Americas Caribbean Coronavirus Latin America
Issue Brief June 28, 2021

The strategic importance of sending US vaccines to the Caribbean

By Ambassador James Brewster, Wazim Mowla


While the COVID-19 pandemic has created challenges across the world, it is having a disproportionate impact on countries in our hemisphere. Just over a month ago, the death toll in the Latin America and the Caribbean (LAC) region passed one million—the region, as of that moment, had the highest per capita death rate in the world. In May, although home to just over 8 percent of the world’s population, the LAC region suffered 31 percent of its COVID-19 casualties. US vaccine assistance has prioritized our hemisphere on balance with other parts of the world. But this policy brief makes the case that even greater assistance is needed for the Americas with a laser focus on the particular support required by our Caribbean neighbors.

The challenges facing members of the Caribbean Community (CARICOM) are often underreported even as some, such as Trinidad and Tobago, Guyana, Suriname, and Saint Kitts and Nevis, have had higher COVID-19 infections per 100,000 people than almost anywhere in the world, including other hot spots, like India. At the same time, CARICOM members have struggled to acquire vaccines, instead relying on actors such as China, Russia, India, and the African Union.

As the United States makes more vaccines available, greater CARICOM vaccine assistance would serve both Caribbean and US domestic and geopolitical interests. Vaccine donations to the Caribbean are critical to build on the United States’ historic friendship with its CARICOM partners. Vaccines are integral not just to the health of the Caribbean but also, given the close personal linkages, to US health. And since the Caribbean is intrinsically linked to the United States, to help them is to help ourselves.

This policy brief, which takes into account conversations we had with key stakeholders at a private roundtable in May, highlights the health, economic, and strategic reasons for greater vaccine access for CARICOM members. This brief and the events that preceded it, including our broader work raising awareness of how the United States can support the LAC region at this historic time of great need, goes to the heart of our mission at the Adrienne Arsht Latin America Center: to elevate and advance the importance of the LAC region in the world community and to build even stronger US ties with the region.

It is for this reason that we established the center’s Caribbean Initiative earlier this year. We aim to raise Caribbean priorities across the globe, with a particular focus on strengthening the US-Caribbean partnership. We understand that the challenges of our time are hemispheric and sometimes global in scope. But all too often, when we think about hemispheric solutions, CARICOM member states are the missing, overlooked piece of the puzzle. With this policy brief, we are shining a spotlight on the Caribbean’s vaccine needs and the linkages with US domestic interests. We are elevating this critical issue to save lives and livelihoods. This is why I am pleased that this is the first publication of our new Caribbean Initiative.

Jason Marczak
Director, Adrienne Arsht Latin America Center
Atlantic Council


Even as the United States rebounds from the COVID-19 pandemic, its Caribbean neighbors are at a critical and worsening moment. Rising infections due to new variants of the virus and limited access to vaccines have elongated the already devasting effects of the pandemic.

COVID-19 will continue to claim lives, stifle economic recovery, and lead to greater security challenges in the Caribbean for the foreseeable future. Ties between the United States and Caribbean nations mean that continued pandemic surges in the Caribbean are likely to affect US national security, the health of US citizens, the United States and specifically Florida’s economic recovery, and US foreign policy priorities. What happens in the Caribbean is unlikely to stay in the Caribbean. That is why US strategic interests and broader hemispheric security and prosperity depend on the United States further assisting its Caribbean partners in their efforts to secure COVID-19 vaccines.

While the COVID-19 pandemic has affected much of the world, it has had a disproportionate impact on members of the Caribbean Community (CARICOM)—a fifteen-member regional group that consists of Small Island Developing States (SIDS) who make up more than one-third of the Western Hemisphere’s states.1The Caribbean Community member states are as follows: Antigua and Barbuda, the Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Montserrat, Saint Lucia, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Suriname, and Trinidad and Tobago.  Small size, limited resources, and tourism-dependent economies have resulted in stunted growth and an inability of Caribbean nations to acquire the requisite COVID-19 vaccines. 

The United States and the Caribbean region have historically enjoyed close ties based on shared interests and values, making the two part of a mutually beneficial partnership. The US-Caribbean relationship is tied by a number of factors, including geography, with Caribbean states in close proximity to the United States, leading US officials to describe the region as a “third border.”2US Department of State Archive, Caribbean Third Border Initiative, fact sheet, April 21, 2001, When global and regional events, such as the COVID-19 pandemic, economic recessions, or natural disasters reach the United States or the Caribbean, neither is spared from the consequences. 

This overarching relationship is one reason why it is imperative that the Biden administration support the Caribbean region’s states in their efforts to acquire COVID-19 vaccines. Another reason more vaccines should be made available to the Caribbean, while simultaneously accelerating the prioritization of distribution to the broader hemisphere, is the need to protect the livelihoods of the American people.

The Caribbean economies, especially those that are tourism-dependent, are connected to the tourism economies of cities in southeastern United States, such as Miami and Orlando. This means that recovery for these economies in the United States might not reach pre-pandemic levels if a key source of growth—Caribbean nations—are unable to reopen their borders and accelerate economic recovery. In addition, as COVID-19 virus variants materialize and are transmitted throughout the region, US populations can be put at risk since the Caribbean is a popular destination for US tourists.

