Pandemic, denial and lack of incentive: Low polio vaccination worsens in Brazil after Covid

The poliomyelitis vaccine is applied in drops.

Photo: Reproduction

The poliomyelitis vaccine is applied in drops. (Photo: Reproduction)

The goal is to have 95% of all children vaccinated against polio each year, but the last two years of the pandemic have seen the worst rates since 2012 in Brazil. The drops that led to the eradication of infantile paralysis in the country were taken by no more than 3 out of 10 children last year.

The downward trend was already observed before, but it has become more pronounced in the recent pandemic period. Denial, lack of investment and the indirect effects of the pandemic are among the reasons pointed out by experts, in addition to the ignorance of new generations about the harmful effects of the disease, eradicated in Brazil for more than 30 years.

“We had with the Covid an abandonment of vaccination rates, an abandonment of the program [de imunizações] as a whole, but we must resume not only for poliomyelitis, but for several other diseases, ”explains Renato Kfouri, infectious disease specialist and director of the Brazilian Vaccination Society (SBIm).

For Gerson Salvador, an infectious disease specialist at the University Hospital of São Paulo (USP), the decline is a consequence of public health management measures taken in recent years.

“Unified Health System (USS) primary care funding has dropped and we have seen a decline in Family Health Team coverage. To guarantee vaccination, you need to have teams in the health posts and teams to work in the community and monitor who is vaccinated or not,” Salvador said.

“In the Bolsonaro government, we are witnessing a dismantling of the national vaccination program. In fact, the manager walked away saying he couldn’t afford to campaign. So we already had less investment for primary care and campaigns and from there we even now have an anti-vaccination movement in Brazil,” he added.

Asked, the Ministry of Health has so far not responded to the measures taken to prevent the resumption of the disease in Brazil.

Downward trend in coverage

In 2018, the World Health Organization (WHO) issued an alert stating that “recorded cases of measles and poliomyelitis have increased globally.” Data this year shows polio coverage was 77%, still declining.

At the time, the Ministry of Health was already reporting that 312 Brazilian municipalities had low polio vaccine coverage and had failed to vaccinate even half of children under the age of one.

Since then, the scenario has worsened. And, according to the infectiologists interviewed, there is no other way to stop poliomyelitis: the vaccine is the only possible protection.

All doses combined, vaccination coverage was 96.55% in 2012. In 2021, it fell to 59.37%. The lowest was the booster dose given at age 4: only 52.51% of children received this dose last year, according to data calculated in DataSUS up to March 6. The WHO recommends that the index be 95%.

The red alert is starting to sound, experts say, with new cases recorded around the world. According to Kfouri, the wild version of the virus was already circulating in two countries: Pakistan and Afghanistan. In recent weeks, new cases have been detected in Israel and Malawi.

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The Israeli Ministry of Health reported on Sunday (6) a new case of poliomyelitis in a 4-year-old child in Jerusalem. The patient was not immune to the disease, although the vaccine is part of the country’s routine schedule.

In addition, the Israeli government said it had opened an investigation to trace the child’s close contacts and determine if further recommendations were needed to combat transmission.

“It should be noted that the virus was found in sewage samples taken from the region where the case occurred, which can happen, but to date there have been no clinical cases. similar precedents,” Israel’s Health Ministry said. .

Already on Thursday (30), the WHO published a report on a wild version of the virus in Malawi. A 5-year-old child was diagnosed with the disease in Lilongwe, the capital of the African country, on November 19, 2021.

On November 26 and 27, two stool samples were collected and received by the South African reference laboratory, the National Institute of Communicable Diseases (NICD). Then, on January 14, 2022, they were referred to the United States Centers for Disease Control and Prevention (CDC).

Brazil: regional disparity

In addition to registering a decline in national coverage, there is also a disparity between Brazilian regions.

In the North, for example, vaccination coverage for the first three doses of the vaccine last year was just 59.43%, the lowest in the country, according to data through March 6.

In the Northeast, it was 64.27%. The three highest were in the South (76.52%), the Midwest (72.15%) and the Southeast (68.53%).

For comparison purposes, in 2012 all Brazilian regions had coverage above 90%. The lowest rate during this period was recorded in the South, where 94.82% of children under the age of one were vaccinated with the first three doses required.

This scenario was similar in 2013 and 2014. 2015 was the first year in which one region – the North – did not reach the rate of 90% of children with the first three doses of vaccine (with a coverage of 88.16 %).