At the María Simmons school, hundreds lined up on a recent morning to receive their COVID-19 shots in Vieques, an island off Puerto Rico’s eastern shores. Classrooms were outfitted with injection stations. Posters reminding those in line to stay six feet apart were stapled on the trunks of lush trees in a grassy courtyard.
Across Puerto Rico, people are getting vaccinated against COVID-19 at rates far higher than most of the Americas, as eligibility requirements expand and more vaccine doses arrive by plane from the United States. Puerto Ricans are flocking to schools, stadiums, fine arts centers, pharmacies, and hospitals en masse to get inoculated.
But in Vieques, one of the first places in the U.S. territory to vaccinate the general population, the arrival of the coronavirus vaccine has special significance.
Battered by Hurricane Maria, and still grappling with its legacy as a U.S. Navy training range, Vieques has faced myriad challenges as it weathers the COVID-19 pandemic. There are few doctors, unreliable maritime transportation, and a periodic scarcity of basic goods. The island of about 8,300 people doesn’t have intensive care beds to handle severe cases of the coronavirus.
“Vieques has no infrastructure, no hospital,” said resident José Gerardo Montiel as he waited to receive his shot. “Everything has to be shipped and we don’t even have an adequate boat service.”
For many, the vaccine’s arrival was a reminder of how far behind the island remains after years of crisis.
“They are putting so much effort in one specific issue and not really into public health,” said Elda Guadalupe, a school teacher and community leader who gathered with a small group of island residents to protest the government as shots were being doled out. “Having the vaccine won’t compensate for not having [medical] access.”
The Puerto Rican government has taken an aggressive stance against the virus compared to many states in the U.S. mainland. When the pandemic began, the archipelago went under a strict months-long lockdown that shuttered all non-essential businesses and imposed a curfew that has still not entirely been lifted. Now the island is on a race to immunize the population of 3.2 million, which in recent years has struggled to recover from hurricanes, earthquakes and economic distress.
Almost 750,000 vaccine doses had been administered in Puerto Rico as of March 14, according to the Centers for Disease Control and Prevention. Dr. Iris Cardona, who directs the Puerto Rico Department of Health’s vaccination program, said there has been strong interest in getting vaccinated. The National Guard has been heavily involved in coordinating vaccination logistics, launching at least six inoculation centers, and supporting operations in Vieques and other municipalities.
At a press conference in Vieques Wednesday, Gov. Pedro Pierluisi said that the island will be among the first places in the U.S. territory to inoculate the majority of their adult population. The government expects to vaccinate 70% of viequenses by mid-March against COVID-19 — a milestone for the medically vulnerable population, who had their main medical facility destroyed during Hurricane Maria in 2017. Culebra, another nearby island, had already vaccinated 83% of residents as of March 10.
“The goal is to achieve herd immunity on these two beautiful islands,” he said.
The central government has restricted ferry travel to the offshore municipalities mostly to only residents. The move was meant to shield residents, but also shut down the island’s main industry: tourism. Pierluisi said that once vaccinations were finished Vieques could be gradually reopened for visitors.
José Corcino, the mayor of Vieques, said he was “proud” and “very happy” that the town has been able to achieve mass vaccination as it plans to rebuild its economy.
“Right now the only factory that we have closes next month. It’s 45 families that are not going to have that sustenance and the municipality in the conditions that it is, cannot employ more people,” Corcino said. “It is a new opportunity for the tourism industry to be reborn.”
No ICU beds for COVID patients in Vieques
Vieques is a land of hills and valleys, surrounded by a crystalline sea. But for more than six decades, the U.S. Department of Navy used two-thirds of the land for military training and weapon storage. With its deep waters, low population, and isolated geography, it offered an ideal training ground for marine defense. The U.S. Navy used live ammunition during drills. Napalm, depleted uranium and other toxic materials were employed only miles away from people’s homes.
The accidental death of a 35-year-old security guard in 1999 during a bombing practice intensified years of mass dissent and civil disobedience in Puerto Rico and abroad. Over 150,000 people marched in San Juan in 2000 protesting the marines, calling for peace in Vieques. Political leaders and civil rights activists from the archipelago and elsewhere were arrested for protesting against the military presence on the island.
Today, Vieques, which has a poverty rate of almost 46%, faces vast challenges. The federal government’s cleanup efforts following the Navy’s exit continue, and swaths of land remain closed off to the public. It could take until 2032 to finish the entire decontamination process, according to a 2018 congressional report.
Hurricane María in 2017 destroyed homes and the island’s infrastructure, leaving Vieques without electricity for over a year and inundating the Susana Centeno Family Health Center.
Passenger and cargo transportation have a hard time getting to the island. Schedules and the weather can change at a moment’s notice, leaving passengers stranded at either end of the journey. Ships routinely delay or break down, making it difficult for residents to get basic supplies or travel to the main island, where they can access better-equipped supermarkets, medical clinics, and basic services. The island has recently been days without fuel because a cargo ship broke down.
“The maritime transportation system is killing us here on Vieques. We are lacking fuel, necessary supplies. We aren’t starving. But if you go look for an item, you might not find it. Some shelves are half-empty,” Corcino said. On Saturday night, Pierluisi activated the National Guard to help transport provisions to Vieques and Culebra, and the head of the Puerto Rico Maritime Transportation authority resigned after the mayor of Vieques asked her to leave her post.
