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Mexico prioritizes rural poor for shots, raising eyebrows


SAN PEDRO EL ALTO, Mexico — As debate rages around the world about who should be vaccinated first, Mexico has come up with its own unconventional approach — one with no apparent epidemiological foundation. The government of populist President Andres Manuel Lopez Obrador is prioritizing the country’s poorest citizens, using the vaccine as a kind of reparation for years of marginalization.

Teachers in rural villages, some of the country’s poorest farmers, elderly members of far-flung Indigenous communities: They will receive coronavirus vaccinations before almost any of Mexico’s city-dwellers, who have endured the worst outbreaks.

It’s an approach that Lopez Obrador’s supporters embrace — proof their president is on the right side of Mexico’s profound class divide. But to many public health professionals, it is scientifically irrational, evidence that politics are distorting the vaccination drive.

Most of the communities being prioritized have had relatively low coronavirus caseloads. And in the government’s rush to get doses to the poor, many of the nurses and doctors in charge of the vaccination program had not yet been vaccinated themselves.

“This is a vision that has no basis in epidemiology,” said Fernando Petersen Aranguren, the secretary of health in Jalisco state. “This has nothing to do with public health and doesn’t focus on the need to break the chain of contagion.”

Aranguren wanted to distribute doses in Guadalajara, Mexico’s second-largest city, where more than 71,000 people have been infected with the virus. But the federal government, which has near-total control over vaccine procurement and distribution, instead gave him a list of small towns and villages it told him to prioritize.

Lopez Obrador has refused to be vaccinated until doses are made available in his Mexico City district. Critics have called the decision a theatrical show of humility. While waiting for the vaccine, Lopez Obrador contracted the virus in January. The country’s coronavirus czar, Hugo Lopez-Gatell, fell sick this month.

Mexico has reported 2 million coronavirus cases and 182,000 deaths, both considered undercounts. The most severe outbreaks have been in large cities. Mexico City, according to one study, has suffered the worst urban outbreak in the world.

Mexico’s government has provided little economic assistance to the country’s poor during the pandemic, even as unemployment has surged. Yet Lopez Obrador’s approval ratings, in several polls, remain above 60%.

The federal government has taken control of the vaccination program, choosing which municipalities are prioritized, deploying military units and dispatching doctors, nurses and federal officials as part of vaccination “brigades” in an extensive ground operation.

This month, the government released a list of 333 “highly marginalized” municipalities that would receive the first doses. Twenty-four of the 333 municipalities are in Mexico state. Most are remote and rural — they lie along the winding, narrow roads that climb through the hills of the state.

The state health department has questioned the federal government’s approach there, too.

Last month, the government began vaccinating thousands of teachers in Campeche, one of Mexico’s poorest states. Health workers poured into the streets to protest the decision, complaining that many nurses and doctors had not yet been given shots.

Next up are the teachers of Chiapas, Mexico’s poorest state. Chiapas and Campeche both have midterm elections this year, considered a critical test for Lopez Obrador’s Morena party — a link frequently drawn by critics.


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