The Race for a Vaccine Is ‘Going to Get Ugly’ in Hard-Hit Brazil

RIO DE JANEIRO, Brazil - It was late July, and Brazil had just cleared the 90,000 COVID deaths mark. President Jair Bolsonaro had tested positive for the virus weeks earlier. Logging on for his weekly Facebook live, the president announced an agreement to purchase 100 million doses of the Oxford-AstraZeneca vaccine. “It’s not from that other country. Ok, people?” he joked.

The “other country” was China, and the comment was a dig at the governor of the state of São Paulo, João Doria, a political rival. Doria, a potential frontrunner for 2022’s presidential elections, had recently touted the vaccine he favors, produced by Chinese company Sinovac in partnership with the state’s Butantan Institute, a renowned public research center allied with São Paulo’s state government.

The political fighting over the Sinovac vaccine has been going on for months. Now, as Butantan prepares to submit final data for federal approval, politics threatens to taint the decision over what could be the first nationally available vaccine in the western hemisphere.

“It’s going to get ugly and it’s going to be along partisan lines,” said Mauricio Santoro, a professor of international relations at the State University of Rio de Janeiro, UERJ. Multiple foreign-developed vaccines are currently undergoing testing in Brazil, and Santoro imagined the next year would present a scenario with several vaccines available at the same time.

But critics worry over potential interference from Bolsonaro at Anvisa, the executive agency responsible for vaccine approval. The president has appointed four new directors to the agency over the last month, and Anvisa recently engaged in a tiff with the São Paulo government over what appeared to be delays in Sinovac material imports.

The president has also cancelled a deal by his own Health Ministry to purchase 46 million doses of Sinovac’s vaccine, what he has called “Doria’s China vaccine,” for national distribution.

Bolsonaro has instead kept his bet on Oxford-AstraZeneca’s product, which is being produced in partnership with the country’s Fiocruz Health Institute.

But the Butantan-Sinovac vaccine favored by Doria has jumped ahead of its Oxford counterpart. Though both remain in phase III trials (large scale human testing for safety and efficacy), Butantan has already shown positive results in its preliminary safety data. Pending the release of efficacy data, approval from Anvisa could take place in the next few weeks.

Oxford-AstraZeneca, meanwhile, has suffered a number of setbacks, including a pause in testing and one reported death in Brazil (CNN Brazil has reported the volunteer test subject received a placebo).

Doria has taken advantage of the lead, repeating unrealistic promises about the vaccine’s timeline to the press, and announcing national availability well before approval and agreement from the federal government. Experts worry that this sort of pressure could erode public trust.

“If there is an issue with the vaccine, it could harm uptake of all vaccines, not just this one,” said Anna Durbin, a professor of international health at the Johns Hopkins Bloomberg School of Public Health.

While the race to develop a COVID-19 vaccine has already taken place at unprecedented speeds — development usually takes a decade or more — it is true that part of Sinovac’s lead may be due to previous experiences with similar diseases. “Many of these vaccines likely did not start from square one,” said Ana Paula Sayuri Sato, a professor at USP’s epidemiology department.

Sinovac in particular produced a similar vaccine for SARS in the late 2000s, and has chosen to develop an inactivated vaccine — a classic, low-tech method that uses a form of the virus rendered uninfectious with a chemical agent — for COVID-19, a technology it has used for decades.

But Durbin said she was “unenthusiastic” about inactivated vaccines. Citing historical examples of health complications resulting from inactivated vaccines, she expressed concern over their long term safety.

None of this technical discussion seems to be filtering down to regular Brazilians, who may be basing their opinions, at least in part, on anti-China rhetoric from the president. Bolsonaro has repeatedly vowed not to purchase Sinovac’s vaccine, recently saying he believed it was unsafe “because of its origin.”

In a recent book, former Health Minister Luiz Henrique Mandetta alleged the president believed the virus was a conspiracy cooked up by the Chinese in an effort to restore leftist governments in Latin America. “We are talking about a man with this sort of worldview. He’s still in the Cold War” said Santoro.

In a mid-October, 46 percent of Brazilians said they would not take a vaccine of Chinese origin, and that number fell to 22 percent for the Oxford vaccine, according to a poll by Real Big Time Data,

“There is pervasive mistrust of China, both fair and not,” said Margaret Myers, director of the Asia & Latin America Program at the Inter-American Dialogue, a think tank in Washington DC. She drew parallels to perceptions of Chinese private sector involvement in Latin America at large. “It doesn’t take much to perpetuate those views.”

“Chloroquine, quarantine, and now the vaccine. These sensitive topics in combatting the pandemic have increasingly been used as political tools by the federal government, some regional and local governments,” said Fernando Aith, a professor of public health at the University of São Paulo (USP).

“Unfortunately, the public interest, minimizing deaths and suffering, is not on the horizon for our main politicians.”