Brazil improves global vaccination ranking, but coverage still falls short of target

In 2023, Brazil dropped out of the top 20 countries with the most unvaccinated children, ranking seventh in 2021. In a new report by the World Health Organization and the United Nations Children’s Fund (UNICEF) released on Monday, the 15th, on vaccination levels worldwide, the country has strengthened its progress in its quest to increase vaccination coverage in the National Immunization Program (PNI), which has been declining since 2016. The decline intensified between 2019 and 2022, when then-President Jair Bolsonaro and his allies spread misinformation about vaccines, increasing distrust in vaccines.

The improvement in vaccination coverage rates in Brazil contrasts with what is happening in the global scenario, where the immunization rate is stagnating.

For Isabella Balalay, director of the Brazilian Society of Immunizations (SBIm), Brazil’s progress in the face of the global recession is a result of the country’s vaccination culture: “We have research that shows that 90% of the Brazilian population believes in the importance of vaccines,” she says.

She highlights that the current management of the Ministry of Health has strengthened communication and micro-planning, i.e. immunization strategies at the municipal level. For the specialist, this was essential to increase vaccination coverage, as it meant that people who were late in their immunization schedule were vaccinated.

“What makes Brazil special? People are late, but they still believe in the vaccine. So when the vaccine reaches them, they don’t think twice about following this recommendation,” he says.

According to the WHO-UNICEF document, the number of children who did not receive any dose of the DTP1 vaccine, which protects against diphtheria, tetanus and pertussis, fell from 418,000 in 2022 to 103,000 in 2023 in Brazil. At the same time, the number of children who did not receive any dose of this vaccine worldwide rose from 13.9 million in 2022 to 14.5 million in 2023.

Global vaccination coverage for this vaccine has remained stagnant at 89%. In Brazil, the rate has risen from 84% to 96%, according to a survey conducted by the World Health Organization and UNICEF.

It is called pentavalent in PNI because it also protects against Haemophilus influenzae type b meningitis and hepatitis B, and DTP is used as a key marker for global immunization coverage. This is because it is a universal vaccine, manufactured worldwide, and is the first vaccine to be administered to a baby outside the maternity ward.

In April, the Ministry of Health already presented data showing an increase in vaccination coverage in the country, stating at the time that 13 out of 16 vaccinations in the childhood calendar had increased adherence.

For the Ministry of Health, the increase is the result of actions such as increased financial investment in the purchase of immunization agents, actions planned according to the reality of each municipality, the resumption of the use of the Zé Gotinha character and communication actions to combat misinformation.

“Let us remember that since 2016, Brazil has faced a growing decrease in vaccination coverage for several immunization companies in the childhood calendar. We have been able to reverse this scenario,” Health Minister Nicia Trindade said in a post on social media. “The national vaccination movement has won with the return of science and the confidence of the Brazilian population in SUS vaccines,” she said.

Despite the progress, vaccination coverage for most vaccines is still below target. “It’s a time for good news, but it’s not a time to relax yet,” says Isabella. “On the other hand, we see 20% of the population who either don’t trust some vaccines or don’t trust them very much. We still have to change that, because before that number was 5%.”

Spotlight on the Americas

The WHO-UNICEF report also highlights the strength of vaccination coverage in the Americas. This was the only WHO region to surpass pre-pandemic vaccination levels in 2019, indicating a significant acceleration in recovery, according to the document.

Overall, coverage of the first dose of DTP vaccine in the Americas increased from 90% in 2022 to 91% in 2023. At the same time, coverage of the third dose increased from 83% to 86%. In addition, coverage of the first dose of measles vaccine reached 85%, compared to 83% in 2022.

“The Americas were the first to eradicate diseases. It was the case with measles, it was the case with polio. So we have a great tradition and we see it with the eyes of improvement and we expect that we have, yes, the conditions to get back the vaccination coverage that we had and to become again a reference in the world for vaccination,” explains the director of SBIm.

measles disease

In addition to the reference trivalent vaccine, the WHO-UNICEF document highlights the global stagnation in measles vaccination coverage. The vaccine in this case is the trivalent viral vaccine, which also protects against rubella and mumps.

In 2023, only 83% of children worldwide received the first dose of this vaccine, and despite a slight increase, the second dose reached 74% of children, numbers that are below the 95% coverage target, which is necessary to prevent outbreaks and avoid unnecessary deaths. As a result, 103 countries have experienced outbreaks in the past five years. Among countries with strong vaccine coverage, which total 91, there has been no increase in cases.

“Measles outbreaks are like an early warning signal, revealing and exploiting gaps in immunization and reaching the most vulnerable first,” said Tedros Adhanom Ghebreyesus, WHO Director-General, in the statement.

In 2016, Brazil was certified as having eliminated measles by the Pan American Health Organization (PAHO), an achievement attributed to the power of vaccination against the disease. However, between 2014 and 2018, vaccination coverage dropped from 90% to 70%, meaning that just three years after the certification, in 2019, the country faced a measles epidemic, with more than 20,000 cases.

Now, the country is on its way to returning to the immunization goal. In 2023, 86.9% of children were vaccinated with at least one dose of the trivalent virus that fights the disease. But this year, Brazil completed two years without local measles cases, that is, those transmitted within the national territory. In this way, it is once again approaching the title of “measles-free country.”