Cut the Transmission, The Multi-Ethnic Health Campaign that promoted vaccination
The Nicaraguan Ministry of Health, with the support of UNICEF, implemented a communication strategy involving community leaders and volunteer brigade members to improve immunization rates.
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By mid-year 2020, Rosa Quintero Bork (25) learned the most painful and unexpected news of her life: her brother Danilo (43) had died of COVID-19. In just 10 days, the virus that had put the world on edge had taken her older brother.
A few months later, the whole world received with hope the development of COVID-19 vaccines, and Rosa decided to transform her pain into motivation and action. “When in 2021 we learned that the first vaccines were coming to Nicaragua, I was very happy,” says the young woman, mother of Gerald (2) and Erwin (3 months). “I was willing to do everything to protect my family,” she says. Her determination made her one of the spokespersons for the vaccination campaign with the greatest impact in her community. Cut the Transmission was conceived and implemented by the Nicaraguan Ministry of Health (MINSA), with the support of UNICEF, to protect the health of families, children, and adolescents.
The Pandemic of Misinformation
With the arrival of the first doses through the COVAX facility—for the equitable access to COVID-19 vaccines, of which UNICEF is a member—health workers had to overcome the barrier of misinformation.
According to Meladi Vásquez, MINSA epidemiologist in that region, infodemic or overexposure to inaccurate information or misinformation during the coronavirus pandemic, has been a significant barrier for vaccine uptake. “Many people believed rumors they heard among their neighbors, social media, or even their religious leaders”, the specialist says.
Rosa´s family did not hesitate to put their arm to receive the vaccine and thus be immunized against COVID-19. But their will was not that of all the families making up this community of the Miskito ethnic group.
“Our colleagues brought the vaccines from Managua to Bilwi and other cities in the region, but few people turned out for vaccination, and the doctors and nurses returned to the capital with most of the vaccines,” Meladi recalls. It was then that the Local Comprehensive Health Care Systems (SILAIS) decided to look for new outreach strategies. “We decided to turn to religious and community leaders to make them our allies. If they told people not to get vaccinated, they obeyed, but if we managed to convince them otherwise, then we would be successful,” Vasquez says.
Culturally relevant
The challenge was to reach the Miskito populations with accurate and reliable information. MINSA launched communication actions to promote confidence in vaccines and COVID-19 prevention. Within the framework of the Cut the Transmission campaign, messages and materials were developed in three languages (Spanish, Miskito and Kriol), considering the country’s culture and multi-ethnic dimension.
The campaign is part of a risk communication strategy that takes into account Nicaragua’s health model, in which the community is actively involved. Female volunteer brigade members, nurses and doctors played a leading role in disseminating all the messages. In Bilwi, SILAIS trained volunteers like Rosa, and provided them with kits containing manuals and support materials with key information on prevention, care of sick people and the importance of vaccination.
Rosa walked the trails that connect the typical Nicaraguan Caribbean tambo houses, bringing information to her Miskito neighbors in their own language. “It made us feel that we were taken into account, and that we could trust what we saw, heard or read, because it’s not the same to hear it in Spanish as in our own language,” she admits. The messages were also available on radio, television, and social media.
The Cokau wan alkaia apia bamna campaign in Miskito had a positive impact on MINSA’s nationwide vaccination campaing. Between November 2021 and June 2022, the percentage of COVID-19 vaccinated people nationwide rose from 8% to 79%.
Speaking the People’s Language
At the National Biological Center (CENABI) in Managua, Dr. Cristhian Toledo, National Director of Health Surveillance, comments that “the cultural adaptation of the campaign was essential to effectively reach citizens of different cultures in Nicaragua”.
Toledo, who led the immunization process at the national level, emphasizes that another of the main strengths of the joint MINSA-UNICEF strategy was the coordinated work between health workers and volunteer brigade members. While in the cities the messages toured the streets printed on buses, in rural areas they reached families via local radios or by word of mouth through health workers and community brigades.
“The cultural adaptation of messages, the support in terms of equipment, training and vaccines from UNICEF, has been crucial; but the determined participation of the volunteer community and all our health staff, nurses who walk around their communities vaccinating families, doctors who were in the first line of response to the pandemic, and the commitment of the volunteer people through the health brigades has been vital to the success of the vaccination process,” says Toledo while going through the refrigerators of CENABI where the COVID-19 vaccines are stored before being distributed to the rest of the country.
In Bilwi and Matagalpa, house-to-house visits are focused on families that have not yet completed their first 2021 vaccination schedule, but those that have, exceed 90 percent and are arriving on their own at the stations established for the current year’s vaccinations.
“We have won this battle,” says Rosario in Matagalpa. A big smile lights up her face. “It was hard work, very tiring, but it was worth it because we all feel safer being vaccinated ourselves and our community,” concludes the brigade member. In Bilwi, Rosa goes to a Pentecostal church in her neighborhood. It is not the church she is a member of, but she attends to greet the pastor and her neighbors, the same ones who once opened their door to hear her talk about vaccines and now applaud at her arrival for convincing them to stop the transmission.
In Bilwi, Rosa goes to a Pentecostal church in her neighborhood. It is not the church she is a member of, but she attends to greet the pastor and her neighbors, the same ones who once opened their door to hear her talk about vaccines and now applaud at her arrival for convincing them to stop the transmission.
