Parents of children with comorbidities ask for a vaccine after ANVISAs approval

Studies show that children with intellectual deficits are at increased risk of being contaminated and developing severe cases of COVID-19

Vaccination of children is routine and widely accepted. Measles, polio, diphtheria, mumps, various types of meningitis, whooping cough, are some of the diseases that little ones are immunized against — sometimes as young as a few weeks old. Other diseases such as the influenza virus, priority is being given to children with comorbidities in receiving vaccines by the Unified Health System (SUS). However, vaccination against COVID-19 does not include children and adolescents with disabilities and comorbidities. With the authorization, on June 11 of this year, for the use of the Pfizer vaccine for adolescents from 12 years of age, by the National Health Surveillance Agency (Anvisa), parents of children with neurological problems and other comorbidities were filled with hope of being able to include their children among the priority groups. At this moment, Pfizers immunogen is the only option for this age group, within the arsenal of vaccines that Brazil has acquired.

In March, Pfizer announced the completion of trial trials of its COVID-19 vaccine in children. According to the research, the vaccine proved to be safe and 100% effective in children up to 16 years old – similar positive results were obtained for young people between 16 and 25 years old.

To learn more about the subject, the Communication Office of the Brazilian Society of Tropical Medicine (SBMT) interviewed Dr. Wanderson Oliveira, PhD in Epidemiology from the Federal University of Rio Grande do Sul (UFRGS), former National Secretary for Health Surveillance at the Ministry of Health and current Secretary of Integrated Health Services at the Federal Supreme Court (STF). Father of little Liz, 3 years old, with disabilities.

Check the interview in full:

The importance of vaccinating children and adolescents with disabilities and comorbidities?

Dr. Wanderson Oliveira: Although children have a lower incidence compared to adults, those with disabilities and comorbidities are just as vulnerable as adults with comorbidities. For this reason, safe return plans for face-to-face teaching activities exclude people with comorbidities and disabilities. However, it is important to emphasize that children and adolescents with disabilities need continuous stimulation and cannot interrupt their activities.

SBMT: Prioritizing vulnerable children aged 12 to 17 in the national vaccination campaign is to promote equity. Could you tell about this statement?

Dr. Wanderson Oliveira: I consider fairness and justice, as the school is not only a teaching environment, it is also a social protection network and for them to have access, they need to be protected.

SBMT: What changes for this group with the authorization by the   National Health Surveillance Agency (Anvisa), on June 11 of the use of Pfizers vaccine against COVID-19 in adolescents from 12 years of age in Brazil?

Dr. Wanderson Oliveira: Pfizer is our only option for this age group approved by Anvisa. Therefore, what changes is that the Federal Government should dedicate a portion to the vaccination of adolescents with disabilities and comorbidities immediately, otherwise we will have no options this year and this group will be without classes until 2022, it would be regrettable and an injustice.

SBMT: After authorized, Pfizers vaccine became the only option for this age group. How to implement solutions to the issue?

Dr. Wanderson Oliveira: One of the solutions is to dedicate the Janssen vaccines that arrived early and use them as compensation so that the Pfizer quantity can be used in adolescents with comorbidities and disabilities. This would make it possible to guarantee the security of this group without undermining the program. Or the NIP [National Immunization Program] should review the operational vaccination plan.

SBMT: Can investment in partnerships with private clinics and companies be a solution? Why?

Dr. Wanderson Oliveira: Historically, the NIP in the Municipalities uses partnerships with pharmacies and companies, such as Belo Horizonte, Porto Alegre and Rio de Janeiro in campaigns against Measles. This initiative can make sense to carry out a large effort. However, it is necessary that the vaccines arrive in sufficient quantity to justify the initiative. If the manufacturers deliver all the quantity on time, the SUS will soon have so much vaccine that it will be strategic to carry out the task force, but for that it is necessary to have a pact of responsibilities and central coordination. If the NIP does not signal this possibility, municipal managers will not join. Therefore, once again we are faced with the need for Central Coordination.

SBMT: According to a study published in the Disability and Health Journal, among people aged 0 to 17 years infected with Covid-19, those with intellectual disabilities had a fatality rate 160 times higher than other patients of the same age. In addition, the chances of infection were 8.6 times higher among those with intellectual disabilities (26%) than among other children in the age group (3%). In your opinion, wouldnt this increased mortality, added to the greater chance of contamination and the difficulty in early diagnosis, be factors that justify the inclusion of this group among the priority ones?

Dr. Wanderson Oliveira: Absolutely and this study was very important to demonstrate this situation. However, society has become the only “healthy” vision, as they believe that all children under 18 are risk-free. It is a mistake and places this group among the most vulnerable among the vulnerable. It is regrettable and the NIP must immediately correct this flaw, as there is no longer any justification for not vaccinating children aged between 12 and 17 with Pfizer – there is a vaccine and all that is missing is good will and management.

