Vaccines and Vetoes: Tracking Brazil's Immunisation Fiasco

Image: Palácio do Planalto via Creative Commons

"Brazil is going through the worst phase of the pandemic."

That sentence has been repeated on Brazilian news for months accompanied by controversial statements from the Brazilian president who insists on minimizing the devastating power of COVID-19. Vaccines recently emerged as the light at the end of the tunnel and the whole world seemed to follow the progress of scientists, hoping to guarantee doses.

This was not the case for the Brazilian government. "It is very clear that the Health Ministry did not believe that there would be a need to vaccinate a large number of people in our country", commented Carla Domingues, former coordinator of Brazil’s National Immunisation Program.

Brazilian President Jair Bolsonaro has repeatedly denied the seriousness of the pandemic and boycotted restrictive measures, despite a death toll of more than 300,000 on 24th March, the second highest in the world after the United States. Bolsonaro is against lockdown measures, even in the face of a collapsing healthcare system and an average of more than 3,000 deaths per day.

Lockdown in Brazil

Duke University professor Miguel Nicolelis, who advised several state governments in combating the pandemic, argues that a lockdown must be decreed at the national level. "We can have the greatest humanitarian catastrophe of the 21st century in our hands," he stated.

However, it does not seem likely that the Brazilian guidelines will change. Bolsonaro has been one of the world leaders who has most vocally denied the effectiveness of population isolation measures in stemming the spread of the virus. On March 3, Bolsonaro guaranteed that, as long as he holds power, there will be no further lockdowns, a measure that he claims “has not worked anywhere in the world”.

Bolsonaro's rejection of lockdown measures contradicts the World Health Organization’s (WHO) recommendations and the broader scientific consensus.

Without support from the federal government, several states have taken measures to try to combat the spread of Covid-19 in their territories. João Doria, governor of the most densely populated of these states, São Paulo, has decreed a total lockdown until at least March 19, halting all non-essential activity.

A call for help

The current severe stage of the outbreak in Brazil is the product of easing restrictions in various parts of the country to coincide with Christmas and New Year festivities. More concerningly it is due to the spread of a new variant detected for the first time in Manaus, Amazonas. Preliminary studies indicate that this mutation, which circulates freely in Brazilian territory, is potentially more contagious than the regular one.

Bolsonaro’s decision to go against medical advice has angered many and his use of reckless denialist rhetoric has even been described as  “genocidal”. In his most recent controversial statement on the pandemic, he said: “We have to face our problems. Stop all this fussing and whining. How long will you be crying?”.

Responding to these controversial comments, Brazilian celebrities - including renowned composers Chico Buarque and Gilberto Gil, Oscar-nominated actress  Fernanda Montenegro, and defender of the homeless, priest Júlio Lancelotti - have asked for “help” in a public manifesto.

“The neglect of vaccination and basic preventive measures, the encouragement of agglomeration and the breaking of confinement, combined with the total absence of a health policy, create the ideal environment for new mutations of the virus and put neighboring countries at risk and the whole of humanity,” reads the document.

Ineffective treatments

Bolsonaro has spent almost a year promoting the use of chloroquine and hydroxychloroquine He ordered the Health Ministry to instruct doctors to prescribe these drugs for mild cases of Covid-19, acquiring doses by enlisting the army’s help in chloroquine manufactureand importing unused supplies from the United States.

But now in 2021, Bolsonaro has changed his tune, backing a new medicine to tackle the pandemic. In March, the president sent an entourage to Israel to obtain large quantities of a nasal spray with no proven efficacy. Bolsonaro has claimed that the drug "has been achieving great success in the treatment of Covid-19 in severe cases", despite the fact it is still in the initial stages of testing. Once again, the Brazilian president is preempting the science to bank on a "miracle" drug just as the few doses of vaccines that the federal government has sent to states and municipalities begin to run out.

Arguably, the president's latest medical obsession reveals his desperate search for a narrative to increase his popularity and regain the confidence of the population after a series of ill-judged decisions: underplaying the pandemic, resisting lockdown measures, boycotting the purchase of vaccines.