Beyond domestic considerations, geopolitical and security implications are also at play if the United States does not step up its vaccine support for the Caribbean nations. Since the onset of the pandemic, medical diplomacy has increased globally. Caribbean countries have been beneficiaries of this diplomacy, first with donations of personal protective equipment (PPE) and medical personnel and now with donations and purchasing agreements for COVID-19 vaccines. China, India, Cuba, Russia, and the African Union (AU) have all supplied medical equipment and/or vaccines to the region and have used these donations to build goodwill with Caribbean governments and people.

On the security front, cash-strapped Caribbean governments, unable to provide public goods and access to social services amid rising rates of poverty and unemployment, can present challenges for the Caribbean and, by extension, the United States. For instance, rising poverty and unemployment benefits the membership of gangs and organized crime. Fiscal challenges can also contribute to social unrest and questioning of government legitimacy. Criminal groups that operate in the Caribbean are transnational in scope, particularly due to the porous borders of the states in the region, meaning that illicit activities can impact US national security. The instability that arises from the pandemic’s consequences can also increase legal and illegal flows of migrants to the United States.

The announcement by the Biden administration that it will deliver vaccines to CARICOM nations via the COVID-19 Vaccines Global Access (COVAX) Facility is a welcome initiative,3“Fact Sheet: Biden-Harris Administration Unveils Strategy for Global Vaccine Sharing, Announcing Allocation Plan for the First 25 Million Doses to be Shared Globally,” White House, June 3, 2021, but it is one that barely scratches the surface. Although there was an additional announcement of 500 million vaccine donations,4Kaitlan Collins and Maegan Vazquez, “US has bought and will donate 500 million doses of Pfizer’s vaccine worldwide,” CNN, June 9, 2021,  the Caribbean, with interests balanced alongside those of other hemispheric countries, must remain top in line to receive vaccines immediately through bilateral channels. At the same time, the United States should donate equipment that will help with the dissemination of vaccines, such as ultra-cold temperature vaccine freezers and medical equipment. Further, the United States should help Caribbean nations in their efforts to purchase vaccines from US manufacturers and, when vaccines are delivered, organize a media campaign in the region to build and strengthen goodwill among Caribbean citizens. 

The ideas presented in this issue brief are part of the Caribbean Initiative’s Strategy Document Series and a larger effort to inform and publicize the strategic importance for the United States of helping CARICOM members acquire vaccines. Many of the ideas presented here are the result of a private roundtable with US and Caribbean experts (see Acknowledgements section) from the private sector, public sector, academia, government, and regional and multilateral institutions, all of whom came together to discuss why the United States should help the Caribbean region in its efforts to secure vaccines. 

Overview of the current economic and health situation in the Caribbean

Although the COVID-19 pandemic has affected much of the world, it is having a disproportionate impact on the Caribbean region, in particular, CARICOM member states. Rising infections have forced states to close borders and governments to inject monetary resources to curb the pandemic’s consequences. For CARICOM, the pandemic has been particularly devasting. The open economies in the Caribbean are highly dependent on tourism, vulnerable to global economic shocks, have incurred large amounts of debt, and many do not qualify for concessional financing from international financial institutions. A combination of these vulnerabilities has made the Caribbean one of the most at-risk regions in the world.5“The World Bank in the Caribbean,” World Bank, accessed June 8, 2021,  

A worsening economic crisis

In 2020, most Caribbean countries were forced to close their borders to curb the spread of COVID-19 infections, resulting in a halt in economic activity for key sectors, such as tourism and trade. This led to an economic contraction of an estimated 8.6 percent for the entire region (an estimated 12.6 percent excluding Guyana).6Ibid. The reduction in tourism resulted in heightened unemployment, further damaging the livelihoods of Caribbean people, especially in states such as Antigua and Barbuda (44.7 percent of employment is tourism dependent in 2019), Barbados (36.4 percent), Saint Kitts and Nevis (60.2 percent), and Jamaica (31.5 percent).7“The World Bank” in Marla Dukharan, COVID-19 Caribbean Economic Impact Report, 6, March 30, 2020,

Closed borders and limited air travel have been particularly detrimental for a region in which a majority of states are tourism-dependent economies. According to the Inter-American Development Bank’s Tourism Dependency Index, ten of the fourteen independent members of CARICOM rank in the top twenty of most tourism-dependent states.8“The World Bank” in Marla Dukharan, COVID-19 Caribbean Economic Impact Report, 6, March 30, 2020, This meant that the 67 percent contraction of international arrivals to the Caribbean in 2020 devastated economies, with a particular effect on micro, small and medium-sized enterprises (MSMEs).9Matt Turner, “Caribbean Tourism Organization Partners with UNWTO on Tourism Data Workshop,” Travel Agent Central, February 18, 2021, These enterprises account for 99 percent of all businesses in the Latin America and Caribbean region.10“Micro, Small and Medium-Sized Enterprises,” IDB Invest, accessed June 8, 2021, en/solutions/advisory-services/micro-small-and-medium-sized-enterprises In addition to the pandemic’s current impact on MSMEs, it also has the potential to disrupt the reemergence of these enterprises since they will not have access to requisite finances needed to reopen for business and rehire employees. 

