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By Gabriel Stargardter
RIO DE JANEIRO, Jan 27 (Reuters) - Weeks after other Latin
American countries began inoculating their citizens against
coronavirus, Brazil finally administered its first shot on Jan.
17 using China's Sinovac Biotech Ltd vaccine.
With efficacy of just over 50% - barely above Brazil's
threshold for regulatory approval - the Chinese shot was not the
government's first choice. But for now, there is
little else available.
The country's principle strategy - to manufacture 100
million doses of the AstraZeneca PLC vaccine locally -
has been plagued by repeated delays. That effort isn't expected
to yield a finished product until March at the earliest.
AstraZeneca last week sent 2 million emergency doses to help
Brazil get started. Meanwhile, Brazil's Health Ministry has yet
to sign deals with other vaccine makers.
The delays leave Brazil's 210 million residents vulnerable
to one of the worst coronavirus outbreaks on the planet. Brazil
has tallied more than 218,000 COVID-19 fatalities, second only
to the United States, and vaccinated less than 0.5% of its
population.
Brazil's vaccine rollout is just the latest misstep by its
Health Ministry, which President Jair Bolsonaro has stocked with
active-duty and retired military men with little public health
experience. Those newcomers failed to grasp how quickly they
needed to move to secure supplies amid heated global
competition, and the importance of hedging their bets by
striking deals with multiple manufacturers, according to
interviews with more than a dozen current and former officials,
pharmaceutical executives, diplomats and public health experts.
The ministry's hesitance led to a missed opportunity back in
August to order 70 million doses of a vaccine made by Pfizer Inc
and BioNTech SE, with delivery starting in
December, Pfizer said in a Jan. 7 statement.
Reuters also viewed an internal Health Ministry WhatsApp
chat log, containing thousands of messages exchanged between
senior officials last year as the global race for vaccines was
heating up. The messages reveal that the new leadership team
prioritized hydroxychloroquine and its cousin chloroquine,
anti-malarial drugs championed by Bolsonaro as COVID-19
treatments despite little scientific evidence that they work.
"There was not sufficient focus on the vaccines, and a lack
of technical vision," former Health Minister Nelson Teich told
Reuters in an interview. Teich resigned in May in a disagreement
with Bolsonaro over the hydroxychloroquine strategy.
Reuters sent a detailed list of questions for this story to
the president's office, which directed queries to the Health
Ministry. The ministry did not respond.
Bolsonaro - who contracted the coronavirus last year and
says he won't take any COVID-19 shot - has defended his
government's vaccine rollout. "With respect, nobody would do
better than my government is doing," he said in a Jan. 15
television interview.
While many nations have struggled to obtain vaccines as
manufacturers strive to meet global demand, Brazil was better
positioned than many. It has a long history of successful
inoculation drives, and its state-funded production facilities
can churn out vaccines at scale.
The federal government squandered those advantages, said
Marcia Castro, a native Brazilian and professor at the Harvard
T.H. Chan School of Public Health in Boston.
"It's a succession of errors that began from the start of
the pandemic," she said. "And sadly, we're measuring those
mistakes in the number of deaths."
HYDROXYCHLOROQUINE OBSESSION
The AstraZeneca shot was supposed to be the main pillar of
Brazil's inoculation plan. According to a person involved in the
deal, the Cambridge, England-based firm started talking to the
Health Ministry about buying its vaccine around early June.
By then, Teich, the former health minister, was gone,
replaced by Eduardo Pazuello, an Army general with no medical
background. He quickly surrounded himself with other military
men.
Negotiations with a ministry in upheaval were challenging,
said the person familiar with the talks.
"There were no decisions being driven from the top," the
person said, referring to Bolsonaro and the new ministry
leadership.
The new officials were betting on hydroxychloroquine to
mitigate Brazil's pandemic, months of internal ministry WhatsApp
chats viewed by Reuters revealed. Vaccines were mentioned
infrequently in the chats, and at times with skepticism.
For example, on June 12, just days after being named deputy
health minister, Elcio Franco, a retired Army colonel, alerted
colleagues to a magazine article featuring AstraZeneca's top
Brazilian executive discussing the company's vaccine. Franco
expressed surprise that anyone might volunteer to participate in
a vaccine trial.
