50 years ago, on September 18, 1973, the guidelines for the creation of the National Immunization Program, the PNI, were defined. Until then, vaccination in states and municipalities was decentralized, which reflected in low vaccination coverage across Brazil.
Today, half a century later, the importance of creating one of the largest public vaccination programs in the world is unquestionable.
With more than 300 million doses distributed per year and 38 thousand vaccination rooms in the country, the PNI is responsible for centralizing everything related to the vaccination program, such as planning for purchasing doses, incorporating vaccines into the calendar, the cold chain (for storage), the purchase of inputs and the launch of vaccination campaigns.
“Before its creation, there was no coordinated vaccination, there was no planning”, says pediatrician Isabella Ballalai, second secretary of Sbim (Brazilian Society of Immunizations). “The main objective with creating the program is for you to know, first, what the objective is [vacina], who is the target audience, ensuring that this vaccine arrives, implementing the campaigns and, of course, after all this, the Ministry of Health launches, through the program, the first vaccination calendars, which did not exist. That was revolutionary.”
When the PNI was created, the federal government was part of a global program to eradicate smallpox. However, immunization was not working in different states, even due to regional difficulties.
“The administration of the vaccine has always been the responsibility of the municipality, but never in isolation, there was always participation from the state, as manager, and from the federal government. And then, when there was centralization, things got into gear once and for all”, says pediatrician Gabriel Oselka, professor emeritus at USP. He was also part of the Permanent Advisory Committee on Immunizations of the State Department of Health of São Paulo and the CTAI (Technical Advisory Committee on Immunizations of the Ministry of Health).
According to him, one of the successes of the PNI, which makes it a global reference to this day, is the fact that the quality of the professionals and the program as a whole presented strong resistance even to changes in government.
“Despite the changes in the Presidency, ministers [da Saúde], of thought and perhaps even of ideological line, the fact is that the program persisted. And it persisted because those who were there since its creation, the people responsible for managing this program, those who I call the program’s persisters, managed to maintain the program for decades, and this is also reflected in the population”, he states.
Recent years have put the PNI to the test, with vaccination coverage falling below what was expected by the Ministry of Health since at least 2015. Allied to this, a government that questioned the effectiveness of immunizations against Covid and created fear and hesitation vaccination in the population has also affected the other vaccines on the calendar, according to experts.
A recent study by Unifesp’s SoU_Ciência research center revealed that rejection of childhood vaccination is greater among supporters of former president Bolsonaro (PL), while the majority of supporters of president Lula (PT) are in favor of vaccination.
“Brazilians trust in the vaccine, if there is an outbreak tomorrow, you can be sure that there will be a queue at the doors of health centers. However, trust is not just in the vaccine, it also needs to be in the authorities. In the pandemic we saw precisely a discourse of distrust from the government itself in relation to vaccine contracts, saying that it would only sign if the pharmaceutical companies assumed responsibility”, continues the doctor.
The very fact that the Covid vaccine was left out of the program coordination is criticized by professionals who have worked with vaccinations for decades in the country. “So much so that you can see that the question was never whether we would be able to vaccinate, the PNI professionals said ‘just give me the vaccine and we will vaccinate X people in a period’. What was missing and there was a lot, in the beginning, was the delay in the delivery of doses, because it was not centralized”, says Oselka.
Looking to the future, starting this year, the expectation is to rebuild what was shaken in the last years of government. Regarding vaccination coverage, there has already been a sign of recovery in vaccines in the children’s calendar in 2022 compared to previous years, but the only one that reached the target was BCG.
“I have no doubt that we will achieve [recuperar o PNI]. When we talk about immunization, Brazil is an international reference, and our population is also a population that understands and sees the importance of vaccination”, says Ballalai.
“What I can say is that, in my personal and professional life, one of the most rewarding experiences was having participated in this program, I am very proud. And this delicate situation we are experiencing is transitory, the program has strength, it has tradition , has the structure to resume everything he was”, adds Oselka.
THE PNI IN NUMBERS
Creation: September 18, 1973
When it was officially released: 1975
Vaccination rooms: 38 thousand
Doses distributed each year: 300 million
Children’s calendar vaccines: 17
Vaccinations on the adolescent calendar: 7
Vaccinations on the elderly calendar: 5
Vaccinations on the pregnant woman’s calendar: 3