The economic contraction that has resulted from the pandemic is coupled with high levels of debt. Prior to the pandemic, the Caribbean, along with Latin America overall, was considered the most indebted region in the world, with debt expected to rise from 68.9 percent in 2019 to 79.3 percent of GDP in 2020.11Economic Commission for Latin America and the Caribbean, “Financing for development in the era of COVID-19 and beyond: Priorities of Latin America and the Caribbean in relation to the financing for development global policy agenda,” No.10, Special Report COVID-19, March 11, 2021, For Caribbean states, which have incurred more debt than their Latin American neighbors, this has placed constraints on their ability to borrow more money while also remaining limited in the ability to service existing debts due to little economic growth. 

The precarious economic situation in the Caribbean is likely to affect the region’s relations with the United States. Prolonged economic contraction and job loss in the region can decrease travel to the United States as well as Caribbean demand for US goods, which can harm US-Caribbean trade relations. Further, high levels of debt for Caribbean countries will mean that they are likely to seek financial support from other countries, such as China, in order to service debts and address citizens’ immediate needs. Finally, if the region cannot reopen its borders to restart tourism industries, Caribbean states will incur additional financial loss over a longer period, meaning that the economic consequences of the pandemic to the US-Caribbean relationship can extend beyond 2021 and 2022. 

Shoppers line up at a supermarket ahead of a 24-hour curfew in St Michael, Barbados, April 3, 2020. REUTERS/Nigel Browne

Infections continue to rise due to new virus variants

At the onset of the pandemic, Caribbean countries were spared rising rates of infections since they closed their borders as early as March 2020. However, an indefinite lockdown was unrealistic due to the region’s dependence on the international system for its economic health. Caribbean countries were forced to gradually reopen their borders, and with this came multiple waves of infections, particularly as new variants of the coronavirus that causes COVID-19 emerged and were transmitted by migrating populations. 

Trinidad and Tobago, which reported that the virus variant first detected in Brazil had entered the country from Venezuela, saw infections climb from forty-four a day at the beginning of April to 558 on May 20.12Reuters COVID-19 Tracker, “Trinidad and Tobago,” accessed May 20, 2021, world-coronavirus-tracker-and-maps/countries-and-territories/trinidad-and-tobago/ Trinidad and Tobago entered its third state of emergency on May 15.13Reuters, “Trinidad and Tobago declares state of emergency as COVID-19 cases surge,” May 15, 2021, In the case of Guyana, which has a porous border with Brazil, the daily infection rate climbed from thirty-one cases a day as of early April to 136 cases by May 20.14Reuters COVID-19 Tracker, “Guyana,” accessed May 20, 2021, Since Guyana shares a border with Suriname, where there are frequent occurrences of illegal crossings, it is likely that the Brazil variant will soon reach Suriname, which would explain the rise in infections in Suriname from ten per day on April 4 to 300 on June 2.15Reuters COVID-19 Tracker, “Suriname,” accessed June 2, 2021, Lax restrictions coupled with limited testing could result in a rapid increase in infections, similar to the case of Trinidad and Tobago, which is experiencing more cases per capita than other pandemic epicenters, such as India. 

If infections rise, Caribbean countries will be forced to close borders or not reopen them in the near future, which will have an economic and geopolitical impact on the United States. Closed borders result in economic contraction, which disrupts demand for US goods and deters Caribbean citizens from traveling to the United States. 

The Caribbean’s vaccine dilemma

The economic and health crisis caused by the pandemic is threatening to amplify existing vulnerabilities in the Caribbean, such as growing debt and revenue loss in key economic sectors, even as the region braces for hurricane season. The region is in desperate need of COVID-19 vaccines. Vaccine donations and rapid inoculation is imperative. In comparison to other affected regions, the Caribbean must grapple with both the pandemic as well as an active hurricane season. According to the National Oceanic and Atmospheric Administration, there is a 60 percent chance that there will be an above average hurricane season this year—this could potentially further reduce the number of tourists traveling to the region.16National Oceanic and Atmospheric Administration, NOAA predicts another active Atlantic hurricane season, media release, May 20, 2021, The Atlantic hurricane season runs from June 1 through November 30. 

If they cannot quickly vaccinate their populations and reopen borders, Caribbean countries will not have enough time to recover lost growth and resources vital to repair the damage caused by strong tropical storms and/or hurricanes. Although, relative to previous years, the region was spared during the 2020 hurricane season, the combination of rising infections and a natural disaster will delay economic recovery and vaccination efforts. An early sign of this was the recent volcanic eruption in Saint Vincent and the Grenadines, which forced the government to pause its vaccination efforts in order to attend to displaced persons and address damage caused to agriculture and infrastructure.17Maria Fernanda Bozmoski and Wazim Mowla, “Hemispheric Aid During a Unique Hurricane Season,” Real Clear World, April 27, 2021,

