Access to Vaccines in Floodplains and Hard-to-Reach Areas of the Brazilian Amazon: The Contribution of Street-Level Bureaucrats and the Use of Social Technologies

Introduction: Access to vaccines provided by the Brazilian National Immunization Program (NIP) to populations living in floodplains and hard-to-reach areas of the Amazon is complex and conditioned by the geographic characteristics of the region. The success of vaccination campaigns requires different strategies, technologies, and the involvement of professionals whose work goes beyond standard procedures and vaccination protocols. Objectives: To investigate the specificities of the immunization process of populations inhabiting floodplains and areas of difficult access in the municipality of Careiro da Várzea, in the state of Amazonas, Brazil. To analyze the theoretical and practical aspects of the National Immunization Program in the region. Methods: The case study included qualitative-descriptive techniques that combined data analysis, document analysis, and participant observation to reveal different socio-sanitary aspects of the immunization process of the Amazonian populations studied. The concepts of Street Level Bureaucracy and Social Technologies guided the analysis and description of the immunization process in the area studied. Results: The study described the geographic conditions, the social technologies used, and the individuals involved in the immunization process of the populations of communities and villages in flooded areas of the Amazon in Brazil. The high temperatures in the region create the need for thermal control in the storage of vaccines during their transfer to the communities and villages. The local coordination of the Imuniza SUS Program acts as a strategic mediator between the different bodies, ensuring the population’s access to vaccines, which means that the actions of government agents (Street Level Bureaucracy) are crucial to the functioning of the immunization program. Conclusions: The success of the immunization campaigns in the hard-to-reach flooded areas of the municipality is due to the existence of a virtuous cycle arising from the synergy between the different stakeholders that make up the immunization service; there is a clear relationship between the vaccination coverage rates achieved and the municipal administration’s commitment to public health. The immunization rates achieved in the municipality studied were compatible with the average established by the Brazilian Ministry of Health. This case study might enhance knowledge about health practices in this important world region.