COVID-19 vaccination in Brazil

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COVID-19 vaccination in Brazil
Vacinação no Brasil.png
Vaccination in May 26, 2021.
Native name Vacinação contra a COVID-19 no Brasil
DateJanuary 17, 2021 (2021-01-17)
Duration5 months and 5 days
LocationBrazil
TypeVaccination campaing
CauseCOVID-19 pandemic in Brazil
BudgetR$2,21 billion
Organised byFederal government of Brazil
State and Distrital Governments
Ministry of Health
Municipal Governments
Participants42 991 742 (1ª dose)
21 214 582 (2ª dose)
Websitewww.gov.br/saude/pt-br/Coronavirus/vacinas
Updated in May 25, 2021, 08:12 p.m. (UTC-3)

The COVID-19 vaccination campaign in Brazil is an ongoing mass immunization campaign for the COVID-19 pandemic in Brazil. It started in January 17, 2021, when the country had 210 thousand deaths.[1]

The Instituto Butantan imported the first 6 million doses of CoronaVac in a collaboration with the Chinese company Sinovac Biotech.[2]

There is no deadline forecast for immunizing the country's entire population due to the lack of supplies for vaccine production[3] and also due to political disputes between the São Paulo state government and the Jair Bolsonaro government.[4][5][6]

As of May 26, 2021, 42,991,742 people, about 20.3% of the Brazilian population, have been vaccinated with the first dose of any of the vaccines; the second dose has been injected in 21,214,582 people, about 10.02% of the population.[7]

Backstory[edit]

Before the Butantan vaccine, Fiocruz sought permission from the Brazilian Health Regulatory Agency (Anvisa) to import the vaccine. It would be more than two million doses of the vaccines developed by Oxford University and the pharmaceutical company AstraZeneca.[8] Anvisa approved, on January 17, 2021, the emergency use of the vaccine in Brazil.[9] On January 22, 2021, after an obstacle between the Indian and Brazilian governments, Brazil received another two million doses of the AstraZeneca vaccine.[10] On the same day, Anvisa approved another 4.8 million doses of the CoronaVac vaccine for emergency use.[11]

Start[edit]

Nurse Mônica Calazans receiving the first dose of the coronavac vaccine, minutes after its approval by Anvisa. To the left, the governor of São Paulo, João Dória.

Soon after the vaccines were approved for emergency use, the government of São Paulo held a press conference to perform the first application. Nurse Mônica Calazans was the first person outside the clinical trials to be vaccinated against COVID in the country.[12]

Elderly man receiving the second dose of coronavac vaccine in Canoas, Rio Grande do Sul.

The vaccination campaign throughout the country would have started on January 18, 2021 at 5 pm (UTC-3), however, due to logistical problems, part of the states postponed it to the 19th, since the vaccines would only arrive at night. The states that started vaccination on the 18th were São Paulo, Rio de Janeiro, Rio Grande do Sul, Amazonas, Mato Grosso, Paraná, Pernambuco, Minas Gerais, Espírito Santo, Maranhão, Tocantins, Mato Grosso do Sul, Ceará, Goiás, Piauí, and Santa Catarina.[13] Mostly nursing technicians, nurses, blacks, and women were responsible for opening the vaccination campaign in the states.[14][15][16][17][18][19]

In the artistic world, the actresses Zezé Motta and Solange Couto became the first personalities to be vaccinated.[20] The social worker and nursing technician, Vanuzia Costa, from the multiethnic village Sons of this Earth, was the first one vaccinated among the indigenous people.[21]

On January 23, 2021, in a symbolic act, vaccination was started in Brazil with the Oxford immunizer. The first person to receive the vaccine was the infectologist Estevão Portela.[22] At the same occasion the pneumologist Margareth Dalcolmo was also vaccinated. Doctor Sarah Ananda Gomes was the third to be vaccinated. Soon after, seven more health professionals were immunized.[23][24]

Mass vaccination[edit]

Serrana[edit]

The city of Serrana, in the interior of São Paulo, became the first Brazilian municipality to carry out mass vaccination with the population over 18 years old, divided into four groups. The campaign began on February 17, 2021, and is part of a study by the Butantan Institute, entitled "Project S", using the Coronavac vaccine. The participation of the population, however, is not mandatory, since it is a voluntary research work. Serrana was chosen because of its proximity to Ribeirão Preto, another important city in São Paulo.[25] According to a balance released on March 14, 97% of the population had already been vaccinated.[26] On March 17, the application of the second dose to the target public began.[27] The project came to an end on April 11 in a virtual ceremony.[28] During the campaign, there was a large reduction in Covid's hospitalization of severe cases, besides the low number of deaths with only six deaths, totaling a mortality of 0.004%, and the absence of waiting lines for an ICU bed.[29][30]