At the moment, the Caribbean region has been unable to secure the requisite number of vaccines which would allow the countries to reopen their borders and accelerate post-pandemic recovery, particularly in larger Caribbean states such as Jamaica and Trinidad and Tobago. Smaller Caribbean islands, like those in the Eastern Caribbean, although with small populations, have been unable to inoculate their populations due to limited vaccines access. While the Caribbean nations have received vaccines via donations and purchasing agreements, as well as through the COVAX Facility, these avenues, thus far, have been inefficient. The COVAX Facility has provided one hundred and ten thousand vaccines to Jamaica,18Ainsworth Morris, “Jamaica receives 14,400 doses of vaccines under COVAX,” Jamaica Information Service, March 16, 2021, sixty-seven thousand to Barbados,19Pan American Health Organization, “Barbados receives its second batch of COVID-19 vaccines through COVAX facility,” May 11, 2021, sixty-seven thousand to Trinidad and Tobago,20Pan American Health Organization, “Trinidad and Tobago receives second shipment of COVID-19 vaccines through the COVAX Facility,” May 12, 2021, sixty-two thousand to Guyana,21Pan American Health Organization, “Guyana Receives Second Shipment of 38,400 COVAX Vaccines,” May 10, 2021, forty-five thousand six hundred to Grenada,22Narissa Fraser, “Covax to deliver covid19 vaccines to St. Vincent, Grenada next week,” Trinidad and Tobago Newsday, May 21, 2021, and twenty-four thousand each to Antigua and Barbuda23Pan American Health Organization, “Antigua and Barbuda receives the first COVID-19 vaccines through the COVAX Facility,” April 8, 2021, and Saint Vincent and the Grenadines.24Pan American Health Organization, “St. Vincent and the Grenadinnes receives the first VOCID-19 vaccines through the COVAX Facility,” April 7, 2021, Vaccines from the COVAX Facility do not cover the entire population of each country and are disseminated in batches spread over a longer period. 

Since the COVAX Facility has delivered few vaccines thus far and is expected not to deliver its full quota until 2022 or 2023, even with US donations to the facility, Caribbean governments have sought vaccines from China, India, Russia, and the AU. China has donated a total of three hundred and eighty thousand vaccines to its diplomatic allies in the Caribbean, India promised a total of five hundred and seventy thousand vaccines to the entire region, Russia is supplying two hundred thousand to Guyana through a purchasing agreement, and the AU has set aside 1.5 million vaccines for CARICOM via a brokered agreement between the two regional groups in 2020.25Wazim Mowla, “Vaccines Open an Opportunity for U.S. Diplomacy in the Caribbean,” Real Clear World, April 16, 2021 However, even though some countries, such as India, have promised vaccines to the region and others, like Russia and the AU, have reached purchasing agreements, these agreements do not immediately result in vaccine delivery. The two hundred thousand vaccines Guyana purchased from Russia will reach it in batches, and the 1.5 million vaccines brokered for CARICOM from the AU have yet to be delivered. 

Importance of vaccinating the Caribbean for the United States

As much as the United States is critical to the financial health of the Caribbean, so is the Caribbean for the United States. It is a mutual relationship, where in addition to the United States benefiting from a significant trade surplus, it is a provider of tourists, is home to a large Caribbean diaspora, and is a space where many Caribbean skilled workers travel in search of jobs. 

Beyond the economic linkages, migration between the Caribbean and the United States is consistent. The US-based Caribbean diaspora attracts visits from family members in the region and the Caribbean is a frequent destination for US tourists. However, in order for travel from Caribbean islands to the United States to occur, Caribbean citizens will first need to be vaccinated. Since many are not, it is unlikely that they will travel to the United States anytime soon, which means that hotels, restaurants, and shopping centers will not benefit from these visitors, thus reducing the growth potential for US local economies. 

As noted, the United States benefits from its trade relationship with Latin America and the Caribbean. In 2018, the State Department said that the United States “is the primary trading partner for the Caribbean” with a $12.3 billion trade surplus.26Bureau of Western Hemisphere Affairs, “U.S. Strategy for Engagement with the Caribbean,” US Department of State, July 23, 2019, The relationship, while presented as one-sided given the large surplus enjoyed by the United States, is mutually beneficial since the Caribbean is almost as important to the United States as the United States is to the region. The Caribbean is the United States’ sixth-largest trading partner. Although the region’s economic impact is not as profound as that of other top US partners, such as Mexico and China, the Caribbean is a significant part of the US economy and vital to its economic growth.27Daniel F. Runde, Linnea Sandin, and Amy Doring, Reimagining the U.S. Strategy in the Caribbean, Center for Strategic and International Studies, April 2021

Low rates of vaccination in the region have a broader impact on US trade with the region. Since the Caribbean consists mainly of MSMEs, where even larger firms are considered small and medium-sized enterprises (SMEs), these enterprises’ ability to produce goods for the US market is likely to have declined. At the same time, since many SMEs are not operational due to the pandemic, there is less chance that they will purchase US goods, especially since imported US goods are used to accommodate the preferences of US tourists in the region. In other words, closed economies and a reduction in key economic sectors have deprived Caribbean governments and citizens of financial resources, which has reduced the supply of exports to the United States and the demand for US goods in the region. 

Florida-Caribbean economic linkages

Decreased US-CARICOM trade has implications for southeastern United States, Florida, in particular, which accounts for about 30.4 percent of total US trade with Latin America and the Caribbean.28Enterprise Florida, 2019 Florida International Business Highlights, June 2020 Of this percentage, the Caribbean represents 38.9 percent of total US trade, meaning that for Florida, more than a third of its trade is dependent on its connection to the Caribbean.29Ibid. 

