Guatemala’s COVID vaccine rollout failed: Here’s what researchers know

A woman receives a dose of the Moderna COVID-19 vaccine in San Juan Sacatepequez, Guatemala, in July 2021.Credit: Johan Ordonez/AFP via Getty

“AstraZeneca, Moderna, Pfizer! Come and get vaccinated against COVID-19 today!” Three nurses shouted through megaphones as they weaved through crowds of weekend shoppers in Guatemala City.

This was the scene in February as healthcare workers, concerned about the declining number of people asking for vaccines, took matters into their own hands. But even with the megaphones, few listened.

“Many people still don’t get vaccinated because they think it will harm their health or kill them, or because their church has forbidden them to do so,” says Nancy Notz, one of the nurses who works at a vaccination clinic run by the Guatemalan Social Security Institute, a government agency. “It’s incredibly difficult to convince them otherwise.”

Researchers have studied vaccination hesitancy in Guatemala and interviewed people to understand their resistance to COVID-19 vaccines and find solutions. Though the phenomenon isn’t unique to Guatemala — many people worldwide have turned down COVID-19 vaccines despite data showing they’re safe and effective — researchers hope the country’s failures could offer lessons beyond its borders to explore prepare for future public health emergencies.

Guatemala has one of the lowest COVID-19 immunization rates in Latin America: only about 35% of people are fully vaccinated (see immunization progress). Since the beginning of the pandemic, the Ministry of Health has recorded more than 900,000 SARS-CoV-2 infections and 18,500 deaths. However, due to a lack of testing, that’s likely an underestimate, says Óscar Chávez, co-founder of data analysis think tank Laboratorio de Datos, based in Guatemala City. And that number will no doubt increase, he adds, as vaccination rates slow.

vaccination progress.  The chart shows that Guatemala has one of the lowest vaccination rates against COVID-19 in Latin America.

Source: Our world in data

The reasons for Guatemala’s reluctance are complicated, say public health and social science researchers. In some rural areas, only 1 in 4 have received a single dose of vaccine. Here, factors range from health officials not working with community leaders to build trust, to the government not providing clear safety information in residents’ native languages.

In 2018, more than 40% of Guatemala’s 14.9 million people identified themselves as indigenous—members of the Garífuna or Xinca or one of 22 Maya groups. The country has a history of human rights abuses by the military against indigenous communities. That would always make vaccination a challenge, says Lesly Ramírez, a consultant on civic participation at the Center for Studies in Health Systems Equity and Governance in Guatemala City.

Past wounds run deep

In October 2021, residents of Alta Verapaz — a remote central region with the lowest immunization coverage in the country — were furious when a mobile unit of nurses arrived with COVID-19 vaccines. According to local reports, residents smashed the cans, hit and threatened the nurses.

The incident is symbolic of the government’s failure to consider Guatemala’s ethnic diversity when rolling out vaccines, researchers say. Indigenous groups in the country are deeply suspicious of doctors due to medical authorities’ history of ethical abuses. And they harbor an even greater distrust of the military over human rights abuses committed by soldiers during a decades-long civil war that ended in 1996; In the early 1980s alone, the government-backed military killed an estimated 200,000 tribal peoples and displaced another 1.5 million.

In some areas, like Petén in the north, people saw the army murder their parents, says Mónica Berger González, an anthropologist at the University of the Guatemala Valley in Guatemala City. When the army arrives to deliver vaccines, she says, “Of course [people are] do not show up for vaccinations. They will hide.”

The fear of vaccination itself also contributes to the reluctance of Guatemalans. The American branch of the World Health Organization, the Pan American Health Organization (PAHO) in Washington DC, commissioned a team of researchers to survey Guatemalan households in 2021 on their attitudes towards COVID-19 and vaccines. The effort was supported by the Guatemalan Ministry of Health.

In an unpublished but seen report Nature, about 54% of households surveyed were concerned about harmful side effects of vaccines, says Berger González, who is a co-author. She adds that people in some communities mistakenly thought their friends or family members would die when they developed a fever, a common side effect, after vaccination.

The failure to educate Guatemalans about the side effects that are a normal reaction to the COVID-19 vaccines has increased skepticism, Ramírez says. “Guatemala’s message was too simple: ‘The vaccine is good, get it.'”

Alex Petzey Quiejú, an independent anthropologist and member of the Tz’utujil, a Mayan community that originated in the south-west of the country, agrees. “They never gave us good information,” he says. “The state’s view of the issue is clouded by its own privileges. They don’t understand us.”

A spokesman for Guatemala’s health ministry says many “cultural and religious factors” have contributed to Guatemalans’ reluctance to vaccinate, pointing out that “false or malicious information” was being disseminated by groups, including community leaders, leading residents to Reluctant to get vaccinations.

connection error

Languages ​​posed another barrier. Altogether the Guatemalans speak 25 languages ​​in different dialects. However, educational materials such as brochures, posters and radio broadcasts promoting COVID-19 vaccines were initially published exclusively in Spanish; the government demanded that they be translated into all languages ​​in November 2021.

The Health Ministry spokesman said that this did not stop local health officials from translating information ahead of the request. The PAHO report found that of the 27 regions surveyed, only 10 had translated materials for their local population as of November 2021.

People in masks and colorful clothes listen to a man holding a piece of paper on the street.

Members of an indigenous community in Guatemala listen to a health worker at a vaccination center.Credit: Luis Echeverria/Reuters

Where the Guatemalan government was slow to educate rural communities about vaccines, disinformation quickly filled the vacuum, Berger González and others found. Religious groups in particular advised people against getting vaccinated. In the PAHO report, 12% of respondents who said they would not get vaccinated because they trusted God to protect them.

The patchy vaccine uptake in Guatemala is the result of a failure to develop a comprehensive strategy that engages indigenous leaders and communities, says Nancy Sandoval, president of the Central American and Caribbean Association for Infectious Diseases in Guatemala City.

“The Ministry of Health only comes to impose itself and never listens,” says Petzey Quiejú, who studied vaccination hesitancy. In cases where researchers have sat down with community leaders such as priests and comadronas — traditional Mayan midwives — to discuss community concerns, they have been able to increase vaccine uptake, he adds.

The Department of Health says it has “worked hand-in-hand and in coordination with other state institutions, business and educational sectors, and local and community leaders.”

logistical failures

Guatemala has struggled to consistently make vaccines available to all of its people. The PAHO report found that when vaccination centers ran out of doses and people were turned away, word spread quickly, discouraging others from attempting to visit.

For Aboriginal people, most of whom live below the poverty line, vaccination centers are often an expensive bus fare and an hour’s drive or more away. And time off is a big expense. “It’s a choice between getting vaccinated or buying a kilo of corn,” says Petzey Quiejú.

The Ministry of Health points out that there are currently 1,188 vaccination posts across the country, including fixed sites, vaccination brigades and door-to-door sweepers. “Every effort has been made to bring [vaccines] to the most remote places,” says the spokesman.

Vaccination hesitancy has emerged in marginalized communities in other parts of the world due to some of the same barriers observed in Guatemala. In black communities in the UK1 and the United States2For example, the logistics of accessing COVID-19 vaccines and a historic distrust of government and medical authorities have acted as a deterrent.

Researchers in Guatemala hope that successful local solutions – like creating community networks to build trust – can be deployed across the country and perhaps beyond.

This simple strategy of getting community leaders to sit down and talk to outsiders has worked in some indigenous communities, says Petzey Quiejú. “And if it works in one, it will work in the others. You just have to adjust it.”

Leave a Comment