Navigating complex waterways to reach remote communities in Brazil’s Amazon is only the first challenge for Waldir Bittencourt, a nurse vaccinating Indigenous and riverine people against COVID-19. Once there, he has faced something he didn't anticipate: a fear of the vaccine.
“It’s a recent phenomenon among Indigenous peoples, stemming from the polarization surrounding the vaccine,” said Bittencourt, 32, who during his eight-year career has been involved in campaigns against tuberculosis, diphtheria and tetanus.
Health professionals like Bittencourt are deploying to far-flung areas in northern Brazil, often travelling for hours on small planes and boats. Most jungle communities have only basic medical facilities unable to treat those with COVID-19. That makes vaccination all the more pressing in order to curb surging cases.
Brazil has had almost 235,000 deaths, second only to the US, according to a tally by Johns Hopkins University. In a survey last month by pollster Datafolha, 17% of respondents said they don’t intend to get either of the vaccines approved in Brazil. That's higher in northern and west-central regions, which are grouped together by Datafolha, and lower in the wealthier southern and southeastern regions.
Health care workers, experts and anthropologists say rejection or fear of the vaccine is partly driven by the doubts sown repeatedly by President Jair Bolsonaro about its efficacy. Bolsonaro, who was infected with COVID-19 himself last year, has said he doesn’t plan to get vaccinated and insists others shouldn’t unless they want to.
He initially refused to authorise the purchase of China’s Sinovac vaccine and said on Facebook that Brazilians would never be anyone’s 'guinea pig'. He also declined the Pfizer vaccine, citing a clause that shielded the US firm from potential liability. He joked there would be no recourse if women grew beards, men’s voices became high-pitched, or people were transformed into alligators.
His anti-science message has made its way to the remote communities.
“This anti-vaccine movement does not come from them. It’s being brought by certain missionaries, social media, fake news,” said anthropologist Aparecida Maria Neiva Vilaça, who works with Indigenous communities in the northern state of Rondonia.
These communities have had greater access to technology and the internet in recent years, but information often arrives in a “very distorted way,” Bittencourt said by phone from Macapa, capital of Amapa state.
In the Purure community, inside the Tumucumaque Mountains National Park, some residents asked Bittencourt if they could be injected with the vaccine imported from India, because they thought this meant it had been produced by Indigenous people. In Brazil, the word “Indian” is still widely used to refer to Indigenous people.
In other villages, some feared they were being used as test subjects for broader vaccination campaigns among non-Indigenous peoples, while others worried it would let the devil into their bodies.
Even though most eventually decided to get the shots, both Bittencourt and Vilaça said they had not seen such reticence before among Indigenous peoples.
Some evangelical leaders have been another source of misinformation, they said. Evangelicals largely backed Bolsonaro in the 2018 presidential campaign, and some pastors in remote communities have contributed to spreading his message against getting the COVID-19 vaccine.
Audio messages circulating on the WhatsApp messaging app told of pastors claiming they could cure the infected. In one message, a man recalls a pastor informing him that the vaccine wasn’t necessary, because God could cure him.
Vilaça, who teaches social anthropology at the Federal University of Rio de Janeiro when she is not in the north, said the rest of Brazilian society is no different when it comes to misinformation.
“A large portion of the population is also informed only by WhatsApp, social media, and have no access to newspaper information,” she said.
Nurse Luciana Dias da Costa also has faced some difficulties in Amazonas state. Vaccination is particularly crucial in the state, where a surge of infections has overwhelmed the already-fragile public health care system in the capital city of Manaus. It has forced a nationwide mobilisation to get oxygen to patients struggling to breathe or airlift hundreds to better-equipped facilities in other states.
“We want to vaccinate everybody, but as I said, some accept, and some don’t,” da Costa, 46, said in an interview while travelling by boat to the Sao Joao do Tupe community, 25 kilometres (15 miles) west of Manaus. Many elders there told her that they feared effects of the vaccine they had heard about on the radio.
Official government data shows a death rate of 224 per 100,000 in Amazonas state - double the national average. Some health experts believe a coronavirus variant that is more contagious and less vulnerable to some treatments has caused the dramatic spike in hospitalisations and deaths.
Dr Ethel Maciel, an epidemiologist who advised the government on its COVID-19 vaccination programme, said remote communities in the Amazon are a priority, given their lack of health infrastructure and the large distances people must travel for proper medical care in Manaus.
“With an acute infectious disease like COVID-19, which tends to get worse very quickly, by the time these people make the journey, the person has sometimes already died,” she said.
In Amazonas, 71-year-old Jane Barbosa de Albuquerque said she was initially skeptical of the vaccine.
“We are doubting. Which is the best? Which one am I going to take? Which one came to us here in Amazonas?” she asked.
Eventually, however, de Albuquerque agreed to let a nurse insert a needle in her left arm. “Health comes first,” she said.
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