For Florida and the companies that operate out of the state, such as cruise lines and other sectors of the tourism industry, it is imperative that the Caribbean and its citizens be vaccinated in order to reopen borders and restart economic activity. If cruise ships, which are an integral link in the Florida-Caribbean economic relationship, do not have destinations for tourists to visit, then these companies will have limited options. Limited options for tourists can deter people from buying cruise tickets and harm additional industries, such as airlines and US-led hotel chains on the Caribbean islands. 

Citizens start to mingle near the bars and restaurants without masks as curfews are lifted in Miami, Florida, U.S., March 26, 2021. REUTERS/Yana Paskova

For Florida, which is a home port for many cruise lines, there are direct and indirect consequences for its economy. For instance, Royal Caribbean, which is one of the biggest cruise companies that has home ports in Florida, has seen contractions of its revenue due to lower levels of tourism. This has resulted in a loss of employment for many residents in Miami, where almost 79,000 jobs are attributed to the cruise industry, including those at ports, retail, and manufacturers, among others.30Johanna Jainchill, “Economic pain from cruise industry shutdown is far-reaching,” Travel Weekly, June 5, 2021

The reasoning behind cruise lines and Florida’s economic contraction and the corresponding rise in unemployment is that Caribbean borders have had to close each time the number of COVID-19 infections goes up. The numerous waves of infections and constant closing and reopening of borders, as well as Centers for Disease Control and Prevention (CDC) categorization of Caribbean islands as high-risk states, has decreased the confidence of prospective tourists. For instance, the CDC recommends that US citizens not travel to states that are classified at level 4 (high risk), as was the case for Trinidad and Tobago and Jamaica as of June 7.31“COVID-19 Travel Recommendations,” Centers for Disease Control and Prevention, accessed June 7, 2021,

At the same time, limited tourism due to closed Caribbean borders will prevent Caribbean residents from traveling to the United States for jobs or to visit members of the Caribbean diaspora—both of which are drivers of economic and job growth. When family members visit the United States, they often stay for an extended period of time, which usually includes hotel stays, shopping at local stores, and eating at restaurants, all of which are vital to local economies and particularly small businesses. In 2019, almost two million people from the Caribbean visited the United States.32Statista, “Number of visitors to the United States from the Caribbean from 2011 to 2020,” accessed June 8, 2021, Large cities that have high concentrations of the Caribbean diaspora, such as Fort Lauderdale, Orlando, and, outside Florida, New York City, would benefit from reopened Caribbean borders. 

Geopolitical importance of the Caribbean to the United States

As the United States aims to strengthen partnerships in the Caribbean, extra-hemispheric vaccine diplomacy and potential rises in instability and illicit activity will add to local vulnerabilities and complicate its ability to advance its interests and partnerships with Caribbean allies. Therefore, US President Joseph R. Biden, Jr., and his administration should use vaccine donations to compliment the goodwill they built in the first half of 2021, such as US Secretary of State Antony Blinken’s virtual roundtable with CARICOM foreign ministers on April 2133Office of the Spokesperson, US Department of State, Secretary Blinken’s Roundtable with CARICOM Foreign Ministers, media note, April 21, 2021, and US National Security Advisor Jake Sullivan’s call with CARICOM Secretary General Irwin LaRocque and leaders from the CARICOM member states on May 7.34White House, “Readout from NSC Spokesperson Emily Horne on National Security Advisor Jake Sullivan’s Call with CARICOM Leaders,” May 7, 2021 

Vaccine diplomacy in the Caribbean

The United States committed COVID-19 vaccines to the Caribbean with the June 3, 2021, announcement that CARICOM will receive a portion of the six million vaccines designated for Latin America and the Caribbean through the COVAX Facility. More vaccines are urgently needed and additional actors have filled the gap. Through either purchasing agreements or donations, CARICOM states have received almost one million two-shot vaccines from China, Russia, and India, with 1.5 million Johnson & Johnson vaccines expected to arrive from the AU. In addition, as Cuban-made vaccines earn approval from the World Health Organization (WHO), the Caribbean is likely to benefit from donations or low-cost purchasing from its neighbor. 

Compared to Latin America, China has not given a substantial number of vaccines to Caribbean governments, but a recent loan from China to Trinidad and Tobago might be a blueprint for future interactions between China and its Caribbean allies. As small states with limited economic resources, Caribbean countries are pragmatic actors whose outreach to richer nations, such as the United States and China, is dependent on the needs of their citizens rather than ideological influences. As a result, many countries’ leaders, including Trinidad and Tobago’s prime minister, Keith Rowley, sought the support of China, as well as the United States, with regard to vaccine acquisition. In this case, China was first to answer the call. 

