As covid-19 vaccines begin to arrive in the Andean highlands in Colombia, Maria Pito, a leader of the Nasa people, is reluctant to receive one. “As a nurse, I will be required by the clinic where I work to be vaccinated but if I had the choice, I would not take it and would continue to rely on traditional medicine,” she says. “I and many others don’t trust this untransparent government.”

Her distrust echoes the feeling of many Indigenous people in the region, even though they belong to one of the demographics most vulnerable to covid-19.

Many are choosing to use traditional medicines and well-established isolation tactics to prevent the spread of coronavirus. “The situation with these new vaccines is complicated, and we have very little information about them,” says Marcelino Noé, a Tikuna leader from the Caña Brava Indigenous community near Tarapaca, Colombia. “We must protect our elders, but we prefer to trust our traditional medicines.”

This approach, which has been supported for decades by intercultural organisations, may not be enough in this situation.

There are several reasons why Indigenous people in the region may be particularly vulnerable to covid-19. Though there is great diversity between groups, many share the characteristics of a community-based way of life. They may also lack access to basic health services, clean water, food security or electricity. In the Amazon, illegal miners, loggers and smugglers have become emboldened since Indigenous communities went into isolation early last year, posing a risk that they will bring covid-19 with them.

Colombia has almost 2 million Indigenous people. It is a prime example of the obstacles facing vaccine roll-outs in Indigenous communities in South America.

The Colombian Amazon is an area of notable concern, especially along the border with Brazil. Colombia’s Amazonas department has registered one death from covid-19 per every 434 inhabitants, the highest rate in the country. Estimates suggest that Indigenous people living in rural parts of the Colombian Amazon are 2.5 times more likely to die from covid-19 than the general population.

In response to the P.1 variant first seen in Brazil, the Colombian government has prioritised the border regions of the Amazon for the first phase of the national vaccine roll-out, which began at the end of February. But it will focus on urban areas. The region’s 64 Indigenous Peoples, who haven’t been consulted on the roll-out and may in some cases refuse the vaccines, aren’t designated as high-priority groups.

“While the West often views Indigenous Peoples as weak, they rightly view themselves as extremely resilient, and many in the Colombian Amazon feel they have already overcome covid-19. This may explain part of the unfortunate resistance to the vaccines,” says Daniel Aristizabal at Amazon Conservation Team (ACT), an organisation that has been working to provide isolating Amazonian communities with information and emergency supplies throughout the pandemic.

Communication is also an issue. “The biggest problem is a lack of respectful information sharing, and the government not including Indigenous communities in the decision-making processes,” says Pablo Montoya, director of Colombian NGO Sinergias.

Sinergias, ACT and others have collaborated to produce a radio show to share news and information about the pandemic with isolated Indigenous communities throughout the Colombian Amazon. “Our radio show is an enlightening experiment, but it is not enough,” says Montoya.

“What we are proposing to the Colombian government and Indigenous authorities is a respectful two-step strategy for Indigenous vaccine roll-out,” he says. In an initial consultation, communities would have their questions answered by an intercultural team. Then, if they agree, a second team would vaccinate the community with the one-dose Johnson & Johnson vaccine. It is the government’s responsibility to gain informed consent with Indigenous groups, which is necessary for building trust, says Montoya.

“Indigenous people are experts in pandemic-response, thanks to a long history of white people bringing disease. We should support and learn from their traditional preventive processes,” says Francisco von Hildebrand at Gaia Amazonas, a Colombia-based NGO.

In the Sierra Nevada de Santa Marta in northern Colombia, the 30,000-plus Arhuaco people are taking a pragmatic approach to the vaccines. They have made the collective decision to remain isolated in the mountains during the first phases of vaccine roll-out, after which they will decide whether or not to be vaccinated.

For Brazil’s approximately 900,000 Indigenous people, vaccine scepticism is less prevalent than in Colombia, with many scientists and Indigenous leaders demanding that Indigenous communities be prioritised for vaccines.

However, anti-vaccine fake news, which has been touted by Brazilian president Jair Bolsonaro and spread by evangelical missionaries inside Indigenous communities, is sowing doubt and causing internal rifts, says Grace Souza at King’s College London’s Brazil Institute.

“We successfully fought for all Indigenous Peoples to be correctly designated as a priority group,” says Eunice Kerexu, a leader of the Guarani people, Brazil’s most numerous Indigenous group. However, the government has stipulated that this prioritisation now only applies within demarcated Indigenous territories, therefore neglecting hundreds of thousands of Brazil’s Indigenous people who live on un-demarcated ancestral lands and in cities such Manaus, which has been devastated by covid-19.

Elsewhere, where Indigenous groups have been consulted in vaccine roll-out, acceptance has been higher. In Canada, for instance, the government has included Indigenous leaders and doctors in vaccine planning and distribution, leading to a wide acceptance of vaccines by Indigenous communities. Similar positive stories of integrated planning, knowledge sharing and vaccine confidence-building within Indigenous communities can be found in New ZealandAustralia and the US.

Author’s Note: This article was originally published as a “New Scientist” cover story.