Vaccinating the Amazon: Hundreds of Indigenous languages, climate, terrain and more all complicate a massive effort
SAN PEDRO DE LOS LAGOS, Colombia – When COVID-19 vaccinators arrived at 78-year-old Matilde Fernando Parente’s remote Amazon home, the first thing she felt was fear.
Her small Indigenous community of San Pedro de Los Lagos sits cloaked in dense jungle, pressed up against the Amazon River Basin, reachable only by canoe or jungle trek. The largely forgotten town sits at the intersection of Colombia, Brazil and Peru.
Fernando’s Ticuna people have historically had to fare for themselves during outbreaks of diseases like yellow fever, dengue and malaria, caring for themselves with the jungle herbs their ancestors have used for centuries.
The abandonment fostered a deep sense of distrust of regional authorities and set the stage for disinformation to spread.
That came to a head in 2020 when COVID-19 devastated the estimated 30 million residents scattered throughout the Amazon Basin. While some authorities deem vaccination in the region a success, those hurdles – logistics, disinformation, language barriers, lack of resources, large distances and cultural differences – remain significant barriers to fully vaccinating the region. Many parts, especially the most remote, still have virtually no one fully vaccinated.
“When my granddaughter came to visit, she told me ‘Don’t get vaccinated because it will kill you.’ She told me everyone who is getting vaccinated is dying,’” Fernando said in her native Ticuna language.
“‘So I said, ‘I’m never getting vaccinated ever.’”
But two years after the virus roiled the region, Fernando is one of millions vaccinated in the Amazon, the result of a strong push by local and international health authorities in early 2021.
“I changed my mind little by little. It wasn’t just that the vaccine arrived and I got it. I wanted to wait and see how I’d feel and figure out what was true. Now, I see that it’s not something bad,” she said.
“Now, I feel protected.”
The virus sweeps through the Amazon
In March 2020, the virus swept across the Amazon, carried by boat, by foot, by car and by other means from cities to hundreds of Indigenous communities in the most remote nooks of the territory.
Responses were divided along national, political and regional lines.
Brazil became famous for right-wing President Jair Bolsonaro’s downplaying of the pandemic and the subsequent devastation to his country.
Countries like Colombia and Peru enacted some of the longest lockdowns in the world. Colombia even sent its military to its Amazonian border in an attempt to prevent imported cases.
Yet the first cases in Brazil quickly rippled past porous international borders.
In Leticia, the capital of Colombia’s Amazon region, the already crippled health system was decimated, explained Saida Viviana Herreño Prieto, director of Hospital San Rafael, the region’s primary hospital. In the hospital, which had six ICU beds but not enough resources for any to be operational, around 15 people died daily in the early days of the pandemic.
“It was all certainly COVID, but we couldn’t say for sure at that moment because we had no tests,” she said. “The Air Force had to fly people to Bogotá, Cali, Medellín, Villavicencio, Barranquilla. Wherever they still had beds.”
At the same time, as they heard of the deaths, communities like San Pedro de Los Lagos closed themselves off from the world one by one, living off the natural resources around them. Fernando and her husband retreated even farther into the jungle, building themselves a small wooden house and living off the land.
Indigenous groups are disproportionately vulnerable to the virus due to malnutrition, little access to potable water and lack of a financial safety net, according to Ashley Baldwin, a spokesperson for the Pan American Health Organization (PAHO).
“As a result, it is vital that Indigenous populations are prioritized for vaccination,” Baldwin told USA TODAY in a statement.
Groups like the Ticuna people – about 70,000 people across Brazil, Colombia and Peru – attempted to fill the void of advanced medical care with traditional medicines. They made herbs for malaria and yellow fever symptoms into teas and vapor baths.
The use of such medicine underscores a larger divide in countries like Colombia, explained Dr. Carlos Alvarez, an infectious disease expert at Colombia’s National University.
While Indigenous communities distrust “western medicine,” partially due to historic state neglect, health authorities are quick to discount traditional medicine and look down on Indigenous communities, he said.