In early May 2021, Trinidad and Tobago entered a loan agreement with China—the Caribbean nation borrowed €170 million ($204 million).35Ryan Hamilton-Davis, “Trinidad and Tobago to take Chinese loan to buy Chinese vaccines,” Trinidad and Tobago Newsday, May 11, 2021, As part of the arrangement, China stipulated that 15 percent of the money must be used to purchase Chinese goods and services, which includes the COVID-19 vaccine produced by the Chinese state-owned enterprise Sinopharm. In addition to this agreement, China announced at the end of March 2021 that it would donate up to 100,000 Sinopharm vaccines, all of which arrived in Trinidad and Tobago a few days before the loan agreement was announced.36Loop News, “Sinopharm vaccines arrive in Trinidad and Tobago,” May 19, 2021, As a part of the loan agreement signed between the two countries, Trinidad and Tobago purchased and received 200,000 additional Sinopharm vaccines in June 2021,37Janelle De Souza, “[updated] 200,000 Sinopharm vaccines to arrive on Monday,” Trinidad and Tobago Newsday, June 12, 2021. which arrived on the same day that Trinidad and Tobago’s government announced that it received 400 doses of the Pfizer vaccines from the United States.38Darlisa Ghouralal, “US donates 400 doses of Pfizer vaccines to T&T,” Loop News, June 13, 2021, 

Chinese engagement was not an ad hoc event. China’s vaccine diplomacy with the Caribbean has entailed more than the arrival of vaccines; it has also included numerous conversations between Chinese President Xi Jinping and the region’s heads of state and government, including the presidents and/or prime ministers of Barbados, Guyana, Suriname, and Dominica. In all cases, excluding Suriname, China donated Sinopharm vaccines, with Barbados receiving thirty thousand,39Randy Bennett, “Barbados to get 30,000 doses of Chinese Sinopharm vaccine – PM Mottley,” Barbados Today, April 1, 2021 Guyana getting twenty thousand,40Xinhua, “Guyana receives donated COVID-19 vaccines from China,” Xinhuanet, March 3, 2021. and Dominica an undisclosed amount.41Ministry of Foreign Affairs of the People’s Republic of China, “Dominican Prime Minister and Charge d’Affaires of Chinese Embassy attend vaccine handover ceremony,” March 5, 2021, In addition to these CARICOM states, China has committed more than eight million vaccines to the Dominican Republic.42Jason Marczak, Pepe Zhang, and Cristina Guevara, “COVID-19 vaccine tracker: Latin America and the Caribbean,” Adrienne Arsht Latin America Center, Atlantic Council, May 12, 2021,

A health worker holds a vial with doses of the Oxford-AstraZeneca vaccine, marketed by the Seerum Institute of India (SII) as COVISHIELD, against the coronavirus disease (COVID-19), in Paramaribo, Suriname, February 23, 2021. REUTERS/Ranu Abhelakh

Beyond China, other actors, such as India and Russia, either through donations or purchasing agreements, have provided vaccines to the Caribbean. India was the first country to donate vaccines to the region. Its Ministry of Foreign Affairs announced in February 2021 a plan (later halted due to India’s own rising infection rate) to supply CARICOM nations, including the Dominican Republic and Cuba, with at least five hundred and seventy thousand of its Indian-made AstraZeneca vaccines.43Jacqueline Charles, “Some Caribbean, Latin American nations are finally getting COVID vaccines, thanks to India,” Miami Herald, February 18, 2021 (updated February 19, 2021), Russia has been less influential. Only a few Caribbean states have received Russia’s vaccine, mostly because the Sputnik V vaccine has not been made available for donation to the region and is only available for purchase. Guyana purchased two hundred thousand Sputnik V vaccines.44Vishani Ragobeer, “Largest shipment of COVID-19 vaccines arrives in Guyana,” Guyana Chronicle, April 20, 2021, While neither India nor Russia have pronounced investments or operations in the Caribbean, the donation or selling of vaccines can build goodwill and/or can lead to additional engagements with the region’s governments, in terms of trade and commerce and investments in key economic sectors, such oil, gas, and additional natural resources. This was most recently seen in a treaty signed between the governments of Antigua and Barbuda and Russia,45Nation News, “Antigua & Barbuda signs bilateral agreement with Russia,” June 8, 2021, which was preceded by a donation of the Sputnik V vaccine.46Nation News, “Antigua & Barbuda signs bilateral agreement with Russia,” June 8, 2021, 

Finally, if Cuba’s vaccine receives approval from the WHO, most CARICOM members, which annually announce their support for their Caribbean ally at multilateral institutions, are likely to receive donations or buy vaccines from Cuba. There is precedent for this during the pandemic, particularly at its onset, when Cuba sent multiple medical brigades to Caribbean countries to help strengthen their public health systems.47Wazim Mowla, “A Cuban lifeline to CARICOM,” Global Americans, May 7, 2020, Cuba’s support to the Caribbean countries was condemned by some members of the US Congress, who frame this support as future Cuban leverage in the Caribbean.48Wazim Mowla, “New Cuba bill puts a strain on U.S.-Caribbean relations,” Global Americans, July 16, 2020, 

Complicating the image of the United States in the Caribbean

While Caribbean partners, including US allies such as Canada, which has pledged $40 million to Latin America and the Caribbean, have supplied vaccines or support to the region, the United States is often cited for its need for further action.49Pan American Health Organization, “Canada and PAHO join forces to advance COVID-19 vaccination of people in a situation of vulnerability across the Caribbean and Latin America,” May 21, 2021, The May 2021 US donation of two field hospitals to Trinidad and Tobago to aid in the third wave of infections and high-level meetings between US and Caribbean government officials have not gone unnoticed, but they do not receive the same publicity as a Chinese vaccine donation or purchasing agreement. The longer the United States takes to donate substantial, game-changing vaccines to the region, the greater the risk that Caribbean citizens will develop a negative perception of the role it played in their time of need. This perception would have geopolitical implications, in particular as the United States prioritizes addressing climate change, outcompeting China, and re-embracing multilateralism. 

