Subjects related to vaccines are, perhaps like never before, present in the daily conversations of the Brazilian population since the covid-19 pandemic spread across the planet.
It is precisely in this context, however, that vaccine coverage for other diseases has fallen so far that it reaches the levels of the 1980s. The alarming data was released by the General Coordination of the National Immunization Program of the Ministry of Health at the beginning of this month.
Among the immunizations that plummeted is hepatitis B. Coverage, which reached 79% in 2019, rose to 63.5% in just one year. The BCG vaccine, which prevents tuberculosis, was applied to 3 million people in 2015 and, last year, to 2.1 million.
Although the fall in vaccination coverage has worsened with the coronavirus pandemic, this is not the only cause. The other reasons that may explain this situation and also the perspectives for reversing it are some of the topics discussed with Dr. Flávia Bravo, director of the Brazilian Society of Immunizations.
Brasil de Fato: The data presented on the fall in vaccination coverage are worrying. For polio, for example, a serious disease that causes paralysis, coverage was 98% in 2015 and dropped to 76% in 2020. Can you break down this scenario?
Dr. Flávia Bravo: The National Immunization Program (PNI) is – or was – the body that establishes strategies, vaccination schedules and also the logistics of vaccine distribution.
The PNI was created in 1973 and gradually solidified in a country the size of ours, with a very serious work, including communication, with which it gained the trust of the population.
Each vaccine that has been introduced into the Program has been introduced with care, with good studies of risk and efficacy, and with enough doses to reach everyone equally in any municipality you are in.
To really reduce the burden of disease, reduce mortality, etc., it is necessary to have vaccination coverage. For some vaccines the target is 90% and for most it is 95%. From the 1980s until 2015, we had been achieving this.
Some people might see this data as a consequence of the coronavirus pandemic alone. Perhaps people have gone less to health centers in search of protection from other diseases, for example. But the data really show that this fall in vaccination coverage was already underway since 2015. What are its main causes?
The pandemic was an additional factor to other multiple causes for the drop in coverage. What are the causes? First: program success. People stopped fearing disease. We no longer saw infantile paralysis, measles, whooping cough. When we had this measles outbreak, we had to have training for the diagnosis even for young doctors, who no longer saw measles.
A paradox, isn’t it Dr. Flávia? The very success of vaccines puts the success of vaccines at risk.
It’s a paradox. But then what do you have to do? That’s the other factor. It’s working this out: reminding the population that the only disease actually eradicated from the planet thanks to vaccination was smallpox. So there is a need to maintain coverage for us to remain free from these diseases.
To achieve this, good communication with the population is necessary. We had Zé Gotinha that the current generation of young people or children doesn’t even know who he is, some I’ve heard say they’re even afraid of the figure. And he was a national hero. There was the dirty world campaign – old people will remember!
The lack of fear; the worsening in communication; the growing complexity of the program and calendars; the difficulty of access and availability; population growth.
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The subject of immunization is not part of the serious agenda of any medical or nursing school. There were also changes made by the technical group that works in the vaccination rooms. Nowadays, we use these NGOs a lot or employees who are hired without a public examination. And in a situation that has been worsening due to the lack of manpower.
Are both scrapping and this privatization movement, of bringing Social Organizations into the Health System, also related?
Exactly. So what we saw was this deterioration, for various reasons, of a system that worked well and that was getting worse to the point where we reached the situation we reached in 2020, in which absolutely no vaccine reached the target.
In 2021, according to the last data I saw, coverage is below 50% in all regions. In some regions it is worse than in others, that is, worse: no homogeneity.
Geographical, racial, and class inequalities also appear in these data. The second dose of the MMR, for example, which protects against measles, mumps and rubella, achieved less than 50% coverage in all northern states this year.
Why do you think you have active transmission in Ceará at that time, which was under control? The coverage is stopped and the disease returns.
What needs to be done so that, still immersed in this pandemic context, Brazil can return to the levels of vaccination coverage it had before?
It is necessary to revive the National Immunization Program. The Program was scrapped, it has not had a national coordinator for two months. Actions need to be integrated and planned by those who understand.
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We have experienced technicians. It’s been 48 years of PNI and we were successful for most of that period. Nowadays it is difficult because the impression we have is that the Program is not managing to work.
It depends on planning, communication, logistics, quality information. Is it possible to revert? IT’S. If we manage to rescue the role of the PNI, use the expertise of these technicians who are there, there is the political will to rescue these coverages and take advantage of what the past has taught us.
Edition: Anelize Moreira