The World Health Organization (WHO) recognizes the benefits of traditional medicine, writing “nearly a quarter of all modern medicines are derived from natural products, many of which were first used in a traditional medicine context. [Traditional medicine] is thus a resource for primary health care, but also for innovation and discovery.”
Such techniques, Alvarez and other health authorities said, do little to help extreme cases but can ease symptoms and prevent mild cases from becoming more complicated.
“It can’t replace the vaccine, but it can help,” Alvarez said.
‘We don’t know if it was COVID’
Yet the virus still came for many of the Ticuna.
In June 2020, three months into their isolation, Fernando’s 80-year-old husband decided to return to their family’s small brick home. The couple had not talked to a soul for months and felt a growing sense of loneliness. One afternoon, he heard people playing soccer from a distance and longed to watch them play as he always had.
But soon he and others around him came down with mild COVID-19 symptoms.
Weeks later, he died of pre-existing health conditions, which family members believe were worsened by the suspected case of coronavirus.
They still feel a lingering uncertainty because they were never able to confirm that. Over two years of the pandemic, health authorities only did seven tests in her village, according to community leaders. Those tested never received results.
In the three months following her husband’s death, she said she could barely eat or sleep.
“There were a lot of people who died, and we don’t know if it was COVID,” Fernando said. “It’s like malaria here. You get it and it makes other sicknesses worse even if the COVID wasn’t serious.”
It’s unclear how many Indigenous people died during the pandemic in the region due to a shortage of tests, fear of getting tested and population undercounting in rural regions like the Amazon even before COVID.
In Brazil – the hardest hit by the pandemic in South America – official data says only 853 Indigenous people have died in the country over the course of the pandemic. Indigenous groups say that is only a fraction of the real number.
Across Colombia, the government has registered little more than 2,000 deaths of Indigenous people.
In Peru, official information on deaths in the Amazon is so poor, one investigation last July by local news organization Ojo Público declared: “Indigenous deaths are invisible to the State” in the Peruvian Amazon.
‘Information has to come from people who inspire their trust’
When vaccines arrived in the region in early 2021, the first place they were sent was the Amazon. Regional governments and global aid organizations like the United Nations launched a large campaign to vaccinate the millions of people living there.
The quick vaccine mobilization by governments like Colombia’s was a result of harsh international criticism Amazon governments faced at the start of the pandemic, explained Dr. Pablo Montoya, director of Sinergias Strategic Alliance for Health and Social Development, an organization working on public health among Indigenous communities.
“The health system completely tossed them to the side (at the beginning of the pandemic), and it was clear that these far off Indigenous communities weren’t a priority,” Montoya said. “And that generated resentment, created some anti-vaccine political positions.”
But vaccinators across the eight countries that make up the Amazon – Brazil, Bolivia, Peru, Ecuador, Colombia, Venezuela, Guayana and Suriname – also faced considerable logistical challenges.
They had to cover more than 2.72 million square miles of rainforest – land more than twice the size of India – largely accessible by river. Speckled across that land are hundreds of Indigenous communities, many like Fernando’s, where people don’t speak Spanish but instead one of the 300 Indigenous dialects spoken in the Amazon.
Authorities and aid organizations sent out videos over WhatsApp in Indigenous languages to dispel COVID-19 disinformation. To more remote parts of the region, they sent out radio broadcasts in Indigenous dialects. They even paid for gasoline and boats to transport Indigenous groups to Leticia to get vaccinated.
But the best tool they found was to travel out to communities, said Gerardo Antonio Ordoñeo, director of Mallamas, an Indigenous health insurance company working to vaccinate communities like Fernando’s.
“It’s so much easier to connect to your patient when you speak their native language,” he said. “We’ve done this (connecting) through word-of-mouth with objective information… But that information has to come from people who inspire their trust.”
A journey through the Amazon
So Indigenous vaccinators like Romario Mujica, also part of the Ticuna people, embarked on a journey.
