Pan American Health Organization · 4 June 2020
PAHO guidance on addressing structural vulnerabilities and ensuring culturally appropriate COVID-19 prevention and care for ethnic minorities.
- Issuer
- Pan American Health Organization
- Edition
- 4 June 2020
- Audience
- Governments, health workers, community leaders, public health professionals
- Evidence
- Expert consensus and policy guidance
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This PAHO guidance document addresses the disproportionate COVID-19 risk faced by indigenous peoples, Afro-descendants, and other ethnic groups in the Americas due to structural racism, discrimination, and social determinants including poverty, limited access to water and sanitation, higher prevalence of chronic diseases, and barriers to health services. It emphasises that these populations require differentiated, culturally appropriate approaches to pandemic response.
The document provides specific recommendations for community members, leaders, health workers, and governments. Key strategies include: eliminating barriers to basic hygiene practices; ensuring culturally appropriate communication in local languages; including ethnicity variables in health registries; respecting traditional medicine and customs; and promoting intersectoral action to address social determinants. Special consideration is given to vulnerable contexts such as the Amazon basin, where 200 communities live in voluntary isolation and 85% face food insecurity.
The guidance stresses the importance of intercultural dialogue, community participation in decision-making, and avoiding stigmatisation. It calls for governments to forge agreements with communities through their leaders, provide essential supplies including soap and clean water, and develop dead body management protocols that respect cultural traditions whilst following infection prevention standards.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Avoid gatherings of more than 10 people and maintain physical distancing where culturally acceptable and practically feasible
- Include ethnicity variables in all health registries and COVID-19 surveillance systems to enable tailored interventions
- Provide essential supplies (soap, water, disinfectant, food) to communities facing barriers to basic hygiene practices
- Translate all COVID-19 information into local indigenous languages and adapt to oral communication methods (radio spots) where literacy is limited
- Conduct ongoing epidemiological surveillance through indigenous health workers and health promoters for timely referrals
- Ensure all health service providers have appropriate personal protective equipment (masks, gloves) matched to exposure level
- Develop dead body management protocols that respect cultural traditions whilst adhering to infection prevention standards
- Coordinate with traditional healers to integrate relevant traditional medicine practices with Western COVID-19 prevention measures
From the guideline
Verbatim
“structural racism and historical discrimination against these populations, which continues today, makes them more vulnerable than the general population to the effects of the pandemic”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Chair of the Public Health Institute of Georgia, I recognise that whilst this PAHO guidance addresses the Americas, its core principles apply directly to Georgia's ethnic minority regions where COVID-19 health communication faced significant challenges during 2020–2021. Our national surveillance systems did not systematically capture ethnicity data during the pandemic, limiting our ability to identify disparities—the recommendation to include ethnicity variables in health registries should be implemented prospectively for all infectious disease surveillance. The emphasis on culturally appropriate communication is particularly salient: during the pandemic, delayed translation of materials into Azerbaijani and Armenian likely contributed to lower vaccine uptake in Kvemo Kartli and Samtskhe-Javakheti. The practical challenge for Georgia will be training health workers in intercultural dialogue methods and establishing formal coordination mechanisms with community and religious leaders, which remain underdeveloped in our primary health care system despite the 2013 universal health coverage reforms.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia’s ethnic minorities—including Azerbaijanis (6.3%), Armenians (4.5%), and smaller communities—face similar structural vulnerabilities to those described in this PAHO guidance: geographic isolation in regions with limited health infrastructure, language barriers to health information (particularly in Kvemo Kartli and Samtskhe-Javakheti), and lower health literacy. The recommendations on including ethnicity in health registries are directly applicable to Georgia’s COVID-19 surveillance systems. National programmes should adapt communication strategies to ensure materials are available in Azerbaijani and Armenian, consider the role of community and religious leaders in health messaging, and assess access to basic hygiene supplies in minority-populated regions. The emphasis on culturally appropriate dead body management is particularly relevant given diverse religious practices across Georgia’s ethnic communities.
Questions this guideline answers
Quick answers
Why are indigenous peoples and ethnic minorities at higher COVID-19 risk?
Multiple factors converge: structural racism and historical discrimination, barriers to handwashing (lack of soap and water), difficulty maintaining physical distancing due to living conditions and subsistence practices (hunting, fishing), higher prevalence of chronic diseases, limited access to health services, lower literacy levels, and lack of social safety nets. Population density correlates positively with COVID-19 incidence.
What specific communication adaptations are needed for ethnic minority communities?
Translation into local indigenous languages is essential but insufficient. Messages must be culturally appropriate to customs and lifestyles, use symbols and images suited to the cultural context, avoid technical language, and be validated by the communities themselves. Delivery should match communication patterns: if communities communicate primarily orally, use radio spots rather than written materials. Images must never stigmatise or stereotype.
How should health systems work with traditional healers during COVID-19?
Traditional healers should collaborate with health personnel to verify whether traditional plants have antiseptic properties relevant to handwashing and other practices. Respect for traditional medicine should be promoted whilst understanding its meaning for indigenous peoples. Health workers should participate in intercultural dialogues and knowledge exchanges, taking an intercultural approach that identifies which traditional practices may conflict with COVID-19 prevention and which can complement Western medicine.
What is the Amazon basin example and why does it matter?
The Amazon basin contains 2,467 territories and 826 communities, approximately 200 of which live in voluntary isolation. These populations face tuberculosis, malaria, vaccine-preventable diseases (measles, yellow fever), food insecurity affecting 85% of the population, and lack of water, sanitation, communication, and transportation services. This demonstrates how multiple vulnerabilities compound COVID-19 risk and require differentiated approaches, including special protocols for peoples in voluntary isolation who lack sustained contact with majority populations.
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- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- 4 June 2020
- Status
- Current
- Published
- 2020-01-01
- Languages
- English
- Scope
- COVID-19 pandemic response for indigenous peoples, Afro-descendants, and other ethnic groups in the Americas
- Audience
- Governments, health workers, community leaders, public health professionals
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus and policy guidance
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Considerations on Indigenous Peoples, Afro-Descendants, and Other Ethnic Groups during the COVID-19 Pandemic. Washington, D.C.: PAHO; 2020. PAHO/IMS/PHE/COVID-19/20-0030.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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