Vaccinators in Peru's Amazon are challenged by religion, rivers and a special tea

The port of Indiana is the largest town for miles on the Amazon River. People travel for days in long, narrow, wooden boats called peque peques down the Amazon and various tributaries to get to the markets in Indiana. Cargo barges and long botes rapidos that can carry dozen of passengers also stop at Indiana before heading down the river to Brazil. And yes, Indiana was named in 1948 after the U.S. state by a Peruvian who'd studied in Indianapolis.

Nimia Uropari Velásquez traveled 4 hours by peque peque to shop at the market stalls and withdraw some cash from her bank account. And maybe get a vaccine against COVID-19.

There is no actual bank in Indiana but there's a guy sitting behind a metal grate at a small grocery store who acts as a "banking agent." He cashes checks, makes online money transfers and deposits cash for people into accounts at banks far up the river in Iquitos.

And there is a vaccine clinic at the sports stadium just around the corner from the banking agent.

Uropari's ultimate decision – to get the shot or not – represents one of many quandaries faced by Peruvian health officials as they try to get everyone vaccinated, including those in remote and rural areas. The country's current vaccination rate is almost 60%.

Special tea or vaccination?

Uropari is from a small village called Manati, where she says most people are not vaccinated against COVID.

"We take care of ourselves," the 28-year-old says. "We are protected. And we have a special recipe." They brew a tea made out of a local pepper plant called cordoncillo, garlic and onions. Local healers say the beverage will protect them against COVID.

Despite the special tea, she's still considering getting the vaccine.

"I don't know," she says. "I'm thinking about getting vaccinated because they say people with health issues like me don't fare well with COVID." She has had some kidney problems and low blood pressure.

After getting her cash, Uropari could walk over and get her shot. But then she changes her mind and says she wants to think about it some more.

Dr. Maura Elizabeth Pachas Pinedo, who's running the vaccination clinic, says Uropari is not unusual in wavering about whether or not to get immunized. Most of the adults in the town of Indiana who really wanted to get the shot have done so, she says. Vaccination rates in more remote villages are much lower.

Now the vaccination campaigns are focused on the people who are more difficult to reach or convince. Pachas says one of the keys is to offer people vaccines multiple times. Maybe the first time someone isn't ready. The third or fourth time, they might say OK and get the shot. Sometimes immunizing people who are on the fence isn't about convincing them, she says. It's about offering the vaccine when they're ready. But that can be a particular challenge in this remote part of the Amazon.

"As the health department here, we only have one boat that we use to get out into the communities," Pachas says. "We also use that boat for emergency evacuations to the hospital in Iquitos. So with this one boat we can't be out of Indiana for many days."

And getting to some of the villages in this part of the Amazon can take days by boat.

Also, Pachas says the health department has a limited budget for fuel.

On this Saturday morning, her team is offering Sinopharm and Pfizer shots to anyone over age 20 at the municipal gymnasium. The people waiting for Pfizer are lined up on the left side of the building. Those waiting for Sinopharm are on the right. Pachas says using Pfizer is difficult once they leave this commercial port of Indiana.

They need to use special coolers to carry the Pfizer vials, which require more cold storage than Sinopharm. Each Pfizer vial has 6 doses. In an effort not to waste doses, they won't open a vial unless they have 6 people ready to be vaccinated.

"At times in a village you don't get 6 people who want to be vaccinated, you get 4 or 5," she says. Rather than risk losing doses, they ask people who want Pfizer to come to Indiana.

Two obstacles: anti-vaccine religious groups and microchip rumors

She says that the other two major challenges impeding vaccination are crazy rumors — a common one is that the injection plants a microchip in your arm — and religious groups that are opposed to vaccines.

One of the villages where most residents have flatly denied the vaccine is Suni Caño, located another hour by peque peque down the Amazon from Indiana. For miles, the river winds through the rainforest. The only signs of settlements are the occasional small boat pulled up on the bank and fish traps close to shore. Pink dolphins occasionally pop out of the mocha brown water and splash in front of boats on the waterway.

Demister Riz Zambrano, who's 25, is the leader of Suni Caño. It's a small community of indigenous evangelicals on the southern side of the river. There's no clear marker for their village, which is home to several dozen families. We have to hike through swampy fields and cross a tributary of the Amazon in a canoe to get to them. Zambrano is welcoming and energetic. And he's quick to dive into a debate about vaccines.

"Here in this beautiful community of Suni Caño, most of the people are not vaccinated," he says proudly. Health workers have come to offer them the vaccine and the residents have flatly told them, no thank you, he says.

"Do you know for why?" Zambrano asks. "Because we are religious people. We believe in God, and we put our trust in God."

Suni Caño is so far out of the way that it doesn't show up on most maps. You can't even see the cluster of simple houses from the river. The only electricity is from solar panels. There's only cell service if you go back by the soccer field.

Zambrano believes that remoteness means villagers are less at risk of getting infected. But his bigger point is that he and many other people in Suni Caño could not care less about vaccines developed in some faraway land. Their view is they don't need vaccines from the United States or China to protect them.

"God is the one who takes care of us. God is the one who protects us," he says. "He gives us life, air, health and everything. And so if I got the vaccine, I wouldn't be believing in God."

Taking a vaccine, he argues, places your faith in something other than God. He views vaccination as a betrayal of his religious faith. So he has no intention of getting inoculated.

For public health officials Suni Caño poses a problem. Dr. Pachas at the health department says among the deliberately unvaccinated, the hardest to convince are evangelical Christians. And there are many communities like this one spread out through the vast Amazon region. Maybe some of the residents will decide they do want to get vaccinated, but given how long it takes to get there from Indiana, she says, you have to ask if it is worth dedicating a vaccination team for an entire day.

Yet an outbreak could occur here.

But Dr. Pachas is optimistic. "As the weeks go by and the vaccination campaigns continue," she says, "we are seeing that people participate. They get vaccinated." It just might take longer here in the Amazon than in some other places in the world.

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