Fiocruz project raises childhood vaccination rate and could serve as a model in the Lula government

In less than a year, the city of Cuité de Mamanguape, 64 km from João Pessoa (PB), almost doubled the global coverage of routine vaccines for its children: it went from 32%, in 2021, to 59% at the beginning of this month. For some immunizations, it more than tripled. Pentavalent coverage increased from 31% to 106%, against infantile paralysis from 26% to 104%, and triple viral coverage from 33% to 91%.

Paraíba was also the first state in the federation to reach, last October, the goal of the vaccination campaign against poliomyelitis, which is 95% coverage. Amapá was the second to achieve this goal. In the country as a whole, the rate was below 60%.

Data from these two states are the result of an unprecedented project that seeks to recover the high vaccination coverage carried out by Fiocruz (Oswaldo Cruz Foundation) in partnership with the Ministry of Health and SBIM (Brazilian Society of Immunizations).

After a diagnosis of the barriers they face in meeting childhood vaccination targets, the municipalities drew up action plans and adopted measures such as vaccination in day care centers, hiring and training professionals for immunization and strengthening communication with the community in dealing with vaccine hesitancy and fake news.

Launched in December 2021, the project was developed in 25 municipalities in Paraíba and 16 in Amapá. The initiative was so successful that, this year, the government of Paraíba decided to extend it to all 223 municipalities in the state.

The project’s overall data is still being tallied and should serve as a model for a series of changes in the area of ​​vaccination that the new Minister of Health, Nísia Trindade Lima, is expected to announce in the coming days.

The PNI (National Immunization Program), for example, should become a department within the structure of the ministry. In 2021, childhood vaccination in the country reached its worst level in three decades, with 68% coverage – against 97%, in 2015. With that, there was the reintroduction of measles and there is the threat of already eradicated diseases, such as polio , claim victims again in the country.

“Vaccination ceased to be a priority a long time ago. There is no investment, there is no training of professionals, many of the people who are in the vaccination rooms are not hired, they change all the time, which increases the risk of errors, application of wrong vaccines”, says pediatrician Isabella Ballalai, vice-president of SBIM.

For her, the project shows that high coverage will only be resumed if vaccination is among the priorities of municipal managers. “We see investments from the Ministry of Health for vaccination being used by municipalities in other areas of health.”

In addition to partnerships with state and municipal managers, the project has the support of various actors, such as universities, schools, churches, unions, the MST (Movimento dos Sem Terra) and the Grupo Mulheres do Brasil.

According to doctor Maria de Lourdes de Sousa Maia, one of the coordinators of the project at Fiocruz, in recent years there has been a huge gap between the PNI and primary health care, which carries out vaccination actions in municipalities. “That generated a lot of discouragement at the end of the system.”

The researchers involved in the project detected several problems that hinder immunization actions, such as the lack of computers in health units and cars to actively search for unvaccinated people, in addition to the absence of permanent nursing professionals in the vaccination rooms.

Maia says she also found vaccine rooms with reduced hours, which makes access difficult. “If the vaccination schedule is from 8 am to 5 pm, it is not possible to close at 11 am and send the person back at another time. Often, it is at lunchtime that someone can take their child to be vaccinated.”

For Talita Alves de Almeida, executive manager of Health Surveillance in Paraíba, the overload of primary care professionals also makes vaccination actions difficult. For example: the nursing technicians who work with vaccinations also monitor hypertensive and diabetic patients, make dressings and provide home care. The nurses, who must supervise the vaccination room, perform prenatal care, collect cytological exams, perform HIV tests, among others.

“The professional is there in the unit, the unit is open, but is he available at that moment when the mother is waiting to vaccinate her child? We need to re-discuss the role of this nursing professional in the vaccination room”, he says.

She says that during the polio vaccination campaign, between August and October, there was daily monitoring and communication with professionals and health agents so that municipalities could reach the targets. “We called and said: you have 70% coverage, your children with the lowest coverage are the one-year-olds. Where are they? At the daycare center? Have you had the vaccine at the daycare center?”

Dialogue with the population about the importance of vaccination took place in various spaces, such as churches and schools, and health units began to open on Saturdays.

As a result, of the 223 municipalities in the state, only eight did not reach goals above 95% in vaccination against polio, but they came very close. And only one got 83%. “We had municipalities that between August and September went from 30% coverage and reached 95%”, says Talita Almeida.

There are still difficulties for professionals in dealing with information systems. “I found stacks of papers, with data to be typed in. It’s no use just doing ‘lives’ with tutorials on the systems. You have to put people in a room with a computer and train in person”, says Maia, from Fiocruz.

There are also problems in the entry of municipal data into the Ministry of Health’s information system. In October, the estimate was that there was a lag of 30 million doses between the vaccines actually applied and the rates that appear in Datasus.

Maia says that the project team did not find a lack of vaccine in any municipality. “In many, the cold rooms were very full. But this is not usually a good indicator. It means that vaccines are not being applied.”