"Who would be a guinea pig?" Franco wrote to his colleagues.
Franco did, however, express confidence in
hydroxychloroquine and chloroquine.
In June, COVID-19 deaths per day were reaching new highs in
Brazil, official data showed. Franco claimed the opposite was
true.
"Death rates are dropping dramatically due to Bolsonaro's
treatment protocol," he posted to the internal WhatsApp group on
June 15. "Chloroquine is reversing the situation."
Franco did not respond to requests for comment through the
Health Ministry or his LinkedIn account.
Brazil is now dealing with another surge of infections
that's pushing hospitals to the breaking point in several
cities.
The Health Ministry has doubled down on anti-malarials. It
publicly has urged infected people to take them soon after the
onset of symptoms, and this month it sent 120,000
hydroxychloroquine pills to the badly hit northern state of
Amazonas.
ASTRAZENECA TALKS
The person involved in the AstraZeneca talks said the Health
Ministry's leadership didn't appear to grasp how quickly they'd
need to act to secure a portion of the company's limited supply.
In an initial meeting around the start of June, Pazuello,
the new chief, showed interest in buying the vaccine, "and then
got up and left the room," the person said. "He didn't come to
future calls."
Pazuello did not respond to requests for comment.
During ministry talks, AstraZeneca officials stressed the
need for Brazil to make a financial commitment to guarantee
delivery, the source said.
Ministry newcomers were still mastering government red tape,
slowing the transaction, three people familiar with the
situation said. The officials also proceeded cautiously to avoid
any perception that they stood to profit from an unproven
vaccine, following public graft scandals that had upended the
country in recent years, the people said.
"They fear that people will assume there were kickbacks
involved and their opponents will use it as a reason to launch
an investigation," the source said.
Meanwhile, Britain, the European Union and the United States
signed large deals with AstraZeneca.
With Brazil's Health Ministry dithering, AstraZeneca reached
out to officials in other parts of government to help unlock
funding, said the person involved in the negotiations.
AstraZeneca did not respond to requests for comment.
On June 27, Brazil announced it had signed a $127 million
agreement to start producing AstraZeneca's vaccine at Rio de
Janeiro's federally funded Fiocruz Institute. Franco, the deputy
health minister, said in late June that Brazil would initially
produce some 30 million doses of the vaccine, half by December
2020, the rest in January 2021.
But Fiocruz has yet to manufacture a single dose because it
lacks the active ingredient needed to make the vaccine. The
first shipment of that Chinese-made material is now delayed
until around Feb. 8, Fiocruz said this week, without giving a
reason. Fiocruz had previously predicted it would produce
finished doses by March. It will update that forecast once the
ingredient arrives, the statement said.
Yang Wanming, China's ambassador to Brazil, said in a
Tuesday press conference that "technical" obstacles were holding
up the shipment. He did not elaborate.
With its timetable slipping, the Health Ministry in late
December appealed to AstraZeneca, which was able to source 2
million ready-to-use shots from India. Those doses, which
arrived in Brazil on Jan. 22, will immunize just 0.5% of
Brazil's population.
PFIZER FAILURE
Negotiations with Pfizer, meanwhile, have turned testy. The
Health Ministry publicly has chastised the company for demanding
Brazil sign a waiver shielding it from any potential liability
regarding its vaccine.
Pfizer says many countries have signed the waiver; it blames
Brazil's government for dragging its feet. In a January
statement, the company said it began talks in June with the
Health Ministry, which it said passed on Pfizer's August 15
offer to supply 70 million doses.
With those negotiations bogged down, Brazil's government has
turned to the Sinovac shot.
Bolsonaro, a vocal China critic, had vowed never to purchase
the Chinese vaccine. On Jan. 13, he delighted in pointing out to
supporters that the vaccine's Brazilian trials, conducted at São
Paulo's Butantan Institute, a public biomedical research center,
had shown a disappointing efficacy rate of 50.4%.
But with few options left, the Health Ministry recently
announced a deal to purchase up to 100 million doses from
Butantan.
On Jan. 18, Bolsonaro struck a more conciliatory tone.
Sinovac's shot, he told supporters, was "Brazil's vaccine."
(Reporting by Gabriel Stargardter; additional reporting by
Pedro Fonseca in Rio de Janeiro; editing by Marla Dickerson)
