Challenges

Significant challenges remain to materialize the right to health in indigenous populations due to geographical, cultural, economic and linguistic barriers. The main strategy to control the COVID-19 pandemic is vaccination, but in transborder areas of the Amazonia region there are four main challenges: 1) low population density; 2) long distances from services; 3) transborder nature of the area and population; and 4) cultural barriers that include language differences and local reliance on traditional medicine and customs.

The logistics in transporting vaccines and maintaining the cold chain in that context together with the remoteness of health services and huge gaps in health sector human resources together with the low perception of population on the results produced by the vaccine require an integrate approach of the countries involved.

Toward a Solution

To overcome the COVID-19 pandemic and achieve the 2030 Agenda, with a specific focus on SGD 3, four countries of the South American Andean subregion (Bolivia, Colombia, Ecuador and Peru) came together to guarantee access to vaccines to their populations in transborder territories. The initiative focuses on indigenous peoples and particular attention is being paid to implementation using an intercultural approach.

In January 2021, the Pan American Health Organization/World Health Organization (PAHO/WHO) Subregional Programme for South America (SAM) was provided a grant by the Presidential Agency for International Cooperation (APC-Colombia), to partner with the Ministries of Health of Bolivia, Colombia, Ecuador and Peru and the four PAHO/WHO Country Offices in a joint operation to close the gaps in vaccination of indigenous populations living in shared transborder areas. The best way to guarantee adequate immunization coverage of this population on the move was to coordinate and share information between countries and local health services in border areas.

The objective of the initiative is to contribute to leaving no one behind and directly to SDG 3 (ensure healthy lives and promote well-being for all at all ages), and its target 3.8 (achieve universal health coverage for all).

The ‘Exchange Platform for Mitigation, Containment and Vaccination against COVID-19 Amazonian Indigenous Peoples’ was built by the Ministry of Health of Peru, with the support of the German Agency for Development Cooperation (GIZ) in Peru, the PAHO/WHO Subregional Programme for South America, the Andean Health Organization and the South American Amazon Cooperation Treaty Organization. This platform supports the collection and assessment of vaccination experiences with Amazonian indigenous populations in border areas, facilitating South-South knowledge exchanges. Virtual seminars were held on the Exchange Platform from July to December 2021 and experiences on health systems shared with the objective of preparing to vaccinate against COVID-19 in the Andean countries taking into account the perspective of the Ministries of Health, indigenous leaders, international cooperation and local authorities.

These seminars were attended by hundreds of people, including representatives of international cooperation agencies, governmental authorities, indigenous leaders, civil society, academia and the general The Platform and seminars served as key instruments to share national vaccinations rates, strategies, protocols and instruments implemented by each country and the challenges faced. Consequently, countries could adapt their strategies by integrating other countries experiences and lessons learned. A common ground between countries was achieved through prioritizing an intercultural approach, integrating traditional medicine and practices and preparing communication materials with clear language and images.

The initiative helped achieve more efficient mitigation and containment measures against COVID 19, including vaccination coverage, in transborder areas through horizontal cooperation and coordinated activities between the countries of the subregions that decided to join forces and share their expertise and lessons learned during the pandemic.

Operating such an exchange platform to achieve an effective coverage of Amazonian Indigenous population led to the below lessons learned:

1. Multiple countries working together can successfully address immunization coverage of populations living near borders.
2. For a successful vaccination, culturally appropriate health services are required.
3. Gaps in human resources need to be addressed using innovative solutions, such as the recruitment of health promoters and/or intercultural liaisons, where flexibility in contracting and recruitment are recommended features, as well as involvement of universities and human resource training centres.
4. Participation of indigenous communities in local governance of the initiative through their leaders using intercultural dialogue is vital to achieving greater vaccination compliance.
5. South-South cooperation in health can play a catalytic role in promoting and facilitating the work of national and local governments, indigenous communities, civil society organizations and academia to build resilient and culturally relevant health systems.

Through this horizontal cooperation, partner countries shared analyses of challenges and management of health access at border areas in a collective and harmonized way and systematized lessons learned . Strong involvement of governments and indigenous organizations, including the appropriation of processes by governmental programmes and sub-regional integration mechanisms, contributes to the sustainability of this initiative. This experience can be replicated in other parts of the Americas, or anywhere in which there are hard-to-reach populations in shared border areas.