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Once approved, a vaccine against Covid-19 should not be offered to the entire population next year, but only to groups at higher risk of exposure and complications from the disease, the Ministry of Health said on Friday (27).
The ministry is working on the construction of a national immunization plan. A preliminary document is expected to be shared with experts and health secretaries next Tuesday (1).
In recent weeks, the ministry has been talking about starting vaccination for priority groups, such as the elderly, people with chronic diseases and health professionals, but it was not clear if it was thinking of expanding the offer.
“We define targets for vaccination, because we do not have a vaccine to vaccinate the entire Brazilian population. Furthermore, the studies do not foresee working with all age groups initially, so we will not even be able to vaccinate the entire Brazilian population,” he said the coordinator of the National Immunization Program, Francieli Fantinato. He says that among the groups that are not part of clinical trials today are children and pregnant women.
With the agreements already signed so far, Brazil can expect an immunization of at least a third of the population at the end of the first half of the population and more than half of the population at the end of 2021; the amount may increase if new deals are closed. .
The executive secretary of the Ministry of Health, Elcio Franco, said that the offer to specific audiences does not mean that other people will not be protected.
“The fact that certain groups of the population are not immunized does not mean that they will not be safe, because other groups that live with them will be immunized and that way they will not be able to be contaminated,” he said.
He compared the vaccination strategy against Covid-19 with that of vaccination campaigns against influenza, also targeting groups at higher risk of exposure and complications from the virus.
“Our goal is to vaccinate 80 million Brazilians a year, we are not talking about the entire population,” he says. According to him, the same discussion occurs in other countries.
“When we talk about vaccination, the world doesn’t understand that it will have to have a vaccine for everyone. Covax [iniciativa da Organização Mundial de Saúde que acompanha nove estudos de vacinas para oferta aos países] points to 2 billion. It is an ambitious goal, and he does not imagine that there will be a vaccine for all the people of the planet, ”he says.
According to Fantinatto, the definition of the groups must take into account the epidemiological scenario of the country and the indications of the available vaccines.
The Ministry of Health has already signed agreements with the pharmaceutical company AstraZeneca, which develops a vaccine in partnership with the University of Oxford (United Kingdom), and is a signatory of the Covax Facility, a vaccine consortium of the WHO (World Health Organization) .
These agreements, whose investments amounted to R $ 2 billion, foresee the availability of almost 143 million doses even in the first half of 2021: 100.4 million doses from AstraZeneca and another 42 million from Covax.
The agreement with AstraZeneca alone would be enough to immunize 50.2 million Brazilians in the first half. However, with the announcement of the effectiveness of the immunizer with doses and a half, it would be possible to vaccinate up to 65 million in this modality.
However, AstraZeneca admitted an error in administering the partial dose in the tests and should do more studies. The immunization schedule and the efficacy of the drug remain undefined.
The folder also reported that Fiocruz, partner institution of the Oxford vaccine in Brazil, could produce another 110 million doses in 2021, if all goes as expected. To produce it, Fiocruz must first complete the technology transfer process.
The Covax facility has not yet announced a forecast for a vaccine with potential for approval in the first half.
The government also said it is looking for other manufacturers, whose vaccines are in an advanced stage of development, but without purchase forecasts or deals.
In addition to the federal government, the state of São Paulo, through a partnership with the Butantan Institute, signed an agreement with the Chinese Sinovac to produce Coronavac in the country. The agreement foresees 46 million doses, the first 120 thousand of which landed in the country on the 19th. The São Paulo government’s expectation is to receive 6 million doses by December 30.
In 2021, Butantan expects to receive the raw material to fill and label the remaining 40 million doses at the institute itself, thus allowing the immunization of another 23 million Brazilians by the first half of next year.
After a first filling moment, Butantan should start producing the immunizer in a factory that is being built for that, according to the technology transfer agreement. The São Paulo government has not yet released details on the production or vaccination schedule.
Thus, we reached at least a third of the population vaccinated in the first semester (23 million doses of Coronavac plus 50 million of the Oxford vaccine, considering two doses), and more than half of the population until the end, since From the second semester, Fiocruz will produce another 110 doses, for a total of 65 million people.
However, there are still many questions about the duration of protection and even if people who have had Covid-19 should also get vaccinated.
“It is still necessary to monitor the two vaccinated people for longer [nos ensaios clínicos até agora] as for those infected to find out if this behavior is different, but it is possible that this immunity is similar ”, says Esper Kallás, specialist in infectious diseases at the USP School of Medicine.
More recent studies indicate that the immunity conferred by the Sars-CoV-2 coronavirus should last for several months, but vaccines in the final phase of testing will answer the question of whether immunity is conferred either by neutralizing antibodies or by defense cells. , prevents the entry of the virus into the body or only protects against the symptomatic manifestation of the disease.
“Science has shown that the detection of neutralizing antibodies is the best way to know if a person is protected or not. And the vaccines that are being tested so far have generally had a good ability to induce these antibodies. “
The answer about the durability of the vaccine should only come with the so-called phase 4 of real life. Kallás explains that even vaccines considered very good, such as measles, can “lose strength” over time. In this case, a combination of different vaccines, considering the many options available on the market, may be more advantageous.
There are also several studies in the preclinical phase that should begin testing in humans next year. These vaccines, which will come later in the race, can provide different protection. This is the case of the Incor group (Instituto do Coração), which develops a vaccine against Sars-CoV-2 using virus-like particles (VLPs).
Coordinated by Jorge Kalil, infectious disease specialist and former director of the Butantan Institute, these tests seek this more durable protective immunity, and therefore more time must pass before it can move to clinical stages.
The immunizer should also be presented as a drop form with nasal or oral inoculation, a more attractive form especially for transport and distribution logistics.
One of the main obstacles to vaccines that use genetic material is their need to be stored at very low temperatures, down to -20˚C (in Moderna’s case) or even -70˚C (like Pfizer’s). So far, Brazil does not have freezers or vehicles in its cold chain that allow the distribution of these vaccines throughout the country, nor has it presented a plan to do so.
Researchers agree that investing in factories and research and innovation is essential. The existence of factories that are not only producers but also creators of technology has put countries like the United States and China ahead of the race.
“Niaid (from the US government) already had the technology platform. When Covid appeared, they only used the genetic material to develop the (Moderna) vaccine. Ideally, Brazil would have its technological platforms developed and, when a pandemic like this hit, we could act quickly, ”says Kalil.
“The great scientific legacy of the Covid-19 pandemic will be in the production of vaccines,” concludes Kallás.
Criticism of social isolation
The statements about the vaccines were given at a press conference at the headquarters of the folder. At the same meeting, representatives of the Ministry of Health carried out attacks on the defense of social isolation, contrary to what is recommended by other entities in the health area.
They also attributed a reduction in mortality from Covid-19 to what they call “early treatment”; To date, there is no proven treatment for Covid that can be used early.
The group even showed a table that cites two dates: the entry of General Eduardo Pazuello as Minister of Health and the date of disclosure of a protocol that expands the use of chloroquine, a drug also without proof of effectiveness against the disease.
Experts, however, have pointed to other factors for the reduction of mortality in addition to these two points. Among them is learning in the clinical management of patients.
