Since 2018, none of the PNI childhood immunizations have reached the coverage target

Posted on 12/25/2022 4:00 AM

One of Nísia Trindade Lima’s first challenges when she takes over as Minister of Health in the government of Luiz Inácio Lula da Silva (PT) will be the improvement of the Unified Health System (SUS), by strengthening the National Immunization Program (PNI). In the administration of Jair Bolsonaro (PL), the program, which was established 50 years ago and was considered a landmark in Brazilian public health – due to the vaccination measures organized throughout the national territory – suffered setbacks, especially with the strength gained by the speech antibody vaccine. One of the minister’s tasks is, as early as January, to announce the targets for the program – which today has all indicators below 70% – to restore momentum.

Since 2018, none of the 15 vaccines that are part of the PNI Child Handbook have reached the immunization target, according to Francili Fontana, General Coordinator of the National Immunization Program (PNI) of the Ministry of Health. This year, a few days before the end of the campaign against polio and multiple immunizations to update the vaccination guide for children and adolescents under 15 years of age, the Ministry decided to extend the deadline until the end of September. The decision was made because there was a long way to go to reach the 95% of people who are immune, as set out by Vol.

On September 2nd, polio vaccination coverage reached 32.5%. After closure, the entry rates excluding polio were 57.05% for vaccine applied in the first months of life; 52.19% for the dose to be taken after 15 months; and 53.27% for the dose at the age of 4 years.

Five years ago, the coverage rate for the BCG vaccine, which fights tuberculosis, was 99.72%, and for the human rotavirus vaccine, which prevents the infection responsible for severe diarrhea in children, at 91.33%. In 2020, the curve has fallen alarmingly. The BCG vaccination rate, the first early-life vaccine, was 63.88%. On the other hand, the rotavirus vaccine fell to 68.46%. Today it is 67% and 57.23%, respectively.

“There is an international phrase and people say here in Brazil: Vaccines cause adults. This is one of the main factors that made it possible to increase our life expectancy by 30 years. And we were able to increase it from 40 to 70 years, 80 years with vaccination. By vaccinating Children we give them the chance to live to become adults,” said Physician Isabella Palalay, Vice President of the Brazilian Society of Immunization (SBIM).

eradicated diseases

One of the losses in low vaccination coverage is the risk that diseases already eradicated in the country will return. Rates are low even in pregnant women who must be given DTP and pregnant DTP, which must be given at four-week intervals to combat the virus that causes diphtheria, tetanus, and whooping cough. This year, the sum of the two came to just over 52% (the DTP for pregnant women was 36.03% and the adult-type DTP for pregnant women was 15.36%).

Renato Kfoury, pediatrician and director of the Brazilian Society of Immunization (SBIm), warned.

On Wednesday (21), Health Minister Marcelo Quiroga stated that “we are on the verge of obtaining the measles-free certificate again”. However, infection scientists point out that adherence to the measles vaccine remains low. In 2019, after a year of circulating virus of the same genotype and new outbreaks emerging, the country lost that certificate.

In the same year, 20,901 cases of the disease were confirmed, in 2020 there were 8,448 cases and in 2021 another 676 cases of measles. The index for the first dose of the trivalent viral vaccine, which should be applied to children under one year of age, is 62.26%. Noting the second dose to be administered after 15 months of age the ratio is 42.21%.

Palalay asserts, “Brazil is in the fifth year of the measles resurgence. It is no longer considered a measles endemic country, and is now considered endemic.”

COVID-19

Low vaccination rates have not been the only problem PNI has faced in recent years. The COVID-19 pandemic has public health technicians racing to manufacture a vaccine. The National Health Surveillance Agency (Anvisa) was a key partner in accelerating the process.

“Vaccines, all of them, are always the best public health strategies, through which treatment costs go down. Therefore, in our work, we seek to expand vaccination in all aspects. We are facing this debate with great qualification technology. The focus has been on ‘saving lives, because it is a disease’ Unknown,” Meroz-Freitas explained.

However, there has been a loss of control in vaccination against covid-19, especially with regard to the age group of children. One of the most serious problems, pointed out in a recent report by the Federal Court of Accounts (TCU), was the “blackout” of PNI data.

The population of six-month-olds and two-year-olds is six million, but there is no information on immunization for this age group. According to Health Technical Group (GT), at ages three to four years, the percentages between the first and second doses are less than 20%. The highest incidence was between five and 11 years of age, with the first dose recording 70.7% and the second 50.1%. The opposite scenario for higher rates among adults.

GT coordinators indicated that the ministry cannot say how many vaccines have been distributed or the expiry date of the doses, which may end in January. Contrary to the data, Quiroga said that Brazil has done a very good job in the face of the COVID-19 pandemic.

War against fake news campaigns

In parallel with the dismantling of the National Institute of Statistics, specialized bodies in public health and technicians in the region have, in recent years, waged a war against false news. Anti-vaccination rhetoric, aimed at immunizing children in particular, gained strength with the encouragement of government authorities. They spread doubts about the authorization of the new covid-19 vaccine, but also about immunity that fights diseases that have already been eradicated.

The final report notes that “the deterioration of the National Health Authority and the role of coordination and expression by the Ministry of Health have been major factors in disrupting hitherto successful policies and programmes, such as the National Immunization Programme.” Move to the area.

A qualitative study on the factors that lead to low vaccination coverage in children under the age of five, conducted by the United Nations Children’s Fund (UNICEF) in five Brazilian capitals, indicates that low perception of disease risk, fake news and difficulty accessing immunization services are important elements in keeping people away from Vaccinations. Isabella Palalay points out that this gets worse when people don’t see the danger, especially in diseases that have already been eradicated.

“People do not have a perception of risk, they do not believe and they are not informed by public authorities. I hear from many people: why has the ministry never carried out a vaccination campaign again? And I answer: it is not true, it does it every year, it is just covert campaigns People need to be afraid of the disease so they have a procedure to look for a vaccine,” he explains.

For Meiruze Freitas, director of Anvisa, the first action to take to bring the population closer should be to resume transparency. Besides, the technician believes that PNI must reinvent itself. INS will be its own division within the portfolio and it will become a “national effort that will go through health, through schools, through the field of social development,” said Nesia Trindade.

“The new minister says she has to do an intensive campaign in schools and kindergartens with parents to raise awareness. We have spent years and years without a vaccination campaign. I think fighting fake news and launching really strong government campaigns, from the famous Ministry of Health Zé Gotinha and it turns out that the vaccine protects, that Children can have serious cases of covid-19 (Fiocruz).

Another containment mechanism being considered by members of the Transition Health WG is to begin mapping fake news content and influencers to frame them for crimes against public health.

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