Photo: ICRC

Dialogues for informed vaccination

COVID-19 vaccination uptake in indigenous communities in Peru.
Article 11 March 2022 Peru

The American continent has recorded the highest number of COVID-19 deaths globally since the start of the pandemic. Access to vaccination is limited for the most vulnerable communities and vastly unequal. While in some countries 90% of the population are fully vaccinated, in others the proportion is not even 20%, further widening the social and economic inequality gap in this part of the world.

Two years on from the start of the pandemic, Peru tops the global COVID-19 mortality ranking, with a rate of 627 deaths per 100,000 inhabitants. The country has recorded over 209,000 COVID-19-related deaths and almost 3.5 million infections, yet only 40% of people in Amazonian communities have been vaccinated against COVID-19, according to the Ministry of Health.

Peru's indigenous communities in hard-to-reach areas with geographically diverse terrain, including Amazon rainforest and mountainous landscapes, have limited access to health services and information.

The agile vaccination roll-out in cities contrasts starkly with the slow pace of delivery to communities living deep in forest or mountain areas, and this problem is further compounded by the misinformation, fear and rumours circulating in these areas.

The International Red Cross and Red Crescent Movement, together with Peruvian Red Cross (PRC) leaders, has coordinated efforts with the Ministry of Health and indigenous organizations to promote community dialogue, based on an intercultural approach, with a view to jointly designing measures, delivering information and promoting COVID-19 vaccination uptake among indigenous people living in these inaccessible areas.

Thanks to these efforts, 2,756 people in 70 Amazonian communities in the regions of Ucayali, Loreto and San Martín have received at least one dose of the COVID-19 vaccine. Additionally, 623 people in 26 rural communities in the regions of Puno and Áncash received at least one jab.

We didn't even know the COVID-19 virus existed. It's the first we've heard of it. Thank you for the information.

Mariano Quisto, Apu (leader) of the Urarina Amazonian community of Mangual in the Loreto region.

Reaching remote areas

Getting to these hard-to-reach places requires the help of a local team that can liaise with the communities to obtain the authorizations the awareness and vaccination units need to gain access.

The teams that carry out this work, formed by health-care personnel and PRC specialists and supported by the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC), have to travel three days upriver on a boat, enduring heavy rains and negotiating fallen trees, to get to the community of Mangual located in the meanders of the Chambira River in the Amazon, a place that has not seen a visit from a health team for several years.

Dry ice is used to refrigerate the vaccines for the journey upriver through the tropical rainforest, where temperatures range from 30 ºC to 38 ºC.

The Red Cross river boats also take health-care and humanitarian personnel, information and vaccines to the Lake Imiría basin in the Ucayali region. In these communities, radio is still the main means of communication and is used to broadcast messages.

Segundo Mozombite, who lives in the area, explained that the internet is slowly and gradually reaching some of the settlements there, which means that they get information about COVID-19 via WhatsApp. "People create groups or call each other saying the vaccine is the '666' mark and implants a microchip in you."

Community dialogue at the core of the initiative

The team's priority when it gets to the community is to understand people's needs and concerns about the virus, assess their health and promote community dialogue. So far, 2,760 people have attended 75 community assemblies, which aim to ensure that their right to information and vaccination is guaranteed and that the independence and representativeness of the community is respected.

According to the Ministry of Health, the low rate of vaccination among indigenous people can be attributed to a variety of factors, including lack of access to vaccination and fear caused by the misinformation they have received about it.

"What I know is that COVID kills people. That hasn't happened in our community yet, but I've decided to get vaccinated to make sure I don't get ill because merchants coming upriver can bring the virus with them", explains a woman from the Santa Hermosa community.

Concerns about vaccination are addressed in the community's own language, based on scientific evidence. In addition, with loudspeakers, megaphones, caravans and home visits, the team members inform the community and hand out leaflets and biosafety materials.

Community members making informed decisions to get vaccinated

"I was convinced by the clear explanation they gave, and I would like to see other people who are hesitant get vaccinated for their own well-being and that of their families," says José, who went to get his first jab after his doubts about the vaccine had been cleared up. Vaccination is carried out by the Ministry of Health, and surveys are conducted to understand people's interest and views about the first and second doses.

It's quite an achievement, and it gives me great satisfaction as a nurse to see people coming happily to get vaccinated because they know they will be protected and will come back for their second jab. It motivates us and gives us the strength we need to carry on fighting this virus.

