and policies that facilitate investment and support for sustainable efforts to mitigate and adapt to the climate crisis.

In 2007, the Caribbean showed global leadership when you signed the Declaration of Port of Spain: “Uniting to Stop the Epidemic of Chronic NCDs”, and the world listened. If ever there were a time to urgently prioritise the needs of people living with NCDs, that time is now. We urge you to act, and we pledge our support. 

–    Sir Trevor Hassell and the Board of Directors of the Healthy Caribbean Coalition and our 100+ members on behalf of the millions of Caribbean nationals living with and affected by NCDs.