The data has been used by supporters of President Jair Bolsonaro (without a party) to criticize states and municipalities regarding the speed of vaccination. The thesis has already been presented by ministers, such as Damares Alves, from Human Rights, and Fábio Faria, from Communications. Yesterday, it was the turn of the Mayor, Arthur Lira (PP-AL) to bring up the subject. In fact, the data shows a problem caused by the federal government itself: the lack of doses.
The comparison between the doses distributed and those actually applied is criticized by specialists and managers in the health field because it disregards factors such as:
- logistics: the dose released for distribution is not applied the next day, as there is a way to get to the vaccination post – which is not so simple in some regions of the country;
- registration: some localities have faced technical difficulties to include data on doses applied in the system, in addition to the fact that the vaccine against covid-19 requires a nominal registration, which also contributes to delaying the process;
- distribution: doses are delivered in small and irregular quantities.
Experts point out that Brazil has a tradition of rapid and massive application, and that the debate over the application of distributed doses masks the main problem, which is the lack of doses, which is the responsibility of the federal government – which has consistently failed to meet its schedule. of deliveries.
“It seems that it takes a long time, but, in fact, it doesn’t,” says Mayra Moura, director of SBIm (Brazilian Society of Immunizations), explaining that, until it reaches the arm of the Brazilian, the dose passes through structures of the federal, state governments and municipal.
In campaigns like the flu – on which the immunization program against HIV is based covid-19—, the application takes place in the same way, but the relationship between dispensing and applying is not highlighted because there is no problem with the quantity of doses.
Time to reach the arm
After receiving doses, states generally take between 24 and 48 hours to deliver immunizers to their cities. To get to the arm of the Brazilians, it is possible that it will take some more time, since the citizen does not need to go to the vaccination post exactly the day after the immunizer arrives at the health post.
“Our logistics have to provide, at least – between getting the vaccine and being at the tip -, from five to seven days”, says Regiane de Paula, coordinator of the immunization program of the State of São Paulo, who already planned the immunization against the covid-19 in the state since August last year.
By March 31, of the approximately 35 million doses sent to the states, 31.6 million had already been passed on to the municipalities, according to data from the ministry. Of the 27 federation units, 14 are below the national average of 63%.
Two of them are states in which logistics are difficult, such as Roraima and Amazonas, where, for doses to reach some locations, it is necessary to use practically all modes of transport, from air to river.
“And the cost is very high for the volume of doses that is coming,” says Ângela Carepa, from the department of Epidemiological Surveillance in Amazonas, remembering the riverside populations and those who live in boats. “Except those who live in the middle of the jungle, which can only be reached by helicopter.”
In addition to facing the logistics problem, notifying the application is also a factor that does not contribute to speeding up the accounting, as happens in the DSEI (Special Indigenous Sanitary District) Yanomami, which is in an area of difficult access and communication in Roraima.
“They receive, apply the doses, but it takes a much longer time to insert this into the system”, says the pharmacist Valdirene Oliveira, general coordinator of Health Surveillance in the state.
The DSEI Yanomami, for example, received 15,396 doses, but there are 2,601 registered as applied, according to data from Tuesday (30).
“They are applying the doses, but they are not showing,” says Oliveira, who, according to a DSEI report, has control that 7,000 have already been applied.
“It is a heavy system, we have internet problems. It makes it even more difficult”, says Carepa, referring to the SI-PNI (Information System of the National Immunization Program).
Another reason that generates delay for the notification is a new way to register the information about the applied dose. For the immunizer against covid-19, the system asks for data about the person and the vaccine used.
In traditional campaigns, such as the flu, the notification is about the dose, without reference to the immunized person. “Before, you launched by quantity [de doses]. Now, you launch the system by name “, says Moura.
“It is the first vaccination that requires a nominal registration”, says Magda Almeida, executive secretary of Surveillance and Regulation of Ceará. She recalls that, at times, even the capital Fortaleza failed to include data in the SI-PNI, “which is unstable, which falls”.
Therefore, in parallel, Ceará maintains a simpler accounting until it is able to include the data in the system. “We even apply it by taking notes on a sheet of paper. To give it agility, give it more transparency. Then, reduce this delay [demora]”, says Almeida.
With a more detailed record, some cities choose to make a “package” of notifications. “Sometimes, the municipalities do not do it at the same time, on the same day. Some gather [os dados de doses aplicadas] to do it at another time, they stop playing on the system at the weekend “, says Janaína Fonseca Almeida, director of Vigilance of Communicable Diseases of Minas Gerais.
She also assesses that the problem may be linked to overload and the lack of professionals for the task. “[Os municípios] always record less than they apply. And this is classic in all campaigns. Influenza campaign is the same thing. ”
Regarding the application of the distributed doses, the Twitter received responses from the health departments of 17 states. In common, they reinforce that the responsibility for the application of the doses rests with the municipalities, leaving the state governments to distribute and monitor the progress of the vaccination.
Maranhão, for example, says that it has reinforced for city halls “the guidance for sending data updated daily and for the speedy application of doses”.
Country needs more doses
The states that responded to the questioning of the Twitter they said that, after the new determination of the Ministry of Health, they stopped making the reservation for the second dose of CoronaVac.
“In practice, this means that the Ministry of Health has an obligation to guarantee the second dose in a timely manner “, says, in a note, the Health Secretariat of Bahia.” We need to believe that the supply will not suffer losses “, says Oliveira, from Roraima.
Some doses of CoronaVac, distributed before the new determination, are saved to complete the immunization schedule of the immunizer in the coming days. “5.2 million is the reserve for the second dose, which has to be there because time is short,” said the governor of Piauí, Wellington Dias (PT), leader of the Governors’ Forum, in reaction to Lira’s criticism. “The real problem is the lack of a vaccine.”
Behind the discussion on the application of the distributed doses appears the point that should have more prominence, in the view of Moura, from SBIm. “What we have to be concerned about is distributing more doses. Having more doses distributed, we will have more people vaccinated. And these other issues are being solved automatically.”
Paula agrees. “The problem is not in the delay of the application because the vaccine arrived for the municipality. The quantity of vaccine that arrived is what is my problem”, he says. “Everyone’s anguish: we need more vaccines.”
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