RIO DE JANEIRO (AP) – Like many Brazilian public health experts, Drs. Regina Flazino spent most of 2020 watching as the COVID-19 with the dreaded Brazil. When the opportunity came to join the government’s vaccination effort, she was thrilled: she would be able to share her decades of experience.
But his excitement quickly faded. Flauzino, an epidemiologist who worked on Brazilian vaccine campaigns for 20 years, became frustrated with what he described as a hasty, chaotic process.
The government has not yet approved a single vaccine, and officials of the Ministry of Health have ignored outside expert advice. Shortly after the government introduced the vaccination plan, more than a quarter of the approximately 140 experts involved demanded their names.
“We were not heard,” Flauzino told the Associated Press. Construction of the plan was “postponed for a very long time and is now being hastily done.”
Brazil has suffered more than 200,000 COVID-19 deaths, the second largest total in the world after the United States, rising again with infections and deaths. Despite the fifties of successful vaccination programs, the federal government is outpacing regional and global peers in approving vaccines and strategizing vaccination together.
The AP interviewed four expert committee members and four former Health Ministry officials. He criticized the government’s unreasonable delay in preparing the vaccination plan, as well as focusing on a vaccine manufacturer for months.
He also complained to President Zaire Bolsonaro, who was replaced by military appointments with little or no public health experience, pointing to the removal of highly trained professionals from leadership positions, reducing the effectiveness of the ministry. Experts blamed a far-right ex-army captain, who was compromising anti-vaccination efforts, to reduce anti-vaccine sentiment in Brazil.
The government’s COVID-19 immunization scheme, finally released on 16 December, lacked the necessary details: how many doses would be sent to each state and how would they be delivered and distributed? How many professionals would be required to be hired and trained – and, above all, how much money would the governors receive to implement the campaign? The plan did not include a start date.
“How is each state going to conduct its campaign if it doesn’t know what dose it is going to receive, and the timeline for delivery?” Dr. Carla Dominguez, an epidemiologist who oversees the logistics of Brazil’s 2009 H1N1 vaccine campaign, and worked on more than a dozen other vaccination efforts.
Bolsonaro’s press office and the Ministry of Health did not respond to AP’s requests for comment about Brazil’s vaccination campaign or why more contracts were not signed with vaccine manufacturers in 2020.
The National Immunization Program of the Ministry of Health has a long history of success. Formed 40 years ago, it has enabled Brazil to eradicate polio and reduce measles, rubella, tetanus and diphtheria. The effort gained recognition from UNICEF for reaching the farthest corners of the vast country and has contributed to increasing Brazil’s life expectancy from 60 to 75 years..
“The central axis of all vaccination campaigns in the country” is the program, Flazino said.
It is no small task in a country with the world’s sixth largest population of 210 million people. The program provides a complex blueprint for vaccination campaigns in more than 5,500 municipalities in 26 states and the federal district.
At the Zoom meeting of 1 December, Health Ministry officials presented the experts with a general overview of the COVID-19 vaccination plan. The consultants interviewed by AP said that it had become clear that the ministry was unable to provide many important details.
Epidemiologist Dr. Ethel Macial, who was later among those seeking her name, said recommendations from several experts, including obtaining vaccines from more than one manufacturer, were not implemented. But neither he nor other advisors could voice their concerns.
“They did not let us talk during this meeting, our microphones remained mute spectators,” Macal said, adding that the authorities instructed him to send his comments in writing, adding that he would get a response within a week.
“To this day, we are still waiting,” she said.
Maciel was also surprised to hear that five months after the ministry signed its first contract to receive vaccine supplements in June – up to 210 million shot by AstraZeneca and the University of Oxford – it was still administered by them. Did not acquire syringe.
The Ministry of Health published its tender for 331 million syringes in mid-December, but received bids of only 8 million in the December 29 deadline. Brazilian syringe manufacturers complained that the government’s price range was lower than the market price.
State health secretaries had for months warned the federal government about the need to buy syringes as soon as possible to avoid excessive pricing, but to no avail, said Carlos Lula, the council of national health secretaries.
“It took too long,” Lula said. Dozens of other countries are already vaccinated, “and we’re falling behind.”
Hamstrung, the government told Brazilian syringe manufacturers in December that it would need 30 million units by the end of January. Calls for an additional 30 million were followed.
However, in an injunction issued last week, the Supreme Court barred the federal government from allowing syringes from state governments like São Paulo that had already bought them.
Justice Ricardo Lewandowski, while delivering the verdict, said, “The negligence of the federal government cannot punish the state toil of São Paulo, who have been preparing for a long time to face the current health crisis.”
The scarcity of syringes has left markets for their supplies to the governors of the state. The Ministry of Health said this week that the state stock held just 52 million syringes, along with an additional 71 million acquired by São Paulo.
This confusion for Domingues is due to the government’s poor epidemic planning.
“You’ll need at least six months to go through all the bureaucratic processes and make that purchase,” she said.
The planning difficulties of the Ministry of Health are even more frightening considering the background of Health Minister Eduardo Pazuelo, an active-army-general who is common to his expertise in logistics.
The rise of a military man with no experience in public health at the helm of the institution among experts concerned with an epidemic. “We don’t have a minister who understands the health sector,” Flazino said.
Since Pazuelo took office in May, more than 30 military personnel have been appointed to key positions in the ministry, including the head of the investigator, who approves the use of the vaccine.
Bolsonaro’s controversial relationship with the state government of São Paulo. In the next year’s presidential race, potential rival João Doria also played a role in Brazil’s vaccination defeat.
When Sao Paulo zeroed in on Chinese medicine Synovac Biotech’s Coronavac vaccine with a contract for 46 million doses in September, the Bolsonaro administration delayed signing a contract for months, focusing only on the AstraZenec shot , Ignoring experts and state officials who insisted, including Synovac. National Immunization Strategy.
“Neither laboratory has the capacity to supply the entire national area,” said Health Minister Luiz Heinrich Mandetta during the first months of the COVID-19 health crisis, until it was removed by Bolsonaro. “We will need a lot of vaccines.”
Then last week, even though Bolsonaro was ridiculing at Coronavac, the Ministry of Health announced that it was buying 100 million doses of the sugar-produced vaccine.
But with the need to provide two doses of the vaccine to approximately 210 million people, Brazil is still short.
Pazuelo visited the Amazon city of Manaus this week, suffering a brutal second wave of viruses, with hospitals again pushed beyond capacity. He assured that vaccines would be dispatched to all states within four days of approval by health regulators, which could arrive early Sunday – followed by a 16-month vaccination campaign.
However, Pazuelo was still unable to provide a rollout date.
He said that the vaccine would arrive in Brazil on D Day and H Hour.
___ areslvares reported from Brasilia.