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Brazil's COVID-19 spike crisis: Vaccine hesitancy, or China's vaccine?

(Ricardo Moraes/Pool Photo via AP)

The Washington Post leads with vaccine hesitancy. It eventually comes around to the vaccines on which Brazil relies to explain its poor performance in controlling the spread of COVID-19. The problem might well be a combination of the two, but the latter could also be fueling the former — and not for no good reason, either.

First, NBC News reports on the scope of the pandemic crisis in Brazil, which has one of the highest spikes of new cases adjusted for population in the world. The South American country has plenty of health-care infrastructure challenges, but even with those in mind, the lack of success has been discouraging. And now, it’s not just the elderly who are dying:

The coronavirus has killed an estimated 1,300 babies in Brazil since the beginning of the pandemic, even though there’s overwhelming evidence that Covid-19 rarely kills young children.

While data from the Health Ministry suggest that over 800 children under age 9 have died of Covid-19, including about 500 babies, experts say the real death toll is higher because cases are underreported because of a lack of widespread coronavirus testing, according to the BBC, which first reported the story.

Dr. Fatima Marinho of the University of São Paolo, a leading epidemiologist who is a senior adviser to the international non-governmental organization Vital Strategies, estimated that the virus has killed 2,060 children under 9, including 1,302 babies. Her estimate is based on the number of excess deaths from an unspecified acute respiratory syndrome during the pandemic.

There is a misconception that children are at zero risk for Covid-19, Marinho told the BBC after she found that there have been 10 times more deaths from an unexplained respiratory syndrome over the past year compared to previous years.

That’s an aspect that might get some review in other places, including here. Small children don’t apparently provide as many vectors for COVID-19 but the risk isn’t zero for infection, as we already know. With infants and pre-toddlers, the immune system isn’t as developed, and their symptoms might not be as clear as with older children and adults. We might see a similar unexplained rise in excess mortality in these groups in later research — or perhaps it’s just an indicator of how intense the pandemic is in Brazil at the moment.

Part of the problem is their vaccination rate, which remains very low against the metrics established by the US and UK, and even neighboring Chile. However, Chile will come back into the picture in just a moment (via Our World in Data):

Brazil has barely dented its population on a first-dose basis at just over 10%. Israel, the UK, and Chile are all out ahead of the US on that metric, but we are approaching 40% too. Brazil’s slow uptake might be due to infrastructure, but as the Post notes, it’s also due to skepticism:

The news received scant notice in the mainstream media, but it quickly gained a foothold in Brazil’s vast right-wing digital landscape: The vaccine on which Brazil had gone all in was a disappointment even to the country that had created it. …

Now there is fear that the seemingly offhand — and quickly censored — comment by George Gao, the head of the Chinese Center for Disease Control, could further complicate Brazil’s bewildered campaign to vaccinate its population. The very people most likely to get their news from right-wing media are those already more hesitant to get the vaccine.

“We have to be very careful how we communicate science during the pandemic,” said Natália Pasternak, a prominent Brazilian microbiologist. “People already look at this vaccine like ‘second best.’ So this kind of message can have a real impact on vaccine coverage.”

That’s certainly true, and we’re experiencing similar impacts from incompetent messaging in the US and Europe. Both areas are undermining confidence in effective vaccines by overreacting to a blood-clot risk that is actually far lower than in the disease it prevents, and which might not be any higher than in the general population anyway. It’s also true about the hypercautious messaging for the vaccinated, warning them not to change any of their mitigation efforts — even though the risk of infection is proving microscopically low. It’s not just in Brazil, and it’s not just “right-wing media,” that disincentivizing messaging for vaccination occurs.

The bigger problem, however, is that the skepticism is probably justified for the vaccines that Brazil acquired. Gao’s remark about the efficacy of China’s vaccines might have gotten retracted and censored, but the real-world data in countries relying on those vaccines demonstrate Gao’s conclusion. Chile, which has used China’s vaccines to gain one of the best vaccination records in the world, now has the highest upward spike in cases per million people among countries in the above chart — higher even than Brazil or India, at least in reported cases:

The US has an upward trend too, but the rate of increase is much lower. That’s also a function of our vast geographical spread and the uneven uptake of the vaccines, plus almost certainly the extension of cold weather in the northern half of the country. The UAE, which used China’s vaccines to achieve 80% or better saturation with first doses, has seen cases plateau — and are suspicious enough that they are ordering third doses for recipients now in order to goose efficacy in those vaccines. Israel and the UK have seen cases plummet through the use of Pfizer and AstraZeneca vaccines, and several states in the US have seen similar effects with Pfizer and Moderna, along with Johnson & Johnson to the extent we have deployed it at this point.

In the cases with China’s formulations, vaccine hesitancy might well be rational and justified. The US and UK are rightly concerned with completing the inoculation of their own populations, but soon they will need to turn their attention to these hot spots. China is clearly not helping in ending the pandemic and the generation of new variants. It will be incumbent on the West to start strategically deploying vaccines that actually work to win the global war, not just the national battles.