Brazil skates to complete vaccination of children to the elderly against Covid-19

Amid the cooling of the pandemic, vaccination against Covid-19 in Brazil faces challenges in all age groups. The country has difficulties to complete the recommended cycles, with stagnant infant coverage, low booster among young people and only 10% of the elderly with the fourth dose.

This is shown by the analysis carried out by the Sheet with data from the Ministry of Health and the IBGE (Brazilian Institute of Geography and Statistics).

The survey points out that, until the 24th of this month, 4 out of 10 children aged 5 to 11 years had not received even the first dose.

After a peak in applications between January and February, partial coverage slowed down and slowed down before reaching two-thirds of children with the first injection (61%).

Even taking into account the waiting interval between doses –eight weeks in the case of pediatric Pfizer–, the return to complement is far below expectations: only 34% of children have completed the primary vaccination cycle.

Among young people, the bottleneck is in the third dose. Coverage with the first cycle –two doses or a single dose of Janssen– reached 81.5% among Brazilians aged 18 to 29 years.

However, most of them did not return after four months to receive the first booster, recommended by the Ministry of Health to all adults since November last year.

Applications have not taken off in this age group and have been falling since March. According to the survey, only a third of young people took the third dose (33%).

The fourth dose among the elderly also has low adherence. Coverage with this second booster is only 18% among Brazilians aged 80 and over, eligible since March throughout the national territory.

Epidemiologist and vice president of the Sabin Institute, Denise Garrett classifies the current scenario as “regretful”. She notes that Brazil repeats waves similar to those of the United States, which is currently facing an increase in the number of cases and underreporting due to self-tests.

Isabella Ballalai, pediatrician and vice president of Sbim (Brazilian Society of Immunizations), says that the situation is worrying and that an increase in cases has been observed in recent weeks.

“A new big wave is not expected, but we may have a variant with greater vaccine escape”, he warns.

While the US has already authorized the third dose of the vaccine for people between 5 and 11 years old, highlights the pediatrician, Brazil has not yet managed to do its homework and immunize children with two doses.

The lack of strong vaccination campaigns and the noise between the Ministry of Health and the states are mentioned by experts as possible causes of the difficulty that the country faces in completing the cycles of immunization for children and reinforcements among adults.

“Communication is not direct with the person. When they say ‘everyone has to be vaccinated’, the 20-year-old doesn’t think it’s him, but only for the elderly”, says Ballalai. “Information is spoken, but it does not impact the population.”

Since May 18, the Ministry of Health has recommended the fourth dose for all people over 60 years of age. Before that, many states had already started vaccination in this age group.

The state of São Paulo, for example, started the campaign on March 21 for people aged 60 and over, in addition to immunosuppressed adults.

The lifting of Sheet points out that, in the entire Brazilian population, only 14% of septuagenarians and 6.5% of sexagenarians have already updated their immunization. Overall, only 1 in 10 elderly people aged 60 and over received the fourth dose of protection (10.5%).

Ballalai comments that, with the cooling of the pandemic, most care has been left aside. She believes that the anti-vaccine movement in Brazil convinced part of the population that the risk of the disease was not so great, and this reduced the demand for the immunizer.

An epidemiological analysis released by Fiocruz on Thursday (26) points out that 48% of cases of severe acute respiratory syndrome (SARS) recorded in the last four weeks were due to Covid-19. The number represents an increase in cases in all regions of the country.

Regarding the lack of adherence to the fourth dose, she attributes it to general tiredness and a feeling that the vaccine does not work. “That’s not true. At all ages there is a clear difference between who is vaccinated and who is not.”

The pediatrician compares the Covid-19 immunization with that of the flu and says that few people know that the first protects from 4 to 6 months.

“The flu has a very marked seasonality. It circulates throughout the year, but the peak is now, so vaccination is necessary now. Covid does not have this seasonality, and the peak can happen at any time”, he says.

The City of São Paulo sent, this Wednesday (25), a letter to the Ministry of Health in which it requests the authorization of the fourth dose for all health professionals and for people aged 50 to 59 without comorbidity, as reported by the column Panel. The municipal management also requested that the third dose be authorized for adolescents aged 12 to 17 years.

So far, however, there is no forecast for the second dose of booster to be made available to the entire population. Therefore, it is common for those who already received the third dose six months ago to consider that they would be less protected against Covid.

The analysis of Sheet points out that, currently, about 4.4 million adults between 18 and 59 years old (3.4%) are part of this portion of the population. By the end of next month, this number should reach 12.4 million (9.6%).

However, experts say that there are still no studies that support the need for the fourth dose for the general population.

Julio Croda, an infectologist at Fiocruz, says there is little data about the extra benefit and how long it lasts. “What we know is that there can be an important gain in protection for the elderly. But, in relation to the general population, data are scarce and contradictory.”

According to the infectious disease specialist, no country is adopting the fourth dose indiscriminately, “even because we have to reduce vaccine inequality among countries that do not have this access”.

Croda adds that the main strategy needs to be based on the prevention of hospitalization and death. Therefore, for the time being, the second booster dose should not be a cause for concern for the majority of the population.

“We will have recitals, yes, related to occasional, winter, relaxation of preventive measures. But, to what extent this will impact on the increase in hospitalization and death is what we need to observe”, says the doctor.

Raquel Stucchi, a professor at Unicamp and a consultant for the SBI (Brazilian Society of Infectious Diseases), agrees with Croda. “People [imunizadas com as três doses e abaixo de 60 anos] can be reassured about the risk of more serious illness”, she says.

As the virus continues to circulate, she recommends that, in case of exposure in crowded places, people who have contact in the following days with the elderly and people with comorbidity should wear a mask.