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Experts on sidelines, Brazil has confused its immunization plans

RIO DE JANEIRO (AP) – Like many Brazilian public health experts, Dr. Regina Flausino spent most of 2020 watching in horror as COVID-19 devastated Brazil. When the opportunity came to join the government’s vaccination effort, she was excited: she would be able to share her decades of experience on the ground.

But her excitement quickly faded. Flausino, an epidemiologist who has worked in Brazilian vaccine campaigns for 20 years, is disappointed with what she described as a rapid, chaotic process.

The government has not yet approved a vaccine, and health ministry officials have ignored the advice of outside experts. Shortly after the government unveiled its vaccination plan, more than a quarter of the 1

40 or so experts involved asked for their names to be cut out.

“They didn’t listen to us,” Flausino told the Associated Press. The creation of the plan “has been delayed too long and is now being done quickly.”

Brazil has suffered more than 200,000 deaths from COVID-19, the second largest in the world after the United States, with infections and deaths rising again. Despite half a century of successful vaccination programs, the federal government is lagging behind regional and global partners in both approving vaccines and developing an immunization strategy.

The PA interviewed four members of the expert commission 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 months spent in a vaccine manufacturer.

They also complained that President Jair Bolsonaro was undermining the ministry’s effectiveness, citing the removal of highly qualified professionals from senior positions who had been replaced by military recruits with little or no experience in public health. Experts accuse the president, a far-right former army captain, of fueling anti-vaccine sentiment in Brazil, compromising mass immunization efforts.


The government’s COVID-19 immunization plan, finally published on December 16, lacked essential details: How many doses will be sent to each country and how will they be chilled and delivered? How many professionals will need to be hired and trained – and most importantly, how much money will the governors receive to run the campaign? The plan does not include a start date.

“How will each country organize its campaign if it doesn’t know how many doses the delivery schedule will receive?” Said Dr. Carla Dominguez, an epidemiologist who led the logistics of the H1N1 vaccination campaign in Brazil in 2009 and works on more than a dozen other vaccination efforts.

Bolsonaro’s press service and the Ministry of Health did not respond to the AP’s requests for comment on Brazil’s vaccination campaign 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. Founded more than 40 years ago, it has enabled Brazil to eradicate polio and significantly reduce measles, rubella, tetanus and diphtheria. The effort won recognition from UNICEF for reaching the most remote corners of the country and 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,” Flausino said.

This is no small task for a country of 210 million people, the sixth largest population in the world. The program provides a comprehensive plan for vaccination campaigns in more than 5,500 municipalities in 26 states and the federal district.

At a meeting on December 1, Zoom, employees of the Ministry of Health presented to experts an overview of the vaccination plan against COVID-19. The consultants interviewed by the AP said it had become quite clear that the ministry was unable to provide very important details.

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 receiving vaccines from more than one manufacturer. But neither she nor other consultants could express their concerns.

“We were not allowed to speak during this meeting, our microphones were left without sound,” Masiel said, adding that staff had instructed them to send their comments in writing and would receive a response within a week.

“We are still waiting,” she said.


Maciel was also shocked to hear that five months after the ministry signed its first contract to receive vaccine doses in June – up to 210 million from the AstraZeneca and University of Oxford shots – it had not yet provided syringes for their administration.

The health ministry published its bid for 331 million syringes in mid-December, but received bids for just 8 million by the December 29 deadline. Brazilian syringe manufacturers have complained that the government’s price limit is 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 over-pricing, but to no avail, said Carlos Lula, chairman of the National Council of Health Secretaries.

“It took too long,” Lula said. Dozens of other countries are already vaccinating, “and we are lagging behind.”

Hamstrung, the government told Brazilian syringe manufacturers in December that it would ask for 30 million pieces to be delivered by the end of January. An invitation for an additional 30 million followed.

However, in an order issued last week, the Supreme Court banned the federal government from requisitioning syringes from state governments such as Sao Paulo, which have already purchased them.

“The negligence of the federal government cannot punish the efforts of the state of Sao Paulo, which has long been preparing with due zeal to deal with the current health crisis,” Judge Ricardo Lewandowski wrote in the ruling.

The shortage of syringes has left state governors looking for markets for their own supplies. The health ministry said this week that state supplies amounted to just 52 million syringes, plus an additional 71 million acquired by Sao Paulo.

For Dominguez, the confusion is emblematic of the government’s poor pandemic planning.

“It will take you at least six months to go through all the bureaucratic procedures and make that purchase,” she said.


The planning difficulties of the Ministry of Health are even more obvious, given the past of Health Minister Eduardo Pasuelo, an acting army general used for his logistics experience.

The rise of a military without experience in public health to the top of the institution in the midst of a pandemic, worried experts. “We don’t have a minister who understands the health sector,” Flausino said.

Since Pasuelo took office in May, more than 30 servicemen have been appointed to key positions in the ministry, including the head of Anvisa, the agency that approves the use of vaccines.

Bolsonaro’s controversial relationship with Sao Paulo Gov. Joao Doria, possibly a rival in next year’s presidential race, also played a role in the failure of vaccination in Brazil.

While Sao Paulo had bet zero on Sinovac Biotech’s Chinese pharmaceutical vaccine ConovaVac with a contract in September for 46 million doses, the Bolsonaro administration delayed signing the contract for months, focusing only on the AstraZeneca shot, ignoring experts and government officials urging Sinovac in the national vaccination strategy.

“No laboratory has the capacity to supply the entire national territory,” said Luis Enrique Mandeta, health minister during the first months of the COVID-19 health crisis, until he was removed by Bolsonaro. We will need a lot of vaccines.

Then last week, even as Bolsonaro continued to ridicule CoronaVac, the health ministry announced it was buying up to 100 million doses of the Chinese vaccine.

But with the need to provide two doses of vaccine to about 210 million people, Brazil is still a long way off.

This week, Pasuelo visited the Amazon city of Manaus, which is suffering from a violent second wave of the virus, and hospitals have once again been pushed out of capacity. He offered assurances that the vaccines would be sent to all states within four days of approval by health regulators, which could come as early as Sunday, followed by a 16-month vaccination campaign.

However, Pazuelo still could not provide a release date.

“The vaccine in Brazil will arrive on day D and hour H,” he said mysteriously.

___ Alvarez reports from Brazil.

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