Botucatu[edit]

On April 27, 2021, the city of Botucatu, interior of São Paulo, was chosen by the Ministry of Health to start the mass vaccination phase in the population over 18 years old. The vaccine used was the AZD1222, in partnership with the University of Oxford, the AstraZeneca laboratory, the Oswaldo Cruz Foundation (Fiocruz), the Gates Foundation, São Paulo State University (Unesp), and the city government. The campaign aims to test the effectiveness of the Oxford Vaccine and its efficiency in relation to mass vaccination. Just like the Butantan Institute's Project S, carried out in Serrana, the participation of the population will not be mandatory and will also not interfere with the National Immunization Plan, since those who have already been vaccinated locally do not need to participate in the project.[31] Botucatu was chosen because the project covers more people and because it is the regional pole of the Hospital de Clínicas, which serves sixty municipalities and has already held a mass vaccination campaign in 2009 during the campaign against yellow fever, using children, besides being the city with the second lowest fatality rate against covid with 1.60% among municipalities with 100,000 inhabitants. The studies will last eight months.[32] The campaign started on May 16.[33]

Vaccines on order[edit]

Vaccine Emergency Use Approval Deployment Final Approval
Oxford–AstraZeneca Green check.svg Yes Green check.svg Yes Green check.svg Yes
Sinovac Green check.svg Yes Green check.svg Yes Dark Red x.svg No
Pfizer–BioNTech Green check.svg Yes Green check.svg Yes Green check.svg Yes
Johnson & Johnson Green check.svg Yes Green check.svg Yes Dark Red x.svg No
Sinopharm Green check.svg Yes Green check.svg Yes Dark Red x.svg No
Moderna Green check.svg Yes Green check.svg Yes Dark Red x.svg No
Covaxin Green check.svg Yes (restricted) Dark Red x.svg No Dark Red x.svg No
Sputnik V Green check.svg Yes (restricted) Dark Red x.svg No Dark Red x.svg No

Controversies[edit]

Accusations of queue jumping and suspension of vaccination in Manaus[edit]

The Public Ministry received complaints of people accused of jumping the vaccination queue in at least eight Brazilian states, through videos and photos posted on social networks. According to the National Immunization Plan (PNI), the first phase corresponds to health professionals, seniors over sixty who live in nursing homes, and the indigenous population.[34] In the Federal District, the Health Secretariat announced that it will investigate the irregularities after groups outside the first phase took the vaccine.[35] In Amazonas, the capital Manaus announced the temporary suspension of vaccination on January 21, to reassess the priority of the first group, since the doses of the vaccine are considered insufficient, besides there is a report of deviation of 60,000 doses of the coronavac vaccine and children of businessmen taking the doses without being part of the priority groups.[36][37]

In Bahia, through the city of Candiba, the mayor Reginaldo Martins Prado (PSD) posted a photo receiving the dose of the vaccine against COVID-19, without yet being part of the priority group, leading to the opening of lawsuits in the MP and MPF preventing the application of the second dose, in addition to the application of fines.[38] In Sergipe, in the city of Itabi, the mayor Júnior de Amintas (DEM) was the first to be vaccinated, generating a revolt from the population, since he is 45 years old, below the age range of the first phase.[39] In Pernambuco, in the city of Jupi, the Health Secretary Maria Nadir Ferro and a photographer who works in the city hall, known as Guilherme JG, who took the vaccine, even without being part of the priority group. The two public servants were removed.[40] In the capital of Rio Grande do Norte, the city of Natal, the State Public Ministry investigates reports that city hall employees, outside the priority group for vaccination, were immunized. According to the reports, submitted to the MP by the Union of Public Servants of the City of Natal, employees who hold commissioned positions in the Municipal Secretariat of Social Assistance received Coronavac in one of the vaccination sites in the city. Among them is the head of the IT sector of the secretariat, who shared on social networks the record of the moment he was immunized.[41]

In the city of Pombal in Paraíba, the mayor Abmael de Sousa Lacerda (MDB), better known as Dr. Verissinho, was the first person to take the vaccine in the city, even without being part of the priority groups, according to a complaint that reached the MPF.[42] In Ceará, in the city of Juazeiro do Norte, the deputy mayor Giovanni Sampaio (Podemos) was the first one vaccinated in the city. He is an obstetrician and, according to the city hall, works as a volunteer in the municipality's health units. In a statement, the Public Prosecutor's Office of Ceará says that it has established a notice of fact to investigate "alleged violation of the rules of vaccination by a municipal official" and that it will decide, after investigation, what is the appropriate measure in the case. The MP also investigates the vaccination of Benedita Oliveira, Quixadá's health secretary.[43] In Castanhal, in Pará, the administrative director of the Municipal Hospital was dismissed by the city government after being accused of jumping the line of the Coronavac vaccine. The public agent Laureno Lemos, 38, presented himself for vaccination in the early evening of Tuesday, 19, just after the first dose was applied in the server Nivalda Pestana, 58, who has worked for almost 20 years in the hospital laundry and is on the front line of COVID-19.[44]

