Covid-19 and the flu: 6 answers about the simultaneous vaccination about to start in Brazil

RIO DE JANEIRO, BRAZIL – According to the Ministry of Health, the immunization against the flu starts on Monday, April 12. This happens every year at the beginning of autumn when the temperature starts to drop and the circulation of viruses that affect the respiratory system (such as influenza) increases considerably.

The campaigns against the flu and the Covid-19 will take place in parallel and raise questions about who should take the doses, the waiting time between one vaccine and another, and how it will be organized to avoid crowds at the health posts.

BBC News Brazil consulted experts to answer the main questions and understand the importance of protecting against these two diseases.

Who can take the vaccines against both Covid-19 and the flu?

You have to pay close attention because the priority groups and the order they will be attended to change a little according to each campaign.

For now, Brazilian municipalities are vaccinating against covid-19 health care professionals and people over 60 in several age groups. Many places started calling for individuals over 90 years old and have gradually lowered the age.

The expectation is that workers in education, security, and rescue forces will start to take their doses against the coronavirus in the coming weeks, according to each city’s schedule.

In the case of vaccination against the flu, the first to be contemplated will be:

• From April 12: children, pregnant women, women who have recently had a child, indigenous people, and health workers;
• From May 11: people over 60 years old and teachers;
• Between June 9 and July 9: individuals with permanent comorbidities or disabilities, truck drivers, road and port workers, security forces and the Armed Forces, prison employees, people deprived of their freedom, and young people from 12 to 21 years old are under socio-educational measures.
• Generally, campaigns against the flu begin with the elderly. But in 2021, they were transferred to a second stage so that there would be no confusion and conflict with the calendar established against Covid-19.

The expectation is that, as of May, most individuals over the age of 60 will be properly protected against the coronavirus and will be cleared to also guard against influenza.

“To avoid risks, managers will need to do a great organization with lines, different times and spaces, so that there is no crowding of people in health units,” suggests epidemiologist Jose Cassio de Moraes, professor the Faculdade de Ciências Médicas da Santa Casa de São Paulo.

Which vaccine should be prioritized?

Both immunizers are essential and help avoid respiratory complications that require hospitalization and can even lead to death.

If you are part of the target audience for both campaigns at some point in the coming months, priority should be given to the Covid-19 vaccine.

“This is the recommendation of the Ministry of Health’s National Immunization Program (PNI) and has to do with the fact that we are in the middle of a pandemic,” explains Dr. Maria de Lourdes de Sousa Maia, coordinator of the Clinical Advisory of Bio-Manguinhos, at the Oswaldo Cruz Foundation (Fiocruz).

But priority should not be confused with exclusivity: it is important to be vaccinated against the flu in sequence, respecting the specialists’ timeframe, as you will see below.

Can I get the Covid-19 and the flu vaccines together on the same day?

No. According to public health authorities’ guidelines, you have to wait 15 days between one vaccine and the other.

But what is the reason for this two-week interval?

“We still don’t have co-administration studies, which would allow us to know the immune system response to the joint application of the two immunizers, against the flu and Covid-19,” explains Dr. Patricia Mouta, a pharmacovigilance professional at Bio-Manguinhos/FioCruz.

Since research on the subject has not yet been done, the Ministry of Health has opted for prudence to avoid any unexpected side effects or decrease the effectiveness of the immunizers.

Here are examples of how this scheme will work in practice: you can take the first dose of Coronavac and wait 14 to 28 days to receive the second dose of this same vaccine.

Then you need to wait another two weeks to be vaccinated against the flu (which requires only one dose to confer protection).

In AZD1222, the AstraZeneca/Oxford University Covid-19 vaccine, the vaccination order changes because the time lapse between the first and second doses is much longer: 3 months.

Hoever, you can take the first dose of AZD1222 and, after  waiting two weeks, receive the single dose flu vaccine. You must wait the remaining two and a half months to complete the protection against Covid-19 with the second dose of AZD1222.

Why is it important to get vaccinated against these two diseases?

Both influenza and Covid-19 are diseases that affect the respiratory system, bring complications or sequels, and even kill. From an individual point of view, therefore, the vaccination reduces health risks.

From the collective perspective, getting immunized is an attitude that protects the entire community because it breaks the chains of viral transmission and prevents hospitals and intensive care units’ crowding.

In other words, by taking your doses, you protect not only yourself but also your family, friends, neighbors, and everyone around you – even those who, for one reason or another, cannot get the vaccine.

Does Brazil have guaranteed doses to protect the population against Covid-19 and the flu?

The situation varies a lot. In the case of the flu vaccines, the concern with an eventual shortage is smaller, almost non-existent.

This is because Brazil is self-sufficient in this matter: the manufacture is in charge of the Butantan Institute, which no longer depends on the import of the active pharmaceutical ingredient (API) to deliver, every year, 80 million doses to the Ministry of Health.

Butantan has the largest influenza immunization plant in the Southern Hemisphere.

When it comes to Covid-19, though, the matter is a bit complicated. Our country depends on shipments of API from China and India to finish the packaging of Coronavac at the Butantan Institute and AZD-1222 at Fiocruz.

Since January 2021, the deliveries have suffered delays and unforeseen events due to the global demand for the product, which has even paralyzed the vaccination campaigns against coronavirus in some cities.

“To speed up people’s immunization, we need to have more vaccine doses available,” points out epidemiologist Carla Domingues, who was PNI coordinator between 2011 and 2019.

In recent days, both Butantan and Fiocruz have been able to extend the delivery of new batches of vaccines against Covid-19, which promises to give more predictability to state and municipal governments.

Also, other vaccines that already have a purchase agreement with the Ministry of Health, such as those produced by Pfizer and Johnson & Johnson, should arrive in the coming months.

The Ministry’s provisional calculation is that Brazil already has more than 500 million doses guaranteed for 2021.

What are the challenges of carrying out two simultaneous campaigns?

Besides the organization and logistics issues, the experts interviewed by BBC News Brazil call attention to the challenge of having good communication to people about the simultaneous campaigns. Unfortunately, in their evaluation, Brazil is doing poorly in this regard.

“I can’t say that communication is terrible because that would mean that there is something being done. Communication is absent. There is no kind of announcement or official campaign,” criticizes Moraes.

For now, the federal government has broadcast few advertisements or other content in the physical and digital media to talk about the target public, when people should get vaccinated, or what documents are needed.

“What we have seen are only advertisements about vaccine purchases. It is necessary to explain to the population about the need to take both doses, respect the intervals, among other things. This communication is not being done,” observes Domingues.

BBC News Brazil contacted the ministry of Health’s press office to hear their version of this point, but had not received a reply as of the publication of this report.

Maia, who was coordinator of the PNI between 1995 and 2005, points out that no matter how much experience Brazil has in immunizations, it is necessary to adapt to the new reality.

“To carry out vaccination campaigns is to reinvent oneself all the time. Staying with the same old thing is a recipe for failure,” says the doctor. “It is necessary to understand the moment we live in and estimate the impact that fake news and WhatsApp chains can have on the acceptance of vaccines. We will have to deal with and overcome this,” she adds.

Source: BBC Brasil