RIO DE JANEIRO (AP) – Like many Brazilian public health experts, Dr. Regina Flauzino spent most of 2020 watching with horror as COVID-19 devastated Brazil. When the opportunity came to join the government’s vaccination effort, she was delighted: she would be able to share decades of experience on the ground.
But her enthusiasm quickly faded. Flauzino, an epidemiologist who has worked on Brazilian vaccination campaigns for 20 years, became frustrated with what he described as a hasty and chaotic process.
The government has not yet approved a single vaccine, and health ministry officials have ignored foreign advice from experts. Shortly after the government presented its vaccination plan, more than a quarter of the approximately 140 experts involved called for their names to be excluded.
“We were not listened to,” Flauzino told The Associated Press. The creation of the plan “has been postponed for too long and is now being done in a hurry.”
Brazil has suffered more than 200,000 deaths from COVID-19, the second-highest total 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 pursuing regional and global counterparts both in approving vaccines and in collaborating on an immunization strategy.
The PA interviewed four members of the committee of experts and four former officials of the Ministry of Health. They criticized the government’s unwarranted delay in formulating a vaccination plan, as well as months spent focusing on a single vaccine manufacturer.
They also complained that President Jair Bolsonaro was undermining the effectiveness of the ministry, stressing the removal of highly trained professionals from leadership positions, who were replaced by so-called military with little or no public health experience. Experts blamed the president, a former far-right army captain, for fueling anti-vaccine sentiment in Brazil, compromising the mass immunization effort.
‘I’M STILL WAITING’
The government’s immunization plan COVID-19, finally launched on December 16, did not have essential details: how many doses would be sent to each state and how would they be refrigerated and delivered? How many professionals should be hired and trained – and, above all, how much funding would the government 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 schedule?” said Dr. Carla Domingues, an epidemiologist who oversaw the logistics of the 2009 H1N1 vaccination campaign in Brazil and has worked on more than a dozen vaccination efforts.
Bolsonaro’s press office and the Ministry of Health did not respond to the PA’s requests for comments on Brazil’s vaccination campaign or why no more contracts were signed with vaccine manufacturers in 2020.
The National Immunization Program of the Ministry of Health has a long history of success. Created over 40 years ago, it has allowed Brazil to eradicate polio and significantly reduce measles, rubella, tetanus and diphtheria. The effort has won recognition from UNICEF for reaching the farthest corners of the great country and has helped expand the life expectancy of Brazilians from 60 to over 75 years..
The program “is the focus of all vaccination campaigns in the country,” Flauzino said.
This is no small task in a nation 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 Zoom meeting on December 1, Ministry of Health officials presented experts with an overview of the COVID-19 vaccination plan. The interviewed PA consultants stated that it has become clear that the ministry is not able to provide many crucial details.
Epidemiologist Dr. Ethel Maciel, who was among those who later called for her name to be removed from the plan, said many of the experts’ recommendations had not been implemented, including obtaining vaccines from several manufacturers. But neither she nor other consultants were able to express their concerns.
“They did not let us speak during this meeting, our microphones remained silent,” Maciel said, adding that officials had instructed them to send their comments in writing and that they would receive a response within a week.
“So far, we are still waiting,” she said.
SHORTAGE SYRINGE
Maciel was also shocked to hear that five months after the ministry signed its first vaccine dose contract in June – up to 210 million in AstraZeneca and Oxford University shootings – it has not yet provided syringes for their administration.
The Ministry of Health published its tender for 331 million syringes in mid-December, but received bids for only 8 million by the December 29 deadline. Brazilian syringe manufacturers complained that the government’s price cap was below market value.
Health ministers had warned the federal government for months about the need to buy syringes as soon as possible to avoid excessive prices, 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 seize 30 million units, which will be delivered by the end of January. A call for another 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 that had already purchased them.
“The negligence of the federal government cannot penalize the diligence 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 rulers scouring the markets for their own supplies. The Ministry of Health said this week that state stocks amounted to only 52 million syringes, plus an additional 71 million purchased by Sao Paulo.
For Domingues, the confusion is emblematic of poor government pandemic planning.
“You would need at least six months to go through all the bureaucratic procedures and make that acquisition,” she said.
A LOGISTICS FAILURE
The planning difficulties of the Ministry of Health are all the more obvious given the context of the Minister of Health, Eduardo Pazuello, an active army general who was used for his expertise in logistics.
The rise of a military man with no experience in public health at the top of the institution in the midst of a pandemic has worried experts. “We do not have a minister who understands the health sector,” Flauzino said.
Since Pazuello took office in May, more than 30 soldiers 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 State Governor João Doria, a likely rival in next year’s presidential race, also played a role in the vaccination disaster in Brazil.
While Sao Paulo eliminated Chinese pharmaceutical CoronaVac vaccine Sinovac Biotech with a contract in September for 46 million doses, the Bolsonaro administration delayed signing a contract for months, focusing only on the AstraZeneca shot, ignoring experts and officials. requested that Sinovac be included in the national vaccination strategy.
“No laboratory has the capacity to supply the entire national territory,” said Luiz Henrique Mandetta, health minister in the first months of the COVID-19 crisis, until he was removed by Bolsonaro. “We’re going to need a lot of vaccines.”
Then last week, even though Bolsonaro continued to make fun of CoronaVac, the Ministry of Health announced that it would buy up to 100 million doses of vaccine made in China.
But given the need to provide two doses of the vaccine to about 210 million people, Brazil is still very short.
Pazuello visited the Amazon city of Manaus this week, which is suffering a second brutal wave of the virus, with hospitals pushed back beyond capacity. He offered assurances that the vaccines would be shipped 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, Pazuello was still unable to provide a release date.
“The vaccine in Brazil will arrive on H-Day and H-hour,” he said cryptically.
___ Álvares reported from Brasilia.