Queiroga minimizes stagnant vaccination and says the government has already spent ‘fortune’ to promote campaigns

Health Minister Marcelo Queiroga, 56, says the government has already spent a “fortune” to promote immunization against Covid-19 in Brazil and minimizes the stagnation of vaccine coverage.

In an interview with Sheet, the cardiologist challenges local secretaries, Fiocruz (Fundação Oswaldo Cruz) and specialists to carry out a vaccination campaign against the virus better than the one carried out by the current administration. But it spares President Jair Bolsonaro (PL), a vector of misinformation about immunization and care in the pandemic, from criticism.

Queiroga took over the Ministry of Health in March 2021, promising to make Brazil a “homeland of masks”. Since then, he has modulated the speech and began to alternate praising the work of the federal government in the purchase of vaccines with nods to the negationist wing of Bolsonarism.

The minister also declares that there is no decision on the vaccination campaign against Covid in 2023. He states, however, that the trend is to reduce the size of the target audience and prioritize the Astrazeneca vaccine.

He also says that the shortage of medicines and basic supplies, such as injectable dipyrone and saline, “inspires attention”.

​How concerned is the ministry about monkeypox and mystery hepatitis? [Sobre a varíola dos macacos] It is a situation of monitoring, not of concern. It’s not something that’s serious. Naturally, the most vulnerable, young children, the elderly, can have a repercussion [forma mais grave da doença].

There are few vaccines. It is not considered a public health problem. We are with Opas [Organização Pan-Americana de Saúde] looking for contacts to have the vaccine.

If it is necessary to buy, it will be for a restricted group. Those professionals who are dealing directly with these cases, those who live in border regions.

About hepatitis, we still don’t know the cause. There are few serious cases. The technical area discusses this matter with the infectology staff.

Is it certain that monkeypox will reach Brazil? Very possible. It is a disease that can also be transmitted by respiratory particles, but as far as I have discussed this subject in the WHO [Organização Mundial da Saúde]does not have the same contagiousness as Covid-19.

It may come, but if it does, after we face an avalanche of deaths from Covid-19, we are prepared to face ‘monkeypox’, hepatitis in children, whatever.

Is there a need for border control? At the time no.

The ministry report says that a form of prevention is the use of masks. Are we now going to create a law to force people to wear a mask because of the ‘monkeypox’? It has no elements. Today, we have to be more careful with the issue of acute respiratory syndrome in children, which Covid is not the main cause, than with ‘monkeypox’.

Mask is functional. A barrier, in theory. But what mask? In order to achieve the goal, they have to be used correctly. What we saw in the pandemic:, the person wore a fabric mask all day. The next day, I was wearing the same mask. In the end the effectiveness is low, although useful.

Sometimes it even serves as a political positioning.

Does Brazil have tests to diagnose smallpox? It’s even talking about a quick test. We are prospecting. Every day, the staff of the Health Surveillance Secretariat discuss this.

Mr. cites Covid-19 as an asset for Brazil to face these other diseases, but there are criticisms about the federal government’s response to the pandemic. Criticism is everywhere. If you go to the United States, check it out: heavy criticism. Who is here, in my place, is to receive criticism.

The health system in Brazil is an achievement, but we were in a position to respond fully [à Covid]? See news from before 2018 about UTIs. crowded, lack of vacancy, lack of medicines. That was what she had.

Fiocruz recently pointed out that the vaccination campaign against Covid is stagnant. Why doesn’t Fiocruz carry out this vaccination campaign? I send her money like crazy.

Isn’t it time to update the campaign? Be more assertive. We spent a fortune on a vaccination campaign. Who is complaining about [falta de] vaccination campaign? I myself have vaccinated a child there in Acre. In Santarém (PA), in the Zoé village. None of these specialists who are on television went to vaccinate indigenous people in the Zoé village. I doubt. If you went there to do that, I ask you to leave [do ministério].

The ministry campaigns. Who are you asking to do? Private vaccination clinic. Want me to campaign to make money selling vaccines? Why don’t they?

Health secretaries are also calling for new campaigns. They just ask. What they have to do is execute public policy at the cutting edge. Because money at the end for them was in sufficient quantity, and most of them misused public resources.

In the way mr. speaking, it seems that the federal government’s communication campaign was ideal. It was the biggest vaccination campaign, we spent more than R$ 400 million [a promoção da vacinação custou R$ 381 milhões, segundo a assessoria de comunicação da Saúde].

But one of the most visible faces of the anti-vaccination movement in Brazil is President Bolsonaro. Imagine if President Bolsonaro were pro-vaccine. How much had we spent? R$ 100 billion in vaccines.

