The humanitarian crisis unfolding in Brazil as a consequence of a mismanaged response to COVID-19 is yet another stark reminder of reality’s unforgiving propensity to exact a high cost in lives and livelihoods whenever politicians fail to face the facts in a public health emergency. AIDS Healthcare Foundation (AHF) calls for public health to be prioritized in Brazil.
With the third largest number of COVID-19 cases in the world, the current outlook for Brazil is grim; however, we are not bound to maintain this course. In fact, we have an obligation to change course before the pandemic claims thousands more Brazilian lives.
Below is a brief overview of how we arrived at this point and what must be done to put the country on a path to recovery and help reduce the impact more broadly among Latin American countries, in a region with highly mobile populations.
In Brazil, the toll from the pandemic stands at over 10.5 million cases and nearly 270,000 deaths. In a country of 212 million, with a robust National Health System and vast experience in carrying out nationwide vaccination campaigns, the current SARS-CoV-2 situation is simply incomprehensible and unacceptable.
Negotiations with companies for vaccines and other critical medical supplies were delayed for far too long, and to date, Brazil is far from guaranteeing sufficient vaccines for the entire population. Additionally, consistent top-down contradictory messaging has only served to confuse communities and make the situation worse.
Brazil has so far only been able to access 14.7 million doses of COVID-19 vaccines, enough to vaccinate less than 4% of its population. This small quantity was obtained thanks to the Butantan and Fiocruz research institutes, which initially imported 8 million doses from China and India, and the domestic production of 6.7 million doses. Despite large domestic pharmaceutical production capacity, local manufacturing of COVID-19 vaccines has been hampered by multiple obstacles imposed on importation of active pharmaceutical ingredients (API).
As a result of delays and decisions that ran counter to good public health practices, Brazil missed out on access to what would have amounted to about 316 million combined vaccine doses between quantities offered by COVAX and Pfizer, or enough to vaccinate approximately 78% of the country. This would have given Fiocruz and Butantan enough breathing room to produce the remainder of vaccines locally to cover the entire population.
Teetering on the brink of collapse under the pressure of millions of critically ill patients, the healthcare system has to contend with oxygen shortages, lack of hospital beds, exhausted or sick frontline workers, and the looming prospect of yet another surge in infections—this time with a new variant of SARS-CoV-2 which recently emerged in Manaus, Amazonas.
It is imperative that vaccination efforts are accelerated and strategically targeted first to the hardest hit communities. Our only chance of outrunning and countering the danger of new SARS-CoV-2 variants is to vaccinate the maximum number of people in a minimum amount of time.
Considering the limited supply of vaccines and the wave-like nature of COVID-19 surges across different communities, the decisions on whom to vaccinate, including where and when, should be informed, and directed by epidemiologists, immunologists, infectious disease experts and technical teams from the National Vaccination Program. Until the vaccine supply catches up with the national demand, spreading the available doses too thin across the entire country will not be as effective as zeroing in on hotspots like Manaus and priority populations such as frontline healthcare workers and the elderly.
The international community should join in calling on Brazil’s leaders to do everything in their power to ensure the country has enough vaccines for the entire population – this means being willing to negotiate, collaborate and engage with international partners and global initiatives such as COVAX, while also ramping up investments of capital and human resources into domestic vaccine production capacity.
However, vaccinations alone will not be a panacea for COVID-19. Assuming Brazil obtains sufficient vaccine quantities for the entire population in the coming months, given the size and remoteness of some parts of the country, it will take considerable time to vaccinate a sufficiently high proportion of the population to bring COVID-19 under control. The vaccination campaign has only just begun, and it is becoming increasingly clear that there is a risk that new strains of coronavirus might bypass the antibodies produced by current vaccines reducing their effectiveness.
Therefore, in addition to developing a robust vaccination campaign, there is an urgent need for a national prevention campaign, which would combine efforts at the levels of the National Health System, federal, state and municipal governments. These governments should commit to encouraging, promoting and requiring adherence to evidence-based public health infection control measures.
Consistent and universal wearing of properly fitted masks remains absolutely essential to stopping the spread of COVID-19, not least because it is the most cost effective and immediate step people can take on their own to protect themselves and those around them. Masking must be accompanied by rigorous hand washing and social distancing. Collectively, these prevention efforts, along with guidance on diagnostics, treatment and vaccination should be standardize under auspices of a national task force.
Regrettably, so far there is no science-based cure nor a “magic pill” for COVID-19, and magical thinking will not wish the pandemic away. All we can rely on is our resolve to face the dire truth of the moment and commit to a long and difficult fight ahead with the evidence-based tools we do have, namely compassion for our fellow human beings, infection control and prevention measures, vaccines, and trust in science.