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 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.
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 "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.
On Jan. 18, Bolsonaro struck a more conciliatory tone. Sinovac's
shot, he told supporters, was "Brazil's vaccine."
(Reporting by Gabriel Stargardter; additional reporting by Pedro
Fonseca in Rio de Janeiro; editing by Marla Dickerson)
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