The challenges of vaccination against COVID-19 in Brazil

This article was exclusively written for The European Sting by Mr. Jhonatan Guilherme Fernandes and Ms. Jaquelini Fernanda Gomes dos Santos, two 3rd-year Medical Students from the Ingá University Center, Maringá – PR, Brazil. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Not even a week after the beginning of the emergency vaccination against COVID-19 in Brazil, the Public Ministry investigates irregularities in the vaccination and stops the application in Manaus, in the state that suffers not only with the shortage of vaccines but also with the lack of oxygen that led to the opening of graves to bury their victims [1,2,3].

What you see in Brazil is a reflection of years. Since 2016, the Ministry of Science, Technology and Innovation has been cutting spending and, due to the budget forecast, will reduce its budget by 34% [4]. As if that were not enough, the government itself encourages scientific denialism, which reveals the more than 214 thousand lives lost by COVID-19 until January 2021 [5].

In addition, in 2020 Brazil changed health ministers twice in less than a month, passing the position of doctors to an army general, an instability that contributes to the aggravation of the pandemic [6]. Since then, the president has defended the use of chloroquine, azithromycin and Tamiflu, medicines without proven efficacy, disbursing almost R$ 90 million in the purchase of these, but still without paying Instituto Butantan for CoronaVac vaccines [7].

Instead of encouraging the population to vaccinate, the president repeatedly attacked CoronaVac, calling it a “VaChine”, questioning its effectiveness and canceling the purchase of 46 million doses in October, which could prevent the shortage of vaccines experienced in January 2021 [8,9].

Another vaccine accepted on an emergency basis by the National Health Surveillance Agency (ANVISA) is AstraZeneca / Oxford. However, Brazil will pay more than twice as many Europeans for the first delivery of 2 million doses [10]. In addition, Butantan only has inputs for the production of 4.8 million doses by the end of January for the country of more than 210 million inhabitants [11,12].

Associated with this, the country is experiencing the “New Vaccine Revolt”, an allusion to what occurred in the country at the beginning of the 20th century due to the popular revolt against vaccination against smallpox epidemic in Rio de Janeiro [13,14]. There was a drop in vaccination coverage, which brought measles back, which was already eradicated, and with COVID-19 it seems to be no different due to the increasingly constant spread of FakeNews on social networks [15].

In December 2020, while 40 countries already applied the vaccine, Brazil had no immunization plan and extended its economic crisis. With 14 million unemployed, the year 2021 started with 40 million Brazilians without government assistance, who will suffer from inflation and falling GDP [16].

Faced with these problems, Brazil suffers from logistical problems due to its continental size because vaccines have to arrive in places of difficult access and at the appropriate temperature. But the biggest problem will be getting the necessary doses, convincing the population to take the vaccine, fighting FakeNews and, above all, monitoring possible irregularities in the national immunization plan [17].

