Impact of the 'Health on Wheels' (HoW) strategy on COVID-19 vaccination coverage in hard-to-reach communities in Alta Verapaz, Guatemala, 2022.

BACKGROUND: In April 2022, after a year of COVID-19 vaccination, there were large differences in coverage between urban and rural areas in Guatemala. To address barriers in rural communities, the "Health on Wheels" (HoW) strategy was implemented. The strategy deployed mobile brigades with a dedicated team of health workers and a culturally sensitive health promotion plan in selected communities in 15 districts in Alta Verapaz, a health area with low COVID-19 vaccination uptake and a high-level of COVID-19 vaccine hesitancy. This study evaluates the impact of the HoW strategy. METHODS: We measured the relative increase in COVID-19 doses administered prior and during the HoW implementation period in the 190 intervened communities and compared to 188 communities without the intervention. Communities were grouped by health district and the impact analyses were stratified by number of COVID-19 vaccine dose (1st, 2nd, and 3rd doses) and history of vaccine hesitancy. RESULTS: The increase in 1st, 2nd, and 3rd dose-COVID-19 vaccination coverage between before and during HoW implementation was 2.4, 2.2 and 2.6 times higher in intervened communities (20 %, 21 % and 37 % increase in 1st, 2nd and 3rd dose, respectively) than in non-intervened communities (8 %, 10 % and 14 % increase in 1st, 2nd and 3rd dose respectively). For the 1st dose, increase in dose administration was 2.9 times higher in intervened communities (n = 24) with hesitancy (24 % increase) compared to non-intervened communities (n = 188) without hesitancy (8 % increase). CONCLUSION: The deployment of mobile brigades with a dedicated team of vaccinators and culturally sensitive health promotion through the HoW strategy successfully accelerated the increase in COVID-19 vaccination coverage in rural communities in Guatemala.

Increased streamflow in catchments affected by a forest disease epidemic.

Natural disturbances help maintain healthy forested and aquatic ecosystems. However, biotic and abiotic disturbance regimes are changing rapidly. For example, the Swiss needle cast (SNC) epidemic in the Coast Range of Oregon in the U.S. Pacific Northwest has increased in area from 53,050 to 238,705ha over the 1996-2015 period. We investigated whether the hydrologic regime (i.e., annual streamflow, runoff ratio, and magnitude and timing of peak flows and low flows) was affected by SNC in 12 catchments in western Oregon. The catchments ranged in size from 183 to 1834km2 and area affected by SNC from 0 to 90.5%. To maximize the number of catchments included in the study, we analyzed 20years of SNC aerial survey data and 15-26years of stream discharge (Q) and PRISM precipitation (P) and air temperature (Tair) data to test for trends in hydrologic variables for each catchment. As expected, we found that runoff ratios (Q/P) increased in five catchments, all with an area impacted by SNC >10%. This was likely due to the effects of SNC on the hydraulic architecture (i.e., needle retention, sapwood area, sapwood permeability) of affected trees, leading to decreased canopy interception and transpiration losses. Interestingly, two catchments with the greatest area affected by SNC showed no changes in hydrologic regime. The lack of hydrologic response could either be due to compensatory transpiration by vegetation unaffected by the disease or sub-canopy abiotic evaporation, which counteracted reductions in transpiration. This study is the first to illustrate that chronic canopy disturbance from a foliage pathogen can influence catchment scale hydrology.