Despite having managed to advance in its vaccination campaign and reduce cases and deaths from covid-19, Brazil is carrying out the immunization campaign in a scenario where planning difficulties and the loss of control by the Ministry of Health raise doubts about the the country’s ability to control the pandemic, especially with the advancement of the more transmissible Delta variant.
The PNI (National Immunization Program) has been without command since June, when the then coordinator Franciele Francinato left office criticizing politicization that was done in the country about vaccines.
Since then, state governments have made decisions individually and without the approval of the ministry, how to start vaccinating adolescents and reducing the dose interval, putting at risk the national goal of vaccinating all adults with both doses by the end of October.
“The PNI without coordination needs to be resolved urgently. This situation demonstrates the weakening of the government. The only responsible for what is happening with the PNI is the federal government itself. At this moment, the minister needs to put a brake on the arrangement, make the PNI fulfill your role,” he told the Reuters the epidemiologist Ethel Maciel.
The main risk at the moment concerns the completion of the vaccine schedule, as only 33% of the population took both doses or a single dose vaccine.
The second dose became especially important as the Delta variant, originated in India and which is more resistant to immunization agents.
Study published in New England Journal of Medicine pointed out that the effectiveness against Delta after just the first dose of the AstraZeneca and Pfizer vaccines is around 30%, but rises to 67% and 88%, respectively, with the complete regimen.
“Accelerating the second dose and expanding the number of people with a complete vaccination schedule is absolutely necessary to face Delta,” said the executive coordinator of the Coronavirus Contingency Committee of the São Paulo government, João Gabbardo, citing a reversal in the downward trend in hospital admissions in the state “probably” due to the spread of the variant.
“Unfortunately we don’t have Pfizer and AstraZeneca for that, even so we will continue without going back on the goal of vaccinating the greatest number of people with the available vaccines,” he added.
The largest city in the country, São Paulo already registers lack of vaccines for the application of the second dose of AstraZeneca’s immunizer, according to data from the city hall.
An alternative would be to apply the Pfizer vaccine as a second dose, but there are also not enough doses of the immunizing agent, which has been applied to teenagers.
According to the government of São Paulo, the Ministry of Health failed to send around 1 million second doses of AstraZeneca to São Paulo, causing a “true blackout of vaccines”, but the ministry claims that it is actually to blame for the lack of doses. , is from the state, which would have used vaccines destined for the second dose as the first dose outside the ministry’s recommendations.
“Changes in the recommendations of the National Immunization Program (PNI) lead to a lack of doses to complete the vaccination schedule for the Brazilian population,” the ministry said in a statement.
The Minister of Health, Marcelo Queiroga, has insisted that states and municipalities follow the vaccination standards determined by the folder, warning that, otherwise, the ministry cannot guarantee the delivery of vaccines.
The states, however, claim that the ministry’s lack of coordination capacity led them to take the decision on how to organize their vaccinations themselves.
“This lack of national coordination is not positive and has brought us concern,” he told Reuters Maranhão’s Health Secretary, Carlos Lula, who is also President of Conass (National Council of Health Secretaries).
“The PNI has always operated centrally and this is one of the reasons for its success, it has always managed to coordinate the distribution of vaccines. Now, at covid-19, it has lost that coordination capacity.”
Only after states such as São Paulo, Rio de Janeiro and Rio Grande do Sul had already announced the reduction of the interval between the doses of the AstraZeneca and Pfizer vaccines and the application of a booster dose in the elderly and immunosuppressed, did the Ministry of Health follow the same way.
In addition, while several states begin to vaccinate adolescents aged 12 to 17, with and without comorbidities, the ministry does not have a strategy for adolescents, and announced only that vaccination should be done after all adults have had two doses.
“In the end, each state chose to make its strategy, some of which were successful, but the result of this is not known in the future. It has been reducing time without respecting the national coordination, and there may not be a guaranteed vaccine. This will bring about problem up ahead,” said Carlos Lula.
Questioned, the Ministry of Health did not respond about the lack of coordination of the PNI since June and the impacts for the national immunization campaign.
The folder emphasizes, however, that 86% of the adult population was vaccinated with the first dose and that enough vaccines will be distributed to all adults by October, if the recommendations are followed.
Former PNI coordinator, epidemiologist Carla Domingues remembers that the ministry took a long time to make a national vaccination plan from the beginning, included several priority groups, gave in to pressure from states and political groups, and then ended up advancing vaccination by age also at the request of state governments, which were already beginning to adopt this strategy.
“The political pressures were not withheld, some states received more vaccines because they had more priority groups, a balance was not made to equalize the distribution before adopting the age and created more distortion”, he said.
The lack of national coordination of the PNI brings another difficulty pointed out by epidemiologist Wanderson Oliveira, former national secretary of Health Surveillance: the risk of the country running out of enough vaccines for 2022.
Despite having contracts for 660 million doses in total, the former secretary points out that this may not be enough depending on the type of booster vaccination for the entire population.
“It hurts to make the entire current population [acima de 12 anos] and a choro to reinforce the elderly. And at the very least, everyone will have to reinforce themselves next year, if it is not necessary to repeat the complete vaccination,” he told Reuters.
In addition, the target population for vaccines will grow each year. It is predicted that at least 3 million children will enter the vaccine age of 12 by 2022, which needs to be calculated.
Planning for this, he says, should have started in July at the latest. However, there are no signs of new contracts from the ministry so far.
“Several countries are already negotiating new contracts. Brazil is going to enter the market late again,” he stated.
According to the Ministry of Health, the government intends to agree this year the purchase of doses to be used in 2022, since a forecast of around 4 billion reais for vaccination was made in the proposed 2022 Union Budget, well below of the 27 billion reais made available for this year.
Copyright © Thomson Reuters.