Brazil starts booster shots while many still await a 2nd jab

Some cities in Brazil are providing booster shots of the COVID-19 vaccine, even though most people have yet to receive their second jabs, in a sign of the concern in the country over the highly contagious delta variant.

Rio de Janeiro, currently Brazil's epicenter for the variant and home to one of its largest elderly populations, began administering the boosters Wednesday. Northeastern cities Salvador and Sao Luis started on Monday, and the most populous city of Sao Paulo will begin Sept. 6. The rest of the nation will follow the next week.

France, Israel, China and Chile are among those countries giving boosters to some of their older citizens, but more people in those countries are fully vaccinated than the 30% who have gotten two shots in Brazil. A U.S. plan to start delivery of booster shots by Sept. 20 for most Americans is facing complications that could delay third doses for those who received the Moderna vaccine, administration officials said Friday.

About nine out of 10 Brazilians have been vaccinated already or plan to be, according to pollster Datafolha. Most have gotten their first shot but not their second.

Brazil’s cases and deaths have been falling for two months, with 621 deaths reported in the seven days through Sept. 2 — far below April's peak of more than 3,000 reported deaths over a seven-day period. Older Brazilians have expressed concern about the efficacy of the Chinese Sinovac vaccine against the delta variant, prompting authorities to offer the booster shots.

Diana dos Santos, 71, received two shots of the Sinovac vaccine even after President Jair Bolsonaro spent months publicly criticizing it. Dos Santos, who lives Rio’s low-income Maré neighborhood, is diabetic and was hospitalized for a heart condition. She refuses to leave home until she gets her booster.

“I can’t go out like before and I’m still afraid of all of this,” dos Santos said. “I will feel safer (with a booster).”

Because of the variant, some experts say the government should slow the rollout of boosters and focus on distributing second doses. Delta is the most contagious variant identified, and many studies have suggested that one dose doesn’t protect against it. Two shots provide strong protection, with nearly all hospitalizations and deaths among the unvaccinated.

Ethel Maciel, an epidemiologist and professor at the Federal University of Espirito Santo, said pushing boosters at this early stage recalls the lack of concern given the gamma variant that overwhelmed Amazonian city Manaus earlier this year, only to feed a new wave nationwide. Brazil has seen more than 580,000 deaths from COVID-19, making it home to world’s eighth-highest toll on a per-capita basis.

“It seems we’re in the same movie, repeating the same errors,” Maciel said. “It’s only a matter of time until what’s happening in Rio leads to a greater number of more serious cases in the rest of the country.”

The delta variant already is dominant in Rio de Janeiro state, detected in 86% of the samples collected from COVID-19 patients, according to the Ministry of Science, Technology and Innovation. Intensive care units have reached full capacity in eight municipalities, although only a small rise in deaths have been recorded so far.

Authorities in Sao Paulo state expect a similar scenario within weeks. It registered its first confirmed death from the delta variant on Tuesday, a 74-year-old woman who had received two Sinovac shots.

Globally, doubts have plagued Chinese vaccines, especially as the delta variant has gained hold in many countries. Chinese officials have maintained the vaccine protects against delta, particularly preventing hospitalizations and severe cases.

Still, Brazil’s Health Minister Marcelo Queiroga said Aug. 25 that people aged 70 or older or who have a weak immune system will be eligible for a third dose, starting Sept. 15 -- preferably with the Pfizer vaccine. He said that people over 18 will have received their first doses by then, althgough he didn’t address their vulnerability to the delta variant without a second shot.

He also criticized governors and mayors who sought to deliver booster shots earlier, saying it could lead to vaccine shortages.

Carla Domingues, former coordinator of Brazil’s national immunization program, agrees with the need to provide the elderly boosters, but not for people aged 70 and up right away. Shots should first go to nursing homes and people who are bed-ridden, she said, then people 80 and above, with the age slowly decreasing as supply allows.

“Certainly there will be problems with shortage, because there won’t be enough vaccine,” Domingues said.

Japan and South Korea both wrestled with slow vaccine rollouts, and under half their populations are fully vaccinated; their governments are only planning booster shots in the fourth quarter of this year. Malaysia also is considering boosters, but Health Minister Khairy Jamaluddin said the priority is those who haven’t received a first dose.

Thailand began giving booster shots even as most people wait to be vaccinated — but only for health and front-line workers who received two Sinovac shots. The decision came after a nurse died of COVID-19 in July.

Russia, Hungary and Serbia also are giving boosters, although there has been a lack of demand in those countries for the initial shots amid abundant supplies.

In addition to doubts over boosters, the issue is sensitive due to implications for global vaccine distribution. World Health Organization Director-General Tedros Adhanom Ghebreyesus has called for a moratorium on boosters “to allow those countries that are furthest behind to catch up.”

Epidemiologist Denise Garrett, vice president of the Sabin Vaccine Institute, which advocates for expanding global vaccine access, said in an interview there is no doubt about the need for two jabs, but she sees no scientific or moral justification for a third.

“Authorities giving a third dose are prioritizing protection against light disease instead of shielding people in poor countries from death,” said Garrett, who is Brazilian. “That is shameful, immoral, and this vaccine inequity must end.”

That doesn’t sway 97-year-old Maria Menezes, who wants to spend time outside her home where she has lived for the last seven decades in Rio’s western region. Her two daughters say Menezes wants to a booster shot.

“She asked us to take her for the third vaccine,” said daughter Cristina França, 38. “It will be important to beef up her immunity to reduce her risks. Her life won’t change much after the third dose, because she is more frail now, but she would live with more calm.”

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Álvares reported from Brasilia. Also contributing were Associated Press writers David Biller and Diane Jeantet in Rio de Janeiro, along with AP writers around the world.