Vaccinating the Amazon: Hundreds of Indigenous languages, climate, terrain and more all complicate a massive effort

IPSI Palaima is working to vaccinate Indigenous families who live in hard-to-reach areas of La Guajira, where there are no paved roads, electricity, or running water and staff must use cars, boats, and motorbikes to reach them. A team of nursing assistants and a doctor spend 15 days at a time at a local outpost and travel by motorbike to surrounding communities, carrying vaccines in cooler bags. The organization was founded by an Indigenous woman who grew up in the area. Many of the staff members speak the local language, which can ease the communities’ vaccine hesitation and mistrust of authorities.

Comprehensive COVID-19 vaccination strategies helped some Native American Nations achieve high vaccination rates. Tribal sovereignty gave Nations the flexibility to create their own methods of distributing the vaccine and allowed officials to distribute doses to hard-to-reach areas – even by dog sled in Alaska. They could prioritize who to vaccinate and diversify how vaccines were offered – from private appointments to mass-vaccination events – to ensure broad accessibility. Medical professionals, tribal leaders, and Native youth used social media to share information and encourage people to get vaccinated.

After becoming a COVID-19 hotspot, Guadalupe built partnerships and built trust among community members to effectively track cases, dispel misinformation, and increase vaccinations. The Town Council partnered with Pascua Yaqui tribal leaders, the broader Maricopa County, Native Health, and a COVID-19 response team composed of faculty, staff, and students at Arizona State University to lower infection rates. A combination of at-home testing, contact tracing and, eventually, vaccination events helped, as did the use of promotoras – community health workers who talk with residents to help ease anxiety.

Wayanad is the first district in Kerala to have vaccinated the entire adult population with at least one COVID-19 vaccine. Rather than waiting for people to make appointments, officials went door-to-door providing all adults with appointment times. The district’s efforts started early, setting up vaccine infrastructure and assigning people appointment dates by where they live. Rapid Response Teams conducted outreach and education efforts, particularly among tribal populations, and made sure people showed up at their appointment. Getting vaccinated with their neighbors also decreased vaccine hesitancy.

One rural hospital in Indiana vaccinated hundreds of immigrants from Central America by working with trusted community leaders and setting up a Hispanic Health Task Force. Health officials held vaccine clinics alongside trusted community members at locations that were familiar to residents, like a local Catholic church that offers Spanish-language services. The hospital and task force initially established community connections to distribute information about COVID-19, so they were able to utilize the connections to increase vaccination rates once the vaccine rolled out.

First United Church Community Ministry Society serves a majority Indigenous clientele with a transitional shelter and space for people to get their mail and use the phone, take a shower, receive a hot meal, and consult with advocacy workers. Centering Indigenous leadership is key to the organization’s mission to provide a safe place for Indigenous people to heal and rebuild their identities.

Political cooperation and an infrastructure of existing relationships and trust built by NGOs and community leaders during Hurricane Maria and a devastating 2019 earthquake allowed for a quick public health response to COVID-19 focused on prevention and vaccination. All trusted public figures, across political backgrounds, advocated wearing masks and getting vaccinated. As a result, Puerto Rico achieved the highest COVID-19 vaccination rate among all other U.S. state or territory. It also had among the lowest Covid-19 death rates since the start of the pandemic.

A centralized communication and record keeping system, along with ensuring convenience for the largely rural population, led Vermont to the highest COVID-19 vaccination rate nationwide. The centralized system keeps track of data and provides consistent guidance. Trusted messengers, like first responders, local pharmacists, and nonprofits like the Association of Africans Living in Vermont, provide culturally competent information that eases hesitancy. Along with mass-vaccination events, house calls and pop-up clinics at small businesses and local events made getting vaccinated convenient and comfortable.

The city of Baltimore escaped the worst of COVID-19 with high vaccination rates, high rates of health coverage, and strong support from political leaders who cooperated across ideological lines. Medicaid expansion helped achieve relatively high health insurance rates. Officials were also a bit more and cautious in reopening businesses and schools and relaxing mask requirements. The city didn’t escape the death and illness seen during the pandemic, but for these reasons it fared better than comparable areas.

The key to United Airlines successful vaccine mandate, even in areas that have low vaccination rates, was gradually phasing in the mandate after a year-long effort laying the groundwork. The airline worked with the union to set up vaccine clinics at its major hubs and offered incentives to employees who got vaccinated. Incentives, like extra pay or vacation days that declined over time until they expired, led the majority of employees to get vaccinated, and the mandate proved to be the final push that was needed.