Sidelining experts, Brazil bungled its immunization plans

FILE - In this Dec. 23, 2020 file photo, a woman participates in a protest against Brazilian President Jair Bolsonaro's handling of the new coronavirus pandemic in Brazilia, Brazil. The country hasn't approved a single vaccine yet, and independent health experts who participated in its immunization program say the plan is still incomplete, at best.

Like many Brazilian public health experts, Dr. Regina Flauzino spent most of 2020 watching with horror as COVID-19 devastated Brazil. When the opportunity to join the government’s vaccination effort came, she was thrilled: She would be able to share her decades of on-the-ground experience.

But her excitement quickly faded. Flauzino, an epidemiologist who worked on Brazilian vaccine campaigns for 20 years, became frustrated with what she described as a rushed, chaotic process.

The government has yet to approve a single vaccine, and Health Ministry officials have ignored outside experts’ advice. Shortly after the government presented its vaccination plan, more than a quarter of the roughly 140 experts involved demanded their names be excised.

“We weren’t listened to,” Flauzino told us. The plan’s creation “was postponed for too long and now it’s being done in a rush.”

Brazil has suffered more than 200,000 COVID-19 deaths, the second-highest total in the world after the United States, with infections and deaths surging again. Despite a half-century of successful vaccination programs, the federal government is trailing regional and global peers in both approving vaccines and cobbling together an immunization strategy.

We interviewed four expert committee members and four former Health Ministry officials. They criticized the government’s unjustifiable delay in formulating a vaccination plan, as well as months spent focused on a single vaccine manufacturer.

They also complained of President Jair Bolsonaro undermining the ministry’s effectiveness, pointing to the removal of highly trained professionals from leadership positions, who were replaced with military appointees with little or no public health experience. Experts also blamed the president, a far-right former army captain, for fueling anti-vaccine sentiment in Brazil, compromising the mass immunization effort.

The government’s COVID-19 immunization plan, finally released on Dec. 16, lacked essential details: How many doses would be sent to each state and how would they be refrigerated and delivered? How many professionals would need to be hired and trained — and, above all, how much funding would governors receive to implement the campaign? The plan did not include a start date.

“How is each state going to organize its campaign if it doesn’t know how many doses it is going to receive, and the timeline for delivery?” said Dr. Carla Domingues, an epidemiologist who oversaw the logistics of Brazil’s 2009 H1N1 vaccine campaign, and worked on more than a dozen other vaccination efforts.

Bolsonaro’s press office and the Health Ministry did not respond to our requests for comment about Brazil’s vaccination campaign or why more contracts with vaccine manufacturers were not signed in 2020.

The Health Ministry’s National Immunization Program has a long history of success. Created over 40 years ago, it has enabled Brazil to eradicate polio and significantly reduce measles, rubella, tetanus and diphtheria. The effort won recognition from UNICEF for reaching the vast country’s most remote corners and has contributed to extending Brazilians’ life expectancy from 60 to over 75 years.

The program “is the central axis of all vaccination campaigns in the country,” Flauzino said.

That is no small task in a nation of 210 million people, the world’s sixth-largest population. The program provides a complex blueprint for vaccination campaigns across more than 5,500 municipalities in 26 states and the federal district.

In a Dec. 1 Zoom meeting, Health Ministry officials presented the experts with a general overview of the COVID-19 vaccination plan. The consultants we interviewed said it became abundantly clear the ministry was incapable of providing many crucial details.

Epidemiologist Dr. Ethel Maciel, who was among those who later demanded her name be removed from the plan, said many of the experts’ recommendations weren’t implemented, including obtaining vaccines from more than one manufacturer. But neither she nor other consultants could voice their concerns.

“They didn’t let us talk during this meeting, our microphones remained on mute,” Maciel said, adding that officials instructed them to send their comments in writing, and that they would receive a response within a week.

“To this day, we’re still waiting,” she said.

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