The vaccination campaign in Brazil suffered problems since before its beginning and is now facing a steep slowdown. High international demand for doses, shortage of vaccine inputs and local obstacles have been preventing the nation from reaching its full vaccination capacity. At this pace, the country has a higher risk of facing new waves and strains. However, a better scenario can emerge with the completion of the campaigns in other nations and the approval of new vaccines by Brazilian authorities.
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THE PACE OF NATIONAL VACCINATION PROGRAM (PNI)
The National Vaccination Program (PNI) officially started on January 18th. Until May 31st, the country managed to vaccinate 11% of the population with only the 1st dose and 10,4% with the 2nd dose. The PNI, which will complete 4,5 months this June, has at its disposal 3 vaccines (CoronaVac, Oxford, Pfizer), a fourth (Janssen) has been approved for emergency use, but not acquired, and two other are under analysis. Despite this progress, since April the program has been showing structural problems that have reduced the hopes of accelerating the rate of vaccination, which is well below national capacity.
According to Our World in Data, during the in the 3rd week of April, the country has reached a total of 784.000 doses administered per day. However, in the first two weeks of May, that average plummeted. First to 415.000 shots per day, then, during the second week, to 280.000 shots.
Another way to monitor the progress of the PNI is through the number of vaccines already administered, and Brazil has already been in the top 5 positions in terms of total number of administered doses. By the time of the slowdown, on May 15th, Brazil had 52,64 million vaccines administered and it was at the 5th global position. However, when the comparison of the total shots given takes into account the size of the population of each country, Brazil appears quite behind, at 83rd position.
The country’s underperformance becomes clearer when the national capacity is assessed. The Health Ministry states that the Brazil has the structure to vaccinate 2,4 million people per day. Though, since the beginning of the PNI, the mark of 1 million vaccinations within 24 hours was only surpassed 3 times. A recent study from the Juiz de Fora Federal University (UFJF) indicates that to control the pandemic in a year, Brazil has to vaccinate 2 million per day.
THE PNI’S OBSTACLES
Several factors can explain the PNI’s current situation. According to some critics, such as senators in the Covid’s CPI, the problems started in 2020. At that time, the federal executive power would have refused vaccine proposals from Pfizer, bet everything in the AstraZeneca and attempted to boycott the CoronaVac supported by the Governor of São Paulo. Moreover, these critics also argue that the government changed its mind when it was too late. For them, this made Brazil fall behind in the global run for vaccines.
Even though Brazil acquired the Pfizer vaccine recently, the country is still strongly dependent on the AstraZeneca and the CoronaVac which can be produced locally. On top of that, China, the supplier of the CoronaVac and an important supplier of components for both, has declared difficulties to keep up with the international demand. India, important producer of the AstraZeneca, is currently under a great crisis and it is focused on using its production for internal use.
The factors above paved the way for the shortages of CoronaVac and AstraZeneca inputs (IFA) in the last month. Due to lack of ingredients, the Butantan has suspended the production of the CoronaVac doses since April. After that, several cities across the country suffered without supplies to administer the 2nd dose. For the same reason, the Fiocruz paralyzed the production of AstraZeneca on May 20th.
In addition, there is a lack of guidance of citizens and health professionals that may also explain the high number of people that are missing the administration of the 2nd dose. Until May 25th, Rio de Janeiro state alone had more than 750.000 people vaccinated with the first dose who did not attend their meeting for the administration of the 2nd dose. There is also the waste of doses due to lack of procedures and standards and, in particular, by health workers because of inadequate use of syringes.
WHAT CAN BE EXPECTED?
Under the current condition, Brazil runs the risk of dragging its vaccination campaign for a long period. If no improvement is seen, the chances of new waves and of the appearance of stronger strains increase.
On the other hand, in the mid-term, the country can benefit from the completion of the vaccination campaigns in other nations. Thus, the demand tends to reduce and producers might be able to deliver more doses to Brazil. Eventually, Covaxin and Sputnik V can also be approved for use, increasing the number of vaccines available. Moreover, the release of ButanVac, a locally developed vaccine, can also help Brazil to cope with new strains by making it easier to adapt the formulas.
Still, specialists say that, for the moment, the preventive measures will play an important role and can be in force for a long period, maybe for 1 or 2 years. Even after that, it is likely that Covid-19 will not vanish and can become endemic, making annual vaccination campaigns necessary.
