Low childhood vaccination threatens disease control

From birth to 1.5 years of life, the child needs to take at least ten vaccines, and in some cases there are two or three doses, in addition to boosters, but it is a fact that low childhood vaccination threatens control of serious diseases. They are safe and effective vaccines, most of which were applied decades ago. In recent years – notably from 2015 – vaccination coverage in Brazil has dropped to rates of around 70%, when the recommended rate is 90% or 95%, depending on the vaccinator.

The main reason for the drop in vaccination, experts say, is the invisibility of these diseases, such as polio, diphtheria, tetanus, whooping cough, mumps and rubella, with few or no cases in the latter. years, and, consequently, the lack of knowledge of their seriousness. Misinformation, the lack of campaigns, the vovid-19 pandemic or even the disorganization of the vaccination network are other causes of the problem.

Health is the theme chosen by West this Friday 5, in the series of reports “Desafios do Brasil”, which will be published until September 30, always in the following order of the themes of the week: Monday (Education), Tuesday (Economy), Wednesday (Agro and Environment)Thursday (Justice and Public Security) It’s Friday (Health). See here the report of this Thursday 4.

The situation is worrying, because serious diseases that have practically been eradicated in the country, such as poliomyelitis or infantile paralysis, could reappear. In Brazil, the last case of this disease was recorded in 1989. Recently in the United States, where there have been no cases of poliomyelitis since 1993, a case was confirmed.

According to data from DataSus, between 2010 and 2015, polio coverage was always above 96%. The recommended minimum immunization rate for this vaccine is 95%. However, between 2016 and 2019, the index was around 80%; in 2020, in the first year of the covid-19 pandemic, it fell to 76%, and last year the drop was even greater, to 70% of the target audience. The Department of Health did not respond to a request for an interview.

“A disease that we [especialistas em imunologia] who is most afraid of coming back is infantile paralysis. It is a very serious disease, with lifelong sequelae for those who have the paralytic form,” said pediatrician Mônica Levi, member of the Brazilian Society of Immunology (SBIm).

Measles is a disease that returns to Brazil

Although there are fears that poliomyelitis will return, another disease included in the basic childhood immunization schedule has already reappeared. It is measles, the very low incidence of which earned Brazil a measles-free territory certificate issued by the Pan American Health Organization (PAHO) in 2016. However, soon after, between 2018 and 2021, more than 40,000 cases were recorded in the country, resulting in the death of 40 people.. PAHO retired the certificate in 2019.

The MMR vaccine, which protects against measles, mumps and rubella, also showed a downward curve starting in 2014, when coverage topped 100%. Over the next two years, it was 96% and 95%, respectively. In 2017, it was only 86%. Last year, only 73% of the target audience was vaccinated. “It is absurd to think that children are dying from measles, a disease that has been almost eliminated in the country,” Mônica said.

BCG, for example, applied in the first days of life, always in the maternity ward, has also experienced a sharp decline in the last three years. In 2015, coverage exceeded 100%. Between 2016 and 2017, it was above 90%. The following year, it again reached the entire target audience. However, in 2019 it fell to 87%; in 2020, 74%; and in 2021, 69%.

Mônica Levi believes that the very success of vaccination campaigns in Brazil, intensified after the creation of the National Vaccination Program (PNI) in 1973, which drastically reduced the spread of diseases, also causes a sense of false security in the population.

“It’s a paradox. There was this elimination of diseases, which caused a loss of perception of fear of them. In the past, mothers were terrified of their child getting polio, meningitis and everyone getting a shot. Today, young parents no longer have the perception of gravity,” says Mônica Levi

The doctor explained that this perception is false. “The only eradicated disease in the world is smallpox. The others are eliminated or controlled. We only speak of eradication when the virus no longer circulates anywhere in the world. Additionally, she cited US research that has shown that vaccines — more than any other medical advancement — help reduce deaths and improve quality of life. “And we’re wasting it,” he lamented.

In addition, another serious problem that may have decisively influenced vaccination coverage was a widespread shortage in public and private networks, between 2016 and 2018, a period in which vaccination rates began to decline. “This temporary shortage poses a terrible problem, because the father or mother who took time off work to take the child to be vaccinated and did not find a vaccine is unlikely to return. Especially since ‘there is no information on when the vaccine will be available,’ Mônica reflected.

She also mentioned that many health offices don’t offer after-hours care, making it difficult for parents who work outside the home to access. “The Ministry of Health is working to resolve this problem,” he commented.

Additionally, the covid-19 pandemic itself has undermined childhood vaccination. Guided to stay at home, parents have stopped having their children vaccinated at health posts, and health structures have essentially taken action against the coronavirus, relegating the vaccination of children to a second plan.

vaccination
Photo: Reproduction / Social networks

There is also a lack of proper communication, the doctor said. SBIm teams and other health-related entities are working with the Ministry of Health to launch awareness campaigns on the importance of childhood vaccinations. “These campaigns aim to know how to speak to reverse this scenario. We need to start talking in an effective way that has the intended effect: that people get vaccinated again.

The pediatrician also spoke about issues such as misinformation, spreading false information and building a so-called anti-vaccination movement. “It has increased during the pandemic,” Mônica assessed. “Are fake news, disinformation, organization of the anti-vaccine movement. People are bombarded with this contrary information from the antivax and Holocaust deniers, more active than the Ministry of Health, which should provide the correct information.

“There is no movement against vaccination”

Called by critics a ‘leader’ of the anti-vaccination movement, Dr Maria Emília Gadelha says the role of doctors should not be confused against the compulsory use of experimental vaccines against covid-19, controversy born at the end of 2020, with the use of vaccines in the children’s calendar. “This phenomenon that we are talking about, that they attribute to a supposed anti-vaccination movement and even saying that I am the leader, I do not know,” said Maria Emília. “These other vaccines [do calendário tradicional] have more studies and have already been more validated. I am not against these other vaccines.

However, the doctor warned that mass vaccination campaigns did not take into account children, who, due to their own medical history or genetic condition, may have adverse reactions even to these vaccines considered safe. According to her, the doctor must take into account the individual conditions of each child, know their genetic parameters, and then, electively, direct them towards vaccination.

“The number of people who have a genetic mutation that impacts the risk of developing an adverse reaction to the vaccine is huge, and nobody talks about it,” says Maria Emília Gadelha.

About vaccine hesitancy, she wrote a scientific paper two years ago. “What’s happening is that Brazil wants to be the country that vaccinates the most in the world, and that’s costing some families.”

Although there is no anti-vaccine movement regarding vaccinations in the children’s schedule, Maria Emília believes that the doubt generated about the efficacy and safety of experimental vaccines against covid, developed in record time, may have “splashed the confidence” of other vaccines. “But that was a detail. The main reasons for the drop in coverage during the pandemic relate to the withdrawal of children from school, the change in their routine, confinementparental job change,” he reflected, noting that the decline in the coverage index began long before the pandemic.

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