Pandemic and Vaccination in Brazil

Since March 2020, the pandemic has guided discussions and the political agenda around the world. In Brazil it was no different. Last year, federal, state and municipal governments, as well as the National Congress, developed measures to prevent the spread of covid and minimize its economic effects. In 2021, with the start of vaccination, efforts are focused on expanding the supply of immunizing agents. Thus, this article presents an overview of the pandemic in Brazil, especially considering the year 2021, the vaccination process and the new management of the Ministry of Health, from March 2021, with the appointment of Marcelo Queiroga.  

Pandemic in Brazil

In recent weeks, bed occupancy rates in the Covid-19 ICU for adults in the Unified Health System (SUS) and mortality rates have fallen. In the last week, for the first time since the beginning of December 2020, no state has a bed occupancy rate higher than 90%. However, the transmission rate is on the rise and at a level much higher than that observed in mid-2020. After more than a year of the declaration of the pandemic, social isolation measures have less and less commitment and vaccination becomes even more important in the fight the disease. With vaccination, the number of deaths and hospitalizations decreases among risk groups or priority groups. At the same time, transmission remains intense among those who have not yet been immunized.

Vaccination

Vaccination in Brazil started at a slow pace and faced resistance from the government itself to advance. The first semester of vaccination was marked by discussions of legislative proposals related to the vaccination process, by changes in the command of the Ministry of Health, by difficulties in importing supplies for vaccines and negotiations to advance contracted doses for the second half of 2021.

Even with these difficulties, still present, Brazil ended the month of June surpassing the mark of 100 million vaccines applied. The Minister of Health, Marcelo Queiroga, says that by September the entire Brazilian population over 18 years old will have received one dose of vaccine and by the end of the year, both doses.

To achieve this goal, it is necessary to triple the amount of doses that has been applied so far. According to information from the Ministry of Health, this amount of doses would already be guaranteed. If the laboratories meet the deadlines agreed with the organ, in December there will be more than 300 million doses left. Until then, it may be necessary to vaccinate adolescents between 12 and 18 years old, give a booster dose to the elderly and health professionals or even save doses for 2022.

On the other hand, Brazil continues as the second country in the world in number of deaths, behind only the United States. In terms of number of contaminations, Brazil ranks third in the world ranking, behind the United States and India. Nationally, six Brazilian states surpassed the mark of 1 million contaminations: São Paulo, Minas Gerais, Rio Grande do Sul, Paraná, Bahia and Santa Catarina.

Vaccine delivery projections can be found in this link updated weekly by the Ministry of Health.

In this page, it is possible to follow the data related to the vaccination process.

Executive power

The federal government's management of the pandemic is marked by polarizations and disagreements on prevention and vaccination measures. In 2020, President Jair Bolsonaro downplayed the seriousness of the disease and criticized mayors and governors for adopting social isolation measures, arguing that the economic losses resulting from these measures would outweigh the damage that the disease could cause. In addition, the president started defending theses such as “herd immunity” and “early treatment”.

In 2021, the pandemic in the country reached even more serious levels, with episodes of collapse of the health system as occurred in February in Manaus. This scenario, added to the difficulties of advancing vaccination, placed the government in a situation of strong criticism and popular dissatisfaction.

To try to alleviate the situation, the government changed strategies to fight the pandemic. The president started to speak out less and Eduardo Pazuello left the command of the Ministry of Health, and gave place to Marcelo Queiroga, physician and former president of the Brazilian Society of Cardiology. The name was well accepted, especially by the Legislative Power, which trusted that the new minister would mark a new phase in the portfolio, aimed at expanding vaccination.

The president, on the other hand, oscillates between moments of few pronouncements and controversial statements. Last month, for example, he again defended that coronavirus contamination would be more effective than vaccines against the disease. Statements were also made against China, the country responsible for sending supplies necessary for the manufacture of vaccines, and against the effectiveness of Coronavac.

Ministry of Health

Since his appointment, Marcelo Queiroga has prioritized the fight against the pandemic and the expansion of the vaccination campaign, but appears to face ideological obstacles and issues related to the previous administration of the ministry.

