Brazil Now Has Vaccines for Only 4% of Priority Groups; Faces Multiple Challenges

RIO DE JANEIRO, BRAZIL – The first batch distributed to states is expected to immunize 2.8 million people. In addition to the import bottleneck, experts recommend negotiation with other vaccine producers.

Despite delays, Brazil has begun to vaccinate priority groups against Covid-19 in several states, but it is still facing a major challenge to increase the amount of doses required to enable mass immunization.

The first batch that began to be distributed on Monday, January 18th, should be enough to vaccinate only 2.8 million people, with the recommended two-dose protocol, according to estimates by the Ministry of Health, which considers in its calculation the portion that may be lost as a result of problems during the logistics operation. This corresponds to 4% of the 68.8 million people in the priority groups established in the National Immunization Plan (PNI), which were reduced at this first stage due to the shortage of doses.

The country is at a disadvantage in the dispute in the global scenario both to purchase the raw materials to produce the immunizers here and to buy ready doses, also from other producers. At the moment, the main bottleneck is importation from China of the raw material for domestic production of the two vaccines already approved by ANVISA, the Butantan/Sinovac and Fiocruz/Oxford/AstraZeneca.

The Ministry priority is to start administering the available doses to elderly people living in nursing homes, disabled inpatients, front-line healthcare professionals and indigenous communities. But this could be adjusted at the state level, which could prioritize one or more of these groups according to local circumstances.

By Monday night, the vaccine had reached ten states, in addition to the Federal District. Vehicles carrying trucks were applauded in some locations, a symbol of hope in the midst of a pandemic that has killed over 210,000 Brazilians and led to the collapse of healthcare systems.

Despite the encouragement of this time with the arrival of immunizers – the first step toward pandemic control – researchers and even the World Health Organization have emphasized that the beginning of vaccination in Brazil should not encourage Brazilians to relax preventive care, such as wearing masks and social distancing. This is because the country is experiencing a worsening of the pandemic and there is still a long way to go both for the country to secure sufficient doses to vaccinate its over 200 million inhabitants and to achieve herd immunity (collective protection against the virus).

Vice-President Hamilton Mourão said on Monday that the country could have 70% of its population vaccinated by the end of this year.

The Ministry of Health estimates to reach 354 million doses in 2021, but relies on doses that are still to be produced. There are existing agreements with AstraZeneca/Fiocruz, the Butantan and the Covax Facility global consortium, which Brazil joined with the lowest possible doses quota to order. But the compliance of delivery schedules, including the doses that will be produced by Butantan and Fiocruz, is dependent on the global scenario of competition for both raw materials to produce the immunizer and the ready doses.

For now, six million doses of the Coronavac are being distributed, approved on Sunday by ANVISA for emergency use. The Bolsonaro Government expects to receive another two million doses of the Oxford vaccine – whose emergency use has also been authorized and which in the coming months should be produced by Fiocruz – but is struggling to secure imports from India.

“There is no positive feedback so far. We are counting on these two million doses so that we can serve the population further,” admitted Minister of Health Eduardo Pazuello, who expects an outcome this week.

Difficulty to import vaccine supplies

The Butantan has already applied to ANVISA for emergency use authorization for another 4.8 million ready doses or being bottled in São Paulo. If on the one hand production in Brazilian laboratories is an important tool, the Butantan and Fiocruz’s difficulty to import the required raw materials from China to maintain production in the coming months and to meet delivery schedules is a concern.

The agreements made by the Federal Government and the São Paulo Government with laboratories provide for technology transfer so that this supply may be produced in the country, but at a later stage, which should only occur in the second half of 2021.

At this time, there is dependence on supplies and worrying delays. Fiocruz is waiting for the arrival of the IFA (Active Pharmaceutical Ingredient) from China to start production. This should occur by January 25th and, should it fail, the contract provides for the delivery of ready doses. Fiocruz’s schedule provides for the delivery of one million doses by February 15th and should reach 100.4 million doses by July.

