After suffering one of the world’s worst Covid-19 disasters, Brazil is staging a turnround with a steep drop in deaths and a mass inoculation campaign as it beefs up its ability to manufacture coronavirus shots.
During a devastating second wave of infections earlier this year, Latin America’s most populous nation was the epicentre of the global outbreak, peaking at more than 4,200 fatalities recorded in a single 24-hour period in April.
But daily deaths from the disease have since fallen to under 200 on a seven-day rolling average, with the rate per 100,000 residents currently below the US, EU and UK.
“Brazil is coming out of its nightmare and the main reason for this is our high level of vaccination coverage,” said José Gomes Temporão, a researcher and former health minister.
Critics of the government say the progress is in spite of President Jair Bolsonaro, who once dismissed the respiratory illness as “a little flu” and has been accused of mishandling the crisis. The far-right leader opposed lockdowns in favour of keeping the economy open, disparaged masks and has voiced scepticism towards Covid-19 vaccines.
Instead, they point to a strong public health system and scientific base, as well as initiatives by civil society and business to support the vaccine programme with donations of equipment.
Following a slow start and initial supply shortages, 64 per cent of Brazil’s 213m population is now fully inoculated, ranking well above the world average of 44 per cent and second place among the ten most populous nations. The number of doses administered is the fourth-largest of any country, according to Our World in Data database. Over three-quarters of Brazilians have had at least one dose.
The improvements have brought into sight the possible end to a calamity that has directly claimed 615,000 lives so far — the second-highest toll from the disease after the US, or 10th on a per capita basis.
“Brazil has been one of the basket cases and worst performers throughout the pandemic. It was almost a poster child of what not to do for Covid,” said Lawrence Gostin, professor of global health law at Georgetown University. “The vaccine seems to be the cavalry and it’s come to save the day.”
In the Amazonian city of Manaus, where patients asphyxiated due to lack of oxygen supplies earlier this year, nurse Thatyana Borges Machado has noticed a marked change. “Today we are no longer experiencing chaos,” she said. “Consultations are back to normal.”
Widespread acceptance of vaccines has played a big part. A survey by the World Bank and the UN found just three in every 100 Brazilians did not intend to get inoculated, the lowest rate in Latin America and the Caribbean, where the average was 8 per cent.
It contrasts with Bolsonaro, who has sworn not to have a jab himself and last year joked that the BioNTech/Pfizer shot might turn recipients into alligators. A video in which the former army captain claimed Covid-19 vaccines were linked with developing Aids was recently removed from Facebook and YouTube.
“The way [Bolsonaro] conducted this entire process, it’s lucky that Brazil has a history of immunisation policies, belief in science and vaccines,” said Eduardo Paes, the mayor of Rio de Janeiro. “It started in the 1970s, during the military dictatorship, and a culture was created from there.”
The deep-rooted trust stems from a public healthcare infrastructure that produces and administers tens of millions of injections every year against diseases such as influenza, yellow fever and meningitis, across a territory the size of a continent.
As Bolsonaro promoted unproven remedies such as hydroxychloroquine and Brasília stalled placing orders with Pfizer because of concerns about contractual terms, state-run biomedical establishments acted to ensure availability of stocks of Covid-19 vaccines.
A partnership between São Paulo’s Butantan Institute and the Chinese pharmaceutical company Sinovac delivered batches that were the first to be administered in January. Although local trials showed a relatively low overall efficacy at just over 50 per cent, backers say the CoronaVac jab was a vital bridge in a time of need.
It has since been overtaken in Brazil by the Pfizer and Oxford/AstraZeneca vaccines. The latter is being produced by the Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro. Under an agreement last year, the ministry of health took on the financial risk for the first purchases from AstraZeneca before final trials were complete.
In total, the government says 600m doses of various vaccines have been ordered. However, Carla Domingues, a former co-ordinator of the country’s national immunisation programme, criticised its actions as “not adequate”.
“It delayed the purchase of vaccines and did not co-ordinate the process,” she said. “If [doses] had arrived earlier, we would have had a lot fewer deaths.”
Domingues cautioned that the campaign was not yet over and highlighted regional disparities. “We need to see if 80 per cent of the Brazilian population will be vaccinated in all municipalities and not just a few.”
In Brazil’s favour is the strengthening of national production capacity that will lessen the need for imports of vaccine inputs and finished doses. Fiocruz has received a technology transfer from AstraZeneca enabling it to produce from scratch the essence of the immunisation — known as the active pharmaceutical ingredient, or API.
As debate rages about vaccine inequality between rich and poor nations, Brazil could yet help plug the international scarcity. A local manufacturer will start producing BioNTech/Pfizer jabs next year for Latin America.
While the Butantan Institute currently has no further domestic contracts for CoronaVac, it intends to start making the API itself next year with an eye on export deals. Its scientists are also developing a homegrown vaccine aimed at domestic and overseas sales.
As for the new Omicron variant, Brazil’s immunity will be tested by social gatherings during the Christmas holidays. Transmission indicators stabilised in the past week following recent falls, according to Fiocruz researchers. A number of cities, including Rio and São Paulo, have cancelled official New Year’s Eve celebrations as a precaution.
The combination of vaccinated and natural immunity resulting from a heavy caseload is a “comparative advantage” for Brazil, said Gostin, but he added it was “way too early to declare victory”.
“The fact that it has a relatively stable epidemic now doesn’t mean it won’t surge with the new variants, or just the natural waves of Covid that have hit the world.”
The presidency declined to comment.
Additional reporting by Carolina Ingizza