Denise Garrett: "Covid-19 vaccines that go to the private sector will be taken from the public sector"

Brazilian infectologist Denise Garrett, vice president of the Sabin Vaccine Institute (Washington). Christy Parry / Arquivo Pessoal

“Vaccination will only work in Brazil if you think about the collective.

Some people can pay so that their family can be vaccinated, but they will not be protected if the population is not vaccinated ”.

The warning comes from the Brazilian infectologist Denise Garrett, commenting on the private sector's interest in the coronavirus vaccine, in a telephone interview with EL PAÍS last Wednesday.

The doctor, vice president of the Sabin Vaccine Institute (Washington), explains that the public sector controls the purchase and free administration of the drug in countries that are already vaccinating, including in the United States.

And he clarifies that, given the lack of supply, there is still no space for the private sector to commercialize them.

This week, the National Confederation of Industry and the Brazilian Association of Vaccination Clinics announced their interest in acquiring a few million doses, given the slowness of the Brazilian government to start a national immunization program.

Question.

Private clinics and the industrial sector have shown interest in buying the vaccine.

Why?

Reply.

Because a vaccine distributed by public health discourages the private market.

We must remember that the vaccine is only authorized for use in emergency cases, it cannot be marketed [according to Brazilian legislation].

So all these initiatives will be of no use.

However, these vaccines have also been made to generate profits for those who have produced them.

Pfizer is already planning to apply to the FDA [US Food and Drug Administration] for full approval of the vaccine in April before it can be marketed.

So, over time, it will happen.

Q.

How has vaccination been in the United States, which does not have public health, and in other countries?

R.

In all countries the governments are supplying the vaccine, as it should be.

In the United States it is provided free of charge.

But let's take the situation of India, which has the largest vaccine production in the world.

Their difficulty lies in distributing them to a population of 1.3 billion people.

The country has resources, but it cannot make vaccination feasible for the entire population.

And the private sector in India has a good distribution.

In this particular situation, I believe that private sector participation can be beneficial.

But it is an exception in a place where perhaps the supply is greater than the distribution channel.

Q.

Would there be a problem if the Brazilian private sector markets vaccines at this time?

A.

Keep in mind that there will not be a large number of doses.

Then, all the doses that go to the private sector will be being taken away from the public sector.

If it were a vaccine that was widely available, it would be a different situation.

And the vaccine cannot be seen as an individual thing.

The vaccine is a common and collective good, because it only works well with that sense of community.

It will only protect when a certain percentage of the population is vaccinated.

If these vaccines are not available to everyone, only to the private system, we will protect some individuals, but we will not protect the population.

Q.

Is it possible that if the elite can pay for the vaccine, the pressure on the Government to initiate a national immunization plan will decrease?

A.

I hadn't thought of that, but I think it's perfectly plausible.

What we have to do is continue to pressure the authorities to make a collective use of the vaccine.

This individualistic thought is frequent, even among middle-class people, of "I go there, I pay for my family to get vaccinated and everything is fixed."

People have to understand that everything will not be settled.

They can pay for vaccines for their families, but even they will not be protected if the rest of the population is not vaccinated.

Q.

To what extent can these differences in access to the vaccine deepen inequality in Brazil?

A.

Those who can afford it will pay more to get the best vaccine.

And what is the highest risk group?

The one who cannot pay.

They are the blacks, the essential workers, the poor of the favelas ... Who are suffering the most?

Are they those from the Manaus favela who have no resources, the people who crowd the bus to go to work, or the people who can stay home and work remotely?

The opposite would happen of what should be done.

We see these initiatives from the richest states and municipalities, which have plans to vaccinate first and this, once again, is reinforcing inequality.

People constantly enter and leave the state of São Paulo.

As long as the entire country is not vaccinated, no one is protected.

Q.

If only a small part of the population is vaccinated and the virus continues to circulate, can that generate new variants of the virus and make even this vaccinated minority vulnerable?

A.

Of course it is.

If we only vaccinate those who can afford it, even for them the protection will not be what it could be.

Because the virus will continue to circulate.

The more people are infected, the more viral replicas, the more mutations we will see.

The vaccine is a prevention, it is not a treatment, it is not a medicine.

And what happens?

This virus is under pressure, a great immunological pressure, with the start of vaccination in some countries.

He will try to escape from that pressure, which is why mutations are increasing.

At the beginning of the pandemic, I gave interviews in which I said that we were lucky that this virus did not mutate like others.

Its mutation rate is half that of the influenza virus and a quarter that of HIV.

But this rate is increasing.

And we also have the scientific debate about whether to give a dose of the vaccine or two [as initially envisaged by the laboratory protocols].

On the one hand, there are people who argue that it is better to vaccinate as many people as possible with a lower level of protection.

On the other hand, we must maintain both doses and ensure the protection we know it provides.

P.

Which side do you take in this debate?

R.

Vaccinating with half a dose is like not taking an antibiotic for the necessary 10 days: the mutation of the virus begins to be pressed and the most suitable are selected.

We will induce a mutation, which is foolhardy.

But there are exceptions.

For example, Moderna's vaccine has 100 micrograms of RNA.

Pfizer's is 30. Moderna designed a protocol keeping in mind that they couldn't go wrong, so they did it with a higher dose to be sure.

But in phases 1 and 2 of the tests they did two protocols: one with 50 micrograms and another with 100, and the data shows that there is not much difference.

So in a situation like this I think it would be plausible to give half a dose, as they have data to back it up.

But Pfizer does not have that data and cautioned: "We do not guarantee what will happen 21 days after receiving the first dose of the vaccine."

Each case must be evaluated individually.

Q.

The United Kingdom was the first country to start vaccinating and has just decreed a harsh lockdown.

How long will it take before the situation returns to normal?

A.

When a sufficient number of people have been vaccinated to have an impact on transmission.

Some say that 60% of the population must be vaccinated.

Others than 70% or 80%.

I am in the middle, at 70%.

But one thing must be clear.

In November, England had a contagion rate of 0.9%.

According to that number, in three weeks we would have a 30% decrease in the number of cases.

And what happened?

The new variant of the virus and the end of the year holidays arrived, and the number of cases tripled, threatening to collapse the health system.

It should also be clear that, despite spreading more, at an incredible speed, this variant can be stopped in the same way: with a mask, with distance, without crowds.