Community initiatives can reduce health inequality: The case of COVID-19 vaccination in Rio De Janeiro’s favelas

The Covid-19 pandemic exposed longstanding inequalities in healthcare access worldwide, particularly in Brazil. These disparities were especially evident in access to hospital beds and vaccines, disproportionately affecting low-income communities in major cities and regions with lower human development indices.

In response, the Vacina Maré project was launched in 2021 to expand vaccination coverage and study health data in favelas during the pandemic. This ongoing initiative was developed by the Oswaldo Cruz Foundation (Fiocruz), the Redes da Maré organization, and the Rio de Janeiro City Hall, with support from the D’Or Institute for Research and Education (IDOR) and several other research institutions.

The Maré Complex, home to 16 favelas and approximately 140,000 residents, became a focal point for community-driven health interventions. Among these efforts, Vacina Maré stood out as part of a broader strategy that included vaccination campaigns, local health surveillance, telemedicine support, social assistance, and risk communication. The initiative’s success was largely due to the massive engagement of the local population, which led to international recognition, including presentations at the World Health Organization (WHO), the Brazilian Ministry of Health, and various global research centers.

Closing the Vaccination Gap

In a 2024 article published in The Lancet Regional Health – Americas, researchers highlighted the impact of community-driven vaccination efforts. The study documented the participation of 1,800 volunteers during the campaign.

The first phase of vaccinations took place from July 29 to August 1, 2021, and the second phase from October 14 to 16, 2021. At that time, six months after Brazil had started its national vaccination campaign, data from Dados do Bem had already shown that infections were disproportionately high in low-income areas, emphasizing the need for targeted public health policies. The campaign prioritized residents aged 18 to 33, a group not yet included in the national vaccination rollout.

Remarkably, 100% of Maré’s adult population received the first dose, and 76% received the second dose, surpassing the coverage rates in the rest of the city. During the campaign weeks, Maré’s vaccination rates were 2.3 times higher in the first phase and 3.0 times higher in the second phase compared to the rest of Rio de Janeiro. As a result, what had been a vaccination coverage gap before the initiative became a 22.4% higher coverage rate compared to the citywide average by the end of the campaign.

The authors concluded that mass vaccination campaigns targeting vulnerable communities are a highly effective strategy for reducing inequities in immunization coverage. They emphasized the importance of multi-stakeholder engagement, involving civil society in outreach and mobilization efforts.

Beyond the Pandemic

The success of Vacina Maré extended far beyond Covid-19. The initiative remains active, focusing on long Covid research, digital health solutions, and continued vaccination studies in the region.

Local community engagement has also evolved into long-term projects, including training programs in clinical research and data science. According to Dr. Fernando Bozza, a researcher at IDOR and Fiocruz, plans are underway to establish a research lab within the Maré Complex.

“The CoLab Maré will be a space dedicated to developing digital health tools, connecting Maré residents with research institutions. Our goal is to create a living lab, an innovation and co-creation hub that fosters youth education in research and data science. It will also feature a space for events and lectures. The architectural design is ready, and we are currently seeking funding to bring this project to life. More than just an innovation center, we want this lab to be a space for inclusion and co-development, where the community actively participates in shaping healthcare solutions,” explains Dr. Bozza.

The Vacina Maré initiative highlights the importance of adapting healthcare interventions to local realities. Its impact serves as a model not only for low- and middle-income countries like Brazil but also for any community facing barriers to healthcare access. The scientific data gathered from this initiative reinforces the global relevance of Brazilian research, contributing to more resilient public health strategies in the face of ongoing social and environmental challenges.