Brazil has one of the best immunisation programs in the world, and the highest vaccine acceptance rate. Polls consistently show more than 95% of Brazilians are willing to get a COVID-19 shot and 84% will take their children to be vaccinated. The antivax sentiment sees no momentum in Brazil. Even attempts at organising movements against vaccines and the hard work done by the federal government to spread mistrust in vaccination have met little or no success.
While President Jair Bolsonaro keeps trying to undermine vaccine confidence in Brazil, going from allegations that vaccines will turn you into an alligator, give you AIDS or have serious side effects such as thrombosis and cardiac problems, Brazilians are still getting vaccinated, getting their second doses and their booster jabs. States like Sao Paulo already claim to have their adult population fully vaccinated with at least two doses. With the omicron variant, the local press noticed a veritable scramble for booster shots.
Why is it that Brazilians seem immune to vaccine misinformation? And let’s make it clear: it’s for vaccine misinformation only. Brazilians are quite vulnerable to other kinds of health misinformation: we have 29 modalities of alternative medicine offered in our public healthcare system, and hydroxychloroquine and ivermectin were both hugely popular during the COVID-19 pandemic, with endorsement from several medical doctors and health practitioners.
The answer to this apparent Brazilian paradox probably lies in 50 years of vaccination campaigns, starting in the 1970s, during the military dictatorship. In 1966 the Minister of Health Raimundo de Brito started a national campaign to eradicate smallpox, joining in the efforts of the World Health Organization. Smallpox vaccination was not a priority in Brazil at that time, placing the country in a shameful situation while the WHO was trying to conduct a global vaccination program. Historian Gilberto Hochman speculates that the smallpox vaccination campaign, which would eventually drive the creation of the National Immunization Program, was, actually, politically motivated. The crimes of the dictatorship – among them, censoring the press, and kidnapping and torturing left-wing politicians – were being exposed to the world, and the ruling generals desperately needed a positive agenda, something to burnish the regime’s image.
Even if for the wrong reasons, the campaigns launched in the 1960s and 1970s were a huge success, and involved bringing celebrities, famous actors, athletes, politicians and religious leaders to vaccination centers. There were funny, and quite educative, government-sponsored pro-vaccine cartoons on TV. Sujismundo (“Dirty Guy”), a cartoon character created years earlier to be seen by children as a bad example of behavior, was shown first rejecting the vaccine, then coming around after listening to the explanations of a gentle physician. Holiday-like National Immunization Days were established, and celebrated with lots of media coverage and famous people getting vaccinated in public. Publicity campaigns were ongoing on radio and television.
In 1973 the National Immunization Program was formally created, and soon would become known as one of the best in the world. It is not, after all, common for a developing country to be able to provide vaccines for the whole population, in a country as big and diverse as Brazil. Vaccination campaigns became part of Brazilian’s daily lives, people got used to TV and radio ads reminding people to take their children to the nearest vaccination centre to get regular vaccines, such as polio vaccines and flu vaccines.
The cartoon character Joe Droplet appeared in 1986, as part of the polio vaccine campaign. He became Brazil’s vaccination mascot, and helped to build an emotional attachment to vaccines, making children and parents more comfortable and engaged with the campaigns.
Vaccine confidence in Brazil was not built overnight. It is the result of 50 years of investments in publicity campaigns, logistics of storage, transportation, and distribution. Not to mention the vaccines produced locally and exported to other countries.
Vaccine trust, however, was not built on science education and science literacy, but on tradition, media and culture. Vaccine acceptance doesn’t come from understanding the science, but from a cultural construction of decades that led to the ingrained belief that being vaccinated and taking children to be vaccinated is the “normal”, “obvious” or “right” thing to do. It’s like a hygiene habit: you brush your teeth, wash your hands, and get your shots.
This “radical normalcy” of vaccines in Brazil may explain why the propaganda campaign launched by President Bolsonaro and Health Minister Marcelo Queiroga against COVID-19 vaccination – especially for children – isn’t having a considerable impact. While both Minister and President go out of their way to badmouth the vaccine in interviews and speeches, the Brazilian State apparatus – public servants, healthcare workers, regulatory agencies, even the courts – and people remain as staunchly pro-vaccine as they had been in the last half century.
The big question, really, is why President and Minister try so hard to break the cultural habit of vaccine acceptance. Queiroga probably loves the perks of being a Minister and knows that he serves at the President’s pleasure. But what are Bolsonaro’s reasons? His political persona was built around the historical lie that the military dictatorship of the 60’s-70’s was a kind of Brazilian golden age, one that he would restore. Why would he try to destroy what may as well be the only unquestionably positive legacy of that period?
One reason may be that Bolsonaro needs to remain “controversial” to be true to himself. His whole political career was built on defending the indefensible (the “right” of students to pay homage to Adolf Hitler during a graduation ceremony, for instance) and saying the unsayable (once he referred to a congresswoman as “not even worth raping”). Attacking vaccines? He’s just staying in character.
But there might be another motive. Before and during his presidential campaign, Bolsonaro actively courted not only the old-school “widowers of the dictatorship”, as they are called in Brazilian politics, but also the new Brazilian “alt-right”, which is heavily influenced by the American template. In America, those people called Donald Trump a “traitor” because he dared to speak well of vaccines.
It is not unreasonable to think that, by using his office to spread fear of vaccines, Bolsonaro is trying to bolster the Brazilian alt-right, giving his younger, more internet-savvy followers talking points to keep their online presence strong.
Organised antivax groups are growing in Brazil. The first citizen group with an overt antivax agenda was launched in 2021, to question the safety of the HPV vaccine, and its main instigator became an outspoken critic of the COVID-19 vaccination program and a supporter of Bolsonaro. The president now works to make vaccine hesitancy a hallmark of the “bolsonarista” (“Bolsonaro-supporter”) identity. Antivax mass movements in the US and Europe did not appear overnight. With this kind of pressure, how long before they become an issue in Brazil?