Brazil’s Vaccination Drive Finally Begins But Risks Abound

(Bloomberg) -- Brazil had a late start to its vaccination campaign, lagging Latin American peers including Mexico and Argentina. Sao Paulo, which sponsored the only shot available in the country for now, is leading the charge, giving out almost 25,000 doses in the five days since the health regulator cleared two vaccines for emergency use.

The country, one of the hardest-hit by the pandemic, has plenty of challenges ahead -- but also a sturdy public health care system with decades of experience in mass vaccinations that could mean it fares better than it did containing the virus.

Here’s what we know so far about Brazil vaccination campaign:

The Vaccines

Brazil’s government acquired two vaccines: one developed by China’s Sinovac Biotech Ltd, known as CoronaVac, and the booster from Astrazeneca Plc and Oxford. Both have partnerships with local institutions with decades of experience making inoculations -- Instituto Butantan and Fiocruz, respectively -- that will produce the shots locally later this year.

The campaign kicked off with 6 million doses. In total, the government says it has some 354 million vaccines that should be deployed in 2021. The breakdown:

• 2 million ready-made Astra shots bought from India pending shipment
• 100.4 million Astra/Fiocruz shots by July (with imported elements)
• 110 million Astra/Fiocruz shots between August-December (made in Brazil)
• 100 million Butantan/Sinovac shots
• 42.5 million shots via the World Health Organization’s Covax Facility

The government has maintained talks with Russia’s Gamaleya, India’s Bharat Biotech as well as Pfizer, Moderna and Janssen, but there are no agreements to buy shots from any of the companies. A first request to give emergency approval use for Gamaleya’s Sputnik-V shot wasn’t granted by the local regulator.

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Health Minister Eduardo Pazuello said this month the firms don’t have enough doses to supply Brazil, and so the country will have to rely on shots it can make domestically. While some states reportedly tried reaching out to Pfizer directly, the U.S. pharma company said it would only file paperwork for emergency use if the federal government buys the vaccines.

Timeline

Vaccinations with CoronaVac began in Sao Paulo on Jan. 17, minutes after the health regulator cleared the Sinovac and Astra/Oxford boosters for emergency use. Other states began receiving shots via planes and trucks on Monday, kicking off the national campaign -- though mostly in symbolic, small scale fashion.

Public Health System

Brazil’s public health-care system, known as SUS, is widely expected to be prepared for the challenge of a mass Covid vaccination drive. Despite decades of underinvestment, SUS is seen by Brazilian doctors and scientists as the reason the pandemic didn’t completely overwhelm the country.

The system is decentralized and carries out several successful vaccination campaigns each year with about 20 types of shots offered free of charge through 35,000 outposts nationwide. In 2020, even with the virus raging, it managed to deliver flu shots to 90% of the target population.

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Conass, the body that represents state health secretaries, also says local governments have ample expertise with mass vaccinations -- receiving shots from the federal government, organizing and deploying them to cities by road, air or water as needed. With Covid, the health ministry offered additional logistical help to deliver vaccines to harder-to-reach locations, especially in the North of the country.

Wealthier Brazilians can usually also get vaccinated at private clinics and labs at a cost -- though there’s no forecast for when that will happen for Covid-19. Fiocruz is fully committed to SUS, while Butantan has been in talks with other countries, and may eventually supply vaccines to the private system.

Fiocruz says it’s too early to estimate when the entire population could be covered -- shots haven’t even been tested in segments that amount to about 30% of the population, including children and pregnant women. But the institute, which provides a large share of the shots given annually by SUS, says it’s safe to expect 150 million people will be vaccinated against Covid in 2021.

The Hurdles

Both Butantan and Fiocruz are having trouble getting the active pharmaceutical ingredient they need to make the boosters from China. IFA, as its known in Portuguese, is essentially the vaccine itself, minus any fillers and stabilizers, before it has been put into vials.

Butantan has enough to produce doses until the end of the month, while Fiocruz can’t start production at all without it. There’s no clarity on what’s holding up the cargo, nor when it will be solved. That’s fueled concern Brazil will run out of vaccines soon after kicking off its immunization campaign, leaving even the priority groups unprotected.

Brazil’s Fiocruz Says Vaccine May Be Delayed by Supply Shortage

The government has run into another problem. It arranged to buy 2 million doses of ready-made Astra/Oxford shots from India but the boosters still haven’t been shipped. India left Brazil out of an initial list released this week with countries receiving exported vaccines. On Thursday, the Health Ministry said the shots will arrive on Friday.

On Tuesday, the Health Ministry sent a letter to states and municipalities asking them to stick to the national plan to ensure there are enough doses for the first cycle of vaccinations. The government also struggled to build up an inventory of needles and syringes as global prices soar.

First Dose, Second Dose

The Health Ministry, which is centralizing distribution of the doses from stockpiles in Sao Paulo, left it up to local governments to decide how far to space the two doses of the vaccines. Sao Paulo established a 21-day interval, while in Rio de Janeiro the shots will be given 28 days apart.

The interval recommended for Sinovac’s shot is between 14 and 28 days, while Fiocruz says the best results are seen when doses are given three months apart.

The national vaccination plan set as first priorities health-care professionals, those over 60 years old in assisted living facilities and people with disabilities in the same situation, plus the indigenous population. Each state is also making its own communication campaign in order to get people vaccinated.

Time Matters

With more than 8.6 million cases and 212,000 deaths from Covid-19, Brazil has been among the hardest hit in the world by the respiratory disease. Initial relief in third quarter of 2020 has given way to a second wave with signs that a new, more infectious strain is spreading rapidly.

Brazil Scientists See Signs of New Virus Mutations Amid Outbreak

Just in the past several weeks, the Amazonian city of Manaus ran out of oxygen at several hospitals, killing a handful of patients at ICU units as families scrambled to buy their own tanks and waited in line to try to fill them. Health experts are concerned that similar scenes may play out in other states in the coming weeks.

(Updates with India vaccines in 16th paragraph)