TEPHINET Supports Efforts to Understand Vaccine Hesitancy and Increase COVID-19 Vaccination in Guatemala

COVID-19 vaccination is an ongoing issue in Guatemala, with national rates of full vaccination falling well below the global average. Differences in vaccination rates are present throughout the country, with communities in hard-to-reach areas and indigenous populations experiencing a multitude of barriers to receiving the vaccine. To address inequities in vaccine access and issues related to vaccine hesitancy, Guatemala’s Ministry of Public Health and Social Assistance (MSPAS) has launched two initiatives to increase education around, and access to COVID-19 vaccines among returning Guatemalan migrants and populations in hard-to-reach areas.

Each month, thousands of people return to Guatemala from Mexico and the United States. From March to mid-September 2022, TEPHINET and the U.S. Centers for Disease Control and Prevention (CDC) supported efforts to provide COVID-19 vaccine education to these individuals as they arrive at the Migrant Center at the Guatemalan Air Force base (Fuerza Aérea Guatemalteca-FAG) in Guatemala City. Two health promoters were placed at the Center to conduct surveys with migrants about their awareness of the COVID-19 vaccine and their vaccination status (i.e. 1st shot, 2nd shot, both boosters, unvaccinated). If migrants were not vaccinated, they were asked if they would be willing to get vaccinated. The open-ended design of the survey allowed for people to share thoughts on what inhibited them from seeking COVID-19 vaccination, or of barriers they faced in accessing the vaccine; many migrants shared their stories, challenges, frustrations and mixed feelings with COVID-19. The data collected has been a crucial resource for better understanding the community’s challenges and diverse perspectives related to vaccine access and hesitancy, and helps better understand COVID-19 vaccination rates among the returnees and their families. In tandem with the survey, health promoters also provided essential education to returnees about COVID-19 and the importance of the vaccine, provided hygiene items, and offered referrals to health services in other areas of Guatemala. One limitation of the survey was that not all migrants spoke Spanish and there was no access to interpreters for indigenous languages.

During the first half of September, health promoters reached a total of 1,410 people, 80% (1135) of whom had received at least one dose of the COVID-19 vaccine, and 275 of whom were unvaccinated. Unvaccinated returnees shared barriers that included lack of awareness of vaccination events in their area, vaccines not yet reaching their remote communities, and the prohibitive hours of vaccination centers, which were closed after long work days. Even for interviewed returnees interested in receiving a COVID-19 vaccine at the Migrant Center, referrals needed to be made to a nearby vaccination center and there was no guarantee they would travel the 10 blocks to get there. 

In addition to these barriers, communication methods, low literacy rates and language were also found to influence a person’s desire and ability to receive a vaccine. Literacy gaps and the fact that information is only available in Spanish, may play a role in people’s ability to understand how the vaccines can help to prevent large-scale spread of disease, especially given Guatemala's large indigenous population–nearly 30% of the country’s inhabitants speak Maya languages. Even if literacy and language are not barriers,communication about when and where vaccines are available has gotten muddled. Health promoters also found that culture and beliefs also affected individuals’ desire to be vaccinated, as well as misinformation about vaccines causing harm or death.

In addition to efforts to promote COVID-19 vaccination among returning migrants, TEPHINET has also been supporting work that MPSAS and the Council of Ministers of Health of Central America and the Dominican Republic (SE-COMISCA) have been engaged in to increase vaccination rates among remote populations. Initially focused on three municipalities–Sololá, Chimaltenango, and Totonicapán–the project has since expanded to include two more municipalities and a total. of 14 departments. Project activities have included establishing local vaccination centers; mobilizing communities in collaboration with local traditional, municipal, church and community leaders; providing personal protective equipment (PPE); and setting short-term contracts for nurses and personnel to provide vaccination. TEPHINET has also been supporting provision of fuel and necessary vehicles to reach distant communities.

Both vaccine projects have found that working alongside communities is critical to ensuring successful dissemination of COVID-19 messaging, combatting vaccine hesitancy, and increasing access to COVID-19 vaccination.