The source of the shortages

It seems clear that Bolsonaro contributed to the shortage of vaccines in Brazil at the height of the pandemic. The current modest vaccination campaign shows two things: the hopeful and enthusiastic adherence of the population to the vaccine, and the complete incompetence of the Brazilian government in relation to its immunization plan.

In June 2020, the Health Ministry announced the purchase of 100 million jabs of the AstraZeneca-Oxford vaccine in partnership with Fiocruz, a science and technology foundation based in Rio de Janeiro.

Two months later, Pfizer-BioNTech offered the Brazilian government 70 million doses to be delivered starting in December. The federal government did not respond to the pharmaceutical company. Despite having surpassed the milestone of 100,000 deaths.

In January 2021, a letter from Pfizer to President Bolsonaro was made public, detailing negotiation points for the sale of the vaccine. The Health Minister stated that the unfair terms established by the laboratory created a barrier of negotiation and purchase, referring to points such as the laboratory's exemption from liability for any effects of the vaccine.

The government’s failure to reply “made Brazil stay at the end of the line”, according to Carla Domingues. “Today, we could have vaccines from Pfizer, Johnson & Johnson for delivery in the first half”, she explained.

On December 24, Mexico, Chile, and Costa Rica started vaccinating - all with the Pfizer vaccine. Meanwhile, Brazil was drawing close to 200,000 deaths.

Bolsonaro x CoronaVac

In September 2020, the São Paulo government signed a contract to buy 46 million doses of CoronaVac - vaccine from Chinese pharmaceutical Sinovac Biotech, in partnership with the Butantan Institute, in São Paulo. Former Health Minister Eduardo Pazuello - the third one of four who took office since the start of the pandemic - later stated the federal government would also buy CoronaVac, but the next day, this was denied by the president.

In addition to denying the purchase, Bolsonaro made several criticisms of CoronaVac. He characteristically took to social media, saying: “China's [vaccine], regrettably, there is already a great deal of discredit on the part of the population. Especially because, as they say, this virus would have been born there".

Epidemiologist Denise Garrett lamented the attitude of the president that encourages vaccine hesitancy. “CoronaVac platform is used for years and years of vaccines, it’s a safe vaccine”, she said. In addition, Coronavac is also effective against the Manaus variant, as Pfizer and AstraZeneca vaccines.

Slow Progress

Yet another setback came in January 2021 when Brazil’s Oswaldo Cruz Foundation requested authorisation from the National Health Surveillance Agency (Anvisa) to import two million doses of AstraZeneca from India. But the Indian government feared negative domestic repercussions because it had not even started to vaccinate its own people and withheld the delivery.

Later shipments from China to Butantan of supplies needed to produce CoronaVac were also delayed.

And so as Brazil topped the milestone of 200,000 deaths, with little hope of a way out of the crisis, 45 countries had already started to vaccinate. In the United States, 10 million people had already received at least one shot.

Finally, on January 17, Anvisa approved the emergency use of vaccines from Fiocruz and Instituto Butantan and started administering the imported doses of CoronaVac.

Days later, Minister Eduardo Pazuello promised "an avalanche" of vaccine proposals, citing the 270 initiatives in the world producing vaccines globally as a major source of hope

In February, the Federal Supreme Court authorized states and municipalities to also purchase vaccines if the federal government fails to comply with the national immunisation plan. The National Front of Mayors also announced the creation of a consortium to buy vaccine doses.

Despite Brazil’s extremely high incidence rate and concerning new virus variant, 55 countries are vaccinating at a greater level than Brazil. In practice, until March 10, only 1 in every 100 Brazilians received the two injections, according to Our World in Data.

“If, months ago, if at the beginning, in the middle of last year, when the agreements were made, if when the government made a deal with AstraZeneca, it would also have made agreements with Pfizer, Moderna, or another vaccine, yes, we would be in a much more comfortable situation now”, commented Denise Garrett.

“The lost time is not enough. Because, unfortunately, lives were lost. These lives will not come back”, she added. “But what we can do is ensure that we lose as few lives as possible, that we guarantee these vaccines as soon as possible.”

Despite limited supplies of the Coronavac and AstraZeneca-Oxford vaccines, the delays in delivery and severe shortages caused by the government’s mishandling mean that the majority of Brazilians will not be immunised this year.