Why do not Brazilians get vaccinated?

At the present time, Brazil is striving to maintain a certificate of elimination of measles virus circulation, issued in 2016 by the Pan American Health Organization ( PAHO). Health authorities are calling on the general population to update the vaccination card – know how to do it. A national immunization campaign will also be held from 6 to 31 August, targeting children from 1 to 5 years old.

In Amazonas and Roraima, this initiative was planned, and actions are also being implemented to block vaccination, which includes vaccination of foreigners present in federal police stations; sweeping (with house-to-house visit); and the isolation of suspected cases.

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In the current concern of the health authorities, the ministry launched an alert early July for the low coverage of polio vaccine.

The return of poliomyelitis, an infantile paralysis, is another concern of the health authorities. According to the statement, 312 municipalities would have vaccination rates below 50%.

However, some of the above-mentioned municipalities contested the data. In Paraná, for example, newly emerged municipalities with coverage of only 5% in 2018 had recorded rates of 85% to 96% in 2016 and 2017. According to the Public Health Department (Sesa), there were technical failures in the data transmission. The system has been regularized, but last week the updated data was not yet available because every municipality had to re-record all the data, reported Sesa. Curitiba, for example, is one of the cities that has used the electronic medical record for many years, and therefore the update of the data is up to date, showing a satisfactory vaccination coverage: 92.5% against polio and 95.8% for the triple viral 1st dose

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The Ministry of Health confirmed the existence of data feeding problems in some municipalities, but stressed that the warning remains as the overall vaccination index is low.

Another hurdle to effective collection of immunization data is the lack of nominal registration in municipalities, to identify by name the vaccinated children.

Vaccination rates began to decline from 2014

Regardless of the accuracy of the data, health professionals confirm the prevalence of the disease. vaccination coverage Since 1994, Brazil has recorded increasing coverage rates. The first dose of Triple Viral, which protects against measles, mumps and rubella, reached a rate of 100% in 2003 and remained at that level until 2014. The same thing happened with vaccination against polio. After that, the rates of all vaccines dropped.

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"Today's program is quite complex, according to José Cassio de Moraes, professor in the department of collective health of the faculty of medical sciences of Santa Casa de São Paulo, where there are 14 immunobiological examinations and several interventions needed to complete the program In 2012, the NIP counted the data for 10 vaccines, from 2013 new doses of existing vaccines were created and new ones incorporated

Thus, a baby of only 1 year and 3 months must receive 20 different applications to complete the basic vaccination schedule in the public network The unified health system has also included the human papillomavirus (HPV) vaccine for the population aged 11 to 13 years To protect against cervical cancer.As it is a sexually transmitted disease, the subject remains taboo and adherence to vaccination is low, which is also reflected in the general data on immunization coverage in Brazil.

Vaccination problems coincide with the economic and political crisis

In fact, the timing of the largest drop in the vaccination rate coincided with the economic and political crisis that Brazil has experienced in recent years. The budget for immunobiological procurement, centralized by the Ministry of Health, is guaranteed by law and has not undergone any cuts, but has increased at a slower pace than that n & # 39; This had been the case until then. In 2014, the total amount paid under this share reached R $ 1.8 billion, up 73.4% from the previous year; in 2015, the increase was 19.7%; in 2016, 26.6%; and in 2017, only 11.1%, reaching R $ 3 billion.

Special vaccination campaigns have also been affected by the economic crisis. Expenditures of the Ministry of Health with all its institutional advertising decreased by 18% in 2014 and fell sharply in 2015 by 40%. After that, the values ​​rose again, reaching R $ 200 million last year. But still below the total spent in 2013: 217.7 million reais (discounted value by official inflation).

In the particular case of vaccination campaigns, the disclosure was reduced in 2015, one year before the dismissal of Dilma Rousseff and Michel Temer to the Presidency of the Republic: messages were restricted to Facebook. In 2016, the Ministry of Health once again invested in a special multi-purpose advertisement, which usually takes place in September, with material for radio, television, print and social media. These same advertising products were however repeated in 2017, reducing the impact of the message to the general public.

In addition, says José Cassio de Moraes, the economic crisis has affected the box of prefectures. "The purchase of the entrance is ensured by law.But all the expenses for the application of the vaccine are made by the municipal secretaries.In times of crisis, all the programs are affected and the priority is given to the patient who knocks on the door of the hospital, and not to prevention, so we must go forward in the form of communication and training of those who apply, so that They can explain the complexity of the immunization portfolio to the population, but the crisis in the country and the crisis in SUS resources make it difficult, "he observes.

The financial data of 21 capitals, available on the website of the National Treasury, prove the crisis: in 2015, they used 397.4 million reais to pay the expenses related to the epidemiological surveillance sub-function. In 2016, these same capitals reduced this amount to R $ 329 million.

One of the reasons that led to low immunization was the success of the NIP, which managed to control infectious diseases in Brazil. "We have not had polio since 1989, for example, and the low incidence of disease has left them in limbo," says Moraes.

Parents end up neglecting the basic diet, too due to another aggravating factor: the presence in vaccination rooms, limited to opening hours. "More and more, we have the couple will work. In times of economic crisis and unemployment, those employed do not feel able to miss or be late to take the child to vaccination, "adds the public health professor.