The minister created the Extraordinary Secretariat for Confronting Covid-19 to concentrate efforts to fight the pandemic. However, the appointment of the director to the new secretariat was subject to disagreements. Initially, Queiroga had announced the infectious disease physician Luana Araújo as head of the Extraordinary Secretariat. However, the appointment did not materialize and it was aired that the reason would be related to the doctor's criticism of the early treatment advocated by the president.

More recently, the minister had to deal with the repercussions of complaints related to the contract for the purchase of the Covaxin vaccine, signed in February, providing for the import of 20 million doses of the immunizing agent, developed by India's Bharat Biotech. The doses were never sent to Brazil, since the National Health Surveillance Agency (Anvisa) repeatedly denied import requests for the immunizing agent, as it did not meet the technical criteria. After the accusations, the minister decided to suspend the negotiation.

Legislative power

In 2020, the Legislative Power's agenda revolved around the pandemic. Measures such as emergency aid, a budget to fight the disease and economic and sectorial measures were approved to minimize the effects of covid in the country.

In 2021, the fight against the pandemic remained in the focus of Congress, focused especially on the issue of vaccination. Observing the difficulties of advancing the campaigns, several proposals were presented that aimed to contribute to accelerating vaccination. The main discussions and projects within the scope of the Legislative Power during the first semester are highlighted below:

Civil responsability

Authored by the President of the Senate, Rodrigo Pacheco (DEM/MG), Congress approved in March the Bill (PL) 534/2021, which provides for civil liability related to adverse events after vaccination against covid-19 and on the acquisition and sale of vaccines by legal entities governed by private law. Sanctioned pursuant to Law No. 14,125, of March 10, 2021, it guarantees, among other measures, legal security for laboratories in case of delay in delivery or any possible side effects of the immunizing agent.

Purchase of vaccines by the private sector

After the enactment of Law nº 14.125, deputy Hildo Rocha (MDB/MA) presented PL 948/2021, which allows the private sector to buy vaccines against covid-19 for the free immunization of its employees, provided that the same amount is donated to the SUS. Under the current law, it is necessary to wait for the public program to vaccinate all priority groups defined by the Ministry of Health. After a quick process in the Chamber of Deputies and with the support of part of the business sector, the bill reached the Senate on the 8th. Of april. However, since then it has not been included on the voting agenda.

The proposal divides opinions. While its supporters claim that the bill would help expedite mass immunization of the population, those who oppose it argue that the proposal institutionalizes the vaccination of groups with greater economic power. 

veterinary industry

In order to expand the production of vaccines in the national territory, senator Wellington Fagundes (PL/MT) presented PL 1343/2021, which allows establishments that manufacture veterinary products to be temporarily authorized to produce vaccines against covid-19 . The matter awaits a decision by the Senate on the changes in the Chamber, and then proceeds to sanction. 

patents

Also with the objective of expanding the production of vaccines, several projects were presented to address the possibility of compulsory licensing of patents for vaccines and supplies to fight the pandemic. The theme also divides opinions, inside and outside the Congress. Contrary to breaking patents, they argue that the change could result in legal uncertainty and disincentives for investments, in addition to the difficulty in internalizing vaccine technology. Those in favor believe that the break would be a way to expand the production of vaccines. PL 12/2021 is the most advanced article on the subject. Authored by senator Paulo Paim (PT/RS), the bill awaits a decision by the Senate on the changes approved in the Chamber of Deputies.

Pandemic CPI

On April 27, the Federal Senate installed the parliamentary inquiry commission (CPI) that will investigate the government's actions and the use of federal funds in the covid-19 pandemic. The pressure for investigation has grown with the escalation of deaths caused by covid-19 in Brazil, while several countries are experiencing an improvement in the situation. Data from the end of March show that Brazil concentrated a third of daily deaths by covid in the world, even with only 3% of the world population.

The investigations are carried out by the commission based on two main axes:

  • Investigate the actions and possible omissions of the Federal Government in confronting the Covid-19 Pandemic in Brazil and, in particular, in the worsening of the sanitary crisis in Amazonas with the lack of oxygen for hospitalized patients.
  • Investigate possible irregularities and offenses involving resources transferred by the Union to States and Municipalities to fight the Covid-19 Pandemic.

