RIO DE JANEIRO, BRAZIL – Although the coronavirus is starting to signal that the number of infections in Brazil is multiplying at a slower rate, it still causes 1,000 deaths and around 50,000 infections per day.
But the outbreak’s virulence, the second worst in the world after the United States, has yet another impact. It is one of the factors that have turned Brazil into an attractive laboratory for scientists and companies involved in the frantic race to achieve a Covid-19 vaccine. Four of them are being tested in this continental-size country with 210 million inhabitants.
President Jair Bolsonaro’s repeated sabotaging of state governors’ initial efforts to contain the virus has caused a health crisis in which the states have long since stopped acting in concert. The result is 114,000 deaths and over 3.5 million people infected since the first case was detected just after Carnaval in late February. These are significant numbers, although the lack of massive population testing suggests that underreporting is very significant. According to official figures, the death rate is lower than in several countries in the region and in Europe.
Demand
The country is a much sought-after test population because, apart from the virus that has been rapidly spreading for months, it has a well-established Public Health System (SUS) that administers extensive national vaccine programs, prestigious biomedical research institutes, and has secured thousands of volunteers willing to be administered the vaccine (or a placebo). According to one source, Brazil is capable of producing 500 million doses of the vaccine per year.
One million people have registered on the Internet as volunteers to test vaccines, although not all meet the requisite criteria. Only healthcare workers who work directly with Covid-19 patients and who have not been infected in recent months are eligible. But the number of applicants is indicative of the level of enthusiasm.
This week, an agreement was announced to test a fourth experimental vaccine, the one developed by Janssen, the Johnson & Johnson pharmaceutical company, with 7,000 volunteers who will be recruited from two dozen research centers spread across several Brazilian states.
This initiative is added to the two sets of clinical trials already underway: the vaccine developed by Oxford University and the AstraZeneca company, now in its final testing phase with 5,000 volunteers in Brazil; and that by Chinese pharmaceutical company Sinovac, with 9,000 subjects. The two are being conducted at several points in a territory that is twice the size of the European Union and where the virus moves at different speeds. A third vaccine, developed by US pharma giant Pfizer, will be tested in 1,000 healthcare professionals in the state of Bahia.
Infectologist Nancy Bellei details the reasons why Brazil is a good laboratory, even better than the United States. “We have one of the best vaccination programs in the world; immunization is widely accepted by the population. In addition, we have experience both in public-private partnerships to produce them, and in technology transfer and clinical trials,” says the Federal University of São Paulo (UNIFESP) Professor who is involved in the Oxford trial. She says she is part of the group of doctors in charge of testing volunteers who become sick after being administered the experimental vaccine against Covid-19 (and who use it as a placebo, for meningitis in this case).
Political and scientific rivalry also explains why Brazil hosts four different clinical trials but does not rule out hosting several others. Rulers and scientists alike want to have their own. So, as countries race to be the first to find, market and distribute the vaccine, within Brazil itself, there is a race between politicians, on the one hand, and the main research centers, on the other.
In this context, the clash between Bolsonaro and state governors – such as those of São Paulo and Bahia – over what is the most effective way to manage the disease (and its economic consequences); and the rivalry between two scientific institutions founded at the start of the 20th century: the Butantan Institute, dependent on the São Paulo state government and manufacturer of most of Brazil’s vaccines, and the Fiocruz Foundation, based in Rio de Janeiro and linked to the Federal Executive.
The expert points out two other reasons that in her opinion weighed in choosing Brazil: it has a good vaccine distribution system, reaching its farthest corners, where there is no shortage of volunteers to take part in the trials. “There is a waiting line to volunteer,” says the infectologist before recalling that “when the H1N1 (swine flu) epidemic arose, people queued at dawn to be vaccinated.” The anti-vaccine movements also reached Brazil, but here they are not as strong as in countries like the United States.
Uncoordinated political management
The disorderly political management of the health crisis triggered by the coronavirus is a catastrophe for many professionals in the National Health System, the largest public health network in the world, which has been intimately involved in the battles against zika, yellow fever, dengue and AIDS.
“If everything works out, we will have a vaccine in Brazil for the priority groups in the first quarter of 2021,” says Ricardo Palacios, medical director of clinical research at the Butantan Institute. “We should have some effective preliminary study before the end of the year. This is absolutely incredible considering we learned about the novel coronavirus in the last days of 2019. It’s something new and it shows that the global coordination of scientists is working,” highlights the researcher.
Preference agreements with pharmaceutical companies
The agreements signed by Brazilian authorities give them preferential rights. The companies have committed to sell them tens of millions of doses of their vaccines. The agreement with Sinovac requires the Butantan Institute, which depends on the São Paulo state government, to invest US$16 million (R$89 million) in research. In exchange, it will be provided with enough doses to vaccinate 60 million people, an amount much larger than the state’s population.
The federal government’s investment with AstraZeneca implies the payment of US$100 million (R$ 558 million) in exchange for 30 million doses even if the trials fail. If they are successful and achieve efficient immunization, the Bolsonaro government will have priority in buying a further 70 million doses, although that is not sufficient to vaccinate the country’s entire population.
In early August, Bolsonaro announced that the Brazilian government had set aside R$1.9 billion to process and produce the Oxford vaccine.
Brazil recently received the first good news since the start of the pandemic. The latest report from Imperial College London on the speed of contagion places it below one, meaning that each infected person transmits the disease to less than one other person, so its spread is slowing. The Brazilian regions of greatest concern are the South and Midwest, with four states where deaths have doubled over the past month.
However, the situation has stabilized in the most populous states, São Paulo and Rio de Janeiro, where normality is advancing, movement is returning and companies and businesses are reopening with some restrictions. Schools and museums remain closed. The situation has also improved in the North and Northeast, the regions where the coronavirus has proportionally caused greater damage because the healthcare network is much more fragile.
Source: El País