five years after the start of the COVID-19 pandemic, brazil reflects on its vaccination rollout-a process marked by both triumph and tragedy. On January 17,2021,São Paulo nurse Mônica Calazans received the country’s first COVID-19 vaccine,a pivotal moment of hope amidst a national crisis [1]. Though, a new examination of the rollout reveals that despite saving an estimated 300,000 lives, delays in vaccine procurement and distribution-now under renewed scrutiny with a federal police investigation-may have contributed to tens of thousands of preventable hospitalizations and deaths.
Five years ago, Brazil began to emerge from a harrowing period of the COVID-19 pandemic. On January 17, 2021, following emergency use approval of two vaccines by the National Health Surveillance Agency (Anvisa), São Paulo nurse Mônica Calazans became the first Brazilian to receive a COVID-19 vaccine. 
Calazans was selected for this historic moment because she had participated in clinical trials for the Coronavac vaccine, conducted in late 2020 to demonstrate its safety and efficacy. At the time, she worked at the Emílio Ribas Institute of Infectology, a specialized hospital and reference center for infectious diseases that treated over 40,000 patients during the pandemic.
The nurse recounts that she was on duty that Sunday when her supervisor informed her she needed to go to the ceremony, where authorities were awaiting Anvisa’s decision to begin vaccinations. When she learned she would be the first to receive the vaccine, she was overcome with emotion:
“I cried a lot! Truly! Because we were going through a traumatic time, and my brother had COVID at the time. And I also cried with emotion, with joy, because science was taking an important step to end this tragedy that was plaguing the world.”
“When I received the vaccine, I brought hope to people. My clenched fist was a message of hope and victory. That we were going to overcome this terrible phase.”
Vaccinations across the rest of the country began the following day, January 18, after the distribution of an initial batch of 6 million doses produced in China and imported by the Butantan Institute, which later began processing the vaccine in Brazil using active ingredients supplied by Sinovac.
Just days later, on January 23, the campaign received a boost with the arrival of the first 2 million doses of the Oxford/AstraZeneca vaccine, initially imported from India by the Oswaldo Cruz Foundation (Fiocruz), which gradually incorporated the technology and began producing the vaccine domestically.
The vaccination campaign prioritized the most vulnerable populations, starting with frontline healthcare workers, the elderly, people with disabilities living in institutions, and Indigenous communities. This period coincided with a surge in cases of the Gamma variant of the coronavirus, which proved to be more aggressive and lethal than previously circulating strains. Understanding variant behavior is crucial for effective public health responses.
Dr. Margareth Dalcolmo, a pulmonologist at the Professor Helio Fraga Reference Center at Fiocruz, receives a dose of the Oxford/AstraZeneca vaccine at Fiocruz. – Tomaz Silva/Agência Brasil
Given the limited initial supply, vaccination progressed slowly, eventually expanding to include other vulnerable groups, such as the general elderly population. In Rio de Janeiro, for example, individuals between the ages of 60 and 70 did not receive the vaccine until March and April 2021.
However, the benefits of vaccination quickly became apparent. Data from the Observatório Covid-19 Brasil shows that hospitalizations and deaths among the elderly began to decline sharply as early as April. These early results highlighted the critical role of vaccination in protecting the most at-risk populations.
Researchers believe that in the first seven months of the campaign alone, 165,000 hospitalizations and 58,000 deaths among the elderly were prevented.
In the following months, both Butantan and Fiocruz completed and packaged the vaccines in Brazil, significantly increasing the number of doses available, along with the arrival of vaccines purchased from private companies.
Within one year, 339 million doses were administered, reaching 84% of the Brazilian population. Experts estimate this prevented 74% of severe cases and 82% of expected deaths in Brazil, meaning more than 300,000 lives were saved.
Delays
However, the same study by the Observatório Covid-19 Brasil that calculated the lives saved by the vaccine also concluded that “an additional 104,000 hospitalizations could have been avoided if vaccination had started earlier” and “another 47,000 lives could have been saved if the Brazilian government had started the vaccination program sooner”, among the elderly alone.
Paola Falceta, vice president of the Association of Victims and Families of Victims of Covid-19 (Avico), believes her mother, who died in January 2021, is included in those statistics. She maintains that the start of vaccination in Brazil was delayed, a result of negligence by the federal government at the time. “We couldn’t save everyone, obviously, because the vaccine depends on a person’s willingness and there would always be a group that wouldn’t take it.”
“But most people wanted access to the vaccine, and many of those who died were people who could have been vaccinated earlier and weren’t. And that lack was imposed by the management itself, which decided not to buy, not to negotiate all the types of vaccines that existed.”
Paola’s assessment is supported by a study by the Federal University of Minas Gerais. If vaccination in Brazil had begun 40 days earlier, on the same date as in the United Kingdom, with more doses, and combined with isolation and protection measures, Brazil could have avoided 400,000 deaths, the researchers conclude. This is more than half of the approximately 700,000 deaths caused by the disease in the country.
The Nossa Senhora Aparecida Public Cemetery in Manaus had to expand the number of graves for COVID-19 victims. Photo: Alex Pazuello/Semcom/Arquivo
Behind the numbers are stories like those of Paola and Ana Lucia Lopes, who lost her partner in May 2021.
“A month after Cláudio died, I went to get vaccinated. We were the same age, so he would have been vaccinated at the same time. And it’s very upsetting to think that he didn’t have that opportunity. Imagine how many people could have been vaccinated and had a chance to survive.”
The CPI da Covid-19 (COVID-19 Parliamentary Inquiry), conducted in 2021, also concluded that the federal government imposed a “shortage” of vaccine doses, which was decisive in increasing the number of cases and deaths, and enabling the spread of new variants. One of the pieces of evidence considered was the proposals made by the Pfizer pharmaceutical company in August 2020, offering 1.5 million doses to be delivered in the first year of the pandemic. The Brazilian government did not even respond.
“The acquisition of immunizers should have been the main provision in the process of preventing the spread of the new coronavirus and, consequently, protecting people’s health, but unfortunately, this measure was neglected. Nevertheless, the negotiations and the conclusion of the federal government’s negotiations suffered an unjustified and intentional delay, which directly impacted the purchase of vaccines and the immunization schedule of the Brazilian population,” the CPI’s final report states.
Senators involved in the COVID-19 CPI deliver the final report of the committee’s work to the Public Prosecutor’s Office of Rio de Janeiro (MPRJ) – Fernando Frazão/Agência Brasil
The committee also recommended the indictment of 68 people, including former President Jair Bolsonaro and former Ministers of Health Eduardo Pazuello and Marcelo Queiroga. However, the request was archived at the request of the then Attorney General of the Republic, Augusto Aras, in July 2022.
Last year, however, Supreme Court Justice Flávio Dino ordered the Federal Police to open an investigation into the facts denounced by the CPI.
