Solutions: What can the U.S. learn from Brazil’s vaccine campaign?

After a slow start, vaccination rates in the Latin American nation have soared, thanks to a deep-rooted vaccine culture.

As the COVID-19 vaccine campaign gained steam in the United States last spring, I was locked down in my apartment in Rio de Janeiro, trying to avoid being infected with the virus.

Brazil seemed to have the world’s slowest immunization program rollout. While Brazilian cities started vaccinating locals in January, there just weren’t enough doses to go around.

As the pace of vaccinations in the U.S. increased, Brazilians were debating the merits of lockdowns and liberally taking medications with no evidence that they were effective against the coronavirus.

I watched with envy as my American friends posted “I’m vaccinated!” photos on my social media feeds. So, in June I left Rio de Janeiro and returned to my hometown of Chicago where I received my first dose the day I landed.

Since then, however, the tables have turned. The vaccination rate has ramped up considerably in Brazil. Back in October, 73 percent of Brazilians had received at least one dose of the vaccine — compared with just 66 percent in the U.S. at the time. A survey conducted over the summer showed that 94 percent of Brazilians plan to get the coronavirus vaccine.

What happened?

Despite rampant misinformation, political infighting, and failures of leadership at the highest levels, Brazil’s vaccination campaign has succeeded because the country has one thing the U.S. does not: an unbreakable vaccine culture.

Credit: contributed

Credit: contributed

As Gilberto Hochman, a public health researcher at Casa de Oswaldo Cruz, a part of Brazil’s Oswaldo Cruz Foundation – a scientific institution for research and development in Rio de Janeiro – has previously written, Brazil’s vaccination culture has rocky origins.

In 1904, when the young republic was attempting to eradicate smallpox and yellow fever in Rio de Janeiro, health officials invaded the houses of the city’s impoverished residents and forcefully vaccinated them.

The residents countered with what has come to be known as the “Vaccine Revolt,” a week-long street rebellion that left 30 people dead and ultimately brought an end to mandatory vaccination.

The revolt is so ingrained in the public memory that a Rio de Janeiro carnival group pays homage every year to one of the revolt’s leaders.

In the late 1960s, with smallpox still circulating in the country, the then-ruling military dictatorship established the guiding characteristics that would shape Brazilian vaccine campaigns for decades to come.

In a renewed effort to eradicate the disease, the government tapped community leaders — local politicians, religious leaders, athletes — and a variety of communication channels, including newspapers, loudspeakers and films screened on school campuses, to get their message out.

In large cities, mass vaccinations took place in iconic public spaces. Popular festivals, processions, religious services, fairs and artistic performances became vaccination sites. Vaccines even reached distant countryside towns. Hochman explained that by the end of the campaign, 84 percent of Brazilians were inoculated, smallpox had been eradicated and the country’s citizens had come to view vaccinations as a public good from the state.

When COVID-19 vaccines developed by AstraZeneca and Pfizer became widely available in Brazil this summer — augmenting the existing Sinovac-CoronaVac stockpile — municipalities followed a familiar playbook.

During the weekend of Aug. 14, São Paulo mounted a citywide effort — “Vaccine Turnaround” — to vaccinate every 18- to 21-year-old. More than 600 vaccine locations dotted the megacity, and 16 locations remained open for 34 hours straight, from Saturday morning until early Sunday evening. Masked people arrived at vaccine drive-through and walk-up sites that had all the elements of a festival — music, dancers, decorations — even throngs of people waiting in line. (There were also no promises of money or lottery entries, as have become common in the U.S.)

By all measures, São Paulo’s event was an incredible success. Tired of waiting a year and a half for salvation from the coronavirus, more than 500,000 young Brazilians answered the call to be vaccinated. They did as their parents and grandparents had done in the preceding weeks and months.

The event helped São Paulo, a city of 12.4 million residents, reach a COVID-19 vaccination milestone that no American city seems likely to ever reach: 99 percent of its residents 18 and older have now received at least one vaccination dose.

Brazil’s vaccination campaign is succeeding despite efforts to undermine it.

In August, my Brazilian friend Lucas Fontainha, a 27-year-old veterinarian, summed up this culture in one tweet: “Fortunately Brazilians love vaccines, they fight for vaccines, they throw vaccine festivals, they kiss all the babies in the line waiting for vaccines, they camp overnight at the clinic to get a vaccine … even the anti-vaccination Brazilians vaccinate in secret. I love this.”

Brazil’s strong vaccination culture will likely make it one of the most vaccinated countries in the world by the end of the year.

But that culture wasn’t created overnight — it took decades of building residents’ trust and forging community relationships.

Kiratiana Freelon is an independent journalist based in Rio de Janeiro, Brazil. This piece first appeared on Undark, a nonprofit, editorially independent digital magazine that explores the intersection of science and society. This piece is republished through the Solutions Journalism Network.

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These stories come through our partnership with the Solutions Journalism Network, a nonprofit organization dedicated to rigorous reporting about social issues.

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