Brazil completes a year of vaccination against Covid with déjà-vu in 2021

The moment in which Brazil completes one year since the start of vaccination against Covid seems like a déjà-vu of January 2021: the Bolsonaro government makes speeches against immunizers, a new phase of the vaccine campaign begins and yet another variant causes a wave of infections that are spreading rapidly across the country.

On January 17, 2021, at 3:30 pm, after the approval of Anvisa (National Health Surveillance Agency), nurse Mônica Calazans received the first dose in Brazil of the Covid vaccine, outside clinical studies.

The Coronavac application took place at the Convention Center of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, in the capital of São Paulo, under the eyes of journalists and the governor of the state, João Doria (PSDB), who, at that time, already rivaled for some time with President Jair Bolsonaro (PL) on matters related to Covid.

The production of the Chinese vaccine Coronavac at the Butantan Institute, in addition to the obvious public health potential, could serve as an asset for Doria in an eventual presidential candidacy.

Almost a year later, this Friday (14), it was the turn of the little indigenous boy Davi Seremramiwe Xavante, 8, to be the first child under the age of 12 vaccinated against Covid in Brazil. Once again, at Hospital das Clínicas, next to Doria.

Before the vaccination of Calazans in 2021, Bolsonaro questioned the safety of immunizers. It even made fun of when Coronavac trials were paralyzed by the suicide of a volunteer.

“But haste for the vaccine is not justified, because you mess with people’s lives”, said Bolsonaro, in an interview with his own son, deputy Eduardo Bolsonaro (PSL-SP), in December 2020. On the same occasion, he said that the pandemic was coming to an end.

While other countries had already started vaccinating, there were no signs of a start in Brazil — the federal government had not signed a contract to supply Pfizer-BioNTech immunizers. “Why this anxiety, this anguish?”, said the then Minister of Health, Eduardo Pazuello, about the start of vaccination.

A similar delay and constant speeches opposing childhood vaccination against Covid marked the end of 2021 and the beginning of 2022. The government even opened a public consultation and planned to require a medical request for children aged 5 to 11 to be vaccinated .

“Hurry is the enemy of perfection. Safety is the main thing”, said Marcelo Queiroga, Minister of Health, in December 2021, when asked about the possibility of anticipating childhood vaccination, with vaccines from Pfizer (immunizer with definitive registration in the Anvisa), which already took place safely in other countries.

Renato Kfouri, pediatrician, infectologist and director of SBIm (Brazilian Society of Immunizations), highlights that the minister does not miss the chance to say that only parents who want to vaccinate children against Covid.

Even on social media this is visible. “Child vaccines against Covid-19 ARE NOT mandatory. Vaccines against Covid-19 are emergency and were authorized in the context of the health emergency and are only included in the PNO [Plano Nacional de Operacionalização da Vacinação contra Covid-19]”, published the minister, in response to tweets.

“We have an anti-vaccine president who, whenever he can, speaks ill of vaccines,” says Kfouri. “The launch of the vaccine in children was almost an apology for putting the vaccine on the calendar.”

Despite all the negative statements, vaccination in the country was very well received by the population, who, at various times, faced queues to get their dose. “It may not get in the way as much, but it doesn’t help”, says the director of SBIm about Bolsonaro’s anti-vaccination comments.

The delay in starting vaccination, however, may have cost lives, says Raquel Stucchi, a professor at Unicamp and a consultant for the SBI (Brazilian Society of Infectious Diseases).

“With political will and adequate planning, we would have avoided thousands of deaths, because we would already have the population vaccinated earlier and more quickly”, says the infectologist.

The year of vaccination against Covid in Brazil also shed even more light on something that was already proven by studies: vaccines are safe and effective for the most diverse groups.

It is worth noting that the immunizations we used were made with the “mold” of Sars-CoV-2 that gave rise to the pandemic, in Wuhan, China. Even so, the vaccines continued with high levels of effectiveness against the variants of concern that have emerged around the world — and, in Brazil, such as gamma.

“Their objective was to reduce mortality and hospitalization. All of them fulfilled this role very well”, says Stucchi.

Deaths from Covid, in general, ended up being relatively controlled in countries with widespread vaccination, including Brazil. Currently, a significant share of severe cases, hospitalizations and deaths occur in unvaccinated people.

Around here, even the impact of the delta — highly transmissible and that wreaked havoc on other nations — was relatively little felt, despite the massive presence of the variant in the country.

According to Stucchi, the previous explosion of the gamma variant in Brazil, which led to average deaths of more than 3,000 per day and, consequently, to a large previous contact with the disease in the population, is one of the explanations for the smaller impact of the delta. The other is the large contingent of people with recent vaccination and, consequently, greater protection.

This, by the way, is one of the lessons learned by Brazil and the world in the last year. Vaccines have diminished protection over time, says Kfouri. In addition, a greater effectiveness was also observed for vaccines made from messenger RNA, as is the case with Pfizer, for more fragile populations, such as immunocompromised people and the elderly.

Initially, vaccination in the country was guided by Coronavac, a vaccine made with inactivated virus, but currently, vaccines from Fiocruz/Oxford and Pfizer are the most used. Studies have shown a considerable drop in protection, over time, for more fragile populations who took the Butantan immunizer.

Another lesson learned was the need for a booster dose, precisely because of the decrease in protection over time. According to Stucchi, the rapid approval in Brazil for the vaccine booster was a hit in the fight against the pandemic.

Déjà-vu in Brazil is completed with a new variant. Just as the gamma, in late 2020 and early 2021, sounded an alarm and the number of cases rose, the arrival of the omicron quickly exploded Covid infections between the end of 2021 and the beginning of 2022.

The new variant made clear something that was much researched and speculated about the vaccines available: they undoubtedly make transmission difficult, but not necessarily able to prevent it. The omicron is the expression of that.

“It is transmissible too and does not spare vaccinated,” says Kfouri.

For the second year of vaccination against Covid in Brazil, the director SBIm hopes that, possibly, everyone ends up having to take some extra dose.

At the same time, updated vaccines with dominant strains of Sars-CoV-2 and even more effective in containing transmission must emerge. After all, the policy of constant application of booster doses is not viable, as the WHO (World Health Organization) has pointed out.

In addition, for vaccine campaigns to succeed even more robustly within countries, entities and experts have warned that a more equitable distribution of immunizations around the world is necessary.

And, once again, the omicron, identified in South Africa, is the expression of the risk that all humanity runs when leaving countries and continents with little access to protection.