The anti-racist movement, which has gained ground with the spread of social networks, is not strong enough to explain the current situation in Brazil, according to experts

The antiviral movement has no force to promote the reduction of vaccination coverage. . "It's not a structured movement, and the biggest burden is the natural laxity of the population and even health professionals to diseases that have not been seen in the past. a long time, "says Isabella Ballalai, president of the Brazilian Society of Immunization (SBIM).

According to pediatrician Jackson Herrera, there is great resistance from families to use the flu vaccine, which is updated every year but this does not happen with the doses that are part of the children's core program.It points out that many parents get lost with the vaccination schedule because they stop taking their children when they are cold or with symptoms of other diseases.

"Parents are anxious to protect their children, to avoid an overdose when they do not go well, but there is a contraindication only when the child has fever at the time of the vaccine "says the director of the Center for Epidemiology. Municipal Health Department of Curitiba, Alcides Oliveira.

He admits that avoiding vaccination in cold situations is understandable, but in practice, this paternal concern may lead to forgetfulness, in addition to other factors already highlighted. Last Monday (16), when the Gazeta do Povo report visited a vaccination room in Curitiba, he found a mother who stayed close to one year without taking her son a year to be made vaccinated. She claimed that she was having trouble leaving work after the end of maternity leave (four months) and regretted that the post near the house did not open on Saturday.

Oliveira points out that there is always a health unit option with extended hours until the night, or service on Saturdays whenever there is a campaign of multivacination. There are also cases of sequencing, as in the case of BCG, which protects against severe forms of tuberculosis. It is an imported vaccine, purchased and distributed by the OPS in all countries of the Americas. Brazil pays for vaccines, but this international purchase guarantees better prices. But the bottle has several doses, with limited validity, and so the SUS does scheduling, trying to reduce losses and waste. "The rationalization of the use is made, but the policy of the Ministry is that there is a vaccine for all."

Governments Require Up-to-Date Vaccination to Enroll Students

Law No. 19,534 / 18 in Paraná, which provides for the mandatory presentation of the updated immunization card for the enrollment of students in institutions public and private. Other states, such as Paraíba and Mato Grosso do Sul, have already put in place similar rules. By 2017, the federal government has announced a joint order with this content to be signed in April 2018, by the Ministry of Health and the Ministry of Education – which has not yet had place.

According to the director of the Center for Epidemiology of the Department of Public Health of Curitiba, Alcides Oliveira, the measure is valid, since vaccination is a public health problem. The State Department for Health has informed, through the intermediary of its press service, that the intention of the law is to encourage parents to keep the vaccination portfolios up-to-date. of their children, but there is still no estimate of the impact

For the president of the Brazilian Society of Immunization (SBIm), Isabella Ballalai, the measure is controversial in the to the extent that it results in a restriction in the education sector. "It's a good initiative, but the question of obligation, when talking about Brazil, is a complex one, try to prevent the student from signing up." we already have a problem so big or even bigger, it's school dropout, so we have to be very careful about it, "he notes.However, it emphasizes that parents have the obligation to vaccinating their children. "Schools could inform the authorities that the family refuses to vaccinate rather than prevent registration," he suggests.

In Rio Grande do Sul, the state prosecutor launched a campaign to alert parents about the obligation to vaccinate their children

The Attorney General of Rio Grande do Sul threatens to impose fines on parents who do not vaccinate them. </ p> <p> The body stresses that The status of the child and adolescent (ECA) provides for mandatory vaccination. not inform can be held liable, with the payment of a fine and even the loss of custody of children.

"The law already exists, it is enough to be fulfilled.The vaccine is a child's right.But I think we will not have any serious situations.We need to invest in the Information and remind parents of the importance of vaccination.There are very few who refuse to do so. "

Check the symptoms of measles and who should take the vaccine:

What is measles?

Infectious disease, acute, viral, severe, transmissible and extremely contagious. The viremia, caused by the infection, causes a generalized vasculitis, responsible for the appearance of various clinical manifestations, such as spots on the skin. Malnourished children and children under one year of age are at greater risk. Transmitted by secretions expelled by coughing, sneezing, talking or breathing.

What are the symptoms of measles?

High fever, above 38.5 ° C; headache; red spots that appear first on the face and behind the ears, then spread through the body; coughing coryza; conjunctivitis.

How to treat

There is no specific treatment against measles – hydration is recommended. The administration of vitamin A is recommended in children affected by the disease to reduce the occurrence of serious and fatal cases. Antibiotic treatment is contraindicated.

Vaccine against measles is indicated for which public?

The measles vaccine for children is one dose at 12 months (triple viral) and another at 15 months (the viral titre). For adolescents and adults up to 49 years old, it is necessary to have two doses (triple or tetravalent); From 30 to 49 years, a single dose (triple or tetravalent) is required.

If there is no evidence of vaccination within the ranges indicated, it is necessary that adults receive the vaccine. There is no risk to health.

Is there a risk that children will take more doses if there is no registration?

If there is no evidence of vaccination within the ranges indicated, they should be vaccinated.

Pregnant women can take the vaccine?

No, only after childbirth.

Can I recover my vaccination history?

In Curitiba, there is the application of the town hall of Saúde Já, which contains the doses given to citizens registered with health facilities, which must be done in person. Simply enter the CPF number and date of birth. It is also possible to register dependents.

Source: Ministry of Health and Curitiba Prefecture.

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