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Vanderlecia Ortega dos Santos, or Vanda, from the Witoto Indigenous tribe, receives the Sinovac COVID-19 vaccine, in Manaus, Brazil, Jan. 18, 2021.BRUNO KELLY/Reuters

Brazil’s vaccination campaign is off to a slow start and may face even more delays because of government inaction and far-right rhetoric, imperilling the country’s most vulnerable group – its 800,000 Indigenous people.

President Jair Bolsonaro, his family and members of his government have regularly blamed China for the pandemic and questioned the efficacy of the vaccine CoronaVac, developed by China’s Sinovac and one of just two vaccines that Brazil has approved for emergency use. (The other is Oxford-AstraZeneca’s product.) The anti-China stand has made it difficult to get supplies, even as Brazil ranks third in COVID-19 cases globally and second in deaths, behind the United States.

Indigenous people have been disproportionately affected by the pandemic and have struggled to protect themselves and treat infected members of their communities. Caetano Scannavino, who co-ordinates the NGO Projeto Saude & Alegria (Project Health and Joy) in the Amazon region, said “COVID is a challenge all over the world, and in the Amazon would be no different.”

In Brazil, COVID-19 deaths are 16 per cent higher among Indigenous people than the rest of the population, and communities are often infected by the health care workers sent to help them. According to the Articulation of Indigenous Peoples of Brazil (APIB), a rights organization, at least 920 Indigenous people have died so far of COVID-19 complications and more than 45,000 have been infected among Brazil’s 161 recognized peoples.

Some tribes, such as the Ashaninka of Acre, have managed to isolate themselves and avoid the worst effects of the pandemic, but others are not so lucky. “There are cases where we can talk of a tragedy,” said Felipe Milanez, a professor of humanities at the Federal University of Bahia.

“The Bolsonaro government’s influence on this mortality is direct. The spread of COVID in the countryside and in Indigenous tribes has to do with the economy of looting Indigenous territories. Mining, whether legal or illegal, has spread coronavirus in [the state of] Para – which is encouraged by the government, not just tolerated,” Prof. Milanez said.

Mr. Scannavino said Brazil’s Indigenous peoples have additional vulnerabilities because of their lack of immunity to many pathogens, especially the most isolated tribes, who “still die of the flu.”

And “the challenges are peculiar when it comes to Indigenous sparse, dispersed populations, in a region that is difficult to access, difficult for logistics and communications, and in a region that lacks hospital infrastructure, basic sanitation,” he said.

Para’s Tapajos region is home to about 14,000 Mundurukus. Most live in 140 villages scattered throughout the municipality of Jacareacanga, which does not have a single ICU bed. The nearest municipality with an ICU is 400 kilometres away and has only four ventilators.

Public Health and Joy has been campaigning to bring food and oxygen to the most isolated communities. “We had to order oxygen cylinders to send to Munduruku villages. While the rest of the country was discussing the need for ventilators, here we were one step behind, needing oxygen,” Mr. Scannavino said.

On Jan. 14, Manaus, the capital of the state of Amazonas, ran out of oxygen. Hospital beds were called “asphyxiation chambers” in the media. Several people died, but Mr. Bolsonaro declared: “We did our part.”

Brazil’s government has failed to present a viable plan for mass vaccination, has let millions of tests spoil for lack of logistics for distribution and, in August, refused to buy batches of vaccine offered by Pfizer.

Pfizer and Johnson & Johnson are still awaiting approval from the National Health Surveillance Agency (ANVISA) to also provide vaccines to the country.

Mr. Bolsonaro is in a virtual war with the government of the state of Sao Paulo, which helped develop the CoronaVac vaccine through its Butantan Institute.

Last week, when ANVISA approved the use of the Oxford-AstraZenca and CoronaVac vaccines, the government of Sao Paulo immediately started vaccinating, but there are still many doubts about the logistics. There are limited doses of CoronaVac, and in the midst of the chaos, health care providers and private clinics tired of waiting for the government to act have sought to obtain vaccines on their own, including acquiring two million doses of the Oxford-AstraZeneca vaccine from India.

Mr. Bolsonaro has mocked the efficacy of CoronaVac, and in fact it has demonstrated an efficacy rate of just 50.4 per cent, barely above the World Health Organization’s minimum of 50 per cent – and far below the 78 per cent that had been previously announced. Last year Mr. Bolsonaro celebrated the brief suspension of its testing after the death of one of the clinical-trial participants. “One more that Jair Bolsonaro wins,” he said.

General Eduardo Pazuello, Brazil’s Minister of Health, is one of a number of military personnel who occupy prominent positions in the government – Mr. Bolsonaro is a former army captain. Gen. Pazuello has no medical training and advocates what the government calls “early treatment” for COVID-19 with remedies that have no proven efficacy.

From the beginning, Mr. Bolsonaro has opposed vaccination efforts. He has denied the severity of the pandemic, calling COVID-19 a “little flu,” and has often refused to wear a mask or avoid large gatherings of supporters. The fact that he contracted the illness and recovered only seemed to harden his stand.

But despite all the statements against the vaccine, opinion in Brazil is beginning to tip in favour of mass vaccination, putting pressure on the government. “I believe that the political risk for Bolsonaro is quite high, because there is no fake news through WhatsApp that satisfies the ordinary citizen who sees the world getting vaccinated and Brazil falling behind,” said Celso Rocha de Barros, an opinion writer for the newspaper Folha de Sao Paulo.

Brazil, and particularly the Amazon region, is waiting for a resolution while struggling with shortages. “While Sao Paulo entered the crisis with one ventilator for 2,400 inhabitants, Santarem, in Para, has one for 20,000. You have towns 700 kilometres away from a ventilator in the Amazon,” Mr. Scannavino said.

He said he is “hoping that the vaccine will arrive soon, quickly, and that it will reach the villages so that we can enter a new phase. Health in the Amazon has always been a chaos. With the pandemic, it has collapsed, and we hope at least to return only to chaos.”

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