Private clinics adopt different rules to vaccinate against Covid

Without a regulation, private clinics have adopted several ways to vaccinate against Covid-19 in the city of São Paulo. Immunization at these sites began last week.

This Monday (6), the report sought 25 private vaccine clinics in the capital of São Paulo and in cities in Greater São Paulo. Four of them confirmed that they are selling the AstraZeneca immunizer, imported from the USA, with different prices and rules.

The other units said they would prefer to wait a little longer to have the product or they will not make the Covid vaccine available because of competition with the public network.

At Clivan’s unit in Pompéia, west of the capital, the Covid vaccine costs R$ 290 and anyone from 18 years of age can be vaccinated, including the second booster dose (or fourth dose), which Saturday (4) it was released by the Ministry of Health for those over 50 years old — people between 18 and 49 years old are not yet included in this vaccination phase according to the PNI (National Immunization Plan).

The AstraZeneca vaccine is not recommended for minors.

According to Vanice Costa, the nurse in charge of the place, the clinic follows, in part, what the PNI preaches: it only applies the third or fourth doses to those who were vaccinated with the previous dose for at least four months. As in the public network, it is necessary to bring proof of identity and vaccination.

From Saturday until early this Monday afternoon, Clivan had already vaccinated 40 people against Covid-19, who needed to schedule an appointment. According to the clinic, all were over 50 years old.

The nurse says that a doctor at the clinic is notified about people who are immunized there and that there is a 24-hour call to attend in case of any side effects. And this is one of the reasons, in her view, that attract people who prefer to exchange public service for private, in addition to the convenience of being attended by appointment.

“We cannot do anything different from what the vaccine package insert says, in this case, follow the four-month interval between one dose and another and not vaccinate children under 18 years of age”, he says.

In Vila Andrade, south zone, the same vaccine costs R$ 420 in a unit of the Santa Clara network. And unlike the clinic in the west, those under 50 only take the fourth dose if they have a doctor’s certificate recommending immunization because of some comorbidity.

Manager Marina Almeida says that this Monday the clinic refused to schedule a 48-year-old man who was looking to reinforce immunization before his age group was released into the public network, without having any health problems to justify.

As each vial of vaccine against Covid has ten doses and lasts 48 hours after opening, Santa Clara only immunizes when it assembles a group of interested parties – this Monday there were three subscribers.

The same occurs in two Vacinarte units, in Lapa (west zone) and Tatuapé (east zone). The clinic charges BRL 300 per dose and requires a medical certificate from anyone over 18, regardless of age.

Last week, ABCVac (Brazilian Association of Vaccine Clinics), in a question-answer on its website, published that, in order to take the fourth dose, patients who are not eligible in the PNI guidelines must await medical advice.

In a note this Monday, the association said that it is not up to it to evaluate the indications for application, but to the manufacturer and scientific entities. And that, in the daily routine of clinics, “some vaccines are carried out with medical prescription in the off-label modality and that, in these cases, have the approval of scientific entities”.

“In these circumstances, the prescribing physician and the professional responsible for the technical establishment are co-responsible”, says the note.

Last week, Anvisa (National Health Surveillance Agency) told the report that it does not “regulate the off-label use” of medication, that is, prescribed at the doctor’s expense and risk.

The Ministry of Health, in turn, says that it assesses the effects of the end of the health emergency, decreed last month, on the law that instituted vaccination against Covid in the country. “The folder recommends not marketing Covid-19 vaccines until the conclusion of the analysis”, he said.

It was with the end of the health emergency that the private network was authorized to sell vaccines, including pharmacies – this weekend, two units of the Drogaria São Paulo network began to vaccinate in the capital of São Paulo and say they are following the same rules of immunization of the public network. .

The SBIm (Brazilian Society of Immunizations) published a document last Thursday (2) saying that the private system should make the vaccine against Covid-19 available only to the groups listed in the PNO (National Vaccination Operational Plan),

“The offer of vaccine in the private system for people who have a recommendation, but cannot or do not want to be vaccinated in the public system, can contribute to the desirable increase in vaccine coverage, especially with regard to booster doses for defined audiences. in the PNO”, published the association.

The doctor Isabella Ballalai, vice president of the medical entity, says, however, that there needs to be a minimum standardization of the private network to avoid situations that can increase even more the doubts of the population about the vaccine.

“We saw this throughout the pandemic, when a government said one thing and a municipality within the same state did another. This created insecurity and people stopped getting vaccinated because they were not calm”, he says.

The doctor recalls that the Ministry of Health recommends what is regulated. And, in a criticism of out-of-hours immunization, she comments that no country is vaccinating with two booster doses whoever is 18 years old, for example. “There’s no experience out there to back it up that it’s worth it, that it’s safe,” she says.

“We don’t think a fourth dose in an 18-year-old will harm their health, but it hasn’t been defined as necessary,” he adds.

Ballalai said that she had already been informed of a patient who was after the fifth dose of the vaccine – currently available only to elderly people with a high degree of immunosuppression, over 60 years old, and who have had the previous vaccine for at least four months.

The association, she points out, was against the entry of vaccines against Covid-19 in the private network until a robust and free vaccination was completed.

Ballalai also warns of the need for clinics to be strict with controls. It reinforces, for example, the need to discount the period that the bottle was out of the fridge from the 48-hour validity after opening.