Equitable COVID-19 Immunization

Equitable COVID-19 Immunization

Reaching the most vulnerable in Latin America and the Caribbean

Opinion by Katie Taylor and Elizabeth Fox

Washington, D.C. (March 3, 2021) –  If the COVID-19 vaccine rollout in the United States is any indication of what to expect, planning mass immunization in Latin America and the Caribbean will pose far more complex challenges associated with vaccine acceptance, public education, logistics, transparency, accountability, and, most importantly, equity.

Our 60 years of professional experience in global health and international development and commitment to Latin America and the Caribbean lead us to argue for a framework for inclusive vaccination in a region that has the highest level of inequality in the world. Without attention to vulnerable, at-risk populations outside any health system – migrants, internally displaced persons, indigenous communities, the vast urban poor – the region and the world will never reach herd immunity and stop COVID-19. In fact, widespread vaccination coverage in Latin America is only expected to be achieved by mid-2022 or later.

Given global supply constraints, access to vaccines in Latin America and the Caribbean will likely follow the same patterns we are observing in the U.S. and elsewhere, with distribution staggered over an extended period. Countries should expect to receive supplies in stages, requiring a thoughtful prioritization process that is consultative and involves grassroots engagement to ensure that the most vulnerable and traditionally excluded populations are not left behind.

Time is of the essence in a region disproportionately affected by the pandemic and experiencing the worst recession in a century. The pandemic has decimated livelihoods, pushing more people below the poverty line and increasing food insecurity. Close to 60 percent of workers rely on informal economy jobs that keep them on the streets, with no access to proper sanitation and protection against the virus. Domestic violence has increased, as women and girls are isolated and critical services are delayed or suspended, adding another layer of complexity to battling COVID.

The continuing migration of Venezuelans to neighboring countries and of Central Americans headed north creates an even greater sense of urgency as human mobility contributes to infections and confusion on where and how migrants get vaccinated. Governments need to consider cross-national and cross-cultural strategies to address the specific needs of this extremely vulnerable group. In addition, national, local, and micro-level planning is needed to reach internally displaced persons, such as victims of armed conflict in Colombia or those displaced by natural disasters, such as hurricanes Eta and Iota in Central America.

To ensure a global supply of vaccine, developed countries need to stand up to the challenge and join efforts like they have with COVAX, the global initiative to ensure rapid and equitable access to COVID vaccines for all countries, regardless of income level. This important initiative acts as a platform to support the research, development, and manufacturing of a wide range of vaccine candidates and negotiate their pricing. We applaud the Biden administration’s pledge of $4 billion to COVAX, with an immediate $2 billion donation and the remaining $2 billion over the next two years, as other governments join the effort.

On the supply side in each country in our region, it is the responsibility of the public sector to promote broad coverage and equity in distribution, even when met with systemic corruption, violence, factional struggles, and unrest. On the demand side, partnering with community and faith leaders to plan vaccination campaigns, validate public messages, and counter misinformation will be key in securing buy-in and acceptance. A successful COVID vaccine rollout will require a multiplicity of approaches, including translating messages into local dialects and crafting media campaigns to reach the illiterate. Promoting vaccination in safe community spaces, such as local community clinics and churches, will also help expedite the process.

Having a clear common goal that is shared from the bottom up, acting with transparency, and holding decision-makers accountable are essential for a successful vaccination rollout in Latin America and the Caribbean. Our experience in global health and the Pan American Development Foundation’s extensive track record of working alongside and supporting local partners throughout the region, including the public sector, leads us to believe that an immunization effort that is broad in coverage and equitable in distribution is possible and reasonable. Let’s not forget that Latin America has done it in the past with its successful vaccination campaign to eradicate polio before most other developing regions. 

Katie Taylor is the Executive Director of the Pan American Development Foundation (PADF) and former Deputy Assistant Administrator for Global Health at the United States Agency for International Development (USAID), where she also served as the U.S. government’s representative on the boards of Gavi, the Vaccine Alliance, and as co-chair of the Partnership on Maternal, Newborn, & Child Health (PMNCH). Dr. Elizabeth Fox is Chief Program Officer of PADF and former Director of USAID’s Office of Health, Infectious Diseases, and Nutrition.

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