The pandemic, which has overwhelmed sophisticated medical systems around the world, has incited fears in the Caribbean island.
“When you have difficulty accessing health services, the entire population is at a great disadvantage,” said Yanina Bernhardt, the epidemiologist who oversees contact tracing in Vieques.
The island has had a total of around 300 accumulated coronavirus cases detected across testing methods, said Bernhardt, part of a team of 12 that tracks infections in the isle. This includes vaccinated people who have tested positive for antibodies. While Vieques has kept coronavirus cases “quite under control,” it had six simultaneous outbreaks in December that killed two residents and sickened over 70 people. The surge in cases at the end of last year was one of the factors that pushed the government to bring vaccinations immediately to the island, the epidemiologist added. Vieques began its vaccination campaign in mid-January. Second doses for those who received their first shot between March 8 and March 12 will be offered in April.
Vieques’s small hospital was shuttered after Maria flooded the facilities. A provisional emergency clinic was prepared in what used to be a hurricane shelter, but it has limited capacities and no delivery room. Specialized doctors travel to the island to tend to patients, but visits are subject to the mercuric nature of the weather and the ferry system as well as the available medical equipment.
A large number of the island’s residents are also elderly, and many suffer from chronic conditions, such as cancer and cardiovascular disease, at higher rates than counterparts in the rest of Puerto Rico.
“Here a person who has COVID and [the case] starts to get complicated, there is no way to give him the services and he has to be transferred to the ‘isla grande’ to seek that specialized medical care,” Bernhardt said.
The arrival of COVID-19 has added new challenges to the already daunting transportation panorama. People with medical emergencies — such as strokes or heart attacks — have to be transported out of the island by medical helicopter. Some patients in need of immediate attention take commercial planes. The contract tracing system that Bernhardt leads purchased air-contained, claustrophobic full-body capsules and isolation helmets to ensure that crew doesn’t become sick while moving COVID-19 patients.
“There are many challenges because of the travel time for a person who is starting with respiratory distress, every minute counts and makes them more vulnerable,” Bernhardt said.
Following the January 2020 death of Jaideliz Moreno, a 13-year-old girl, in the Vieques makeshift clinic, the Federal Emergency Management Agency promised $39.5 million to rebuild the Susan Centeno Community Health Center. Moreno’s family sued the Puerto Rican government in January 2021, alleging violations of human and civil rights for the lack of available services in the municipality.
Corcino, the Vieques mayor who assumed office in January, said he hopes construction will begin early next year.
‘We are equal constituents here in Puerto Rico’
While residents largely welcomed the opportunity to be vaccinated, a small group decried the lack of essential services in an island only miles from Puerto Rico’s shores. On one of the main paved roads, viequenses protested on the afternoon of the governor’s visit.
“They are going to immunize a population against COVID-19, but there are hundreds of students who lack the immunization of normal vaccines,” said Guadalupe, the school teacher and community leader.
Guadalupe supports inoculating the population against the novel coronavirus, but pointed out the same urgency in distributing vaccines has not been applied to fix the island’s deficient medical and transportation systems. Due to the lack of a delivery ward on the island, Guadalupe was sent on a commercial plane to an isla grande hospital while in labor to give birth to one of her children.
The governor was not present when residents gathered to protest outside the chain-link fence of the island’s port terminal.
“We are equal constituents here in Puerto Rico and we deserve the same rights as any resident Puerto Rican,” said Hilcia Guadalupe, Elda’s sister, as others behind her held a large banner that said “hospital, dignified transportation, and food sovereignty.”
“It is unnecessary for me to be here under the sun, demanding something that by Constitution, by right, is mine,” chimed in Adelmarí Lassús, another Vieques resident and public school history teacher.
A second, separate protest began when one lone aquatic protester on a surfboard dove into the turquoise waters to block the arrival of the passenger ship — the main mode of transportation for Vieques residents. Dressed in yellow flippers and a black cloth covering his face, he addressed the press from the ocean, as reporters pushed down their microphones and cameras to the water’s surface, and echoed the concerns of other protesters. Three other swimmers soon joined him as the white and navy boat could be seen from afar in the roiling ocean.
After 30 minutes, the water protesters let the Cayo Blanco passenger ferry dock. Elderly viequenses and patients with a host of medical conditions were on the boat, who had been on the main island for the day for medical appointments. One woman had to be carried off on a stretcher from the Vieques port, hyperventilating as she was rolled away. Maritime conditions had been choppy, and the boat had tossed and turned its passengers.
Ismael Guadalupe, a well-known community activist instrumental in pushing the U.S. Navy out of Vieques, was on board.
“We are Vieques people. In solidarity, we understand the claim, but do not do it to the sick of Vieques,” said the community leader of the aquatic manifestation that had delayed his journey.
The tension and disagreement was a reminder of the complexities of community organizing and civil disobedience in an island whose history is rife with resistance. For the protesters, the COVID-19 vaccine is just the first of many steps still needed.
“It is not worth celebrating when you have like five other things that you have not done,” Elda Guadalupe said.