RIO DE JANEIRO (AP) – Like many Brazilian public health experts, Dr. Regina Flauzino spent most of 2020 watching in horror as COVID-19 devastated Brazil. When the opportunity came to take part in the government’s vaccination effort, she was delighted: she would be able to share her decades of experience on the ground.
But her excitement quickly disappears. Flauzino, an epidemiologist who worked on the Brazilian vaccine campaigns for 20 years, became frustrated with what she described as a hectic, chaotic process.
The government has yet to approve a single vaccine, and officials have ignored the advice of experts. Shortly after the government submitted its vaccination plan, more than a quarter of the approximately 140 experts involved demanded that their names be cut out.
“We were not listened to,” Flauzino told The Associated Press. The creation of the plan “has been postponed for too long and is being done quickly.”
Brazil has suffered more than 200,000 COVID-19 deaths, 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 maintains local and global counterparts to approve both vaccines and tie together a vaccination strategy.
The AP interviewed four expert committee members and four former Ministry of Health officials. They criticized the government’s unjustified delay in drafting a vaccination plan, as well as months focused on one vaccine manufacturer.
They also complained about President Jair Bolsonaro undermining the ministry’s effectiveness, and pointed to the removal of highly trained professionals from leadership positions, who were replaced by military appointments with little or no health experience. Experts have also blamed the president, a former right-wing army captain, for promoting anti-vaccine sentiment in Brazil, which jeopardizes the mass immunization effort.
‘STILL WAIT’
The government’s COVID-19 vaccination plan, which was finally released on December 16, did not have essential details: how many doses would be sent to each state and how would it be refrigerated and delivered? How many professionals will need to be hired and trained – and above all how much funding will governors receive to implement the campaign? The plan does not include a start date.
“How is each state going to organize its campaign if it does not know how many doses it is going to receive, and the timeline for delivery?” says Dr Carla Domingues, an epidemiologist overseeing the logistics of Brazil’s 2009 H1N1 vaccine campaign, working on more than a dozen other vaccination efforts.
Bolsonaro’s press office and the Ministry of Health did not respond to AP requests for comment on the vaccination campaign in Brazil or why more contracts with vaccine manufacturers were not signed in 2020.
The national immunization program of the Ministry of Health has a long history of success. It was created 40 years ago and has enabled Brazil to eradicate polio and significantly reduce measles, rubella, tetanus and diphtheria. The effort was recognized by UNICEF for reaching the most remote corners of the country and contributed to extending Brazilians’ life expectancy from 60 to more than 75 years..
The program “is the central axis of all vaccination campaigns in the country,” Flauzino said.
This is no small task in a country of 210 million people, the sixth largest population in the world. The program provides a complex blueprint 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 the experts with a general overview of the COVID-19 vaccination plan. According to the consultants interviewed by the AP, it has become clear that the ministry is not able to provide very important information.
Epidemiologist dr. Ethel Maciel, who was among those who later asked for her name to be removed from the plan, said many of the experts’ recommendations had not been implemented, including obtaining vaccines from more than one manufacturer. But neither she nor other consultants could express their concern.
“They did not let us speak during this meeting, our microphones remain dumb,” Maciel said, adding that officials had 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.
SPRAY SHORT
Maciel was also shocked to hear that five months after the ministry signed his first contract to obtain vaccines in June – up to 210 million from AstraZeneca and Oxford University – he still did not have syringes to administer.
The Ministry of Health published its tender for 331 million syringes in mid-December, but by the December 29 deadline, only 8 million bids had been submitted. Brazilian spray manufacturers have complained that the government’s price cap was below market value.
State health secretaries have been warning the federal government for months about the need to buy syringes as soon as possible to avoid excessive prices, but in vain, said Carlos Lula, chairman of the National Council of Health Secretaries.
“It took too long,” Lula said. Dozens of other countries are already being vaccinated, “and we are falling behind.”
Hamstrung, the government told Brazilian spray manufacturers in December that they would demand 30 million units to be delivered by the end of January. A call for an additional 30 million followed.
However, in an order issued last week, the Supreme Court banned the federal government from demanding syringes from state governments such as Sao Paulo that have already bought it.
“The negligence of the federal government cannot punish the zeal of the state of Sao Paulo, which has been preparing for a long time, with the necessary zeal to face the current health crisis,” Judge Ricardo Lewandowski wrote in the ruling.
The shortage of syringe has led state governors to search markets for their own supplies. The Ministry of Health said this week that state supplies amounted to just 52 million syringes, plus an additional 71 million that Sao Paulo acquired.
For Domingues, the confusion is indicative of the government’s poor pandemic planning.
“You will need at least six months to go through all the bureaucratic procedures and make the purchase,” she said.
A MISSION OF LOGISTICS
Moreover, the planning problems of the Ministry of Health are striking due to the background of Eduardo Pazuello, Minister of Health, an army general of active duty for his expertise in logistics.
The rise of a military man with no experience in public health to the top of the institution amid a pandemic has worries experts. “We do not have a minister who understands the health sector,” Flauzino said.
Since Pazuello took over in May, more than thirty military personnel have been appointed to key positions in the ministry, including the head of Anvisa, the agency that approves vaccine use.
Bolsonaro’s controversial relationship with Sao Paulo state government João Doria, a likely rival in next year’s presidential race, also played a role in the vaccination debacle in Brazil.
While Sao Paulo canceled Chinese pharmaceutical synovac Biotech’s CoronaVac vaccine with a 46-million-dose contract in September, the Bolsonaro government delayed the contract for months, focusing only on the AstraZeneca shot, ignoring experts and government officials who insisted on including Sinovac. the national vaccination strategy.
“No laboratory has the capacity to supply the entire national territory,” Health Minister Luiz Henrique Mandetta said during the first months of the COVID-19 health crisis until he was removed by Bolsonaro. “We will need a lot of vaccines.”
Last week, even as Bolsonaro continued with CoronaVac, the Ministry of Health announced that it was buying up to 100 million doses of Chinese vaccine.
But because about 210 million people have to deliver two doses of vaccine, Brazil is still very short.
Pazuello visited the city of Manaus in the Amazon this week which has a brutal second wave of the virus, and hospitals have once again pushed beyond their means. He gave the assurance that vaccines would be sent to all states by health regulators within four days of approval, which could come as early as Sunday – followed by a 16-month vaccination campaign.
However, Pazuello still could not give a launch date.
“The vaccine in Brazil will arrive on D Day and H Hour,” he said cryptically.
___ Álvares reported from Brasilia.