When the first COVID-19 death was reported in Peru on March 19th 2020, the government had already declared a state of emergency, prohibited mass gatherings, implemented nightly curfews, and closed schools and borders (Benitez et al., 2020). Despite a strict national lockdown from March 16th to June 30th, Peru had the highest COVID-19 death rate per capita in the world in August 2020 (Quigley, 2020) and June 2021, after the death toll was doubled following a review (Reuters and Associated Press in Lima, 2021). In fact, projections of life expectancy at birth were cut by almost 3 years by January 2021 (Heuveline & Tzen, 2020). Information delays and chronological differences in identifying the first cases or waves of the pandemic hamper international comparisons.
Structural unpreparedness
The early national response hinted at the country’s unpreparedness for the crisis. The Peruvian health system is divided into five entities with multiple providers (WHO, 2020) and is underfunded – only 2.2% of the GDP was invested in healthcare in 2019, with 6% promised in 2014. As a result, Peru had 2.64 ICU beds and 2.9 ventilators per 100, 000 inhabitants in 2017, well below that of its regional peers (Garcia et al., 2020). Furthermore, there was a severe lack of personal protective equipment. There are reports of doctors even using plastic bags (Gonzales-Tamayo et al., 2020). Physicians were also unequally distributed per region and this deficit coincided with some of the highest number of COVID-19 cases (Gonzales-Tamayo et al., 2020).
Social challenges
The pandemic exacerbated inequalities (income, gender, geography) that determine access to services (Gianella et al., 2020). As 72% of jobs are in the informal sector, the lockdown was a significant challenge for daily-wage workers (INEI, 2018). Thousands of citizens internally migrated on foot from the capital to other regions in search of survival despite the challenging geography (Lázaro, 2021). In addition, markets became hotspots for transmission because 58% of Peruvian households do not own a refrigerator (INEI, 2020); this was intensified by controversial gender-based permissions to leave homes, on female-allocated days, which led to increased interactions in markets between women, as they usually buy the food (Pulcha-Ugarte et al., 2020). Additionally, considerable numbers waited at banks to collect government-issued relief cheques because only 38% of Peruvians have bank accounts (Dyer, 2020).
The lockdown adversely affected mental health, especially for the elderly and those with high levels of anxiety/depression. In fact, COVID-19-related distress had higher prevalence in areas affected by the virus (Kruger-Malpartida et al., 2020). Moreover, as schools were closed, the government implemented a digital educational platform (Aprendo contigo) to provide universal access to kindergarten, elementary, and high school students. Although it was highly criticised, the digital barriers and multicultural differences were addressed via campaigns on radio and television in nine national languages (Morales, 2020).
Misinformation
The national communication strategy was dominated by Presidential conferences on television with undertones of a battle-like discourse, which may have negatively impacted empathy and caused repression. Even though individual action was recommended, supportive material or local reinforcement were missing. The media and private sector voluntarily amplified messages; however, their lack of coherence was exacerbated by misinformation on social media (Macassi, 2020).
Misinformation may have led to self-medication to prevent COVID-19 (Tejada & Medina-Neira, 2020). Consequently, vaccine hesitancy doubled from August 2020 to January 2021, with 13% opting to self-medicate with ivermectin instead (Pereyra, 2020). Ivermectin, an antiparasitic drug, was once approved by the Ministry of Health for COVID-19 treatment without scientific evidence of its effectiveness. It presented antiviral properties in vitro at unachievable doses in the human body and no clinical trials have proven its efficacy or safety (Lescano & Pinto, 2020, Merck 2021). In fact, 80% of COVID-19 patients hospitalised report self-medication, with 67% taking ivermectin to prevent the novel disease (Zavala-Flores et al, 2020).
The vaccine scandal
Peru witnessed protests and marches when President Vizcarra was impeached and Merino (then Speaker of Congress), was declared acting president in November 2020. The protests surrounding the “Merino does not represent me” movement might have been fuelled by the pandemic’s impact: the rising unemployment rate (17%), contracting economy (30%), and ever-growing fatalities (Arnold- Parra, 2020).
“Neglected infectious diseases continued to affect the poorest and public hospitals struggled with a continuing oxygen crisis“
The second wave in January 2021 was followed by the arrival of the first batch of COVID-19 vaccines (Sinopharm) in February 2021. Further agreements have ensured millions of doses from AstraZeneca, Pfizer, and the Covax Facility due to arrive throughout 2021 (Peruvian Government, 2021b).
As the vaccination rollout began, a COVID-19 vaccine scandal – “vaccinegate” – was revealed. Almost 500 people were secretly vaccinated since October 2020 with surplus vaccines from the Sinopharm clinical trial in the capital. Among them were the former President Vizcarra and Mazzetti (Romo, 2021), the fourth health minister to resign or be removed during the pandemic. Distrust towards politicians increased as Peruvians were reminded
that the last six presidents had been charged with corruption.
Moreover, health inequalities were highlighted as neglected infectious diseases continued to affect the poorest and public hospitals struggled with a continuing oxygen crisis, especially in remote communities (Kenyon, 2021).
The 2021 presidential elections were testimony to an anti-establishment sentiment and widespread frustration with the political system (Taj, 2021). The elections differed from previous ones, as traditional media (radios and televisions spots) was not allowed. Instead, political parties broadcasted their messages via digital platforms (social media). In order to mitigate misinformation, Lira (2021) suggested that digital users should report misuse by political parties to ensure a democratic process.
Lessons Learned
- National diversity and social challenges must be acknowledged early to increase the effectiveness of measures or restrictions. Community involvement and understanding can further add to this.
- Evidence-based decisions founded on international experiences and local context could improve measure effectiveness.
- Prioritisation of educational strategies and digital user engagement are vital for addressing misinformation.
- The digital educational platform must be improved to increase crucial access to digital information in the future.
By Camila Carbone of Public Health Pathways
9 August 2021
