Ministry of Health canceled purchase of 14 million antigen tests in 2021

The offer of rapid antigen tests for Covid in the SUS could have been greater if the Ministry of Health had made the purchase of 14 million tests in 2021, whose process began in March and dragged on for more than five months until it was cancelled.

With the rise of the omicron variant, some cities now face a shortage of tests — both in health centers and in pharmacies or laboratories.

The process of acquiring these exams was marked by internal failures and “comings and goings” between two departments of the ministry in the preparation of documents for the electronic auction, which was never opened.

The case was investigated by the TCU (Union Court of Auditors), which verified “slowness” in this and other processes of purchasing urgent supplies to combat Covid (such as medicines and lung fans).

The control body also stated that the ministry’s servers were unaware of the internal procedures for carrying out electronic auctions, according to a report from the technical area published in December.

In the case of the 14 million rapid antigen tests, the ministry informed the court that the purchase was suspended because another acquisition process had begun, this time with Fiocruz, to acquire 60 million units.

However, for experts heard by Repórter Brasil, the country should have acquired more tests to execute a mass testing plan.

The Ministry of Health even promised in May last year that it would send between 10 and 26 million antigen tests. monthly to the states, with the aim of implementing a mass testing program, scheduled to start in September.

But without holding the auction and depending solely on Fiocruz, the goal was not reached. The folder was only able to distribute around 30 million units throughout the year — enough to test just 14% of the population once.

In the report, the technical area of ​​the TCU also highlighted that the Ministry of Health took 11 months to present a mass testing plan to the court, which only took place in September.

“The pace for approval of the testing program, as well as the acquisition of tests, is characterized by being slow, which ends up weakening the priority that the action needs to have within a pandemic scenario”, says the document.

Minister Vital do Rêgo, rapporteur of the process, highlighted in his vote “the need to promote mass testing of the population, with emphasis on increasing the number of tests applied” and on genomic surveillance to identify new variants. Such measures would be pillars, along with vaccination, for the return to social life, in the minister’s assessment.

“Brazil, despite occupying the third position in the ranking of infections by Covid-19, is only in 125th place when it comes to the proportion of tests per million inhabitant”, said the minister in December, when we had the mark of 615,000. killed by the disease.

To date, the country has failed to implement an adequate testing program, according to experts.

“The government always thought that it would not need to invest in tests, that the pandemic would end soon. They underestimated the importance of making a diagnosis. This could only be done with a much larger amount of distributed tests”, says the doctor and public health lawyer Daniel Dourado, researcher at Cepedisa/USP and at the University of Paris.

“The Ministry of Health does not invest in testing, either antigen or any other. It only uses the test as an assistance, without understanding the role of testing in controlling the pandemic. Saying that they started late [a enviar testes de antígeno] it would be a compliment. The truth is that they never started”, criticizes epidemiologist Pedro Hallal, from the Federal University of Pelotas.

luxury item

Because they are cheaper than RT-PCR tests (gold standard to detect Covid), easy to use and with reliable results in 15 minutes, antigen tests have become an important tool for the initial diagnosis of suspected cases, quickly allowing the isolation of the contaminated, reducing the transmission of the coronavirus.

The offer of these tests, however, is concentrated in private services, with a greater offer for those who are able to pay around R$ 100 (or more) for an exam.

“Brazil has never had a decent testing policy, capable of slowing down the pandemic. In this scenario, antigen tests have become a luxury for those who can afford it”, says Hallal.

From the second half of 2020, when the technology emerged, until the end of 2021, private manufacturers sold 69 million units in the country, according to the CBDL (Brazilian Chamber of Laboratory Diagnosis) to Repórter Brasil.

The main customers were from the private market, such as pharmacies, laboratories and hospitals, in addition to state and municipal governments.

The Ministry of Health, the main buyer for the public network, only started to acquire the tests in 2021. In all, the ministry received about 44 million units over the past year —3.2 million through PAHO (Pan American Health) and 41 million from Fiocruz, according to the institutions. Of the total, around 30 million were distributed in 2021.

“The offer [dos testes] meets more a market rule than the public interest”, says Claudio Maierovitch, sanitary doctor at Fiocruz Brasília and former president of Anvisa, regarding the low supply in the SUS.

The high demand in the private network caused pharmacies in São Paulo to suspend the schedule for carrying out Covid tests due to lack of stock. Abramed (Brazilian Association of Diagnostic Medicine) started to recommend carrying out tests only in more severe patients, as well as hospitals and laboratories in the capital.

But at this point, tests should be widely available not just to those who have symptoms, but to everyone who suspects they are infected, says Maierovitch. “The best thing health services can do is identify who has the virus and take preventive measures.”

Amid the risk of shortages, the government is now rushing to send more tests to the states. On Friday (14), the distribution of 15 million antigen tests began — another 13 million should be sent by the end of the month. Repórter Brasil has sought the folder several times since January 5th to deal with the acquisition of exams, but so far there has been no response.

Health Minister Marcelo Queiroga said on Tuesday (11) that he will only acquire new tests when there is a guarantee that the current stocks are used.

“I cannot come and buy 300 million tests without the guarantee that these tests will be carried out there at the end”, he said in an interview with CNN Brasil.

Another criticism that specialists make is related to the fact that the government has not released self-tests, a type of examination that is performed by the patient himself, without the need for a professional.

The self-test is vetoed today by Anvisa regulation, but the norm contains a loophole that allows the release of this exam, as long as the Ministry of Health draws up a public policy for its use – which has never happened since the beginning of the pandemic, almost two years ago. . This request was made only last Thursday (13).

“The self-test could have been thought of earlier, as it has been adopted in other countries for a long time,” says Dourado, suggesting that the tests be distributed directly to the population, as is the case in France and the United Kingdom.