Raging virus, few shots - How Brazil missed its chance to secure COVID-19 vaccines

With efficacy of just over 50% - barely above Brazil's threshold for regulatory approval - the Chinese shot was not the government's first choice. But for now, there is little else available.

The country's principle strategy - to manufacture 100 million doses of the AstraZeneca PLC vaccine locally - has been plagued by repeated delays. That effort isn't expected to yield a finished product until March at the earliest. AstraZeneca last week sent 2 million emergency doses to help Brazil get started. Meanwhile, Brazil's Health Ministry has yet to sign deals with other vaccine makers.

The delays leave Brazil's 210 million residents vulnerable to one of the worst coronavirus outbreaks on the planet. Brazil has tallied more than 218,000 COVID-19 fatalities, second only to the United States, and vaccinated less than 0.5% of its population.

Brazil's vaccine rollout is just the latest misstep by its Health Ministry, which President Jair Bolsonaro has stocked with active-duty and retired military men with little public health experience. Those newcomers failed to grasp how quickly they needed to move to secure supplies amid heated global competition, and the importance of hedging their bets by striking deals with multiple manufacturers, according to interviews with more than a dozen current and former officials, pharmaceutical executives, diplomats and public health experts.

The ministry's hesitance led to a missed opportunity back in August to order 70 million doses of a vaccine made by Pfizer Inc and BioNTech SE, with delivery starting in December, Pfizer said in a Jan. 7 statement.

Reuters also viewed an internal Health Ministry WhatsApp chat log, containing thousands of messages exchanged between senior officials last year as the global race for vaccines was heating up. The messages reveal that the new leadership team prioritized hydroxychloroquine and its cousin chloroquine, anti-malarial drugs championed by Bolsonaro as COVID-19 treatments despite little scientific evidence that they work.

"There was not sufficient focus on the vaccines, and a lack of technical vision," former Health Minister Nelson Teich told Reuters in an interview. Teich resigned in May in a disagreement with Bolsonaro over the hydroxychloroquine strategy.

Reuters sent a detailed list of questions for this story to the president's office, which directed queries to the Health Ministry. The ministry did not respond.

Bolsonaro - who contracted the coronavirus last year and says he won't take any COVID-19 shot - has defended his government's vaccine rollout. "With respect, nobody would do better than my government is doing," he said in a Jan. 15 television interview.

While many nations have struggled to obtain vaccines as manufacturers strive to meet global demand, Brazil was better positioned than many. It has a long history of successful inoculation drives, and its state-funded production facilities can churn out vaccines at scale.

The federal government squandered those advantages, said Marcia Castro, a native Brazilian and professor at the Harvard T.H. Chan School of Public Health in Boston.

"It's a succession of errors that began from the start of the pandemic," she said. "And sadly, we're measuring those mistakes in the number of deaths."

HYDROXYCHLOROQUINE OBSESSION

The AstraZeneca shot was supposed to be the main pillar of Brazil's inoculation plan. According to a person involved in the deal, the Cambridge, England-based firm started talking to the Health Ministry about buying its vaccine around early June.

By then, Teich, the former health minister, was gone, replaced by Eduardo Pazuello, an Army general with no medical background. He quickly surrounded himself with other military men.

Negotiations with a ministry in upheaval were challenging, said the person familiar with the talks.

"There were no decisions being driven from the top," the person said, referring to Bolsonaro and the new ministry leadership.

The new officials were betting on hydroxychloroquine to mitigate Brazil's pandemic, months of internal ministry WhatsApp chats viewed by Reuters revealed. Vaccines were mentioned infrequently in the chats, and at times with skepticism.

For example, on June 12, just days after being named deputy health minister, Elcio Franco, a retired Army colonel, alerted colleagues to a magazine article featuring AstraZeneca's top Brazilian executive discussing the company's vaccine. Franco expressed surprise that anyone might volunteer to participate in a vaccine trial.

