Abstract

The process of developing Brazil’s COVID-19 immunization plan began belatedly and involved a number of experts, including a technical group responsible for defining priority groups for vaccination. This process was permeated by contradictions between the government and researchers. Finally, on 20 January 2021, the government published an updated version of the plan, which remains limited in scope.

Key words:
Coronavirus infections; Immunization; Brazil

With the publication of the results of clinical trials of immunobiologicals against COVID-19 some months after the start of the pandemic, global efforts intensified to establish trade agreements for the acquisition of the long-awaited vaccine. Within this context, the Brazilian government, albeit belatedly, began the process of developing a national COVID-19 immunization plan. As part of this process, the government invited experts to make up thematic working groups, including researchers responsible for defining priority groups for vaccination based on scientific evidence.

At the same time, Brazil’s Supreme Court was considering a Claim of Non-Compliance with a Fundamental Precept (ADPF, acronym in Portuguese), which is an action brought to combat acts that disrespect the underlying principles of the 1988 Constitution¹1 Brasil. Supremo Tribunal Federal (STF). 30 anos de Constituição. Arguição de Descumprimento de Preceito Fundamental - ADPF [Internet]. Brasília: STF; 2021 [acessado 2021 fev 9]. Disponível em: http://sistemas.stf.jus.br/30anosconstituicao/. As a result of the claim in question, the Supreme Court ordered the government to develop and publish a national immunization plan.

At the time, the Ministry of Health only considered the number of vaccine doses under Government purchase agreements - such as the Oxford/AstraZeneca and Covax Facility agreement, which promised 100 million and 20 million doses, respectively - not fully covering previously established priority groups (approximately 78 million people).

On 1 December 2020, the government issued an official public statement outlining the plan development process, phases and priority groups, which included prisoners²2 Brasil. Agência Saúde. Assessoria de Comunicação do Ministério da Saúde. CORONAVÍRUS. Vacinação contra a Covid-19 será feita em quatro fases [Internet]. 2020. Brasília: Agência Saúde; 2021 [atualizado 2020 dez 4; acessado 2021 fev 9]. Disponível em: https://www.gov.br/saude/pt-br/assuntos/noticias/vacinacao-contra-a-covid-19-sera-feita-em-quatro-fases. This statement provoked a reaction from government supporters, who questioned the inclusion of this group.

It is worth noting that this issue reinforces the social disadvantages experienced by certain population groups, demonstrating how the pandemic has a disproportionate impact on individuals who are more vulnerable from a health, social and/or environmental perspective and bringing historical problems exhaustively reported by studies investigating the social determinants of health to the surface³3 Figueiredo AM, Figueiredo DCMM, Gomes LB, Massuda A, Gil-García E, Vianna RPT, Daponte A. Determinantes sociais da saúde e infecção por COVID-19 no Brasil: uma análise da epidemia. Rev Bras Enferm 2020; 73(Supl. 2):e20200673..

In a meeting with experts on 9 December 2020, the government announced that prisoners would be excluded from the list of priority groups, including only prison system staff. In response to the announcement, consultants from the Technical Group of the “Epidemiological Component of the National COVID-19 Vaccination Roll out Plan” issued a public statement claiming that the Plan was flawed, stating that it was unfeasible in its current form - which included only the two vaccine purchase agreements already established by the government. The statement also highlighted that the national plan should cover all individuals who wish to be vaccinated, recommended the inclusion of all previously established priority groups and reinforced the underlying principles of Brazil’s national health service, the Sistema Único de Saúde (SUS)⁴4 Nota técnica. Considerações sobre vacinação contra a COVID-19 em populações vulneráveis e trabalhadores essenciais. Documento produzido pelo Grupo Técnico do Eixo Epidemiológico do Plano Operacional da Vacinação contra COVID-19. 2020..

Contradicting the Ministry of Health’s decision to exclude prisoners from the Plan, studies and reports suggest that this group should be classified as a COVID-19 risk group, especially considering the most frequently reported diseases among these individuals, aggravated by the worrying conditions in Brazil’s prisons. It is therefore extremely important to develop strategies to interrupt the transmission of COVID-19 with the aim of protecting the health of prisoners, prison workers, health professionals and the public as a whole⁵5 Fundação Oswaldo Cruz (Fiocruz). COVID-19 e a população privada de liberdade [cartilha]. 1ª ed. Rio de Janeiro: Fiocruz; 2020..

In response to the ADPF mentioned above, on 11 December 2020, the Ministry of Health presented a preliminary version of the National COVID-19 Vaccination Roll out Plan to the Supreme Court⁶6 Brasil. Ministério da Saúde (MS). Gabinete do Ministro. Coordenação-Geral do Gabinete do Ministro. Divisão de Análise Técnica de Documentos Oficiais. Ofício nº 1499/2020/DATDOF/CGGM/GM/MS. Arguição de Descumprimento de Preceito Fundamental nº 754; Brasília: MS; 2020.. In an attempt to confer legitimacy to the Plan, the document contained the names of experts without their consent, who only became aware of the new document and the exclusion of certain groups through the news media. These experts immediately expressed their surprise on social media, resulting in the widespread dissemination of the happening. They clarified that, despite the appearance of their names in the Plan, they were not in agreement with the removal of prisoners and education workers from the list of priority groups, given that the Plan presented to the Supreme Court encompassed only teachers, excluding other education staff. The experts therefore confirmed once again that the current Plan was not consistent with the real needs of Brazil’s population.

After these happenings, the government announced the first edition of the National COVID-19 Vaccination Roll out Plan on 16 December 2020, reinstating the excluded groups⁷7 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Coordenação Geral do Programa Nacional de Imunizações. Plano Nacional de Operacionalização da Vacinação contra a COVID-19. 1a ed. Brasília: MS; 2020.. An updated version of the Plan was published on 20 January 2021 (National COVID-19 Vaccination Roll out Plan - 2nd edition)⁸8 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Coordenação Geral do Programa Nacional de Imunizações. Plano Nacional de Operacionalização da Vacinação contra a COVID-19. 2a ed. Brasília: MS; 2021.. It is important to clarify, however, that the new Plan only encompasses around 40% of the country’s population, failing to obtain the number of doses ideally needed to achieve herd immunity. Thus, despite the daily increase in the number of recorded cases and deaths, Brazil has yet to present an effective national immunization plan.

Acknowledgments

We are grateful to the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and to Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (Faperj).

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