RIO DE JANEIRO (AP) – Like many Brazilian public health experts, Dr. Regina Flauzino spent most of 2020 watching in terror as COVID-19 devastated Brazil. When the opportunity came to join the government’s vaccination effort, she was delighted: she could share her decades of experience in the field.
But his excitement quickly faded. Flauzino, an epidemiologist who worked on Brazilian vaccine campaigns for 20 years, was frustrated with what he described as a chaotic and hasty process.
The government has not yet approved a single vaccine and Ministry of Health officials have ignored the external advice of experts. Shortly after the government submitted its vaccination plan, more than a quarter of the approximately 140 experts involved demanded its elimination.
“They didn’t listen to us,” Flauzino told The Associated Press. The creation of the plan “was postponed too long and is now 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 following regional and global partners in both approving vaccines and combining a vaccination 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 the months spent on a single vaccine manufacturer.
They also complained that President Jair Bolsonaro was undermining the ministry’s effectiveness, noting the withdrawal 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 far-right army captain, for fueling anti-vaccine sentiment in Brazil, compromising the mass vaccination effort.
‘STILL WAITING’
The government’s COVID-19 vaccination plan, finally released on December 16, had no 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 most importantly, how much funding would governors receive to implement the campaign? The plan did not include a start date.
“How will each state organize its campaign if it doesn’t know how many doses it will receive and the delivery schedule?” said Dr. Carla Domingues, an epidemiologist who oversaw the logistics of Brazil’s 2009 H1N1 vaccine campaign and worked on more than a dozen vaccinations.
Bolsonaro’s press office and the Ministry of Health did not respond to PA’s requests for comments on Brazil’s vaccination campaign or why no more contracts were signed with vaccine manufacturers in 2020.
The Ministry of Health’s National Immunization Program has a long history of success. Created more than 40 years ago, it has allowed Brazil to eradicate polio and significantly reduce measles, rubella, tetanus and diphtheria. The effort gained UNICEF recognition to reach the most remote corners of the vast 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 world’s sixth largest population. The program provides a comprehensive plan for vaccination campaigns in more than 5,500 municipalities in 26 states and the federal district.
At a December 1 Zoom meeting, Ministry of Health officials presented experts with an overview of the COVID-19 vaccination plan. Consultants interviewed by the PA said it was clearly clear that the ministry was unable to provide many crucial details.
The epidemiologist, Dr. Ethel Maciel, who was one of those who later demanded that her name be removed from the plan, said many of the experts’ recommendations did not apply, including obtaining vaccines from more than one manufacturer. But neither she nor other consultants were able to express her concerns.
“They didn’t let us speak during this meeting, our microphones remained silent,” Maciel said, adding that officials told them to send their comments in writing and they would receive a response within a week.
“To this day, we are still waiting,” he said.
SYRINGE BARK
Maciel was also surprised to learn that five months after the ministry signed its first contract to obtain vaccine doses in June (up to 210 million shots from AstraZeneca and Oxford University), it still did not have syringes insured for administer them.
The Ministry of Health released its tender for 331 million syringes in mid-December, but received bids for just 8 million before the December 29 deadline. Brazilian syringe manufacturers complained that the government price cap was below market value.
State health secretaries had warned the federal government for months of the need to buy syringes as soon as possible to avoid excessive 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’re lagging behind.”
Hamstrung, the government told Brazilian syringe manufacturers in December that it would requisition 30 million units to deliver them by the end of January. An additional 30 million call was then made.
However, in a court order issued last week, the Supreme Court banned the federal government from confiscating syringes from state governments like Sao Paulo that had already bought them.
“The negligence of the federal government cannot penalize the diligence of the state of Sao Paulo, which has long been prepared, with due zeal, to face the current health crisis,” Judge Ricardo Lewandowski wrote in the resolution.
The deficit of the 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 the government’s poor pandemic planning.
“You will need at least six months to do all the paperwork and make that purchase,” he said.
A LOGISTICS FAILURE
The planning difficulties of the Ministry of Health are even more evident given the background of the Minister of Health, Eduardo Pazuello, an active army general taken advantage of his experience in logistics.
The rise of a military man with no public health experience at the top of the institution amid a pandemic worried experts. “We don’t have a minister who understands the health care sector,” Flauzino said.
Since Pazuello took over in May, more than 30 military personnel have been appointed to key ministry positions, including the head of Anvisa, the agency that approves the use of vaccines.
Bolsonaro’s controversial relationship with the governor of the state of Sao Paulo, João Doria, a likely rival in next year’s presidential race, also played an important role in the debacle of vaccination in Brazil.
While Sao Paulo had focused on the CoronaVac vaccine from Chinese pharmaceutical company Sinovac Biotech with a 46 million dose contract in September, the Bolsonaro administration delayed the signing of a contract for months, focusing only on the AstraZeneca shot, ignoring experts and state officials who urged Sinovac to be included in the national vaccination strategy.
“Neither laboratory has the capacity to supply the entire national territory,” said Luiz Henrique Mandetta, Minister of Health during the first months of the COVID-19 health crisis until he was fired by Bolsonaro. “We will need a lot of vaccines.”
Last week, even as Bolsonaro continued to mock CoronaVac, the Ministry of Health announced that it would buy up to 100 million doses of the vaccine made in China.
But with the need to provide two doses of vaccine to some 210 million people, Brazil is still a long way off.
Pazuello has visited this week the Amazonian city of Manaus which is suffering a second brutal wave of the virus, with hospitals again pushed beyond its capacity. He offered the guarantee that vaccines would be shipped to all states within four days of approval by health regulators, which could arrive 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.
___ Alvares reported from Brasilia.