How São Paulo Became the ‘Vaccine Capital of the World’


Many non-Brazilians, even epidemiologists, were surprised by the announcement in November 2021 that São Paulo had achieved full universal vaccination of adults against Covid-19. After all, São Paulo is one of the five largest cities in the world, which creates potential logistical challenges to reach 100%.

Throughout the country, political obstacles also had to be overcome. President Jair Bolsonaro has been spreading ridiculous misinformation throughout the pandemic, while delaying vaccination. (More recently it is fiercely opposed to the vaccination of children aged 5 to 11, which began in January 2022.) Yet most Bolsonaro supporters ignored his vaccine-related rants.

Overall, Brazil’s high vaccination coverage should come as no surprise.

While there are of course pockets of vaccine hesitancy, as well as deep health disparities, Brazil has had a strong vaccine culture for years. This is related to the strength of government institutions. Campaigns and demands from the public health system, public schools, and public assistance programs have contributed to the total normalization of vaccination.

“Brazil and São Paulo have always been a model of excellent vaccination campaigns thanks to the universal health coverage system, low vaccination hesitancy and high uptake,” according to Otavio T. Ranzani, epidemiology researcher at the University of São Paulo (as well as an assistant professor at the Barcelona Institute of Global Health). And, “unfortunately, the COVID-19 pandemic has strongly affected the population of São Paulo, which is a factor that drives the rate of vaccination.”

Brazil, like some other countries, even has a vaccine mascot. Since 1985, the character of Zé Gotinha (Droplet Joe) has helped overcome suspicion publication vaccination programs – although the Bolsonaro administration has limited its role during the pandemic.

Vaccine acceptance is high throughout Brazil. According to the US-based Institute for Health Metrics and Evaluation (IHME), as of December 23, 2021, 92% of people aged 12 and over in Brazil said they would or would probably accept a Covid-19 vaccine. In no state was the percentage lower than 80%. (Some other Latin American countries also have high vaccine acceptance rates – reaching 100% in Brazil’s neighbors Colombia and Argentina.)

The rush to get vaccinated has been high throughout the pandemic. In January 2021, 89.5% of Brazilians surveyed online said they intended to be vaccinated against Covid-19.

This does not necessarily translate to high actual vaccination, partly due to supply issues. As of December 13, according to IHME data, 62% of Brazilians were fully vaccinated, while 72% had only received a single dose.

To some extent, the Brazilians took to the road to gain access. In fact, São Paulo’s vaccination rate exceeds 101% because of non-residents going there to get bitten. The city has long been a magnet for migrants and visitors.

Covid-19 vaccines used in Brazil have not always been those with the greatest efficiency. Yet even low-efficiency vaccines have helped reduce the number of cases, for example in Serrana in the State of São Paulo. In São Paulo, the distribution of more effective vaccines made it possible to significantly reduce coronavirus infections and hospitalizations.

According to Ranzani, “The success of vaccination reduced the burden of the Gamma wave in São Paulo, which was massive. Another remarkable success that occurred in São Paulo and elsewhere was the containment of the spread of the Delta, leading to much lower numbers of cases, hospitalizations and deaths than expected.

The speed and scale of the vaccine’s rollout boosted São Paulo’s immunization rate. “There was a quick and coordinated allocation of doses,” comments Ranzani. Vaccination has been made widely accessible, in terms of time (weekends, public holidays, sometimes 24 hours a day); location (mobile units); and sensitization of vulnerable populations (homeless, those whose second doses are overdue).

Yet extremely high vaccination is not a panacea. In a press briefing on January 12, Carissa F. Etienne, director of the Pan American Health Organization, said that Omicron “has led to an increase in reinfections, even among those who are fully vaccinated. This new wave of infections will not be “light” on our healthcare systems, as the Omicron variant is already straining our healthcare workforce and limiting care for other illnesses. »

And Ranzani notes, “I don’t think we should consider the concept of ‘herd immunity’ as a public health goal at this time. The arrival and spread of Omicron again made this clear. Through Brazil, coverage of booster shots is currently low.

Yet as it enters new phases of the pandemic, São Paulo demonstrates that a strong public health service and the legacy of vaccination can replace politics to protect as many people as possible.

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