With the government's vaccination programme against Covid-19 underway, in the midst of a second lockdown since the pandemic hit Mauritius last year, a number of contradictions seem to be cropping up in the health minister Kailesh Jagutpal's response to this second wave of Covid-19 and its vaccination campaign. So what are they?
Who gets the vaccine?
At the start of the vaccination programme, the government identified essential workers obligated to work and come into contact with the public, the elderly and those living with non-communicable diseases (co-morbidities) as priority groups for receiving Covid-19 vaccinations.
In practice however, things have turned out quite differently. Following the start of the second lockdown in March, the government suspended anti-Covid-19 vaccination for the elderly. In parliament last Tuesday, Minister of Health Kailesh Jagutpal explained the decision: "It seems very risky to continue vaccinating the elderly in the centres, even by maintaining all hygienic measures, without exposing them to the risk being infected. Our government chose to stop the vaccination in order to better protect them." Vaccinations of the elderly, Jagutpal continued, will resume once the second wave of Covid-19 is brought under control. Out of the 228,284 elderly in Mauritius, only 18,034 (or 8 percent) have been vaccinated so far.
"They had a strategy before, but that was when there was no virus in Mauritius," explains Dr. Vasantrao Gujadhur, former Director of Health Services at the Ministry of Health, who played a key part in fighting the first wave of Covid-19 when it hit Mauritius in 2020.
The problem with suspending vaccination for the elderly and confining them at home during the lockdown is a problem. "The elderly should confine themselves, okay, but for how long? They have to be vaccinated and it should have been done by opening vaccination centres in health centres in their neighbourhoods, so it's close by and with no big crowds. The 8 percent of senior citizens who have been vaccinated, how many of them are working as front-liners? It's just too little. They need to fast-track vaccination for them," Gujadhur insists.
For critics of the government's decision to suspend vaccination for the elderly, the problem is not so much who is not getting the vaccine, but rather who is. According to Jagutpal, "with the lockdown, the vaccination programme was targeted to persons who had been granted the work access permit (WAPs-ed.)".
The trouble with vaccinating those with WAPs, Gujadhur maintains, "the government themselves don't know how many front-line workers there are in the country, there is no data on this, so people with WAPs, even though they are not essential workers, are just going to get vaccinated".
Speaking to l'express, Leader of the Opposition Xavier-Luc Duval says, "Those with WAPs are basically those who are relatively young and in good health, right now when it comes to vaccines, it's just a free-for-all."
The WHO and the vaccines
One of the biggest contradictions coming from Kailesh Jagutpal, however, is the choice of vaccines being doled out in Mauritius. This month, Mauritius approved the use of Covaxin, currently not yet approved for use by the WHO. The same for the Sinopharm vaccine.
This represents a sea-change in the attitude of the health minister from as recently as December. "First he said he will never order any vaccine not approved by the WHO, now suddenly they are proposing that every vaccine should be used, including Covaxin that has not even applied for WHO approval yet," argues Duval.
To understand Jagutpal's contradictory stance towards vaccines and WHO approval, one needs only go back to 8 December 2020. Back then in parliament, Jagutpal rejected the need to order vaccines not approved by the WHO by arguing, "currently countries around the world are purchasing vaccines which are not yet endorsed by WHO... there is therefore, absolutely no necessity, at this stage, for us to impose a candidate vaccine, which is yet to be approved, on our population".
So when this week, Jagutpal was challenged about Mauritius using and ordering vaccines not yet approved by the WHO, Jagutpal replied, "Back in December, we were Covid-19 safe." Presumably, the one thing that changed between then and now is that back then, there was no urgency because of Covid-19 cases unlike today, hence the rush to embrace all the vaccines we can get. Indeed, back on 8 December, Jagutpal made this even more clear when explaining why unlike other countries, Mauritius was not buying vaccines not approved by the WHO, "Why those countries are doing so is because they are in a chaotic situation where cases are rising daily. Mauritius is not in this situation. Mauritius being Covid-safe, we should not rush into engaging ourselves with any countries about purchasing a vaccine."
But Jagutpal's statements in parliament this week indicated that the government's attitude towards WHO approval for vaccines has never been very strong from the start.
Take the AstraZeneca vaccine to begin with. This week, on 23 March 2021, Jagutpal told parliament, "on 27 January 2021, a firm order was placed with the Serum Institute of India for the purchase of 300,000 doses of Covishield (AstraZeneca -ed.) vaccines, that is, 100,000 doses to be supplied in February 2021, 100,000 doses in Quarter 1 and 100,000 doses in the second Quarter". And then on 16 December 2020, the health ministry approached the Russian Direct Investment Fund (suppliers of the Sputnik V vaccine) to buy 250,000 doses of that vaccine.
