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Without placating Covid, the country begins a flu vaccination campaign tomorrow, which could spiral out of control if underestimated.

Without placating Covid, the country begins a flu vaccination campaign tomorrow, which could spiral out of control if underestimated.

RIO – Brazil has started its annual influenza vaccination, a mass killer with millions of doses controlled. But coverage of the disease has been declining for three years, and with the parallel challenge of vaccination against Covid-19, experts fear that the application will decrease again and that the flu will kill more, causing a storm within the epidemic storm.

Scientists say concern is growing because the federal government has not implemented specific information measures and could have provided clearer guidance to states and municipalities, charged with the logistical challenge of the dual campaign.

For influenza, the concern is not a lack of doses – an estimated 80 million are guaranteed (along with a vaccination schedule). But there are doubts, for example, about measures to avoid crowding and ensure the time interval between the use of immunization devices.

What worries me is that the flu cap will fall off. Epidemiologist Carla Domings, who led the National Immunization Program (PNI) from 2011 to 2019, says Covid disease is a priority, but the flu cannot be neglected: the vaccine against it reduces many diseases and deaths.

Dominguez says that in the past three years, coverage for children and pregnant women has fallen below 80% as a minimum. In 2020, the figure is 78%.

Vaccine scientist Herbert Geddes, a professor at UFRJ, confirms that the flu, when it gets worse, affects the lungs in a similar way to Covid-19 and competes with it for the family. That is why the vaccine against it has never been more important.

Protection against influenza is only maintained with the vaccine, because the virus is spreading. The flu is like a ferocious, tied dog. The pollen is a collar. If I take it out, the dog attacks – says Guedes.

There are many reasons to be apprehensive. A global example of proficiency in PNI, Brazil has become an international public health pariah, record-holder for deaths and misfortune in vaccines against Covid-19, highlights Ligia Bahia, of UFRJ’s Institute for Studies in Collective Health:

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There is a risk of coming back against the flu. This should be prevented, it would be an even greater tragedy.

Since January 17, only 4% of the population has been immunized, that is, they have taken both doses against Covid-19. 99% of those, and 82% of the total, received CoronaVac, an immunization device that was not part of the federal government’s strategy, epidemiologist Gilherme Wernicke, of the IESC, also confirms. For the specialists, the initial bet on a single vaccine is a stark example of its lack of strategy and efficiency.

Every vaccination program has detailed goals, but it is not present in Brazil today, and the result is the disaster we see – Wernick confirms. In the case of massive and simultaneous vaccinations, the complexity increases. There is no massive media campaign to explain the residents going forward at such a complex time.

The flu vaccine cannot be given 15 days before or 15 days after vaccination against Covid-19. This alone would be a complicated factor. But to make matters worse, the Covid-19 vaccines have different time periods: from 15 to 21 days for CoronaVac and up to 90 days for Astrazeneca.

The president of the Brazilian Society of Virology, Flávio Fonseca, a researcher at UFMG, says this interval exists because the vaccines against Covid are new and it is not yet known how they will interact with others. There is no indication that there will be problems, but caution is necessary.

Butantan is also the manufacturer of the flu vaccine and has guaranteed SUS 80 million doses of the immune system – which can also be found on the private network. But the attachment ends there.

It takes immense control over who gets what and when. It’s another component of the lack of control that already exists – says Wernick.

The year 2022 may bring an even worse picture, as the flu vaccine will have to be renewed while many people still have not taken a single dose against Covid. Details: There is a possibility that COVID-19 vaccinations are annual, like influenza, and everyone will have to be re-vaccinated – either because there is a risk of variants emerging that are able to escape from existing vaccines or because the protection offered may be temporary.

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Pediatrician Daniel Baker, a member of the Scientific Committee to Monitor Actions Against Covid-19 in Rio de Janeiro, confirms that the flu vaccine is very important for children, pregnant women and the elderly.

– For children, it is essential. Without it, they would need an ICU, because the flu kills a lot – Baker warns.

The “massive media campaign” demanded by the scholars is not in the plans. The Ministry of Health, which was researched by GLOBO about how it communicated to the population about influenza vaccination, responded that there would be “more information at launch, on Monday, to update”. The file provided public data about the campaign at health centers, and in March sent a technical report to state governments.

With regard to parallel vaccinations, the Ministry of Health directive to those who are a priority in both campaigns is to give priority to the vaccine against Covid-19 “while respecting the period of at least 14 days” between it and the flu.

The city of São Paulo will only use educational institutions to carry out the flu vaccination campaign this year. The measure, which differs from previous years’ guidelines, aims to separate the public from this vaccination from those who will be dosing against Covid-19.

– The idea in particular is that we are not making any conglomerate and transit for these residents who are receiving two different types of vaccines – Edson Aparecido, the municipal health minister, said in a press announcement on Thursday.

In the state of São Paulo, in places where there is vaccination against the Corona virus and influenza, the directive issued by the PNI, is to have separate rooms for the two campaigns, explains Nubia Araujo, Director of Immunization at the State Ministry of Health.

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The municipality of Rio de Janeiro did not provide details of the vaccination campaign. In response to GLOBO, the Municipal Health Administration informed that it “decides with SES the technical issues to start vaccination in the capital.”

The state Ministry of Health responded that “it is up to the municipalities to administer the vaccination and the places in which it will be applied (the doses).” He also mentioned that “monitoring the implementation of vaccines will be carried out by the municipalities, indicating the dates on the vaccination slip on the day of vaccination” as a way to avoid applying the two vaccinations 15 days before.

The Municipal Health Service of Belo Horizonte has informed that the vaccine will be implemented in more than 150 health centers and nine units around the clock. According to Undersecretary for Health Promotion and Surveillance, Fabiano Pimenta, the health centers “have the structure to carry out both campaigns simultaneously, safely and effectively.”

The first stage

From April 12 to May 10

Priority groups: children, pregnant women, postpartum, indigenous peoples and health workers (25.2 million people)

The second phase

May 11 to June 8: Seniors and Teachers (32.8 million people)

third level

June 9 to July 9

People with permanent comorbidities or disabilities, truck drivers, mass road transport workers, port workers, members of the security and military forces, personnel of the prison system, youth between the ages of 12 and 21 under social and educational measures and residents deprived of liberty (21.7) Million people)

Evelyn Azevedo, Juliana de Toledo and Renata Maryse collaborated