Butantan has been waiting for days for the Chinese Government’s authorization to ship the raw material to Brazil. According to the Institute’s president Dimas Covas, the available IFA is only enough for this week’s production.

“The Butantan’s production capacity is of one million daily doses, depending on the arrival of the raw material. Capacity has been reached now with the available raw material,” he explained at a press conference. The Brazilian embassy in China was called in to help in the negotiations. Butantan needs the raw material to deliver a total of 46 million doses of the Coronavac to the Ministry by April.

Purchase negotiations need to continue

“What we have today is a drop in the ocean given the magnitude of Brazil’s territory and population,” defines Melissa Palmieri, member of the board of directors of the Brazilian Immunization Society – São Paulo State.

She says that, despite the national production capacity, the country must not stop negotiating the purchase of other types of vaccines given the gravity of the health crisis and factors that may delay national production, such as the lack of raw materials. Virtually the whole population will need to be vaccinated for the country to achieve collective or herd immunity.

Asked about the negotiations to buy 70 million Pfizer vaccine doses, Health Minister Eduardo Pazuello only said that “when the laboratory comes up with plausible proposals, I will be the first to buy it”. He mentioned no plans to purchase other vaccines. The Janssen immunizer, for instance, is pointed out by experts as a good option, should trials confirm efficacy with only one dose, which would simplify logistics.

“For now, we need to work full time to continue negotiations with other laboratories. We can only start to relax when the majority of the population is vaccinated”, says Palmieri. São Paulo Health Secretary Jean Gorinchteyn, who has publicly advocated for the country to purchase more vaccines, agrees.

“We need vaccines for mass immunization. Unless we vaccinate, our healthcare system will remain in chaos. This will only be solved by the impact of vaccination, particularly of priority groups,” he argues.

The vaccine reaches other Brazilian states

The Federal Government distributed the first six million doses proportionally to the population of priority groups in the states. The campaign’s goal is to immunize, with two doses, the 2.8 million prioritized in this phase – which includes elderly people living in nursing homes, disabled inpatients, indigenous communities and about 35% of healthcare professionals in the country.

Following unrest sparked by São Paulo Governor João Doria’s decision to start immunization on Sunday to secure the first picture’s political capital, governors traveled to Guarulhos to symbolically receive the doses in person from Minister Pazuello. The only vaccine available at the moment is the result of an initiative of the São Paulo government, but the doses were purchased by the Federal Government – whose performance was marked by a degree of inertia – after a long ideological battle.

The plan was to start a national campaign on Wednesday, January 20th, but governors pressured to begin vaccinating earlier, given that São Paulo had moved ahead.

Monday was therefore a time of logistical efforts to ensure that immunizers reached the states. Throughout the day, planes and trucks carried tons of doses across the country.

Batches were divided in an attempt to expedite the arrival of the first doses in capitals and metropolitan cities, and some delays were recorded. Rio de Janeiro began to administer the doses at the symbolic Christ the Redeemer.

Governors are now organizing a task force to ensure that the doses reach municipalities in the coming days. Last week several of them had already begun to distribute syringes, needles and refrigerators to inland cities.

The Amazonas state government, which is experiencing an unprecedented crisis in its healthcare system and is also facing major logistical challenges, convened on Monday health authorities from the interior and prepared them for a “long night” to receive vaccines.

Everything was rushed. Only after airplanes took off to distribute the doses throughout the vast national territory, the government published an ordinance determining the obligatory notification of vaccination in their systems.

The administration of doses began before all details of the national campaign were adjusted, although the main strategy had already been discussed with states and municipalities. The Federal Government is still testing a panel to provide online information on the distribution of vaccines and approved doses. But the minimum was set to start vaccination in the country, which has its immunization program as a global reference.

It is estimated that 50,000 health posts will be ready for vaccination when the doses begin to arrive. Municipalities are now the campaign’s main protagonists. They are the ones implementing vaccinations in the farthest regions of Brazil.

Source: El Pais