Half of Brazilian children did not receive all the vaccines they should have in 2020, according to data from the Ministry of Health | Vaccine

According to the PNI indexes, updated until Monday (7), vaccination coverage is 51.6% for childhood vaccines. Ideally, it should be between 90% and 95% to ensure protection against diseases such as measles (which has an ideal 95% rate), whooping cough, meningitis, and polio.

This year, however, vaccination coverage for the first dose of MMR (which protects against measles, mumps, and rubella) is below 60%. The second dose is below 50%. None of the vaccines provided for in the children’s calendar had rates higher than 60% (see the table below).

The low immunization rate already has consequences: data from the Ministry of Health show that, until the In early August, the country had 7,700 confirmed measles cases. Last year, Brazil lost its certificate of eradication of the disease.

For Isabella Ballalai, pediatrician and vice president of the Brazilian Society of Immunizations (SBIm), the reason for the low coverage is the Covid-19 pandemic, which led people to stay home and not go out to vaccinate their children.

“This situation is repeated all over the world. There was a drop between 30% and 50%,” says Ballalai. The doctor remembers that, Despite the decreases observed in immunization rates in Brazil in recent years, the country continues to have one of the best vaccine coverage in the world.

“This coverage is not just a number. Without vaccination coverage, we are susceptible to all these diseases: outbreaks of meningitis, return of poliomyelitis,” recalls the pediatrician.

“These eliminated diseases are only eliminated with vaccination,” says Ballalai.

The infectologist Raquel Stucchi, from the Faculty of Medicine of the State University of Campinas (Unicamp), estimates that the possibility that the country will achieve ideal vaccination coverage this year is “almost nil”.

“I think it is very unlikely that in 3 months we will be able to recover and achieve that coverage,” says Stucchi.

Last year, the country did not reach the goal of childhood immunization coverage (see video below). The last year in which child coverage reached 90% was 2015.

Professor Túlio Batista Franco, from the Instituto de Saúde Coletiva of the Universidade Federal Fluminense (UFF), in Niterói (RJ), points out political factors as contributors to the low vaccination coverage.

“This reduction in vaccines is certainly already an impact of the lack of coordination that we have in the Unified Health System (SUS),” he evaluates.

“The federal government disorganized the entire technical balance that existed in the Ministry of Health. There were two changes of ministers, and today there is a military minister who does not know aspects of Health, the operation of the SUS machine, and who took him to the technical areas. military that they don’t know either, ”he says.

Raquel Stucchi believes that another problem may be that younger pediatricians, unlike older ones, place little emphasis on the need to keep vaccinations up-to-date. “It was something very emphasized by older pediatricians,” she says.

“Another factor is that, in most families, the adults responsible for the children work and the vaccination schedule is during business hours. This greatly limits access, ”says Stucchi.

The infectologist also points out the anti-vaccine movement as a factor that contributes to the drop in vaccination coverage, but, in the evaluation of Isabella Ballalai, from SBIm, this movement is not so strong in Brazil.

The reasons that lead people to delay the vaccination schedule, according to the pediatrician, are what she calls “three Cs”: confidence, complacency and convenience. If people don’t trust healthcare professionals, for example, they are less likely to get vaccinated (but Brazilians tend to trust vaccines, says Ballalai).

“In Brazil, all the surveys carried out show that at least 90% of Brazilians trust the vaccine. Around 10% sometimes have doubts. And around 4%, 5% do not really want to be vaccinated. This has always existed “, He says. .

For a pediatrician, the two main factors in Brazil are the “C’s” for “complacency” and “convenience”: complacency occurs by lack of risk perception – when people don’t realize the risk of not being vaccinated because they haven’t seen a case of that particular disease in a long time, for example), they can also take time to do it; and if the vaccine is not available the day they go to a health clinic, they tend not to return (convenience).

An Ibope survey published on Monday (7) showed that 72% of Brazilians in classes A, B and C, students only need to return to face-to-face classes after a vaccine for the new coronavirus (Sars-CoV-2 ) being available.

In August, a Datafolha survey found that 89% of Brazilians intend to get vaccinated against the new coronavirus as soon as the vaccine is available.

PNI data show that the Federal District is the federal unit (FU) with the highest rate of childhood vaccination coverage: is close to 70%. They are followed by Tocantins, with 64%, Rondônia, with 61%, and Minas Gerais and Espírito Santo, with 60%.

The worst states were Amapá, with 25%, Maranhão, with 35.5% and Rio de Janeiro, with 36% coverage. Pará also had coverage below 40%.

For infectologist José David Urbaéz, scientific director of the Brazilian Society of Infectious Diseases of the Federal District, the district has a history of good vaccination coverage, and the reasons include the fact that the creation of Brasilia was planned.

This was followed, in the 1980s, by the best public health network in the country, which includes both the hospital part and a network of highly capillarized health centers around Mexico City. Nowhere else is there this network of health posts, which are essential for these immunization policies, ”he explains.

“Starting in the 2000s, it started with a policy of dismantling – in Brazil and also in Brasilia. Human resources began to be lacking – and the training of human resources in immunization is very particular, you have to know the cold chain, transport, storage. People were retiring and there was no replacement. So this whole structure was withering away, which was very strong. It still is, but not even a shadow of what it was, ”says Urbaéz.

He explains that Amapá, the last in the ranking, has a precarious health structure; Maranhão, on the other hand, has the second lowest Human Development Index (HDI) in the country, behind Alagoas, “which points to a precarious health structure,” recalls the doctor.

Rio de Janeiro, on the other hand, “draws attention” for the conditions of the health system, says Urbaéz.

“The economic crisis in the state of Rio de Janeiro, which has been taking place since the middle of the last decade, has a strong impact on public health, which is very, very, difficult, with difficult access. The salary structure is very bad, the infrastructure much more scrapped, although the scrapping disease is widespread ”, he evaluates.