In the first months of work, the Commission mainly investigated issues related to the role of the federal government during the Pandemic. Witnesses were summoned to deal with an alleged “parallel cabinet”, which would guide President Bolsonaro on the defense of measures that are at odds with those defended by the WHO and other health entities. This is the case of the so-called “early treatment”. Investigated members of the cabinet denied the existence of any group like this and doctors who advocate early treatment argued that the doctor has the autonomy to indicate the medications he finds most convenient for each patient.

Another point of investigation of the CPI was the acquisition of vaccines. The regional President of Pfizer in Latin America, Carlos Murillo, said in testimony that the company's first contacts with the Brazilian government for the presentation of its immunizing agent took place between May and June 2020. He also stated that the company even offered it on Monday and in the third proposal presented to the Ministry of Health in August last year, 1.5 million doses to be delivered in 2020, which did not occur due to lack of government response.

More recently, the Covaxin vaccine took over the agenda of the CPI and even resulted in the suspension of the purchase contract for the immunizing agent. This negotiation became a political issue when a testimony by Luis Ricardo Fernandes Miranda, a servant in the Ministry of Health's import area, was made public to the Public Ministry. In the testimony, given on March 31, Luis Ricardo claims to have suffered unusual pressure to speed up Covaxin's procedures within the folder.

The negotiation between the federal government and Need Medicines, which mediates the negotiations of Covaxin, was already in the scope of the work of the CPI of the Pandemic, which included its partner Francisco Maximiano in the list of expected deponents. However, after the public servant's testimony was revealed, the case became one of the main work fronts of the commission, which heard Luis Ricardo and his brother, deputy Luis Miranda (DEM/DF).

Speaking to the CPI, the Miranda brothers said they had reported what they knew about irregularities to President Jair Bolsonaro. In addition to having said that he would trigger the Federal Police, according to the report, the president would have related the irregularities to Deputy Ricardo Barros (PP/PR), former Minister of Health and leader of the government in the Chamber. It was also stated that after notifying the president about possible irregularities in the purchase of the vaccine, deputy Luis Miranda would have received an offer of bribes so as not to disturb the negotiation.

Government senators accuse the CPI of concentrating activities solely on federal government investigations. Senator Eduardo Girão (PODEMOS/CE) is the author of one of the requirements for the creation of the CPI, to ensure the investigation of states and municipalities. Although hearings were held to deal with the issue, especially in the case of the Manaus collapse, this line of investigation did not advance like the others.

This week, the president of the Senate, Rodrigo Pacheco (DEM/MG), read the application for extension of the CPI on the Pandemic. With the reading, the commission is officially extended for another 90 days and will be able to work until the beginning of November. The CPI rapporteur, senator Renan Calheiros (MDB/AL), and other opposition members of the government argued that in addition to an extension of the term, the extension is an opportunity to deepen investigations into evidence of serious crimes, especially in light of the evidence of corruption and irregularities in the processes of purchasing vaccines and supplies.

Final considerations

After a difficult start, vaccination in Brazil ended up advancing as expected by the Ministry of Health and goes into the second half in a more predictable situation. With the advance of vaccinations in other countries, the supply and demand of immunizing agents come closer and the scenarios of disputes for doses become milder. Investment in health will continue to be necessary to deal with the sequelae that covid can leave in the long term.

The country's economic situation has also improved and data from the Ministry of Economy affirm that the country has already returned to economic parameters prior to the pandemic. Thus, the government resumes its reform agenda and argues that, in order to achieve a stable fiscal scenario, it is necessary to approve structural reforms to increase the productivity of the Brazilian economy. On the other hand, critics of the agenda argue that it is up to the country to implement an agenda that allows for Brazil's development and guarantees levels of competition with the rest of the world, which is currently strengthening state intervention agendas for economic recovery.

In addition to the economy and health, the pandemic will also continue to impact Brazilian politics, especially on the front led by the CPI on the Pandemic. If its extension is approved, the Commission must continue its main line of investigation, focused on the actions of the federal government. In addition, the actions of the CPI can also reflect on state political scenarios, both because of those investigated in actions aimed at the states and because of the visibility that the senators who are members of the CPI have been acquiring. Thus, in addition to the current scenario, it is possible that the effects of the CPI are also observed in the elections scheduled for 2022.

Timeline with events between the first case of covid-19 in Brazil and the milestone of 100,000 doses of vaccines applied nationwide.

Last Update: 07/15/2021

Prepared by Umbelino Lôbo Team: Leonardo Nunes, Advisor.

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