SAO PAULO, Brazil
A battle is brewing Thursday between the Governor of Sao Paulo Joao Doria and Brazilian President Jair Bolsonaro to see who will deliver on a coronavirus vaccine.
Doria touted the Chinese vaccine, CoronaVac, which initially was reported to be 78% effective but later corrected to 50.38%. And is betting against his main political rival, the president, that deaths from the virus in Brazil will soon exceed 210,000.
“We got the vaccine for Brazil, the one that will save millions of our people. We have it here, and we are ready to start using it,” Doria said in a speech.
Hours after Doria’s remarks were made, the health ministry met with technicians in charge of the remaining states and said they should be prepared to receive 1 million doses of the British-developed AstraZeneca/Oxford vaccine produced in India by the Serum Institute under the Covishield brand during the week of Jan. 2.
The credibility of the Health Minister Eduardo Pazuello was questioned by specialists in Sao Paulo, who think the government will not be able to begin its vaccination plan before Jan. 25, the date Doria stipulated he would start vaccinations in Brazil’s most populous state.
Outside Sao Paulo, governors trust that Pazuello will win the race against Doria.
But in the battle for vaccines between Sao Paulo and the federal government, there is a bid for the importation of vaccines between the public and private sectors.
After receiving information that representatives of private Brazilian vaccination clinics traveled to India to negotiate the purchase of 5 million doses of Covaxin, an ethical debate was generated since public health specialists understand that the coronavirus vaccine has little availability in the world and the supply within the private sector may generate a dispute with the Unified Health System (SUS), increasing inequalities and delaying immunization of priority groups.
But private companies, through representatives, argue their objective is "not to compete with the SUS but to complement the available supply” and offer the immunizer, for example, to those who are not included in priority groups within the National Vaccination Plan.
There is a push by some economic sectors for it o happen because they see it as a way to reactivate the economy.
The National Confederation of Industry (CNI) is evaluating financing the vaccination campaign for a group of workers between 20 and 50 years old, with access to private medicine.
“We always complement SUS vaccination coverage. Our goal is to collaborate with them. The role we play, as we understand it, is more to help the public offering than to harm it,” said Geraldo Barbosa, president of the Brazilian Association of Vaccine Clinics.
Public health specialists, however, see a huge risk of competition in the private sector initiative. “In theory, having a vaccine available in the private network should not affect the public offer so much, but these are times of great caution and dialogue is more than necessary,” said Isabella Ballalai, vice president of the Brazilian Society of Immunizations.
Lawyer and public health specialist Daniel Wang is not that cautious when it comes to expressing himself about the private initiative.
“If there were a surplus of vaccines in the public sector, private vaccination would be logical; but in the current context, with all the governments fighting for some doses, I don't see it reasonable," he said.
“If there is something we learned from the virus, it is that no one can save himself. If only one group gets vaccinated and thinks that this is why they are safe, they are very wrong. We need to achieve herd immunity; for this, it’s essential that all or almost the entire population is vaccinated,” said Tulio Franco, a doctor in Collective Health from the State University of Campinas.
Echoing Franco was infectious disease doctor Helio Bacha, who is a consultant for the Brazilian Society of Infectology. “Private parties can buy the vaccine, sure, but they won't be able to apply it. Historically, private vaccination clinics follow the guidelines of the national vaccination program. There is no coherence if vaccination is carried out for the rich man and another for the mass,” he said.
Ethel Maciel, epidemiologist, nurse, and professor at the Federal University of Espírito Santo warned of having access to a small fraction of the population. “The vaccine is not a remedy and vaccination requires a collective prevention strategy. If you buy it, they give you the vaccine and your whole environment does not apply it, the virus can mutate and the vaccine will be useless” she said.
While private clinics have the right to purchase as many doses of vaccines as they think are convenient, there are some important points to keep in mind. "If private clinics buy vaccines before there is a sufficient quantity in the public network, the authorities can requisition these vaccines and distribute them in the SUS," explains Daniel Araújo, a researcher at the Center for Studies in Health Law at the University of Sao Paulo (USP). "The administrative requisition enables the use of private goods or services by the state in cases of collective need," added the lawyer.
Law 13,979 of 2020, better known as the “COVID Law,” attributes this power to the Ministry of Health and local health managers. It is not to punish or sanction private industry but expropriate when the need arises, he said.
“It is not a question of right or left. When it comes to spreading the virus, the government is being very competent,” said Deisy Ventura, a global health specialist and professor at USP. “They do it deliberately. So, since there is no strategy by the federal government to obtain the vaccine and vaccinate the people, the private sector gets into the conversation, taking advantage of the gap left by Bolsonaro and his people.”
*Maria Paula Trivino contributed to this story.
