In Brazil, a proposed bill would allow private companies to skip the vaccine line

Back in March, before the Brazilian government had secured any Pfizer COVID-19 vaccine doses, nearly 60 business owners and politicians illegally paid a nurse over $100 each — around half the country’s monthly minimum wage — for what they thought was their first Pfizer dose.

The vaccines turned out to be a scam. Yet in Brazil, where vaccines are exclusively distributed for free through the national immunization plan but the rollout is proceeding slower than the spread of new variants, some wealthy Brazilians who are not part of priority groups and have the means to pay are looking for fast ways to acquire shots on their own. Although there are no reports yet that anyone in Brazil has successfully done so, a new bill headed to the Senate floor would authorize private actors to obtain the vaccine, which could make things easier — and legal — for them.

If enacted, the bill would allow private corporations to purchase and distribute vaccines to their employees, so long as they donate at least half to the national immunization plan. They would also be allowed to strike deals with manufacturers beyond those the National Health Surveillance Agency has given the green light to — which so far include Pfizer, AstraZeneca, Johnson & Johnson, and Sinovac.

The business-friendly government of President Jair Bolsonaro encourages the initiative. But some public health policy experts believe it could be seen as skipping the line.

“There is no conflict of interest. The [health] ministry has closed deals for over 500 million doses,” said House Speaker Arthur Lira when Congress approved the new bill in late March. “We’re in a moment of war, and in a war anything goes to save lives.”

Fabio Villas-Boas, who serves as the health secretary of the northeastern state of Bahia, which currently ranks fourth out of 26 Brazilian states in doses administered per 100,000 people, called the bill “absurd.”

“By favoring those who have money or who are lucky enough to be formally employed, in the medium run they have a comparative advantage to survive in comparison to those who don’t have money or are not part of the formal workforce,” Villas-Boas told Devex. “It’s a genocide of the poorest.”

With daily deaths still topping 2,000, Brazil has reached over 423,000 deaths since the start of the pandemic, the world’s highest toll after the United States. Brazil’s national immunization plan establishes 29 priority groups accounting for roughly 37% of the population. They include groups such as the elderly, Indigenous people, and school workers. To fully vaccinate them all, the country will require 155 million doses. 

Worsening inequality

Brazilian companies have already been allowed to buy vaccines since March, but current law requires all privately acquired doses to be donated to the government until it finishes vaccinating the priority groups. The bill would allow them to bypass the national plan.

Brazil is not the first Latin American country to consider allowing corporations to acquire their own vaccines. But after countries like Colombia, Mexico, and Peru authorized the private acquisition and distribution of vaccines, the Pan-American Health Organization, Latin America’s public health agency, began warning that such an approach could lead to further inequality in what is already one of the most unequal regions in the world.

“The use of vaccines for out-of-pocket payment can amplify the inequities that unfortunately the pandemic has highlighted so much in the region,” PAHO Assistant Director Dr. Jarbas Barbosa said in a press conference last month. “There is no surplus of vaccines anywhere, there are no vaccines to vaccinate only those who want or can pay.”

Despite having distributed over 45 million doses, ranking fifth in the world in absolute number of shots, the country of over 212 million is running against the clock to inoculate priority groups as more deadly variants emerge. As of May 11, only 7.3% of Brazil’s population had been fully vaccinated, and around 15% had received the first shot.

And although the health ministry estimated in March that Brazil would receive nearly 600 million doses — enough to inoculate two times of the adult population — by early 2022, the federal government’s delay in closing deals with manufacturers has resulted in a vaccine race. On Wednesday, a Senate investigation concluded the government did not prioritize vaccine acquisition, as it took the Bolsonaro administration two months to respond to a Pfizer offer for vaccines made in September.

Despite the intense lobbying of Brazil’s Congress by prominent business leaders to pass the bill — including retail tycoon Luciano Hang and education magnate Carlos Wizard, both of whom are billionaires — public health experts say it is unlikely that private actors will get ahold of new doses before the government does, as most manufactures are prioritizing deals with the public sector.

The more pressing problem, Villas-Boas said, is not buying more vaccines, but making sure the ones the government has already bought arrive in the country.

“The federal government has closed deals with all manufacturers worldwide. It hasn’t received the doses because they cannot meet global demand,” Villas-Boas said. “If we had signed (these deals) at the beginning, we’d be at the front of the line, but because we only began closing deals in February, March, now we’ll have to wait for everyone in the U.S. and Europe to get vaccinated before it’s our turn.”

A problem beyond Brazil

Some worry that the bill’s passage could destabilize not only the rollout in Brazil, but also worldwide, said Juarez Cunha, the president of the Brazilian National Immunization Society.

“If there was this possibility for private clinics and businesspeople to buy vaccines, we would certainly keep vaccines from countries that need to vaccinate,” Cunha told Devex. “There’s no point in Israel vaccinating 100% of its population, the U.S. 70%, if poorer countries will only vaccinate 10% or 20% of their populations because the virus will continue to circulate and evolve into new variants.”

“This global equity worries me,” Cunha added.

Meanwhile, two-thirds of Brazilians believe that the government should be responsible for the acquisition and distribution of vaccines, while 23% agree that the private sector should help the government by buying vaccines, according to a University of Oxford study. Around 54% of Brazilians said they would pay to get the vaccine, given the opportunity — compared to less than one-fifth of French citizens and nearly 80% of Indians.

Allowing healthy citizens to get vaccinated before priority groups may also have long-term implications for keeping the virus under control. A recent study concluded that when priority groups are established, infections and deaths are reduced by up to 44%.

Brazil’s national vaccination plan has long been recognized for its effectiveness. The country’s vaccination campaigns against the flu and polio have consistently been able to inoculate over 2.7 million people on a single day, and by 2017 Brazil was a global leader in inoculation, with vaccines against different diseases being widely available to over 97% of the population.

Given the country’s reputation, Cunha believes that if Brazil had enough doses, it would be able to apply at least 2 million shots a day — and ideally reach 4 million, as the U.S. has done. 

“They didn’t even have this tradition and are being able to do it,” he said of the U.S. “Here with the tradition of over 40,000 vaccination rooms, and the expertise we have, we could do it.”

“Brazil’s National Immunization Plan is something few countries have,” Villas-Boas said. “It’s free, universal. … We don’t lack structure, freezers or people to administer the doses, we have that. What we don’t have is the vaccine.”