  • Climate change: In many ways, the effects of climate change and the methods of addressing it are similar to the pandemic. Both cause economic contraction, particularly for tourism-dependent Caribbean countries, and both require solutions that involve a whole-of-government and multilateral approach. As a result, Caribbean countries will view Biden’s approach to supporting partner nations during the pandemic as an example of how his administration might work to address the climate crisis. 
  • Outcompeting China: While the number of vaccines China has sent to the Caribbean is small, the delivery of these vaccines has an impact on the region’s populations. Vaccine arrival is a televised media event that usually makes local and regional news. High-level Caribbean government officials attend the handover ceremony organized by the local Chinese embassy. This means that when it comes to public perception, specifically related to the pandemic, China has gained more ground than the United States. China can use this advantage to further build its domestic political capital.
  • Re-embracing multilateralism: Although Caribbean countries are small in size, their regional body, CARICOM, has fourteen votes in multilateral organizations. In organizations such as the United Nations and regional ones, such as the Organization of American States (OAS), CARICOM votes carry significant weight. Other countries are aware of CARICOM’s importance in these organizations. When Ireland and Canada sought seats on the UN Security Council, high-level government officials traveled to the Caribbean in an effort to secure CARICOM votes.  If the United States provides a significant number of vaccines to the region, while it will not guarantee support at these organizations, it will make countries more inclined to listen and potentially compromise with US positions. In the best-case scenario, the United States and CARICOM could work together, as partners, to push key resolutions on climate change and security in smaller organizations such as the OAS. 

Case study: When China donated its Sinopharm vaccines to Dominica and Guyana, each shipment received substantial media coverage and included official handover ceremonies between Caribbean and Chinese government officials. When China’s vaccines arrived in Guyana in March 2021, Guyana’s minister of health, Frank Anthony, and China’s charge d’affaires to Guyana, Chen Xilai, met at the airport to welcome the shipment.50Xinhua, “Guyana receives donated COVID-19 vaccines from China,” Xinhuanet, March 3, 2021, At the airport, both representatives offered brief remarks about the importance of the relationship between their two countries. Similar to Guyana, China’s vaccine donation to Dominica was greeted with publicity, including a handover ceremony. The Chinese charge d’affaires to Dominica, Luo Songtao, posed for photographs with Dominica’s prime minister, Roosevelt Skerrit, as they held a box of the Sinopharm vaccines. Coverage of the event included a photo of a Dominican official receiving the first jab of the vaccine.51Xinhua, “Dominica receives China-donated COVID-19 vaccines,” March 5, 2021,  

Preventing instability and illicit activity  

An additional implication of the COVID-19 pandemic in the Caribbean is the risk of instability and illicit activity that can arise as the region’s economic situation worsens. This is of particular concern for the United States due to its proximity to the region. Increases in instability and the membership of transnational criminal organizations can lead to forced migration as well as upticks in drug and human trafficking. The risk of instability and illicit activity is not a direct cause of the pandemic but instead an indirect cause that results from limited government resources, widening inequality, and increases in crime and unemployment. In essence, the pandemic should be viewed as an amplifier or aggravator of existing stressors, with the potential to create new ones. Limited economic resources mean that governments will have less resources to invest in the public health sector and labor market if more funding is needed to strengthen security forces in a scenario of increased instability, crime, and/or violence. 


Donations: The Biden administration will distribute eighty million vaccines by the end of June 2021, and while the Caribbean is part of this distribution, it will be imperative to look beyond this initial batch of indirect global donations. As the United States shares 500 million vaccines globally by the late 2021 via the COVAX Facility, the Caribbean, in balancing the broader needs of the hemisphere, should be a top priority for bilateral distribution. Due to the small populations of Caribbean states—the population of the English-speaking states hovers just over seven million people—a small donation of vaccines goes a long way. If the United States were to directly donate at least four million two-shot vaccines, it would cover two million people, or more than a fourth of the region’s English-speaking population. Vaccines for countries directly linked to the tourism industry would benefit US businesses as well. 

  • US distribution of vaccines to the region should involve continued coordination with the Caribbean Public Health Agency (CARPHA), which could help ensure that the supply is distributed equitably. This would ensure that the United States is not accused of choosing beneficiaries. This strategy is a diplomatic advantage that the United States holds over China since only the United States has diplomatic relations with all CARICOM countries. 
  • When sending vaccines to the region, the United States must ensure that CARICOM countries are provided with the appropriate equipment that allows for equitable and efficient vaccine distribution. This means that along with the AstraZeneca vaccines, the United States should bilaterally donate ultra-cold temperature vaccine freezers to CARICOM members to support and strengthen governments’ cold chain systems. 
  • Finally, the United States should deploy other forms of medical diplomacy to Caribbean countries that are seeing rising infection rates. This should include more donations of field hospitals, PPE, and rapid testing kits. Such donations will help Caribbean countries that are awaiting vaccines to avoid additional lockdowns, mitigate rising infections, and support hospitals that are close to full capacity. Already, the United States has donated field hospitals, generators, hospital beds, medical teams, and hand-held thermometers.52US Department of Defense, “Southcom Donates Field Hospital to Jamaica in Support of COVID-19 Response,” September 25, 2020, More should be done. 