For nearly a month he traveled along the river in a wooden canoe. In a white hazmat suit and in the stifling jungle heat, he carried vaccines to some of the most remote swathes of the region.
Because mRNA vaccines like Pfizer and Moderna need to be kept cold and their global supply is sparse, medical authorities instead used less efficacious but easier to transport vaccines like Sinovac, Johnson & Johnson and AstraZeneca.
Ordoñeo also said using non-mRNA vaccines made it easier to address false information circulating, which he said is mostly attached to vaccines like Pfizer because the new mRNA technology is less familiar.
Raised in an Indigenous community himself, the first person he vaccinated was his father, in the rural community where he grew up.
Mujica and other vaccinators would meet with community leaders called curacas to ask permission to enter a village and hold group meetings to address questions or doubts.
In gaining trust, he said it’s been crucial to respect long-held cultural beliefs like traditional medicine and incorporate those into conversations about the vaccine.
At first, they were met with shut doors and suspicion. But with the rise of the gamma variant, first identified in Brazil, and heightened death tolls, opinions slowly began to shift.
“When I speak to people they ask me, surprised, ‘You speak Ticuna?’ … Sometimes you even go house to house to speak with elders who aren’t able to walk to where we’re vaccinating,” he explained.
Montoya said many families who lost loved ones were more inclined to get vaccinated.
Echoes of past epidemics
But when Mujica arrived in San Pedro de los Lagos with vaccines in tow in March 2021, what stuck in the mind of Fernando’s daughter, Nallive Parente, was not her father’s mysterious death but rather an outbreak of yellow fever that ravaged the region in 2002.
Her family fell incredibly ill for weeks back then, and the outbreak almost claimed the life of her then-eight-year-old son.
Globally, 30,000 people die from yellow fever each year, according to the World Health Organization. Malaria, also endemic in the region, claims the lives of nearly half a million people annually. Those death tolls helped people in the region see COVID as part of a larger whole, and not an unexpected, out-of-the-blue occurrence.
So when the Colombian government began the vaccination campaign against yellow fever, the entire population of the village traveled hours by river to Leticia to get vaccinated.
“You don’t eat, you don’t sleep, and it kills you,” Parente said of yellow fever, cradling a small folder with her family’s vaccine cards. “It was just like now – so many infections – when we got the yellow fever vaccine.”
Memories of the outbreak have helped Mujica and other vaccinators bridge the divide between the health system and rural communities. It also helped build confidence in older generations like Fernando’s that are less inclined to get vaccinated.
While she said she ultimately got the vaccine due to requirements to receive her pension in banks, she said she no longer feared the jab after talking to Mujica and her daughter Parente, who convinced her to get vaccinated together.
Now, as Parente holds out her white COVID-19 vaccine card in her hands, calloused and caked in dirt from hard work in the fields, Mujica’s name is the one jotted in blue pen.
The challenges ahead
Mujica and other teams of vaccinators traveled out to 152 communities by boat and applied around 100,000 vaccines to largely Indigenous groups.
In the Brazilian Amazon, 10.6 million people, 91,000 of them in Indigenous territories, have gotten at least their second dose or one dose of the Johnson vaccine, government figures available in early March show. In Peru’s Amazon, that number is more than 2.7 million people, although it’s unclear how many are Indigenous.
In Colombia, official data shows that 473,851 people have gotten fully vaccinated in the Amazon.
But Baldwin said PAHO has struggled to measure vaccination progress due to a lack of data on Indigenous populations in the Amazon.
And medical care providers, experts and rural communities worry that vaccination efforts that originally started out strong may be petering out.
On a morning in late January, Mujica walked out of a small health clinic in the center of Leticia dressed in deep red scrubs, snapped on a pair of gloves and tapped a small vial of the Sinovac vaccine with his syringe.
“We’re going to do Sinovac today,” he said soothingly to a pale teenage girl gripping her chair anxiously. “It’ll only hurt for a second.”