Here is the contradiction: AstraZeneca was only approved for emergency use by the WHO on 15 February 2021. So when Mauritius placed its order for these vaccines - and actually first started using them on 26 January - it was not actually approved by the WHO. Nor was Sputnik. Nor was it the case - as Jagutpal said of other states then buying vaccines not yet WHO-approved - that Mauritius was struggling with Covid-19 cases at the time.
The first wave of Covid-19 effectively ended locally in April last year and the first case of the second wave was only found in March this year. So, at the time, Mauritius was "Covid-safe".
So was Jagutpal misleading when he said that Mauritius would not countenance imposing non-WHO approved vaccines back in December?
Clearly his own answer this week shows that Mauritius had no such qualms about non-WHO approval. Or is he misleading now when he says that the resurgence of Covid-19 is forcing the state to turn to vaccines not approved by the WHO? Once again, Jagutpal himself says that the state was placing orders for vaccines not yet approved by the WHO at a time when there were no locally-transmitted cases being found.
Which is it? It also indicates why it should not come as such a surprise why the state rushed approvals for Covaxin without waiting for WHO approval. After all, the state didn't wait for the WHO when it came to AstraZeneca either. Nor Sputnik for that matter. Nor Sinopharm. "It is a contradiction, the problem is that we don't have enough vaccines, but we are being pushed to the wall, what can we do?" asks Gujadhur.
Consent forms and compensation
The next set of apparent contradictions concerns the question of the consent forms and the issue of compensating those who might suffer from serious side-effects from these vaccines. First the consent forms. Speaking in parliament this week, the health minister explained that those supplying the vaccines to Mauritius, "have also made it a condition prior to the supply of any vaccines to have the following clauses, i). no claim clause, ii). a hold harmless clause and iii) a no liability clause".
The result is the consent form required to be signed before any vaccine jabs. Section 5 of the form reads, "I waive all claims against the state of Mauritius, the Global Health Partnership also known as GAVI alliance, donor states or organizations, manufacturers of the vaccine and their agents or preposes for any adverse event following immunisation, including injuries and death, whether known or unknown, foreseen or unforeseen, which arise from/during or as a result of the vaccine, regardless of whether or not caused, in whole or part, by the negligence or fault on their part, I release and forever discharge them from all claims."
As for the question of compensation, matters seem a lot less clear. According to Jagutpal, having funds to compensate those suffering from vaccine side-effects was something that the World Health Organization's (WHOs) COVAX facility insisted that high-and middle-income countries do: "Hence, it would be advisable to establish a compensation mechanism to compensate individuals suffering from adverse events associated with COVID-19 vaccines distributed under COVAX and to pay any legal awards in that regard against the indemnified Entities." Will such funds be paid in case of all vaccines given out, or just those distributed under the WHO's COVAX facility?
Explaining matters still further the health minister continued that due to the fact that the State Law Office and the Attorney General's Office advised against setting a cap on compensation claims, any such funding for compensation would come out of the consolidated fund (the general fund for financing government activities). With no changes to the consent form being required.
"This seems to be very confusing," Labour MP and ex-leader of the opposition Arvin Boolell tells l'express, "there is no clarity or certainty, will the compensation be automatically paid in cases where the recipients of these vaccines get side-effects, or will they be paid if they bring cases in court?"
For Duval, there is an obvious contradiction here, "what are the parameters for making these compensation payments? How long do you have to be incapacitated for to qualify for compensation? How much can you be compensated? What if you have to go overseas for treatment that costs more than the maximum the state currently allows? First you make people sign a consent form waiving the liability of the state and then talk about compensation as if it would just be given voluntarily, it just does not make any sense."
This is not a small matter: according to the 2018-2019 Audit Report, the health ministry was then dealing with 230 case files alleging medical malpractice or negligence, with just 63 of them with claims totalling Rs530 million. "Total estimated contingent liabilities arising from the litigations may amount to some Rs1 billion," the report reads.
While refusing to set up a preset no-fault vaccine injury system (which has set parameters and caps for payment, as an alternative to potentially expensive lawsuits) while at the same insisting on people sign a form waiving the right to sue the state in cases of negligence in vaccine administration, for his critics, the minister is sending out a mixed signal. "They have far more to gain, and it is more economical, for the state to just get everybody vaccinated and then deal with compensation as when they arise, rather than asking people to sign such forms that may lead to people becoming reluctant to take the risk and get vaccinated," argues Duval.