"1. Introduction
COVID-19 pandemic lockdowns arguably represent the most unprecedented and dramatic policy instrument used in recent public health history. Whole economies were shut down, billions of people were told to stay home, social interactions were deemed unsafe, markets and transport were stopped and democratic processes were suspended by emergency law. Originally presented as temporary measures in 2020 (e.g. two weeks to ‘flatten the curve’) quickly transformed into many months of changing rules and regulations aimed at limiting human movement and interaction. From the beginning, there have been major concerns about lockdowns harming the global poor and public in fragile states...
A growing body of research has validated initial concerns that lockdowns and NPIs would have substantial and negative livelihood and health consequences for people in LICs [low-income countries]. According to the 2021 United Nations (UN) Sustainability Development Goals report, 'Years, or even decades, of progress have been halted or reversed. In 2020, the global extreme poverty rate rose for the first time in over 20 years. Hundreds of millions of people were pushed back into extreme poverty and chronic hunger'...
In this paper, we present a qualitative analysis of community perceptions and experiences of the pandemic from one remote, rural department of southwestern Haiti, vulnerable to natural disasters and ongoing political crisis...
4. Discussion
... A recent excess mortality study found that LICs have had the lowest excess mortality rate of the pandemic. Haiti is near the bottom of this list, despite having one of the world's lowest vaccination rates (1%).
Our study found that people in Grand’Anse, Haiti, associated this low mortality rate with: the strength of people's immune systems, widespread use of natural prophylactic folk teas, spiritual protections, the low mortality burden of the virus itself and tropical weather. Other studies have emphasized the demographic age-structure of LICs as the main causal factor (nearly 65% of Haiti is under 25 years old, average life-expectancy is 64) as well as pre-existing immunity from co-circulating viruses, the built environment and time spent outdoors...
The negative attitudes towards lockdown found in our study, as well as masking and COVID-19 vaccination, suggest that future control of respiratory pandemic viruses will encounter substantial resistance in Haiti...
[B]ecause the age-based distribution of global COVID-19 mortality was known early on, lockdown was not warranted in Haiti and top-down policy became associated with resistance and resentment. Our study found that most participants believed pandemic restrictions were ineffective, not appropriate, driven by political interests and were socially harmful. In line with other quantitative and qualitative studies, Haitian participants reported multiple, negative social harms in food security, income, education, health, and psychosocial wellbeing...
Our research suggests that alternatives to lockdown and restrictive NPIs, such as shielding the most vulnerable, are likely to be a more appropriate strategy for future pandemic respiratory viruses in fragile states."
© 2023 The Authors. Published by Elsevier Ltd.
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