"Who would be a guinea pig?" Franco wrote to his colleagues.

Franco did, however, express confidence in hydroxychloroquine and chloroquine.

In June, COVID-19 deaths per day were reaching new highs in Brazil, official data showed. Franco claimed the opposite was true.

"Death rates are dropping dramatically due to Bolsonaro's treatment protocol," he posted to the internal WhatsApp group on June 15. "Chloroquine is reversing the situation."

Franco did not respond to requests for comment through the Health Ministry or his LinkedIn account.

Brazil is now dealing with another surge of infections that's pushing hospitals to the breaking point in several cities.

The Health Ministry has doubled down on anti-malarials. It publicly has urged infected people to take them soon after the onset of symptoms, and this month it sent 120,000 hydroxychloroquine pills to the badly hit northern state of Amazonas.

ASTRAZENECA TALKS

The person involved in the AstraZeneca talks said the Health Ministry's leadership didn't appear to grasp how quickly they'd need to act to secure a portion of the company's limited supply.

In an initial meeting around the start of June, Pazuello, the new chief, showed interest in buying the vaccine, "and then got up and left the room," the person said. "He didn't come to future calls."

Pazuello did not respond to requests for comment.

During ministry talks, AstraZeneca officials stressed the need for Brazil to make a financial commitment to guarantee delivery, the source said.

Ministry newcomers were still mastering government red tape, slowing the transaction, three people familiar with the situation said. The officials also proceeded cautiously to avoid any perception that they stood to profit from an unproven vaccine, following public graft scandals that had upended the country in recent years, the people said.

"They fear that people will assume there were kickbacks involved and their opponents will use it as a reason to launch an investigation," the source said.

Meanwhile, Britain, the European Union and the United States signed large deals with AstraZeneca.

With Brazil's Health Ministry dithering, AstraZeneca reached out to officials in other parts of government to help unlock funding, said the person involved in the negotiations.

AstraZeneca did not respond to requests for comment.

On June 27, Brazil announced it had signed a $127 million agreement to start producing AstraZeneca's vaccine at Rio de Janeiro's federally funded Fiocruz Institute. Franco, the deputy health minister, said in late June that Brazil would initially produce some 30 million doses of the vaccine, half by December 2020, the rest in January 2021.

But Fiocruz has yet to manufacture a single dose because it lacks the active ingredient needed to make the vaccine. The first shipment of that Chinese-made material is now delayed until around Feb. 8, Fiocruz said this week, without giving a reason. Fiocruz had previously predicted it would produce finished doses by March. It will update that forecast once the ingredient arrives, the statement said.

Yang Wanming, China's ambassador to Brazil, said in a Tuesday press conference that "technical" obstacles were holding up the shipment. He did not elaborate.

With its timetable slipping, the Health Ministry in late December appealed to AstraZeneca, which was able to source 2 million ready-to-use shots from India. Those doses, which arrived in Brazil on Jan. 22, will immunize just 0.5% of Brazil's population.

PFIZER FAILURE

Negotiations with Pfizer, meanwhile, have turned testy. The Health Ministry publicly has chastised the company for demanding Brazil sign a waiver shielding it from any potential liability regarding its vaccine.

Pfizer says many countries have signed the waiver; it blames Brazil's government for dragging its feet. In a January statement, the company said it began talks in June with the Health Ministry, which it said passed on Pfizer's August 15 offer to supply 70 million doses.

With those negotiations bogged down, Brazil's government has turned to the Sinovac shot.

Bolsonaro, a vocal China critic, had vowed never to purchase the Chinese vaccine. On Jan. 13, he delighted in pointing out to supporters that the vaccine's Brazilian trials, conducted at São Paulo's Butantan Institute, a public biomedical research center, had shown a disappointing efficacy rate of 50.4%.

But with few options left, the Health Ministry recently announced a deal to purchase up to 100 million doses from Butantan.