Despite challenges, Brazil’s immunizations become model for the world

Prevention of measles infection among children from indigenous lands of Baku Rizinho, Maranhão state. A bedridden elderly man is vaccinated against pneumonia at his home in a Rio de Janeiro slum. Protecting a teenager from rabies in the interior of Minas Gerais state from wild bats. Babies are immunized against tetanus while they are still in the mother’s womb.

Hundreds of millions of vaccine doses are administered each year in more than 5,000 cities. Doing it all for free and safely has made Brazil’s National Immunization Program (PNI) the largest in the world, even a reference for developed countries.

For 50 years, PNI has carried out an ambitious mission to vaccinate large populations on the Brazilian mainland, a region deeply affected by the diversity of cultures and landscapes and unequal living conditions.

Even though the program is considered the world’s largest free public vaccination program, with 20 vaccines and the eradication of important diseases such as polio, neonatal tetanus and congenital rubella, the program celebrates half a century as a turnaround Vaccination coverage brings setbacks and struggles for life back to 1980s levels. The researchers are optimistic about the program’s newfound momentum, but note that there is still a long way to go.

Rio de Janeiro (RJ) - Vaccines against esquisosmos. Photo: Gutemberg Brito/IOC/Fiocruz

PNI administers hundreds of millions of doses of vaccines annually in more than 5,000 cities – Gutenberg Brito / IOC / Fiocruz

world reference

Luciana Phebo, head of the United Nations Children’s Fund’s (UNICEF) health sector in Brazil, sees the program as a world reference, especially for low- and middle-income countries and countries with socioeconomic similarities to Brazil .

“This is a reference program not only for Latin America, but also for countries in Africa. UNICEF, together with the World Health Organization (World Health Organization), also has the function of bringing good practices from Brazil to other countries with similar backgrounds. PNI not only It’s important for Brazil, and it’s important for the whole world.”

Luciana Faber pointed out that Brazil has important tools to create the conditions for this successful plan, such as public health and a universal health system, institutions with the technology needed to produce a vaccine, and a primary care network that still needs to be improved, but this is not true for those have major implications for those who need a vaccine.

“The SUS (Unique Sanitation System) is extraordinary, superior to the situation in the world even in developed countries, with capillary action, unified management, Ministry of Health covering the most remote cities and the entire national territory, which” is vast in size. Few countries have such a structure. “

However, the decline in vaccination coverage since 2015 has sounded alarm bells for health authorities in Brazil and abroad, and there are concerns that diseases that have been eliminated in the country may make a comeback.

“This reduction has worsened with the onset of the pandemic. In the post-pandemic period, things improved slightly and the curve started to go in a different direction, but that response has to accelerate. It hasn’t accelerated enough to ensure that it won’t Reintroducing diseases like polio or measles that could recur.”

Mato Grosso do Sul receives 158,760 doses of two vaccines produced by the Butantan Institute acquired by the federal government

PNI administers hundreds of millions of doses of vaccines annually in more than 5,000 cities – Mato Grosso do Sul state government

incremental reconstruction

during an interview Brazil agencyHealth Minister Nicea Trindade stressed that the government has worked hard to restore the program’s prominence and the community’s trust in the Ministry of Health as the national health authority. While he believes challenges are being overcome, he noted that rebuilding will be gradual and will take time.

The minister said that restoring high vaccination coverage could put the country back in a reference position, thereby contributing more to addressing vaccine denial and misgivings. “Our aim is to once again be an example to the world. Retaking the status of international reference and mobilizing it in cooperation with other countries, including vaccination, is our top priority,” he said.

BRASILIA (DF) – September 5, 2023 – Minister of Health Nísia Trindade, the first drug to treat cystic fibrosis, is included in the Unified Health System (SUS). Photo Valter Campanato/Agência Brasil.

Health Minister Nísia Trindade – Valter Campanato/Brazilian News Agency


Carla Domingues, a consultant to the Pan American Health Organization (PAHO) and former PNI coordinator, noted that the plan was strengthened because it was considered a national policy that had been in place since the military dictatorship , and through various democratic governments. However, its strength mainly came in the 1990s with the creation of the Unified Health System (SUS).

“PNI is a successful example because all SUS principles are effectively consolidated. Starting with universality, this means that all vaccines reach the entire Brazilian population, whether in large cities, medium-sized towns, riversides or indigenous populations ’, explains Carla Dominguez directed the Brazilian project for 13 years.

She recalls that this success story continued until 2016, when the main indicators declined: “Unfortunately, we are no longer a model. The biggest challenge is to restore the trust we have had for more than four decades to allow Brazil The people take responsibility and responsibility.” Assisting vaccination centers.

BRASILIA - Carla Domingues, General Coordinator of the Immunization Program at the Ministry of Health, talks about scaling up HPV vaccination in SUS (Marcelo Camargo/Agência Brasil)

Carla Domingues, Advisor to the Pan American Health Organization and former Coordinator of the PNI – Marcelo Camargo/Brazilian News Agency

An important point introduced by the PNI in the country, the expert explained, is the involvement of state and municipal governments in immunization policy, with clear roles defined for each area of ​​government. It is crucial that the federal government centralize vaccine purchases on a large scale for the entire country (also guaranteed by the program) so that the entire population can be vaccinated, regardless of states’ financial status or budget priorities.

“Until the 1970s, smallpox, polio and rubella programs were procuring and there was no national vaccine procurement policy. For diseases like measles, diphtheria, tetanus and coughing pertussis, states with resources ran local programs. This has no impact on eliminating the disease. Centralized procurement, decentralized distribution and execution, guaranteed supply, complete transportation and logistics chain, this vaccination policy.”

to all

The whole structure has allowed the program to grow from four vaccines offered in the 1970s to 20 vaccines offered today, targeting children, teens, adults, pregnant women and mass campaigns such as the annual flu shot.

For these reasons, Brazil has been invited to present its experience at PAHO meetings, recalls Carla Dominguez, adding that the country has also been quick to implement the recommendations and commitments discussed by the international organization.

“Brazil is a model when the organization presents success stories, and most importantly, because Brazil is a country with such a large size, such a dispersed population, and such different geographical conditions, it faces challenges.”

*in partnership with national radio station Tâmara Freire

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