Although less affected by the Covid-19, children became more susceptible to other diseases that can be avoided with vaccines available for decades in Brazil. Vaccination coverage against infections such as tuberculosis and measles, which had already been declining, plummeted further during the pandemic. Rates returned to the levels of the 1980s and experts warn of the risk of resurgence of serious diseases.
Data on vaccination coverage in Brazil were presented yesterday by the technical advisor of the General Coordination of the National Immunization Program of the Ministry of Health, Antônia Teixeira, during an event held by the Brazilian Society of Immunizations (Sbim). Fake news and even lack of knowledge about vaccines by health professionals are pointed out as causes of the drop in coverage.
The pandemic has further halted vaccination. Between the beginning of the 1980s and the end of the 1990s, there was an increasing trend in vaccination coverage in Brazil, with stability at high levels in the 2000s. From 2015, there was a reduction in coverage. “We observed a progressive and very accentuated fall, where the last period, from 2019 to 2021, returns to the levels of vaccination coverage of the first period, from 1980 to 1982”, stated Antônia.
Compared to 2019, there was a reduction in the coverage of all vaccines last year, with the exception of pentavalent (against diphtheria, tetanus, whooping cough, hepatitis B and haemophilus influenza type b bacteria). For polio, a serious disease that causes paralysis, for example, coverage reached 98% in 2015, but dropped to 76% in 2020.
Compared to 2019, the reduction was eight percentage points, according to data from the Ministry of Health. There was also a drop in hepatitis B coverage. The rate reached 79% in 2019 and, last year, it was 63.4%. The application of the BCG vaccine, against tuberculosis, reached 3 million doses in 2015 while last year only 2.1 million were applied.
Data are subject to change, but highlight the need to devise strategies to reach children. Last year, the percentage of municipalities with adequate coverage in children under one year of age was below 50% for seven vaccines. Only 38% of municipalities have adequate vaccination against polio, for example – the lowest percentage at least since 2015. A percentage above 90% for rotavirus and BCG and above 95% for other immunizing agents is considered adequate.
The challenge is greater in the North Region. The second dose of the MMR, for example, which protects against measles, mumps and rubella, achieved less than 50% coverage in all northern states this year. The result of the low rate is the reappearance of measles, which was already considered eradicated. In 2019, there were 20,900 confirmed measles cases. This year, there are cases in the states of Pará, Amapá, Ceará, Rio, São Paulo and Alagoas.
During the pandemic, there was a decrease in the incidence of measles and other diseases of respiratory transmission – despite the reduction in coverage by vaccines -, which is related to social isolation and the use of masks. Researchers fear, however, that diseases will reappear with the return of social interactions and low vaccination. “We are playing with fire,” said the professor of Pediatrics at the Faculty of Medicine of the Federal University of Ceará Robério Dias Leite, during the Sbim event.
According to experts, the fall in coverage was not caused by the pandemic, but made worse by it. Among the factors are the fear of seeking the vaccine and contracting covid, in addition to the disarticulation of care at health centers. In the most acute phases of the pandemic, even Basic Health Units were used to treat patients. The reappearance of these diseases becomes an even bigger problem since some of the health professionals are not able to treat these infections – because they have never seen such cases. The number of doctors who do not prescribe vaccines is also not small – which demands improvement in training.
“Unfortunately what we have observed is that not only politicians are antiscience. Our colleagues too. We have to be the example and try to convince them,” said Juarez Cunha, president of Sbim.
In a statement, the Ministry of Health reported that, even in the pandemic, immunization is maintained and the orientation is for the population to look for posts. The folder also guides municipal managers to make local partnerships to decentralize vaccination as much as possible.
The information is from the newspaper O Estado de S. Paulo.