Queiroga’s plan to label Covid as endemic poses a risk to vaccines

The Minister of Health, Marcelo Queiroga, wants to start considering Covid as an endemic disease by the end of March, but the plan is incipient and faces doubts about the impact of the change in status on vaccines with emergency use records.

According to members of Saúde, Queiroga’s idea is to find a way to defend the end of restrictions against the virus, such as the mandatory use of masks.

The measure would still be a new nod to President Jair Bolsonaro (PL), according to an assistant to the minister. Queiroga has bet on pleasing the government’s base of supporters to hold on to the position.

The Health team should only address the issue after Carnival. In preliminary discussions, Queiroga’s assistants are still trying to decipher the minister’s will, but already assess that the change may require revoking or altering the February 2020 Health Ordinance that declared Espin (Public Health Emergency of National Importance).

This measure would not only have the impact of reinforcing the minister’s speech that the government has given a firm response to the pandemic, as the ordinance supports a series of actions taken in the crisis.

The most sensitive of these is the emergency authorization for the use of vaccines and medicines. According to the current rules of Anvisa (National Health Surveillance Agency), this type of endorsement that was given to Coronavac and to the immunizing agent from Janssen, for example, ends when the ordinance is revoked.

To avoid this inconvenience, the minister’s assistants believe that one way out is to publish a transitory instrument to recognize that the disease has lost strength, encourage the reduction of restrictions, but leave room to maintain the emergency use of vaccines.

Members of Health will also measure whether the change or repeal of the ordinance also prevents the continuity of other actions released in crisis situations, such as hiring without bidding and the issuance of extraordinary credits, which are not computed within the spending ceiling.

“Certain contracts were made during the duration of the pandemic. Can vaccines that have emergency registration continue to be used outside the pandemic character? (22).

This is not Queiroga’s first attempt to reduce restrictions against Covid. He had planned to release a document recommending waiving the use of masks by Christmas 2021, but the emergence of the omicron variant ended the plans.

In a note, Saúde said that “it will evaluate the measure in due course, always considering the epidemiological scenario and the behavior of the virus in Brazilian territory”. He also stated that other ministries and competent bodies will participate in the discussion.

Members of the portfolio say that epidemiological, economic and territorial factors will be considered before the decision. The impact of Carnival parties will also be seen.

The governor of São Paulo, João Doria (PSDB), should announce the easing of the use of masks after Carnival. It is not yet defined whether they can be dispensed only when the person walks outdoors or in all environments, as shown in the Mônica Bergamo column.

SUS managers, however, consider it premature to open the discussion on treating Covid as an endemic disease and reducing restrictions.

For Carlos Lula, president of Conass (National Council of Health Secretaries) and Health Secretary of Maranhão, this is not the time to talk about ending the public health emergency. He stated that the moving average scenario of more than 800 deaths per day is unfavorable.

“We can’t think it’s over, it’s not over yet [a pandemia]”, said Lulu.

Vice President of Conass and Secretary of Health of Espírito Santo, Nesio Fernandes added that there is no epidemiological support to decree the end of the pandemic. He also said that it is necessary to wait for the behavior of the subvariant of the omicron, in addition to the period of highest incidence of the flu to make any decision.

Fernandes stressed that opening a speech to end the pandemic can also hinder communication and the mobilization of the vaccination campaign, which still needs to move forward.

“We are talking about the campaign of multiple doses being applied to people. To get a high degree of adhesion from society, it has to understand that there is a pandemic situation. If people think the pandemic is over because the status has changed, many of them leave to take the vaccine thinking there is no need.”

For Adriano Massuda, physician, professor at FGV (Fundação Getulio Vargas) and former executive secretary of the Ministry of Health, the transition from the disease to an endemic disease must be planned.

“When political, partisan and electoral interests take precedence over the toilet, it hinders the process of exiting the pandemic”, said Massuda.

The professor said that it is necessary to pay attention to the repressed demand for SUS services for other diseases.

“The right thing would be to have a plan, goals, monitor testing indicators, vaccination coverage, number of hospitalizations and deaths,” he said.

Earlier this year, some countries, such as the United Kingdom and Denmark, decided to consider Covid-19 as an endemic disease and relax restrictions.

In a bulletin on the pandemic released on the 9th, the Covid-19 Fiocruz Observatory states that the transition from pandemic to endemic does not mean the elimination of the virus. In general, the disease becomes endemic when it is recurrent in a region and there is no unexpected increase in cases.

“This change does not represent, in any way, the elimination of the virus and the disease, nor the reduction of the adoption of individual and collective protection measures”, states the document.

According to the Observatory, the classification of “endemic” can only be thought of after the drastic reduction of transmission by the new variants and through a worldwide vaccination campaign.

WHO Director Tedros Adhanom Ghebreyesus said on 12 February that the “acute phase” of the Covid-19 pandemic could end this year if a vaccination rate of 70% of the world’s population is reached.

“Our expectation is for the end of the acute phase of the pandemic this year, provided that 70% of the world’s population is vaccinated by the middle of the year, around June or July”, declared the director-general to the press, during a visit to Africa. of the South. “It’s in our hands. It’s a matter of decision.”