It was 7 a.m. and there was already a jumbled line running down the street. Men and women hoisted strips of cardboard over their heads to block the sweltering sun; some who traveled hours to be there broke out into arguments.
Yesterday, he explained, no doses arrived. This day, they only had a couple dozen. When they do get doses they’re Johnson & Johnson, Sinovac and AstraZeneca, which have proven less effective against variants like delta and omicron.
Travels along the river have stalled due to lack of resources, he and other health authorities said.
“They need more of these journeys,” he said. “Right now, there are many, many people that still aren’t vaccinated, or don’t have the second dose. And those people, you have to go to them.”
That was Nallive Parente’s concern, she described as she cooked lunch for her large family on the porch of her humble brick home, smoke pluming up from the stove in front of her.
She’s vaccinated, yes, but she worries about her kids as they go back to school because they were unable to get vaccinated until now. She peers over at 11-year-old daughter Rosie and 9-year-old son Rafael, who run home after playing in the nearby river.
She wanted to take them to the city to get the jab, but the river they normally use for transit has largely dried up, a consequence of climate change. She said she couldn’t afford to trek through the jungle and pay to travel by car.
At the same time, the children have lost nearly two years of classes.
“These vaccines are important, especially now, because my kids have to go to classes,” she said. “It worries me because what if someone isn’t vaccinated, the kid is contagious, and then my children bring COVID back here. I wouldn’t know what to do.”
Lingering vaccine hesitancy
Montoya and others warn there is still a long way to go.
Montoya, whose organization tracks vaccination in Indigenous groups, said that while vaccination in many areas has been a success, vaccination rates in some of the most remote areas are still at zero.
And in some areas traditional medicine has caused many to reject the vaccine.
That divide was one of the principal “barriers” to inoculating Indigenous people that PAHO underlined to USA Today.
That was the case for Betty Souza, a community leader in the small town of San Sebastian, a few hours from Fernando’s home.
Souza works for the Colombian Health Ministry to document people in her small town of San Sebastian with COVID symptoms because the Amazon still lacks a testing infrastructure. Early in the pandemic, she traveled around the area, attempting to care for patients too scared to go to medical facilities or out of the state’s reach.
Yet Souza herself has not gotten vaccinated.
She said she believes that she found the cure to the virus at the beginning of the pandemic and has walked around her small town and surrounding communities to give steam baths to people who have COVID symptoms.
“What’s the rush in getting vaccines when we’ve learned how to cure (COVID) here,” she said.
While research suggests that traditional medicine can assist treatment of COVID-19 patients, there is no evidence it can cure COVID as Souza claims.
Her words are interrupted by her dry cough, and she sits next to her Brazilian husband, who refers to the vaccine as “poison.”
Souza was banned from Facebook after she started posting videos spreading COVID disinformation that went viral.
‘What this pandemic taught us is to trust people’
Still, some good has come from the pandemic, said Saida Viviana Herreño Prieto, director of Leticia’s hospital and state vaccination efforts in the region.
Following the devastation in early 2020, hundreds of thousands of dollars in donations began to roll in. Some came from aid organizations, businesses or individuals around the world. More came from investment by Colombia’s federal government, something the hospital lacked until now.
The hospital was able to build up their infrastructure, buy an oxygen plant, create ICU beds and invest in expensive vaccination journeys like Mujica’s.
“It was a strengthening” of the medical system, she said. “And now we can say we in the hospital are stronger for it. We’re ready for another pandemic peak.”
She said she hopes those resources can help communities like Fernando’’s even after the COVID-19 pandemic ends.
Last month Fernando sat surrounded by her family as the sun dipped below the trees and plants she uses to make teas and medicines.
The woman leaned on the wooden wall of the small house she built at the beginning of the pandemic with her husband. Now, though, she’s alone.
She said she hopes that what has come out of this is a newfound conversation between rural communities and health authorities.
“What this pandemic taught us is to trust people, to listen to others, especially the ones who care for us,” she said. “To share knowledge. We hope that someday the system will work better for us.”