RIO DE JANEIRO (AP) – Like many Brazilian public health experts, Dr. Regina Flauzino spent most of 2020 in horror as COVID-19 devastated Brazil. When the opportunity arose to join the government’s vaccination effort, she was thrilled to share her decades of hands-on experience.
But her excitement quickly faded. Flauzino, an epidemiologist who worked on Brazilian vaccine campaigns for 20 years, became frustrated with what she described as a rushed, chaotic process.
The government has yet to approve one vaccine, and health ministry officials have ignored the advice of outside experts. Shortly after the government presented its vaccination plan, more than a quarter of the roughly 140 experts involved demanded that their names be cut.
“We were not listened to,” Flauzino told The Associated Press. The creation of the plan “has been delayed too long and is now being implemented urgently”.
Brazil has suffered more than 200,000 COVID-19 deaths, the second highest in the world after the United States, with infections and deaths on the rise again. Despite half a century of successful vaccination programs, the federal government is lagging behind regional and global colleagues in approving vaccines and designing an immunization strategy.
The AP interviewed four expert committee members and four former officials from the Department of Health. They criticized the government’s unwarranted delay in drafting a vaccination plan and criticized the months they spent working on one vaccine manufacturer.
They also complained that President Jair Bolsonaro was undermining the effectiveness of the ministry, pointing to the removal of highly skilled professionals from leadership positions who were being replaced by military officials with little or no public health experience. Experts also blamed the president, a far-right former army captain, for fueling anti-vaccine sentiment in Brazil, jeopardizing mass immunization efforts.
‘STILL WAITING’
The government’s COVID-19 immunization plan, which was finally released on Dec. 16, lacked essential details: How many doses would be sent to each state and how would they be refrigerated and delivered? How many professionals would need to be hired and trained – and above all, how much funding would the governors receive to run the campaign? The plan did not include a start date.
“How is each state going to organize its campaign if it doesn’t know how many doses it will receive and the timeline for delivery?” said Dr. Carla Domingues, an epidemiologist who oversaw the logistics of Brazil’s H1N1 vaccine campaign in 2009, and worked on more than a dozen other vaccination efforts.
Bolsonaro’s press service and the Ministry of Health did not respond to AP requests for comment about the vaccination campaign in Brazil 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. Founded over 40 years ago, it has enabled Brazil to eradicate polio and significantly reduce measles, rubella, tetanus and diphtheria. The effort received UNICEF recognition for reaching the most remote corners of the vast country and has helped extend Brazilians’ life expectancy from 60 to over 75 years..
The program “is the central axis of all vaccination campaigns in the country,” said Flauzino.
That is no small task in a country of 210 million inhabitants, the sixth largest population in the world. The program provides a complex blueprint for vaccination campaigns in more than 5,500 counties in 26 states and the federal district.
In a Zoom meeting on Dec. 1, officials from the Department of Health presented the experts with a general overview of the COVID-19 vaccination plan. The consultants who interviewed the AP said it became abundantly clear that the ministry was unable to provide many crucial details.
Epidemiologist Dr. Ethel Maciel, who was one of those who later demanded her name 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 they nor other consultants were able to voice their concerns.
“They did not let us speak at this meeting, our microphones remained muted,” Maciel said, adding that officials ordered them to submit their comments in writing and that they would receive a response within a week.
“We are still waiting to this day,” she said.
SYRINGE SHORTAGE
Maciel was also shocked to learn that five months after the Department signed its first contract to obtain vaccine doses in June – up to 210 million from the AstraZeneca and the University of Oxford – the Department still had not secured any syringes to administer them. .
The Ministry of Health published its tender for 331 million syringes in mid-December, but received a bid of only 8 million on December 29. Brazilian sprayers complained that the government’s price limit was below market value.
Public health secretaries had warned the federal government for months about the need to purchase syringes as soon as possible to avoid excessive pricing, but to no avail, said Carlos Lula, chairman of the National Board of Health Secretaries.
“It took too long,” Lula said. Dozens of other countries are already vaccinating, “and we are falling behind.”
Hamstrung, the government told Brazilian sprayers in December that they would demand 30 million units, to 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 claiming syringes from state governments like Sao Paulo, which had already bought them.
“The failure of the federal government cannot punish the zeal of the State of Sao Paulo, which has long been preparing with due diligence to face the current health crisis,” Judge Ricardo Lewandowski wrote in the ruling.
The shortage of syringes means that state governors are looking for their own supplies. The Ministry of Health said this week that state stocks amounted to just 52 million syringes, plus an additional 71 million acquired by Sao Paulo.
For Domingues, the confusion is characteristic of the pandemic’s poor planning.
“You need at least six months to go through all the bureaucratic procedures and make that purchase,” she said.
A MALFUNCTION IN LOGISTICS
The Ministry of Health’s planning difficulties are all the more striking given the background of Health Minister Eduardo Pazuello, an active duty army general who draws on his expertise in logistics.
The rise of a serviceman with no public health experience 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,” said Flauzino.
Since Pazuello took over in May, more than 30 military personnel have been appointed to key positions in the ministry, including the head of Anvisa, the agency that approves the use of vaccines.
Bolsonaro’s contentious relationship with the Sao Paulo state government, João Doria, a likely rival in next year’s presidential race, also played a part in Brazil’s vaccination debacle.
While Sao Paulo had targeted Chinese pharmaceutical Sinovac Biotech’s CoronaVac vaccine with a contract in September for 46 million doses, the Bolsonaro government delayed signing a contract for months, focusing only on AstraZeneca’s shot , ignoring experts and government officials pushing for Sinovac to be included in the nationwide vaccination strategy.
“Neither lab has the capacity to supply the entire national territory,” said Luiz Henrique Mandetta, health minister during the early months of COVID-19’s health crisis until he was removed by Bolsonaro. “We need a lot of vaccines.”
Then last week, even as Bolsonaro continued to scoff at CoronaVac, the Health Ministry announced it would buy up to 100 million doses of the Chinese-made vaccine.
But with about 210 million people having to be given two doses of vaccine, Brazil is far from coming.
Pazuello visited the Amazon city of Manaus this week suffering from a brutal second wave of the virus, with hospitals pushing back over capacity. He offered assurances that 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 rollout date.
“The vaccine in Brazil will arrive on D Day and Hour,” he said cryptically.
___ Álvares reported from Brasilia.