Nearly a million people have died of COVID-19 in Latin America so far, and the region is still struggling to get enough vaccine supply to protect the lives of its citizens. While Chile has fully vaccinated around 40% of its population, roughly comparable to the United States, only between 9% and 18% have received their first vaccine dose in Argentina, Colombia, Mexico and Brazil, and the figure falls dramatically in countries such as Honduras, Venezuela and Nicaragua. Eventually the supply problem will be solved, however. A mixture of vaccine purchases, international vaccine donations, and even domestic production should end the desperate search for vaccines to protect the population.
But another problem will then likely arise—demand. Widespread skepticism of the safety and efficacy of vaccines, stoked by social media, may emerge as it has in many developed countries, including the United States and France. If great enough, that hesitancy to get vaccinated could represent a major threat to public health. Guarding against it should be a priority for governments and development agencies alike.
In some cities in the United States, volunteers have been recruited to help people schedule vaccine appointments. They have helped people navigate the multiplicity of hospital, state and pharmacy websites and provided special assistance to those who lack either internet access or the internet sophistication to manage the online registration process. Volunteers have also been recruited to encourage vaccination by providing accurate information about the vaccines’ effects and their safety. It is easy to imagine that similar techniques could be used to reach some of the population in Latin America and the Caribbean.
An Experiment on Vaccines in Guatemala
As an IDB experiment in rural Guatemala reveals, the use of volunteers to provide reminders to people in need of vaccines can make a real difference at low cost. Guatemala’s government began to address the health problems of its rural communities in the mid-1990s with the Coverage Extension Program that provided free basic health services to women of reproductive age and children under five. Under the program, the government contracted with non-governmental organizations that ran basic clinics. Mobile medical teams, with doctors, nurses, and medical equipment visited the clinics once a month, and local health workers coordinated with the community to ensure attendance at the clinics for those in need of specific services, like vaccinations.
The stumbling block was that although the mobile health teams maintained records to generate aggregate statistics, such as the total number of children vaccinated, these records did not tell local health workers who in the community needed prenatal care or a vaccine booster at a given moment. As a result, needed treatments were sometimes missed. Indeed, coverage rates for complete vaccinations dropped dramatically from 86% during the first year of a child’s life to 67% for children 18-48 months old and 42% for children 48-53 months old.
A Simple Intervention Increased Vaccinations
A pilot tested by the IDB in 130 rural communities sought to correct this lower take up of children’s second and third vaccine doses. By using special software to combine the addresses of patients and their medical records, simple lists were generated to let local volunteer health workers know exactly who in the community needed what before each visit of the mobile health team. As a result, the targeting of patients was significantly improved and the vaccination rates for children needing them rose nearly five percentage points during the six-month trial. The estimated cost of scaling up the intervention at a national level during a similar time period would only be $0.17 per child.
Of course, the use of such reminders for COVID-19 vaccinations, together with explanations of the importance and potential side effects of immunization, may work in some places better than others. More research is needed to determine the best ways to deliver such information: whether it should take the form of in-person visits, text messages, or cell-phone calls.
The Need for Flexibility in Approaches to Vaccination
Latin America and the Caribbean is hugely diverse – ranging from metropolitan areas to remote village hamlets and across all socioeconomic strata. The content and form of vaccine reminders must inevitably depend on circumstances, including levels of education, cultural beliefs, internet access, and internet sophistication. There is no one-size-fits-all approach when it comes to public health. Still, as the experiment in Guatemala shows, the efficacy of vaccine rollouts can be improved in even the hardest to reach communities through the use of local personnel and better digital techniques. Such elements are worth considering, once supply issues have been resolved, to ensure that the vast majority of the population is aware of the vital significance of immunization and does their part to try to achieve herd immunity. The COVID-19 pandemic caught everyone around the world by surprise and found virtually all nations unprepared. There will be no excuse for not addressing the problem of limited demand that, as the experience of more developed regions suggests, is likely coming.