Vaccine detour controversies and the "windfall vaccine" case[edit]

During the course of vaccination, there have been several accusations involving the detour of vaccine doses by health professionals and political leaders in various locations around the country.[45][46][47]

In several municipalities around the country, there have been flagrant cases of health professionals pretending to vaccinate the elderly, using empty syringes or not squeezing the plunger of the syringe. There have been cases where discarded syringes were found with liquid inside. In the cases reported, the professionals were removed and the elderly returned later to take the correct dose of vaccine.[48] Health authorities consider the cases "isolated". The Federal Council of Nursing (COFEN), the Public Ministry of the State of Rio de Janeiro (MPRJ), and the police are investigating whether the false applications are related to the detour of vaccine vials.[49] The cases have been called "windfall vaccines" by the media.[49][50][51][52]

Vaccination interruption in some Brazilian cities[edit]

Soon after approaching one month from the beginning of the vaccination campaign in the country, several Brazilian cities, including capitals such as Salvador, Rio de Janeiro and Curitiba started to restrict the priority groups and then announce the interruption of the vaccination campaign until the arrival of new doses to the states. The action generated a movement by the state governments to start negotiations on their own with the laboratories, with a group uniting sixteen states, led by governor Wellington Dias (PT-PI).[53][54] With the arrival of new doses of Coronavac and Covishield on the 24th, the vaccination calendar is resumed in the cities where there was a pause.[55][56]

On February 23, 2021, the Supreme Federal Court (STF) decided by simple majority that state governments and municipalities have the autonomy to purchase vaccines on their own if the federal government does not comply with the vaccination schedule. The release of vaccines approved by foreign agencies was also approved, in case the Brazilian Health Regulatory Agency (Anvisa) does not decide on the issue within 72 hours. The authorized agencies are the Food and Drug Administration (FDA), from the United States; the European Medicines Agency (EMA), from the European Union; the Pharmaceuticals and Medical Devices Agency (PMDA), from Japan; and the National Medical Products Administration (NMPA), from China.[57][58] On the 24th, the Senate approves the PL that authorizes the purchase of vaccines by the private sector, as long as 50% of the doses are donated to the Unified Health System (SUS).[59]

Use of different vaccines[edit]

In Natal, a physical therapist received the first dose from AstraZeneca, but the second dose she received was from Sinovac Biotech. The health department of Rio Grande do Norte acknowledged the error and said that the professional will be monitored.[60]

In the Federal District, a 93-year-old received two doses of different vaccines. According to G1, he first got vaccinated with the AstraZeneca, but his granddaughter scheduled for only 1 month the second dose, and ended up receiving the Sinovac Biotech. In a statement, the health department of the Federal District said that the elderly will have monthly monitoring and checks of the clinical status.[61]

In Rondônia, 35 health professionals from a hospital received doses from different laboratories. In a note, the state health secretariat said it is investigating the case.[62]

On April 16, 2021, the Ministry of Health informed in a statement that if there are reports of people with thrombosis because of the Oxford/AstraZeneca vaccine, another vaccine from another laboratory will be applied. Also in the clarification, the ministry stressed that the vaccine to be applied is not from a viral vector. The only ones purchased by the government that do not have this technology are the Pfizer/BioNTech and Moderna vaccines. Brazil is the first country in the world to have this initiative.[63]

Clandestine immunization in Minas Gerais[edit]

According to Piauí Magazine, on March 24, 2021, a group of businessmen from Minas Gerais illegally imported doses of the Pfizer vaccine to get vaccinated in a garage. None of them were in the priority group.[64] A hospital employee, who is a neighbor of this garage, filmed the moment the clandestine immunization took place.[65] One day after the denunciation, there was a Federal Police operation in the state to carry out search and seizure warrants, and it was authorized by the 35th Criminal Court of Belo Horizonte.[66] ANVISA sent a letter to the police to investigate this illegal importation by individuals.[67]

In the second phase of the operation, an elderly caregiver and two big bus businessmen were arrested by the Federal Police. In her house, ampoules of sodium chloride and flu vaccines were found. In a statement released to the press, Pfizer denied having sold doses to Brazil to individuals and reaffirmed, along with BioNTech, that it will deliver 100 million doses to the Federal Government throughout 2021. Another 57 people are also investigated.[68]

On March 18, 2021, the Legislative Assembly of Minas Gerais installed a CPI to investigate vaccination irregularities in addition to the accusations of queue jumping.[69]

