The Covid-19 pandemic has hampered the application of all vaccines in the children’s calendar, such as those that protect against meningitis, whooping cough and measles. What experts recommended, then, was to reinforce vaccination campaigns, to encourage mothers and fathers to take their children to take the doses even with the difficulties brought by the coronavirus.
But the government of President Jair Bolsonaro (PL) did the opposite: it cut more than half of spending on vaccination advertising, according to unprecedented data obtained by Repórter Brasil via the Access to Information Law.
The result? A historic drop in the immunization of children and adolescents in 2021, with the worst vaccination coverage in more than 30 years. And, along with this picture considered an “absurd setback”, comes the risk of the return of diseases eradicated years ago, such as infantile paralysis (polio).
Last year, the Ministry of Health spent BRL 33 million on just two campaigns (flu and multi-vaccination), a reduction of 52% compared to 2020, when BRL 69 million were spent on influenza, measles, polio, general vaccination and yellow fever.
The cut is even greater compared to 2017, when the PNI (National Immunization Program) invested R$97 million in five campaigns: hepatitis, yellow fever, multi-vaccination, flu and HPV. The values ​​were corrected for inflation.
“I hear people saying that there is no longer a vaccination campaign. But every year there is. What there is no longer is communication”, criticizes Isabella Ballalai, vice-president of SBIm (Brazilian Society of Immunizations).
Communication actions include advertising campaigns on radio, TV and internet, in addition to billboards, posters, folders, booklets and educational materials, distributed in health clinics and places of great circulation, such as public transport.
The advertising cuts couldn’t come at a worse time. That’s because the country has been facing a persistent reduction in childhood vaccination rates — a drop that started in 2016 and that has worsened since 2019.
“Today’s coverage is at the level of 1987. This is an absurd step backwards”, says Ballalai.
Among the biggest drops is that of the MMR vaccine (against measles, mumps and rubella), which in 2015 reached 96% of children, but in 2021 it dropped to 71%; pentavalent (diphtheria, tetanus, whooping cough, hepatitis B and hemophilia B), which dropped from 96% to 68% in the same period; and poliomyelitis (or infantile paralysis), which ranged from 98% to 67%, according to PNI data in DataSUS — the 2021 figures are subject to review.
Another serious point that stands out in the data obtained by Repórter Brasil is the total absence of campaigns for the HPV vaccine since the beginning of the Bolsonaro administration. The immunizer, which prevents cervical cancer, is intended for girls aged 9 to 14 years and boys aged 11 to 14 years, but never reached the goal of vaccinating 80% of this public.
“There is a myth that the HPV vaccine stimulates sexual activity. But this theory, which is false, seems to be prevailing among ministry managers”, says epidemiologist Carla Domingues, who coordinated the PNI from 2011 to 2019.
With low vaccination, the fear today is the return of diseases considered under control, such as polio. In recent years, the setback has already caused outbreaks of measles, yellow fever and whooping cough in Brazil, as well as cases of diphtheria and meningococcal disease, according to Ballalai.
She points out that the fault is not of fathers and mothers, but of the Ministry of Health. “There’s no way to criticize the population if the ministry doesn’t invest more in communication [acerca das vacinas] of the NIP”.
To recover coverage and prevent new outbreaks, communication should play a central role in the government’s strategy, as one of the reasons for low vaccination is the fact that the population has forgotten about the damage caused by the diseases.
From 1980 to 1994, when childhood vaccine target diseases caused hospitalizations and deaths, such as polio and measles, vaccination rates grew steadily, according to SBIm data. In the following years, Brazil experienced a period of high vaccination coverage, until it began to fall in 2016.
“The main lever that drives the population to get vaccinated is the perception of risk. For many years, Brazilians saw diseases up close and worried. But, little by little, this memory begins to disappear, coverage rates fall and outbreaks happen”, says the vice president of SBIm.
“It needs publicity all the time. Immunization is not a one-off action. It’s no use campaigning this year and not next year. Every year there are new births and new vaccines to reinforce. It’s an eternal action that cannot be demobilized” , reinforces Domingues.
“Without communication, the population begins to think that vaccination is not so important and puts it in the background, which is exactly what happened.”
Effect of the pandemic
The coronavirus pandemic has also hampered vaccination, according to experts, because of going to health centers or even because of the main message of the beginning of the pandemic of “stay at home”. However, once again, an efficient communication campaign was lacking.
“At the beginning of the pandemic, there was an interruption of routine vaccination for three months. Afterwards, there was no adequate message about reopening the posts. There was a lack of communication from public authorities that there were high risks for the population besides Covid”, says Ballalai.
For the former coordinator of the PNI, the scenario of vaccinating children against Covid is “even more serious”, as not only was there a lack of an awareness campaign on the importance of the vaccine and against fake news, but the ministry itself discouraged the application. of doses, delaying the start of vaccination and spreading the message that the vaccine was “voluntary”, not mandatory.
“The government itself left the population confused,” says Domingues.
The result is that Covid vaccination has not taken off to date — only 39% of children aged 5 to 11 years received the first dose and less than 5% the second, according to Fiocruz.
“Not only was there a lack of positive communication, but sectors of the Ministry of Health embraced the anti-vaccination cause and began to listen to these groups”, says Ballalai.
The Ministry of Health said, in a note, that “it closely monitors vaccine coverage and has worked to intensify strategies to reverse the scenario of low coverage”. He also highlighted that in the last three years he carried out vaccination campaigns against influenza, polio, measles and multi-vaccination to update the vaccination card.
“The folder has also reinforced, together with states and municipalities, the importance of maintaining routine vaccination actions, even during the pandemic”, continues the note.
The agency did not comment on the cut in advertising funds or on the absence of campaigns on HPV.
Reporter Brazil requested the HPV vaccination rates, which are not in the PNI information system, but the folder did not send the numbers. The note only highlights that, from 2014 to 2020, 18.5 million of these doses were applied.
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