Puerto Rico has the highest rate of COVID vaccination among U.S. states and territories, Vox reported Friday.
Through Monday, Puerto Rico had fully vaccinated 74% of its population, and reported the relatively low COVID death rate of 102 per every 100,000 people.
Vermont, in comparison, led the U.S. mainland with nearly 72 percent of its population vaccinated, ABC News reported.
Puerto Rico has seen cases and hospitalizations trending downward while a spike has occurred across the mainland.
Vox reported that Puerto Rico Gov. Pedro R. Pierluisi, a Partido Nuevo Progresista member who caucused with Democrats while a commissioner in Congress, has implemented broad vaccine mandates across the private and public sectors.
The island's residents largely have embraced the mandates without protest, Vox said.
The Vox story said a resilient public health system, and a trusting relationship between Puerto Ricans and government officials ,has helped. That connection was strengthened in the aftermath of other recent crises, such as Hurricane Maria in 2017.
The Category 4 storm left more than 5,000 dead and caused $90 billion in damage — homes, roads, and bridges were destroyed — and caused power outages.
With Puerto Ricans having limited access to food and safe drinking water, and with adequate hygiene and sanitation lacking, a serious public health crisis existed.
A 6.4 magnitude earthquake in late 2019 — which was followed by dozens of significant aftershocks — and a 5.9 magnitude quake resulted in more damage to infrastructure and hampered post-hurricane rebuilding efforts.
Thousands of Puerto Ricans were relegated to emergency tent shelters with limited access to health care.
Following the hurricane and earthquakes, Puerto Rico's government mismanaged federal funds that had been delivered.
Nonprofit organizations and community leaders then led the way, helping people assess the damage, setting up emergency support centers, and helping to clear routes to water sources and medical facilities.
The groups also distributed items including non-perishable food, medicine and water.
"It was the [nonprofits] that put together everything because the government, locally and federally, couldn't deal with the aftermath of Hurricane Maria," José Rodríguez-Orengo, executive director of the Puerto Rico Public Health Trust, told Vox.
When the coronavirus pandemic hit the island, the organizations had established the infrastructure and community relationships necessary for effective COVID-19 prevention and vaccination campaigns.
Vox said politics played a smaller role with COVID vaccinations in Puerto Rico than it has on the mainland.
"Our main sport in Puerto Rico is politics. We are a very political society," Rodríguez-Orengo said. "What helped us out from the beginning was that the main political parties in Puerto Rico were saying the same message: 'Let's start with the scientists. They will lead us in public policymaking.'"
Puerto Rican government officials, scientists, physicians, pharmacists, the National Guard, and religious and community leaders rallied in a unified campaign around the vaccine.
"People trusted their physicians to provide them with health information," María Fernanda Levis-Peralta, a consultant in Puerto Rico working on improving systems for public health delivery, told Vox. "And one of the things that Puerto Rico has had is a very vocal physician community and consistent communication from folks on both sides of the aisle."
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