Timelines and targets[edit]

Logo from the Vaccination Campaing.
Vaccination
Immunized Brazil
We are just one Nation

On February 17, 2021, the then Minister of Health, Eduardo Pazuello, in a meeting with governors, presented a schedule about vaccination in Brazil. He stated that between February and July 2021, an additional 230.7 million doses of vaccines against COVID-19 will be distributed.[70][71]

On March 3, 2021, the Ministry of Health published in the Official Gazette a decree that mentioned the exemption of bidding in the acquisition of 38 million vaccines from Janssen (pharmaceutical branch of Johnson & Johnson group) and 100 million doses of the Pfizer vaccine. So far, the vaccines approved for definitive use in the country are: the Pfizer/BioNTech and Oxford/AstraZeneca vaccines. The Butantan/Sinovac and Janssen vaccines, on the other hand, are only authorized for emergency use and are intended for priority groups. Negotiations between Brazil and Pfizer/BioNtech began in the second half of 2020, but did not move forward due to the Brazilian government's refusal to accept a contractual clause exempting the pharmaceutical company from bearing the costs of[72] possible side effects of the vaccine.[73][74]

On March 4, 2021, in a final meeting for contractual arrangements with Pfizer, the Ministry of Health ended up giving in and accepted the clauses imposed by the pharmaceutical company and that blocked the negotiations for Brazil to acquire Pfizer's vaccines. Among the clauses is that Pfizer will not be held responsible for the costs of eventual side effects of its immunizer. In other words: "that a term of responsibility for eventual side effects of the vaccine be signed". The Ministry of Health said that this signing was possible thanks to bill 534 of 2021 that mentions the following:

“the Union, the States, the Federal District and the municipalities are authorized to purchase vaccines and to assume the risks related to civil liability, under the terms of the instrument of purchase or supply of vaccines entered into, in relation to post-vaccination adverse events".

The contract has already been signed and analyzed by the Ministry of Health's legal department.[75]

In a schedule released on March 5, 2021 by the Ministry of Health, the CoronaVac vaccines from the Butantan Institute will be delivered weekly throughout March to the states and the Federal District. In all, 22.7 million doses of CoronaVac are expected to be distributed. According to the Ministry of Health they will also be delivered:

  • 3.7 million doses of the AstraZeneca/Oxford immunizer in the second half of March;
  • 2.9 million doses by the World Health Organization (WHO) Covax Facility alliance;
  • 8 million of Covaxin - Indian vaccine not yet approved by Anvisa. With this, there will be a total distribution to the states and to the Federal District of 38 million doses in March, a number below the one estimated by the Ministry of Health in February for the following month: 46 million doses. That is a reduction of 7.8 million doses of vaccine for the month of March.[76]

On April 16, 2021, Minister Marcelo Queiroga announced the anticipation of the delivery of 1 million ready doses of the Pfizer vaccine. What was supposed to be in June, will now be on April 29. The cargo of vaccines arrived at Viracopos airport, Campinas (SP) from Belgium.[77][78]

On May 11, 2021, the Ministry of Health announced the purchase of an additional 100 million doses of the Tozinameran vaccine from Pfizer/BioNTech. With this, the company must deliver throughout 2021, an additional 199 million doses. Two weeks ago, 1 million were already delivered.[79]

Also on May 11, the ministry vetoed the use of the Oxford/AstraZeneca vaccine in pregnant women because of cases of thrombosis reported in other countries. Pregnant women who have already been vaccinated with vaccines from this laboratory must be followed up.[80]

Priority Groups[edit]

Data is still being updated according to the vaccination campaign, and there may be changes in the period.[81]

Stage Priority Period
I Frontline professionals; seniors aged 60 and over living in long-stay institutions; people aged 18 and over with disabilities in Inclusive Residences; indigenous population living in indigenous lands; riverside population After the emergency use approval at Anvisa
II Elderly above 60 years old, even if they do not live in long-stay institutions First month after the beginning of Stage I
III People with comorbidities, such as diabetes, severe hypertension, chronic obstructive pulmonary disease, kidney disease, cardiovascular, cerebrovascular and neurological diseases, solid organ transplant recipients, sickle cell anemia, cancer, severe obesity, HIV positive Second or third month after the beginning of Stage II
IV People living on the streets; People deprived of freedom; Employees in the system of deprivation of freedom; Education workers in basic education (daycare, pre-schools, elementary school, high school, vocational and EJA); Education workers in higher education; Security and rescue forces; Armed Forces; Public road passenger transport workers; Subway and railway transport workers; Air transport workers; Water transport workers; Truck drivers; Port workers; Industrial workers; Pregnant women and women who have recently given birth 45 days after the birth of the child As doses remain, the groups will be included in the first stages

See also[edit]

References[edit]

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