SBMT: People with intellectual and developmental disabilities (IDD) are a vulnerable health population that does not receive adequate attention in research and public health interventions/efforts. The fact that there is no adequate surveillance structure to monitor COVID-19 is disconcerting. This group may even be at higher risk of developing serious outcomes of COVID-19. Furthermore, if they are not vaccinated, they will be the only priority group that will continue to be harmed by the lack of vaccine protection. In your opinion, why is this group still forgotten by the government?

Dr. Wanderson Oliveira: In 2015 the congenital Zika syndrome pandemic began. On that occasion we discovered a great assistance gap. Unfortunately, despite being provided for in Consolidation Ordinance No. 03/2017, the Care Network for People with Disabilities is still limited and needs greater attention from managers. For this, it is necessary to ensure what is provided for in Law No. 13.146 of July 6, 2015, which institutes the Statute of Persons with Disabilities. I think that, despite the Operational Plan having foreseen the vaccination of adults, there is no provision in the plan so that when the vaccine for minors is approved, the plan should be revised and new targets implemented. That was missing and with that, this age group was forgotten by the government. Its a pity, as the First Lady herself has been so concerned about the disabled, but for this matter it seems to me that even she doesnt have her eyes and heart open. It is regretable.

SBMT: Would you like to add something?

Dr. Wanderson Oliveira: Brazil has the capacity to guarantee vaccination for everyone until October 31st 2021. But for that it is necessary to adjust the schedule and expand monitoring. As a suggestion, I would expect the government to make programming based on scenarios, so that the system adapts to each reality. For example:

Scenario 1: vaccines will arrive on time and in sufficient quantity

Scenario 2: there will be partial delay, but it will be possible to guarantee vaccination of the most affected groups

Scenario 3: there is a delay that compromises the realization, with that, which criteria and groups the Municipalities must follow according to their availability of vaccines.

This is a better and smarter way to deal with a pandemic. However, it seems to me that the NIP has chosen to do and anchor itself in a routine experience and small outbreaks. It is necessary to recognize that we have no history of facing reality like this, vaccines for the same agent with different dose schedules, different technologies, in emergency use. In other words, we must be less smug and more realistic in order to adjust to realities, but this requires coordination, transparency and implemented risk communication and daily panels that allow society to know and respond to situations based on credible spokespersons. Unfortunately, there are no more technical press conferences and the bulletins no longer come out with adequate transparency. This must change!

According to the Federal Government, 123,214,292 doses of vaccine were delivered. Of these, 90,289,638 doses were applied, reaching a total of 66,620,222 people with at least one dose. Of this total, 23,669,415 people received two doses of vaccine.

According to IBGE, the population of Brazil in 2020 was estimated at 212.893.890 people. Of these, 74,8% (159,303,037) are 18 years old or older, 9,1% (19,304,353) are between 12 and 17 years old and 16,1% (34,283,500) are up to 11 years old. Considering that Pfizers vaccine was recently approved for use in adolescents from 12 years of age, it means that the population eligible for vaccination includes this age group. Therefore, we need to guarantee the vaccination of everyone aged 12 and over, which represents 83.9% or 178,610,390 people.

If we set the goal of vaccinating 90% of the entire population aged 12 and over, we will have to vaccinate 160,749,351 million people. This means that 75.5% (160,749,351/212,893,890) of the total population of Brazil. Considering that the municipality of Serrana in São Paulo reached collective protection from 75% of its population vaccinated, this should be the new goal of the NIP.

According to a publication by the Ministry of Health on June 16th 2021, the Federal Government signed agreements for the acquisition of 662,512,770 doses of vaccines that should arrive by December 2021. Only in the 4th quarter are expected deliveries of 53% (348,547,300) of the total purchased doses. Therefore, by the end of September, we should have received 47% (313,965,470) of the doses purchased, or closer if the manufacturers honor their commitments.

Considering that 123,214,292 doses of vaccines have already been delivered by June 29th 2021 at 9 am, according to the Ministry of Healths Vacinometer, we will still receive a total of 190,751,178 doses or 60.8% of the total for the first three quarters.

Whereas we have already vaccinated 41.4% (66,620,222/160,749,351) of people aged 18 years and over with at least one dose. Therefore, a total of 94,129,129 people need to be vaccinated. Considering that we have a total of 190,751,178 doses in our hands, it would also be possible to vaccinate those over 12 years of age with Pfizer and apply a second dose to those over 40 years of age. For this, the NIP should change the dose range of Pfizer and AstraZeneca and make available doses for vaccination of the group from 12 to 17 which represents about 19 million people. Therefore, the government would have:

12 to 17 years: 20 million doses from Pfizer for this group

18 to 39 years: 90% of the group with at least one dose applied

40 years or more: 90% of the group with at least one dose applied