- André Biernath
- BBC News Brasil in São Paulo
6 hours ago
Brazil will experience an even more challenging situation from the point of view of public health in the coming weeks: the country will run two mass vaccination campaigns simultaneously.
According to the Ministry of Health, the immunization against influenza begins on April 12, which happens every year from the beginning of autumn, when the temperature begins to fall and the circulation of viruses that affect the respiratory system (as is the case of influenza, the cause of the disease) increase considerably.
The campaigns against influenza and covid-19 will take place in parallel and already raise doubts about who should take the doses, how long to wait between one vaccine and another and how the organization will be to avoid crowds at health posts.
BBC News Brasil consulted experts to answer the main doubts and understand the importance of protecting themselves against these two diseases.
Who can get vaccines against covid-19 and flu?
It is necessary to pay close attention, as the priority groups and the order in which they will be served change a little according to each campaign.
For now, Brazilian municipalities are vaccinating health professionals and people over 60 in different age groups against the covid-19. Many locals started by calling individuals over 90 years old and gradually reduced their age.
The expectation is that education workers and the security and rescue forces will start taking their doses against the coronavirus in the coming weeks, according to the schedule of each city hall.
In the case of influenza vaccination, the first recipients will be:
- From 04/12: children, pregnant women, puerperal women (women who had children recently), indigenous people and health workers;
- As of 05/11: people over 60 and teachers;
- Between 9/06 and 9/07: individuals with permanent comorbidities or disabilities, truck drivers, road and port system workers, security forces and the Armed Forces, prison system employees, prisoners and young people aged 12 to 21 who are under socio-educational measures.
Generally, flu campaigns start with the elderly. But, in 2021, they were transferred to a second stage to avoid confusion and conflict with the timetable established against the covid-19.
The expectation is that, as of May, most individuals over the age of 60 will be properly protected against the coronavirus and be free to also protect themselves against influenza.
“In order to avoid risks, managers will need to organize a great organization with different lines, times and spaces, so that there is no overcrowding of people in the health units”, suggests epidemiologist Jose Cassio de Moraes, full professor at the Faculty of Medical Sciences at Santa Casa de São Paulo.
Which vaccine should be prioritized?
Both immunizers are essential and help prevent respiratory complications that require hospitalization and can even lead to death.
If you are part of the target audience for both campaigns at some point in the coming months, priority should be given to the covid-19 vaccine.
“This is the recommendation of the National Immunization Program (PNI) of the Ministry of Health and it has to do with the fact that we are in the middle of a pandemic”, clarifies the doctor Maria de Lourdes de Sousa Maia, coordinator of the Clinical Advisory of Bio- Manguinhos, from the Oswaldo Cruz Foundation (FioCruz).
But the priority should not be confused with exclusivity: it is important to get vaccinated against the flu in the sequence, respecting the deadline guided by the specialists, as you will see below.
Can I get the vaccines against covid-19 and flu together on the same day?
No. It is necessary to wait 15 days between one vaccine and another, according to the guidelines of the public health authorities.
But what is the reason for this two-week break?
“We do not yet have co-administration studies, which would allow us to know the response of the immune system to the joint application of the two immunizers, against the flu and against covid-19”, explains the doctor Patricia Mouta, a professional in pharmacovigilance of Bio- Manguinhos / FioCruz.
As research on the topic has not yet been done, the Ministry of Health has chosen prudence, to avoid any unexpected side effects or a decrease in the effectiveness of immunizers.
Let’s see examples of how this scheme will work in practice: you can take the first dose of Coronavac and wait 14 to 28 days to receive the second dose of Coronavac.
Hence, it is necessary to wait two more weeks to be vaccinated against the flu (which requires only one dose to provide protection).
In the case of the immunizer AZD1222, from AstraZeneca and University of Oxford, the order of vaccination changes, since the period between the first and the second dose is three months.
You can then take your first dose of AZD1222 and wait two weeks to get the flu shot.
Then, just wait the remaining two and a half months to complete protection against covid-19 with the second dose of AZD1222.
What is the importance of getting vaccinated against these two diseases?
Both flu and covid-19 are diseases that affect the respiratory system, can cause complications or sequelae and even kill.
From an individual point of view, therefore, vaccination reduces health risks.
From a collective perspective, immunizing is an attitude that protects the entire community, as it breaks the chains of viral transmission and prevents the filling of hospitals and intensive care units.
In other words, when you take your doses, you not only protect yourself, but also your family, friends, neighbors and everyone around you – even those who, for one reason or another, cannot get the vaccine.
Does Brazil have guaranteed doses to protect the population against covid-19 and the flu?
The situation varies widely. In the case of flu vaccines, there is less concern about a possible shortage, almost nonexistent.
This is because Brazil is self-sufficient in this regard: the manufacture is in charge of the Butantan Institute, which does not even depend on the import of the active pharmaceutical ingredient (IFA) to deliver, every year, 80 million doses to the Ministry of Health.
Butantan has the largest influenza immunization plant in the entire Southern Hemisphere.
When the subject is covid-19, the subject complicates a little.
Our country depends on IFA shipments from China and India to finalize the filling of doses of Coronavac, at the Butantan Institute, and AZD-1222, at FioCruz
Due to the worldwide demand for the product, since January 2021 deliveries have suffered delays and unforeseen events, which have even stopped the vaccination campaigns against coronavirus in some cities.
“To speed up people’s immunization, we need to have more doses of vaccines available,” points out epidemiologist Carla Domingues, who was coordinator of the PNI between 2011 and 2019.
In the past few days, both Butantan and FioCruz have managed to expand the delivery of new batches of vaccines against covid-19, which promises to give more predictability to state and municipal governments.
In addition, other vaccines that already have a purchase agreement with the Ministry of Health should arrive from the coming months, such as those produced by Pfizer and Johnson & Johnson.
The ministry’s provisional calculation is that Brazil would already have more than 500 million guaranteed doses for 2021.
What are the challenges of running two campaigns simultaneously?
In addition to the issues of organization and logistics, the experts heard by BBC News Brasil draw attention to the challenge of making good communication to people about simultaneous campaigns.
And, in their evaluation, Brazil is doing poorly in this regard.
“I cannot say that the communication is terrible because it would mean that there is something being done. The communication is absent. There is no official announcement or campaign,” criticizes Moraes.
For now, the Federal Government has run few advertisements or other content in physical and digital media to talk about the target audiences, when people should be vaccinated or what documents are needed.
“What we have seen are only advertisements about vaccine purchases. It is necessary to explain to the population about the need to take the two doses, respect the intervals, among other things. This communication is not being made”, notes Domingues.
BBC News Brasil contacted the press office of the Ministry of Health to hear their version on this point, but even the publication of this report did not get a response.
Maia, who was the coordinator of the PNI between 1995 and 2005, points out that, despite more experience that Brazil has in immunizations, it is necessary to adapt to the new reality.
“Running vaccination campaigns is to reinvent yourself at all times. Staying the same is the recipe for failure”, thinks the doctor.
“It is necessary to understand the moment we live in and estimate the impact that fake news and WhatsApp currents can have on the acceptance of vaccines. We will have to deal with and overcome this,” he adds.
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