References

1. Cristaldo H, Brandão M. Vacinação contra a covid-19 começa em todo o país. [Internet]; 19 jan 2021. [cited 2021Jan22]. Available from: https://agenciabrasil.ebc.com.br/saude/noticia/2021-01/vacinacao-contra-covid-19-come%C3%A7a-em-todo-o-pais
2. G1 [Internet page]. Ministério Público apura se houve irregularidade na vacinação de políticos, empresários e servidores em 12 estados e DF; 21 jan 2021.[cited 2021Jan22]. Available from: https://g1.globo.com/bemestar/vacina/noticia/2021/01/21/ministerio-publico-apura-se-houve-irregularidade-na-vacinacao-de-politicos-empresarios-e-servidores-em-estados-e-df.ghtml
3. UOL  [Internet page]. Sem oxigênio nem vacinas suficientes, Manaus só não pode ficar sem memória; 22 jan 2021.[cited 2021Jan22]. Available from: https://noticias.uol.com.br/saude/ultimas-noticias/redacao/2021/01/22/resumo-amazonas-pandemia-covid-19-oxigenio.htm
4. Pires B. Ciência brasileira sofre com cortes de verbas e encara cenário dramático para pesquisas em 2021. [Internet]; 30 dec 2020. [cited 2021Jan22]. Available from: https://brasil.elpais.com/brasil/2020-12-31/ciencia-brasileira-sofre-com-cortes-de-verbas-e-encara-cenario-dramatico-para-pesquisas-em-2021.html
5. Caponi S. Covid-19 no Brasil: entre o negacionismo e a razão neoliberal. Estudos Avançados. 2020 v. 34, n. 99, p. 209-224. [cited 2021Jan22]. Available from:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-40142020000200209&lng=en&nrm=iso
6. Zylberkan M, De Campos J P. Queda de dois ministros em apenas um mês deixa Saúde à deriva. [Internet]; 22 may 2020. [cited 2021Jan22]. Available from: https://veja.abril.com.br/politica/queda-de-dois-ministros-em-apenas-um-mes-deixa-saude-a-deriva/
7. Shalders A. ‘Tratamento precoce’: governo Bolsonaro gasta quase R$ 90 milhões em remédios ineficazes, mas ainda não pagou Butantan por vacinas. [Internet]; 21 jan 2021. [cited 2021Jan22]. Available from: https://www.bbc.com/portuguese/brasil-55747043
8. Agência O Globo. Relembre 10 vezes que Bolsonaro atacou a Coronavac. [Internet]; 18 jan 2021. [cited 2021Jan22]. Available from: https://saude.ig.com.br/2021-01-18/relembre-10-vez-que-bolsonaro-ataco-a-coronavac.html
9. De Andrade H. Toda e qualquer vacina está descartada, diz Bolsonaro. [Internet]; 21 oct 2020. [cited 2021Jan22]. Available from: https://noticias.uol.com.br/saude/ultimas-noticias/redacao/2020/10/21/bolsonaro-cancela-acordo-por-coronavac-nao-abro-mao-da-minha-autoridade.htm
10. Chade J. Para 1ª entrega, Brasil paga o dobro dos europeus por vacinas. [Internet]; 22 jan 2021. [cited 2021Jan22]. Available from: https://noticias.uol.com.br/colunas/jamil-chade/2021/01/22/para-1a-entrega-brasil-paga-o-dobro-dos-europeus-por-vacinas.htm
11. Gielow I. Falta de insumo da China ameaça vacinas do Butantan e da Fiocruz. [Internet]; 18 jan 2021. [cited 2021Jan22]. Available from: https://www1.folha.uol.com.br/equilibrioesaude/2021/01/falta-de-insumo-da-china-ameaca-vacinas-do-butantan-e-da-fiocruz.shtml
12. Instituto Brasileiro de Geografia e Estatística [Internet page]. Projeção da população do Brasil e das Unidades da Federação; 2021. [cited 2021Jan22]. Available from: https://www.ibge.gov.br/apps/populacao/projecao/index.html
13. Lucena I. A nova revolta da vacina. [Internet]; 03 nov 2020. [cited 2021Jan22]. Available from: https://saude.abril.com.br/blog/com-a-palavra/a-nova-revolta-da-vacina/
14. Porto M Y. Uma revolta popular contra a vacinação.Cienc. Cult.,São Paulo. 2003  v. 55, n. 1, p. 53-54. [cited 2021Jan22]. Available from: http://cienciaecultura.bvs.br/scielo.php?script=sci_arttext&pid=S0009-67252003000100032&lng=en&nrm=iso
15. Madeiro C. Movimento antivacina avança na web: por que ele é ameaça à saúde pública. [Internet]; 29 oct 2020. [cited 2021Jan22]. Available from: https://www.uol.com.br/vivabem/noticias/redacao/2020/10/29/movimento-antivacina-avanca-online-por-que-ele-e-ameaca-a-saude-publica.htm#:~:text=Especialistas%20apontam%20que%20h%C3%A1%20v%C3%A1rios,vacinar%20contra%20a%20covid%2D19
16. Mendonça H. Atraso do Brasil em começar vacinação contra covid-19 estende crise e retarda retomada da economia. [Internet]; 30 dec 2020. [cited 2021Jan22]. Available from: https://brasil.elpais.com/brasil/2020-12-30/atraso-do-brasil-em-comecar-vacinacao-contra-covid-19-estende-crise-e-retarda-retomada-da-economia.html
17. R7 [Internet page]. Quais os principais desafios da vacinação contra covid no Brasil; 21 jan 2021.[cited 2021Jan22]. Available from: https://noticias.r7.com/saude/fotos/quais-os-principais-desafios-da-vacinacao-contra-covid-no-brasil-21012021#!/foto/10

About the authors

Jhonatan Guilherme Fernandes, 21, is a 3rd-year Medical Student from the Ingá University Center, Maringá – PR, Brazil and Local Officer on Medical Education Director (LOME-D) in the local committee Uningá of IFMSA Brazil.

Jaquelini Fernanda Gomes dos Santos, 24, 21, is a 3rd-year Medical Student from the Ingá University Center, Maringá – PR, Brazil and Local Officer on Reproductive Health including HIV/AIDS Director (LORA-D) in the local committee Uningá of IFMSA Brazil.