Vacina Brasil e estratégias de formação e desenvolvimento em imunizações

Abstract

Health System (SUS) in 1988-, has been a determining factor for successful control of vaccine-preventable diseases in Brazil. The Program's work has contributed above all to important improvements in the health situation of the Brazilian population. Examples include: eradication of smallpox; elimination of poliomyelitis and urban yellow fever, elimination of the circulation of the measles virus (2016) and the rubella virus (2015); as well as reduction in the incidence of diphtheria, whooping cough, meningitis caused by type B H. influenzae , tetanus, tuberculosis in the under fifteen year-olds and, more recently, meningitis and pneumonia. 1 Reduction in vaccine-preventable disease incidence and mortality, especially in the first years of life, has had notable repercussions on increased life expectancy and reduced hospitalizations. 2-4 The list of vaccines offered by the SUS has increased over time. Nineteen vaccines are currently provided against more than twenty diseases. The National Vaccination Schedule, in the same way as in developed countries, covers not only children, but also adolescents, adults, seniors, pregnant women and indigenous peoples. 5 PNI's success and its growing complexity have, however, become an obstacle for maintaining adequate vaccination coverage. While people are no longer living alongside death and disabilities caused by vaccine-preventable diseases, they have become oblivious to the risk these diseases represent to their own health and to that of their family members and the community. 6 Within this scenario, fear of adverse events and spreading of fake news about immunobiologics emerge and outweigh knowledge about the importance and benefits of vaccination. Anti-vaccination movements, 7 although they are not very active in Brazil, are increasingly frequent and persuasive, and spread scientifically unfounded information about the risks of vaccination. In addition, operational factors such as restricted health center opening hours and under-recording of vaccine dose administration on the National Immunization Program Information System (SI-PNI), hinder both access to immunobiologics and monitoring of vaccination targets. The intense migratory movement seen in a country bordering Brazil, with an initial influx in the Brazilian state of Roraima, has contributed to the propagation of the measles virus, which is now circulating once more in Brazil, especially in the states located in the country's Northern region. More than 10,000 cases of the disease were confirmed in 2018, 8 and 646 cases distributed over eight states had been conformed as at July 2019. This demonstrates that additional efforts need to be mobilized in order to maintain adequate vaccination coverage. 9 In order to reverse the decline in vaccination coverage in Brazil, on April 9 th 2019 the Ministry of Health launched the Vacina Brasil Movement, during the XXII March to Brasília in Defense of the Municipalities, as part of the agenda of the first 100 days of the new Federal Administration. The aim of the initiative is to mobilize the three levels of health service management (federal, state and municipal) and diverse sectors of Brazilian society and alert as to the importance of vaccination as the main measure for controlling vaccine-preventable diseases, and as the only measure capable of avoiding the reappearance of diseases that have already been eliminated in Brazil. Its first actions have been directed towards publicizing the influenza vaccination campaign, by means of posters, banners, films and images for use in social media. On May 3 rd the Christ the Redeemer (Cristo Redentor) statue in Rio de Janeiro was illuminated with the Movement's projected logo. Apart from actions already carried out, intensified vaccination is planned against yellow fever, as well as vaccination against yellow fever and measles in the country's border regions, in order to scale up vaccination coverage and disease control. Strategies intended to reverse vaccination coverage reduction need to take into consideration the diverse factors that contribute to this situation. Use of the media, which has been the main Vacina Brasil Movement strategy so far, is fundamental for scaling up access to information based on scientific evidence, especially regarding the benefits of vaccination. In addition to spreading information via traditional and electronic media, these strategies also need to include active tracing of unvaccinated people in key populations, partnerships with schools and universities,