Come for Caribbean Escape, Stay for COVID Shots

 When Weehawken, New Jersey, resident Hemal Trivedi decided to get away to a Caribbean island this winter, she wasn't expecting to be vaccinated against COVID-19 by the time she flew home.

But that's exactly what happened, for her, her husband, and four other friends in their 30s and 40s who stayed on St. Croix from late December to early March, working remotely and enjoying each other's company.

"We wanted a winter escape and we realized this opportunity would never happen again, so we said we should all go somewhere together," Trivedi told MedPage Today. "Getting the vaccine was just a happy accident."

MedPage Today spoke with several travelers from the mainland who went to the island, which is part of the U.S. Virgin Islands (USVI), who received the vaccine as an added benefit, or who were able to secure an appointment before heading south.

It's not clear exactly how widespread vaccine tourism to the island is, or how large of a surplus the island has, but officials insist that supply is robust.

At the same time, it's been an uphill battle to convince vaccine-hesitant residents to get their shots, but USVI Gov. Albert Bryan, Jr. said during a Monday press briefing that vaccine tourism isn't a worry for the territory.

"Our real concern is not if we're getting vaccine tourism," Bryan said during the briefing. "Our real concern is, do we have enough vaccines for everybody? We're seeing 90 to 100 walk-ins on each island per day, and we're able to serve them. There are no lines. As long as we're able to do that, it will not be as much of a concern to us."

He estimated only about 3% of the territory's 33,862 doses administered as of Monday went to vaccine tourists. About 30% of the population have had a first dose, and about 13% have received two doses, he said.

While Caucasians make up a larger proportion of vaccine recipients than they do in the community, that could indicate vaccine tourism, Bryan said, but "more likely it means Caucasians living in the Virgin Islands are more apt to take the vaccine and take it quicker."

He said everyone on the island should be encouraged to go and get a vaccine, "because it is a privilege now. Nowhere else in the U.S. can you just walk in and get a vaccine, anybody over 16. We need to take advantage of that."

'Shot in the Arm' for a Battered Economy?

Rob DeRocker, a 62-year-old communications and real estate professional based in Tarrytown, New York, owns a condo on St. Croix and comes down most winters. (Also, his business includes promoting the USVI.) This year, he arrived in early January, and the next day made an appointment for a vaccine the following week. His wife, 66, came down in mid-February and received her first dose 2 days later.

"I was initially reluctant to get the shot, because I didn't want to deprive others, but I kept being reassured that the supply is not an issue," DeRocker told MedPage Today. Several younger friends had received theirs, he said, and "it was an open secret by February that if you wanted one, you could get it here."

Trivedi said her vaccine opportunity arose after a friend overheard a group of people at the pool of the condo they were renting talking about getting vaccine appointments. The six friends were all able to put their names on a list that would notify them about extra doses.

"We were on the beach when we got the text message saying, 'come now to get vaccinated!'" Trivedi said. "We dropped everything and went to the clinic."

Michael and Joanie Berg of Maplewood, New Jersey, were looking for a winter getaway after a few stressful events. When they heard that they could probably get the vaccine in St. Croix, they were sold.

"It wasn't the reason for coming here, but it was a nice bonus," Joanie Berg told MedPage Today.

The couple, in their late 30s, was able to make a vaccine appointment a few days before flying down. They'll receive their second dose at the end of the month, a few days before flying home.

The Bergs received their vaccine through Plessen Healthcare's vaccine clinic on St. Croix. Angela East, the company's corporate administrator and vaccine coordinator, told MedPage Today that Plessen gives between 180 and 230 shots each day, making them one of the top providers in the territory.

East didn't have numbers on vaccines given to tourists, but said, "we're not going to turn you away because you're not from St. Croix."

Sometimes, it's obvious that people seeking shots aren't residents, she said: "Last week a tour group from Puerto Rico pulled up in a safari bus to get the vaccine."

Vaccine hesitancy among residents is also starting to lift, from her perspective. "Once you tap into one or two core influencers at churches or in a neighborhood, then more people become open to it," she said.

Plessen and others want to ensure that supply remains adequate for all who want it, which is one reason they're eager to vaccinate.

"We're getting adequate supply based on the fact that we are distributing effectively," she said. "[Allocation] has to do with the population but also with the number of vaccines we're distributing."

In an interview conducted through a USVI health department representative, Monife Stout, territorial immunization director, said that supply and distribution are "fluid, with the public demand to be vaccinated and the increase in federal allotments." The current federal weekly allocation to the entire territory -- which encompasses St. Croix, St. Thomas, and St. John -- is 2,340 doses of Pfizer's vaccine, 1,100 doses of Moderna's, and 100 doses of Johnson & Johnson's, Stout said.

"The number has increased twice already and will continue as the presidential administration approves and vaccines are produced," Stout said.

When asked about the surplus on St. Croix, Stout noted that some of the USVI's "larger providers and federally qualified health centers that have high vaccination rates are on St. Croix. Most of these providers have satellite offices from which vaccines are offered, enabling a wider reach of persons to be vaccinated."

Fighting Vaccine Hesitancy

On March 1, USVI opened up vaccination to all residents ages 16 and up -- mainly as an effort to increase local uptake.

The three islands count about 100,000 people as residents, the majority being Afro-Caribbean, with about half on St. Thomas (which has the territory's major cruise port) and half on St. Croix. St. John, which is mostly a national park, has only about 4,000 residents.

The governor's goal is to vaccinate 50,000 residents by July 1.

Convincing residents to take the vaccine hasn't been easy. Trivedi and DeRocker described seeing vans driving through towns with people using megaphones to advertise the availability and safety of the vaccine.

"It reminded me of elections in India," said Trivedi, who originally hails from Mumbai.

During a press briefing last Friday, the territory's medical director, Tai Hunte-Ceasar, MD, expressed frustration about vaccine hesitancy, delivering an impassioned plea for everyone to get vaccinated, her voice cracking as she talked about health officials growing very tired.

"We are still struggling to get our people to come get vaccinated," she said. "We've opened it up to the entire population, there are no barriers. Yet we still have individuals who are contemplating the benefit."

Hunte-Ceasar answered MedPage Today's questions about addressing vaccine hesitancy through a department of health spokesperson, noting that vaccine hesitancy was a problem in the territory before COVID.

"However, we have seen a significant increase in the acceptance of the vaccine over a gradual process that has been consistent throughout the nation," she said. "We launched a vaccine education/confidence campaign with agency presentations to provide Q&A sessions. These presentations increased the acceptance of the vaccine tremendously."

As well, the government sponsored a media campaign, she said. "This, paired with community engagement through outreach, has worked to combat hesitancy throughout the territory."

Each island has a community vaccination center, in addition to other vaccination locations, with longer lists for St. Croix and St. Thomas.

Still, COVID-19 cases continue to crop up, especially on St. Croix, officials said. Over the most recent 10-day period (March 12 to March 22), there were 91 new positives, with 68 on St. Croix and 23 on St. Thomas. Three patients were hospitalized, with one ventilated, on St. Croix; one was hospitalized and ventilated on St. Thomas.

It's not clear whether those cases were locally transmitted, or brought in by tourists. However, DeRocker sees vaccine tourists being more of a boon than a detriment to the economy.

"It's bringing people to St. Croix for the first time," he told MedPage Today. "If they stay for 3 weeks, that's a substantial investment of time and money."

Indeed, the Bergs told MedPage Today they'd come back to St. Croix, possibly for a very long time: "This is the place we've decided we'd like to retire someday," Michael said.

https://www.medpagetoday.com/special-reports/exclusives/91785