Myriam Ríos, a nurse at a health post in the Ucayali region.
Photo: Sebastián Castañeda/ICRC
Photo: Sebastián Castañeda/ICRC Indigenous children take part in community dialogues at the local school.

Meanwhile, in communities in the Andean highlands – some located at more than 3,800 m above sea level – access to vaccination has been hindered by the difficult topographic conditions and misinformation.

Teams in the field talk to the communities there in Quechua, their native language, answering any questions they may have. As observed by Julio Mendigure, executive director of Indigenous Peoples at the Ministry of Health, their main concerns about the vaccination include fears that it is being used as a method for sterilizing women, that it may affect men's sexual performance, that it could lead to death and that the virus is a divine punishment.

We are institutionalizing the intercultural dialogue on vaccination against COVID-19.

Julio Mendigure, executive director of Indigenous Peoples, Ministry of Health.
Photo: Melissa Alleant/IFRC
Photo: Melissa Alleant/IFRC A couple from the Jochi San Francisco community in Puno hold up their COVID-19 vaccination certificates just after being vaccinated.

La hija de Rufina Luque, habitante de Puno, se infectó asintomáticamente de la COVID-19 pero fue agravándose. Antes de ver enferma a su hija, Rufina no creía tanto en la vacuna, pero reflexionó al respecto luego de recibir su primera dosis: ''Hay que hacerse vacunar; no nos cura, sino que nos protege", comentó.

Como parte de este proceso de escucha e intercambio de conocimiento, la Cruz Roja Peruana lleva a las comunidades toda la información que la población requiere. De esta manera, pueden recibir la vacuna y estar seguras de que el proceso realizado por el Estado se implementa para proteger la salud de la ciudadanía.

De vuelta en la región amazónica de Ucayali, Cecilia Brito recordó que antes de la llegada de los equipos de sensibilización y vacunación hubo muchas informaciones falsas. Ella es representante indígena Shipibo de la Organización Regional Aidesep Ucayali (ORAU), que realizó una encuesta en mayo de 2021, la cual arrojó que más de la mitad de la población indígena se oponía a su inoculación.

"Frente a esa realidad, las organizaciones en conjunto han respondido las preguntas que la población hace con información transparente. Eso nos ha permitido lograr el objetivo de la vacunación", explicó Brito.

Myriam Ríos es licenciada en enfermería del Puesto de Salud de Bella Flor, en Ucayali, y tiene 18 años trabajando y conviviendo con los comuneros de la zona. Al inicio tenía dudas sobre la sensibilización previa a la vacunación, pero al ver la convocatoria y responder a las preguntas que sus mismos pacientes le hacían, ganó confianza en el proceso.

"Estaba nerviosa, pero con muchas expectativas positivas. Al final fue muy exitoso porque había personas que decían que no se iban a vacunar, que creían algunos mitos y desinformación, pero después de los diálogos de sensibilización ellas eran las primeras en vacunarse", comentó.

Atención de la COVID-19, una de las múltiples necesidades de las comunidades

Si bien los esfuerzos avanzan por promover una vacunación informada y segura, allí las personas enfrentan cada día diversos desafíos. En la comunidad de Mangual, las condiciones de salubridad dificultan instaurar buenas prácticas de lavado de manos, puesto que bombean agua subterránea que no es apta para consumo humano. "Sufrimos de malaria, diarrea, dolores de cabeza, y conjuntivitis", comenta el Apu Mariano Quisto, habitante de la comunidad.

La labor de la Cruz Roja Peruana y los miembros del Movimiento Internacional de la Cruz Roja y de la Media Luna Roja, junto con el Minsa, responde a la preocupación de la población y promueve la activación de brigadas de atención integral en salud a lo largo de la intervención comunitaria.

De la mano con el Minsa y las organizaciones indígenas, la Cruz Roja seguirá promoviendo el derecho a la salud, a la información, a la toma de decisión previamente consultada y a la vacunación gratuita y voluntaria. Es una prioridad ética asegurar que las poblaciones más vulnerables y marginalizadas cuenten con información y acceso a las vacunas para promover su protección y prosperidad.

Photo: Sebastián Castañeda/ICRC
Photo: Sebastián Castañeda/ICRC Two children take a rest in a peque-peque canoe on the Chambira River.