Vaccination in Curitiba – Photo: SMCS
The National Immunization Program (PNI) has the capacity to vaccinate at least two million people per day. But you need to have doses available. As the federal government did not guarantee the purchase in 2020 – unlike the United States and Europe -, Brazil now faces problems. It has difficulties in acquiring ready-made immunizers and also Active Pharmaceutical Ingredients (IFA) – the raw material needed for national production of vaccines at the Butantan Institute, in São Paulo, and in Biomanguinhos / Fiocruz, in Rio.
Because of these difficulties, the Ministry of Health frequently revises the number of doses delivered to the PNI downwards. The vaccination campaign has already been interrupted several times for lack of immunizers. On the 31st, Minister Marcelo Queiroga lowered the vaccine delivery forecast in April from about 40 million to 25 million doses. Even so, on the same day, the government announced that it intended to vaccinate 80 million people (half the population eligible to receive the vaccine) by half the year. For immunization, two doses are required.
For specialists, it would only be possible to reach the number promised by the government if, as of today, we vaccinate at least one million people per day on a continuous basis, without reductions or interruptions. Currently, it seems impossible. According to scientists, this continuous flow should only be available in September, when Biomanguinhos starts producing the IFA of the Oxford / AstraZeneca vaccine. Even this schedule may change, as the signing of the technology transfer contract between AstraZeneca and Fiocruz has been delayed for four months.
As for the Butantan schedule, the production of Coronavac’s IFA should only occur on a large scale as of the beginning of next year.
“If we managed to reach 1.5 million vaccinated people a day, in April we would complete group 1 of the priorities”, says epidemiologist Pedro Hallal, from the Federal University of Pelotas. “Then it would be possible to complete all priorities by August, September, and the rest of the population, by the end of the year. But I think it is unlikely that this will happen because every time the Ministry of Health announces a goal, it corrects it soon after. ”
Coordinator of the Covid-19 Analysis Network, Isaac Schrarstzhaupt explains the math: “For half the population to receive a dose by the middle of the year, we would have to vaccinate, from now on, 970 thousand per day; for two doses, it would be practically two million a day. ”
But the scenario of uncertainty and unpredictability about when new doses will actually be available prevents planning. “We don’t really know what we can count on. And it is very difficult to work with this policy of distributing vaccines to droppers, ”says epidemiologist Carla Domingues, who coordinated the National Immunization Program from 2011 to 2019.
“The lack of a reliable schedule prevents any proper planning,” agrees Isabella Ballalai, vice president of the Brazilian Society of Immunizations. “Whoever is on the edge has a lot of difficulty. How do you plan a vaccination without having the fundamental raw material at hand, which is the vaccine? ”, He asks.
As the forecast for receiving vaccines for April has already been revised, experts find it unlikely to keep pace. “With the frequent downward revisions that the ministry has made regarding the acquisition and supply of vaccines, it is very unlikely that in the first semester we will be able to increase (and maintain) the speed to a level that we can call mass vaccination – something between a million to two million people vaccinated per day, due to lack of supplies. We can only begin to glimpse something for the second semester ”, says infectologist Alexandre Naime Barbosa, from Unesp.
For the experts, the biggest mistake was not buying the vaccines when they were available, even last year. “There was an unacceptable negligence on the part of the federal government”, adds Barbosa.
Specialist in health management and member of the Committee to Combat Coronavirus at UFRJ, Chrystina Barros believes that we will only be able to have sustainable mass vaccination from September. It will be when Brazil will already be producing its IFA and will not need to import it to make its anti-covid-19 immunizers. “We do not have a reliable timetable”, he reinforces. “We will only be able to have self-sufficiency when Butantan and Fiocruz have already completed the new plants and started manufacturing the IFA. We will only be able to breathe when we have our own production ”, he says.
In addition to costing thousands of lives, the slowness also favors the emergence of new variants of the Sars-Cov-2. The alert is from virologist Fernando Spilki, from Feevale University (RS), a specialist in mutations. “With only a portion of the population immunized and a lot of susceptible people, we have the Darwinian conditions for the emergence and selection of new variants and, over time, increased resistance to the immunizer,” he says. “This process needs to be stopped. Without more vaccines available, the only way to do that is with restricted mobility, something that managers are refractory to. ”
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