RIO DE JANEIRO (AP) – Like many Brazilian public health specialists, Dr. Regina Flauzino spent most of 2020 watching in horror as COVID-19 devastated Brazil. When the opportunity arose to join the government’s vaccination effort, she was thrilled: she would be able to share her decades of local experience.
But his excitement quickly disappeared. Flauzino, an epidemiologist who has worked in Brazilian vaccine campaigns for 20 years, was frustrated by what he described as a hurried and chaotic process.
The government has not yet approved a single vaccine and Ministry of Health officials have ignored the advice of outside experts. Shortly after the government presented its vaccination plan, more than a quarter of the approximately 140 experts involved demanded that their names be removed.
“We were not heard,” Flauzino told the Associated Press. The creation of the plan “was postponed for a long time and is now being done in a hurry”.
Brazil suffered more than 200,000 deaths from COVID-19, the second highest total in the world after the United States, with infections and deaths increasing again. Despite half a century of successful vaccination programs, the federal government is behind regional and global peers in approving vaccines and developing an immunization strategy.
The AP interviewed four members of the expert committee and four former employees of the Ministry of Health. They criticized the government’s unjustified delay in formulating a vaccination plan, as well as the past months focused on a single vaccine manufacturer.
They also complained about President Jair Bolsonaro undermining the ministry’s effectiveness, pointing to the removal of highly trained professionals from leadership positions, who were replaced by military appointees with little or no public health experience. Experts also blamed the president, a former right-wing Army captain, for fueling anti-vaccination sentiment in Brazil, undermining the massive immunization effort.
‘STILL WAITING’
The government’s COVID-19 immunization plan, finally released on December 16, lacked essential details: how many doses would be sent to each state and how would they be refrigerated and delivered? How many professionals would need to be hired and trained – and, most importantly, how much resources would governors receive to implement the campaign? The plan did not include a start date.
“How will each state organize its campaign if it does not know how many doses it will receive and the delivery time?” said Dr. Carla Domingues, an epidemiologist who oversaw the logistics of the H1N1 vaccine campaign in Brazil in 2009, and worked on more than a dozen other vaccination initiatives.
Bolsonaro’s press office and the Ministry of Health did not respond to requests from the AP to comment on Brazil’s vaccination campaign or because more contracts with vaccine manufacturers were not signed in 2020.
The Ministry of Health’s National Immunization Program has a long history of success. Created more than 40 years ago, it allowed Brazil to eradicate polio and significantly reduce measles, rubella, tetanus and diphtheria. The effort won UNICEF recognition for reaching the most remote corners of the country and has contributed to extending the life expectancy of Brazilians from 60 to over 75 years..
The program “is the central axis of all vaccination campaigns in the country,” said Flauzino.
This is not an easy task in a nation of 210 million people, the sixth largest population in the world. The program provides a complex plan for vaccination campaigns in more than 5,500 municipalities in 26 states and the federal district.
At a Zoom meeting on December 1, Ministry of Health officials presented experts with an overview of the COVID-19 vaccination plan. The consultants that the AP interviewed said it was quite clear that the ministry was unable to provide many crucial details.
Epidemiologist Dr. Ethel Maciel, who later demanded that her name be removed from the plan, said that many of the experts’ recommendations have not been implemented, including obtaining vaccines from more than one manufacturer. But neither she nor other consultants were able to voice their concerns.
“They did not let us speak during this meeting, our microphones remained silent,” said Maciel, adding that the authorities instructed them to send their comments in writing and that they would receive a response within a week.
“To this day, we are still waiting,” she said.
SHORT SYRINGE
Maciel was also shocked to learn that five months after the ministry signed its first contract to get vaccine doses in June – up to 210 million AstraZeneca and Oxford University vaccines – there were still no safe syringes to administer them.
The Ministry of Health published its tender for 331 million syringes in mid-December, but received bids of just 8 million by the December 29 deadline. Brazilian syringe manufacturers complained that the government’s price limit was below market value.
State health secretaries for months have warned the federal government of the need to buy syringes as soon as possible to avoid excessive prices, but to no avail, said Carlos Lula, president of the National Council of Health Secretaries.
“It took too long,” said Lula. Dozens of other countries are already vaccinating, “and we are falling behind”.
Hamstrung, the government told Brazilian syringe manufacturers in December that it would order 30 million units, to be delivered by the end of January. A call followed for another 30 million.
However, in an injunction issued last week, the Federal Supreme Court prohibited the federal government from ordering syringes from state governments like São Paulo, which have already purchased them.
“The negligence of the federal government cannot penalize the diligence of the State of São Paulo, which has long been preparing, with due zeal, to face the current health crisis”, wrote Minister Ricardo Lewandowski in the decision.
The lack of syringes left state governors scouring the markets for their own supplies. The Ministry of Health reported this week that state stocks total just 52 million syringes, in addition to another 71 million acquired by São Paulo.
For Domingues, the confusion is emblematic of the government’s insufficient planning for the pandemic.
“You would need at least six months to go through all the bureaucratic procedures and make the purchase,” she said.
A LOGISTICS FAILURE
The planning difficulties of the Ministry of Health are even more striking considering the background of Minister of Health Eduardo Pazuello, an active general in the Army hired for his expertise in logistics.
The rise of a military man with no public health experience to the top of the institution amid a pandemic worries experts. “We don’t have a minister who understands the health sector,” said Flauzino.
Since Pazuello took office in May, more than 30 military personnel have been appointed to key positions in the ministry, including the head of Anvisa, the body that approves the use of vaccines.
Bolsonaro’s contentious relationship with São Paulo state governor João Doria, a likely rival in next year’s presidential race, also played a role in Brazil’s vaccination disaster.
While São Paulo had focused on the CoronaVac vaccine from Chinese pharmaceutical Sinovac Biotech with a 46 million-dose contract in September, the Bolsonaro government delayed signing a contract for months, focusing only on the injection of AstraZeneca, ignoring experts and state officials who called for the inclusion of Sinovac in the national vaccination strategy.
“None of the laboratories has the capacity to supply the entire national territory,” said Luiz Henrique Mandetta, Minister of Health during the first months of the health crisis of COVID-19 until its dismissal by Bolsonaro. “We are going to need a lot of vaccines.”
Then, last week, even as Bolsonaro continued to mock CoronaVac, the Ministry of Health announced that it was buying up to 100 million doses of the vaccine made in China.
But with the need to provide two doses of the vaccine to about 210 million people, Brazil is still far behind.
Pazuello visited the Amazon city of Manaus this week, which is suffering a second brutal wave of the virus, with hospitals again overloaded. He guaranteed that vaccines would be dispatched to all states within four days of approval by health regulators, which could happen as early as Sunday – followed by a 16-month vaccination campaign.
However, Pazuello has not yet been able to provide a release date.
“The vaccine in Brazil will arrive on D-Day and H-Hour,” he said cryptically.
___ Reported Álvares de Brasília.