Purchasing agreements: The small size of Caribbean populations, and, therefore, small relative orders, has contributed to challenges in purchasing vaccines from manufacturers such as Pfizer-BioNTech, Moderna, and Janssen/J&J. The US government can serve as a key interlocutor for Caribbean countries to find solutions to this problem. In addition, the US government can find opportunities to facilitate agreements with the vaccine manufacturers that allow for Caribbean governments and even US private sector members invested in the Caribbean to purchase vaccines at an affordable rate. 

Diplomacy: To build on recent high-level engagements between US and CARICOM government officials, the Biden administration should work with the public diplomacy officers and US ambassadors in US embassies to ensure that the donation of vaccines is part of a larger media campaign. This would build goodwill among Caribbean citizens by advancing messaging with the public on US involvement to help defeat the virus in the region. This form of diplomacy at the local level would build on existing US-led initiatives such as electoral reform, combatting narco-trafficking, and promoting US investment. At the same time, since Caribbean governments have faced challenges to educate and incentivize their citizens to trust COVID-19 vaccines, US embassies can aid their efforts to encourage their populations to get vaccinated.


The United States has the economic and political resources to provide the Caribbean with the support needed to change its COVID-19 trajectory. Timely bilateral vaccine and medical donations to CARICOM would have an immediate impact on Caribbean economies and livelihoods, would strengthen US-Caribbean relations, and would have positive consequences for US economic and geopolitical interests.  

The United States has an opportunity to cement its position as CARICOM’s most trusted ally. The US commitment of at least 580 million vaccines to the COVAX Facility is a step in the direction, but more emphasis must be placed on bilateral donations. If the United States is seen as contributor to re-opening economies via substantial vaccine donations, the perception of the Biden administration is likely to increase. This can make Caribbean governments more favorable to current and future US initiatives. At a broader level, vaccine and medical donations can assist US geopolitical strategies, as it can reduce the likelihood for instability and will help compete with Chinese and Russian engagement.

Sending US vaccines to the Caribbean is in the best interest of the hemisphere. The Caribbean is at a disadvantage in terms of mitigating the effects of the pandemic and acquiring vaccines. Support from the United States can help the Caribbean level the playing field. Doing so can usher in a renewed sense of optimism within the US-Caribbean dynamic. Simply, helping the Caribbean is helping the United States, as the two, through geography, shared values and interests, and frequent travel, are intrinsically bonded together.


This issue brief benefited from the insights and expertise of a Caribbean Initiative private roundtable in May 2021, which consisted of participants from the US and Caribbean policy and business communities, including: Ambassador Riyad Insanally, Marla Dukharan, Gervase Warner, Therese Turner-Jones, Timothy Johnston, and Dr. Ivelaw Griffith. We thank the many participants of that strategy session. 

As well, we would like to thank Adrienne Arsht Latin America Center Director Jason Marczak for his leadership and guidance in the drafting of this issue brief and for his prioritization on how to help accelerate vaccine access. In addition, the Atlantic Council thanks Board Member Melanie Chen for her steadfast focus on accelerating US-Caribbean ties and for her broader support of the Caribbean Initiative. 

About the authors

Ambassador James Brewster is currently a Managing Partner at Patino, Brewster & Partners and the CEO of Insignias Global. Most recently, he served as the United States Ambassador to the Dominican Republic, and his appointment made history when he became the first openly gay Ambassador to serve the United States in the Western Hemisphere alongside his husband, Author Bob J. Satawake. As an expert in Latin America and the Caribbean business and political communities, Ambassador Brewster had a positive and significant impact on trade between the U.S. and countries in the Western Hemisphere. His knowledge of NAFTA, CAFTA, HELP and HOPE in addition to Foreign Corrupt Practices Act and trade policy has made the Ambassador a top resource for international companies and leaders of foreign governments.

Wazim Mowla is the Assistant Director for the Caribbean Initiative at the Adrienne Arsht Latin America Center. Mowla holds an MA in History from Florida International University, where he is currently a Non-Resident Scholar for the Jack D. Gordon Institute for Public Policy. He is also an MA candidate at American University’s School of International Service and is honored to have interned for Ambassador Ronald Sanders of Antigua and Barbuda and Ambassador Riyad Insanally of Guyana.

The Adrienne Arsht Latin America Center (AALAC) broadens understanding of regional transformations through high-impact work that shapes the conversation among policymakers, the business community, civil society, and media. Founded in 2013, the center focuses on Latin America’s strategic role in a global context, with a priority on pressing political, economic, and social issues that will define the trajectory of the region, now and in the years ahead. Select lines of programming include: China in Latin America; Venezuela’s crisis; Mexico’s US and global ties; Colombia’s future; a changing Brazil; Central American prosperity; combatting disinformation; shifting trade patterns and modernization of supply chains; charting a post-COVID future; Caribbean development; and leveraging energy resources. Jason Marczak serves as center director.

Related Experts: Wazim Mowla