Or it would have spent less, but vaccinated more, for the efficiency of the campaign. No, what the president has always told me is that he is against forcing people to get the vaccine.

But don’t you think that the way he [Bolsonaro] did you say, discouraged people from getting vaccinated? It’s not up to me to judge the president’s speeches. Nor do conjectures about whether or not people wanted to get the vaccine.

The president’s biggest advocate in healthcare is me. And I am the biggest advocate of the vaccine. And the president never told me not to do that. He just said, ‘Queiroga, we’re not going to force people to get the vaccine’. And I agree with him. Let’s not force it, let’s call to get vaccinated.

This is an expired agenda, 80% of the Brazilian population has already taken the primary vaccination schedule. We advance in the booster dose [Cerca de 43,5% da população recebeu o reforço].

Could the Covid-19 vaccination campaign be smaller next year for budget reasons? It depends on the epidemiological scenario. In the influenza campaign, we vaccinated 80 million. The cost of this campaign is R$ 1.2 billion. With the Covid vaccine, the orientation was to vaccinate en masse, from 5 years old to the elderly. We spent R$38 billion. Worth it? It cost. But in a scenario where we have a low average of deaths, seasonal disease, is this same value necessary? I can’t answer that right now. Neither I know nor anyone else knows.

If everything remains as it is now and a new vaccine does not appear, we may be able to limit it. Seniors, healthcare professionals, [pessoas com] comorbidities. It’s possible. I don’t say that’s it.

Soon the ministry will have to send the budget forecast for the next year. You have to send. Imagine if I get there in the Economy and say that it is R$ 30 billion for vaccines?

What I think? I have Astrazeneca. Invested BRL 1.9 billion [na transferência de tecnologia para produção na Fiocruz] and I can get the vaccine for less than $4 a dose. This is the main vaccine. It was the gamble that the government made. On whom do we not use Astrazeneca? In pregnant women, people at increased risk of thrombotic events, children.

What is the trend for 2023? Astrazeneca as a first option and Pfizer for those audiences who cannot take Astrazeneca.

There are a number of missing medicines. Is this year’s scenario different? The previous year was worse, there was no intubation kit. When I took over, my biggest concern was oxygen and intubation kit.

Now IFA is missing [insumo farmacêutico ativo] for injectable dipyrone. It is a disease of the health industrial complex. It’s not new, it comes from a wrongly adopted policy back then.

A decade ago, PDPs were instituted [parcerias entre laboratórios públicos e privados]. Have you seen any partnerships to make dipyrone IFA?

Will releasing the maximum price of medicines solve the shortage? It was one of the measures we took. If the market doesn’t behave correctly, we can use a more interventionist measure. We do not want.

Do you think the scenario is serious? There are reports of difficulties with medication. There is also competition from [mercado] private, which makes stock. Something that inspires ministry attention. It’s not supposed to be a shortage of supplies such as saline.

We are monitoring inventories with Anvisa, with distributors. [O] The objective of these people is to earn money, I am not against it, but we will earn it correctly.

Do you advocate intervention by the Legislature in the health plan readjustment? [Há propostas de governistas para suspender o percentual autorizado] I argue that [a ANS] show me the calculation value across the industry, not just individual and family plans. And that shows how the agency is working so that we have better deliveries and lower costs.

It is not my job to interfere in the Legislative Power. But, like, we have proposals, like the “open health” [inspirada no “open banking”, a ideia de compartilhar dados de clientes entre operadoras de saúde é apoiada por Queiroga, mas enfrenta resistência de parte dos médicos e especialistas]. I am not a regulatory agent — but I am not speaking here as a minister, I am speaking as a citizen. A sector that conglomerates, becomes vertical. You have to do like those suspension medications, right? Shake before use.

There is a possibility of budget cut in health [para viabilizar reajuste de servidores]. Did you complain to the president or Guedes? Do you know what the value should be? My role here is not to complain to the president. The president’s job is to complain to me if the matter has to be resolved.

No, I don’t have the exact value yet. But these budget adjustments, they are made. Naturally, in Health, the demands made on me are always for more service, for more resources. We have to find a way to balance this by offering adequate public policies.

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Marcelo Queiroga, 56

Minister of Health since March 2021, he is a cardiologist. He was president of SBC (Brazilian Society of Cardiology) and SBHCI (Brazilian Society of Hemodynamics and Interventional Cardiology). He graduated in medicine from the UFPB (Federal University of Paraíba) and did his residency in cardiology at Hospital Adventista Silvestre in Rio de Janeiro.