Puerto Rico: Getting COVID-19 vaccines where they’re needed

When Doctors Without Borders/Médecins Sans Frontières (MSF) wrapped up its COVID-19 response in Puerto Rico last September, it felt less like an end but a new beginning. That’s because we were able to hand over medical activities to Puerto Rico Salud, an organization created by members of the original MSF team who wanted to continue offering health services to vulnerable groups on the island. The COVID-19 crisis had exposed some of the chronic needs and systemic failures of the local health system, issues that require more sustained attention and collaboration with community-based organizations.

Now that vaccines are available, we are showing that it is possible to go into communities and ensure that people are not left out because of their circumstances.

Carla Sofia Gonzalez, a nurse with Puerto Rico Salud

After the handover, Puerto Rico Salud continued monitoring COVID-19 patients and offering primary care services in some of the areas previously covered by MSF. In January, they started providing COVID-19 vaccinations. “We have seen that many people face barriers in accessing COVID-19 vaccinations because they lack transportation, live in remote areas, or have conditions that make it difficult to reach a vaccination site,” said Carla Sofia Gonzalez, a nurse with Puerto Rico Salud. “Now that vaccines are available, we are showing that it is possible to go into communities and ensure that people are not left out because of their circumstances.”

With support from MSF, Puerto Rico Salud was able to expand the vaccination campaign starting in April. The Department of Health is providing the doses, and the Colegio de Profesionales de Enfermería de Puerto Rico is aiding in the safe storage of the vaccines.

Doctors Without Borders/Médecins Sans Frontières (MSF) physician Dr. Jonathan Caldera (left) and MSF nurse Rolando Betancourt (right) clean the wounds on a patient’s foot during a medical consultation in Arecibo, Puerto Rico. — MSF nurse Rolando Betancourt (right) and MSF physician Jonathan Caldera (left) tend to the wounds on a patient’s foot during a medical consultation in 2020 in Arecibo, Puerto Rico. Last year we partnered with local organization Ángeles Anónimos to reach people who are homeless and in need of medical services.

The team is reaching out to communities with certain risk factors, including people experiencing homelessness, living in long-term care facilities, or with disabilities. Vaccinations will be offered in Arecibo, Humacao, Aguadilla, Mayagüez, Ponce, Loiza, and La Perla, San Juan. This effort aims to help protect these communities who might otherwise be missed by local vaccination efforts due to geographic isolation or living conditions.

Puerto Rico Salud is building on the local networks established in 2020, when some of the founding members worked with MSF to provide home-based care and COVID-19 monitoring for people isolated at home in multiple communities across the island.

In early April, health workers from Puerto Rico Salud began visiting sites to vaccinate people whom community leaders identified as lacking access to existing services. The team plans to vaccinate people in local health centers or community buildings, or, when necessary, in private homes.

MSF physician Dr. Jonathan Caldera evaluates a patient while MSF nurse Omar Martinez takes her blood pressure reading during an in-home medical consultation in the community Buen Consejo in Rio Piedras, Puerto Rico. — MSF physician Jonathan Caldera evaluates a patient while MSF nurse Omar Martinez takes her blood pressure during an in-home medical consultation in the Buen Consejo community in Rio Piedras, Puerto Rico.

“Based on our experience in Puerto Rico, we understand the logistical challenges of bringing health care to geographically isolated areas, to people who are homeless, or to those who are home-bound due to chronic health issues,” said Sophie Delaunay, coordinator for MSF in Puerto Rico. “While all too often, health care providers lack the means to ensure that hard-to-reach people are vaccinated, we are showing a way to overcome these challenges.”

Even as the COVID-19 vaccination rollout ramped up across the US, Puerto Rico had one of the lowest vaccination rates, highlighting disparities in access to medical services. The numbers also reflected a lag in administering doses or recording them. According to the Centers for Disease Control's COVID Data Tracker, as of March 25, Puerto Rico had received 1,310,000 vaccine doses, of which 867,570 had been administered.

“Thanks to the commitment of our nursing professionals in Puerto Rico, we will have the opportunity to join with MSF and support this vaccination effort against COVID19,” said Dr. Ana García, president of the Colegio de Profesionales de Enfermería de Puerto Rico. “Our goal is to reach places that are difficult to access in order to ensure that we can impact as many people as possible.”

Puerto Rico's vaccination efforts so far have targeted primarily health professionals, frontline workers, people 65 years old and above, people above 60 years old with chronic conditions, prisoners, and people with disabilities. The team from Puerto Rico Salud is working hard to expand access to these lifesaving vaccines and other essential health services.

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Spring 2021: Vaccines Work

Photos: Bringing COVID-19 vaccines to underserved communities in Puerto Rico

Photos: Getting COVID-19 vaccines where they’re needed in Puerto Rico

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