Cobertura vacinal e o movimento antivacina: o impacto na saúde pública no Brasil / Vaccination coverage and anti-vaccine movement: the impact on public health in Brazil / Cobertura de vacunación y movimiento antivacuna: el impacto en la salud pública en Brasil

A vacina constitui um dos principais métodos de prevenção contra doenças. Em 1973, o Brasil criou o Programa Nacional de Imunizações a fim de promover a imunização gratuita para a população, o que mais tarde tornou o país em referência mundial em vacinação. No entanto, a recusa vacinal ainda é um grande problema de saúde pública, sendo o movimento antivacina um dos destaques dessa realidade. Dessa forma, o objetivo deste artigo é avaliar como o movimento antivacina impacta na saúde pública no Brasil através da diminuição da cobertura vacinal. Trata-se de uma pesquisa de metodologia mista, com uma primeira etapa qualitativa, composta de uma revisão integrativa nas plataformas PubMed, LILACS e SciELO, no período de 2010 a 2020, e uma pesquisa documental em portais de movimentos antivacina; e uma segunda etapa quantitativa, em que foi realizado um estudo epidemiológico do tipo ecológico, com consulta nas bases eletrônicas do Datasus e no Sistema de Informações do Programa Nacional de Imunizações (SI-PNI), no período de 2010 a 2022. No período investigado, apenas em 2015 o Brasil alcançou a meta preconizada de cobertura vacinal, diferentemente dos anos seguintes, que apresentaram oscilações preocupantes. As publicações apresentam argumentos utilizados pelos grupos antivacina, evidenciados entre 2015 e 2019, período em que os dados de cobertura vacinal oscilaram. Assim, conclui-se que a ascensão do movimento antivacina é um dos fatores que influenciaram na queda da vacinação no Brasil, a exemplo do sarampo e da febre amarela.

The vaccine is one of the main methods of preventing diseases. Since 1973, Brazil created the National Immunization Program to ensure free immunization to the population, which later made the country a world reference in vaccination. However, vaccine refusal is still a great public health issue, and the anti-vaccine movement stand out in this reality. Thus, the purpose of this article is to evaluate how the anti-vaccine movement affects public health in Brazil with vaccination coverage reduction. This is a mixed methodology study, with first a qualitative step, composed of an integrative review in the platforms PubMed, LILACS, and SciELO, in the period from 2010 to 2020,and a documental research in portals of anti-vaccination movements; and a second quantitative step, where an epidemiological study of the ecological type was carried out, with consultation in the electronic databases of DATASUS and in the Information System of the National Immunization Program (SI-PNI) in the period of 2010 to 2022. In the investigative period, only in 2015 Brazil managed to reach the recommended vaccination coverage goal, unlike in the following years, which showed worrying fluctuations. The publications summarize arguments used by the anti-vaccination groups, evidenced between 2015 and 2019, a period in which the vaccination coverage data fluctuated. Therefore, it is clear that the rise of the anti-vaccination movement is a factor that influenced the drop in vaccination numbers in Brazil, with yellow fever and measles as examples.

La vacuna es uno de los principales métodos de prevención de enfermedades. En 1973, Brasil creó el Programa Nacional de Inmunización con el fin de promover la inmunización gratuita para la población, lo que luego convirtió al país en un referente mundial en vacunación. Sin embargo, la negativa de la vacuna sigue siendo un problema importante en la salud pública, y el movimiento antivacunas es uno de los aspectos más destacados de esta realidad. Así, el objetivo de este artículo es evaluar cómo el movimiento antivacunas impacta en la salud pública en Brasil mediante la disminución de la cobertura de vacunación. Se trata de un estudio epidemiológico mixto, con una primera etapa cualitativa, consistente en una revisión integradora en las plataformas PubMed, Lilacs y SciELO, en el período de 2010 a 2020, y una investigación documental en portales de movimientos antivacunas; y una segunda etapa cuantitativa, en la que se realizó un estudio epidemiológico de tipo ecológico, con consulta en las bases de datos electrónicas de DATASUS y en el Sistema de Información del Programa Nacional de Inmunización (SI-PNI), en el período de 2010 a 2022. Entre eses años, solo el año 2015 logró alcanzar la meta recomendada, a diferencia de los años siguientes, que mostraron fluctuaciones preocupantes en la cobertura de vacunación. Las publicaciones mostraron los argumentos utilizados por los grupos antivacina, evidenciados entre 2015 y 2019, período en que los datos de cobertura de la vacuna fluctuaron. Así, se concluye que la asunción del movimiento antivacunación es uno de los factores que influye en la caída de la vacunación en Brasil, como en el sarampión y la fiebre amarilla.

Prediction and reasons for COVID-19 second dose vaccine hesitation: a cross-sectional study in a municipality of Brazil

ABSTRACT BACKGROUND: Hesitation and refusal to take a second dose of the vaccine for coronavirus disease 19 (COVID-19) are prevalent. OBJECTIVES: We aimed to identify predictive factors for hesitation or refusal and describe groups with higher rates of vaccine hesitancy. DESIGN AND SETTING: A cross-sectional study in Assis City, Brazil. METHODS: The study included adults who passed the due date for taking the COVID-19 second dose vaccine. Participants were recruited in December 2021 using a mobile-based text message. Sociodemographic and clinical data and reasons for hesitance were collected. The outcome was the attitude towards completing the recommended second dose of the vaccine. Bivariate and multivariate Poisson analyses were performed to determine the adjusted predictors. RESULTS: Participants between 30-44 years of age had a 2.41 times higher prevalence of hesitation than those aged 18-29 years. In addition, people who had adverse events or previously had COVID-19 had 4.7 and 5.4 times higher prevalences of hesitation, respectively (P value < 0.05). CONCLUSION: We found a significant group of adults aged between 30-44 years who refused the second dose of the COVID-19 vaccine. Furthermore, those who reported adverse effects after the first dose and those who had COVID-19 previously were a significant group for refusal.

Correlation between Parental Vaccine Hesitancy, Socio-demographic Factors, and Novel SARS-CoV-2 Vaccination in Puerto Rico.

OBJECTIVE: Accurate and inaccurate vaccination information is readily accessible. Unfortunately, the information found by parents may be wrong. Due to the limited studies on this issue in Puerto Rico, we aim to correlate Puerto Rican parents' sociodemographic characteristics to their vaccine hesitancy level. METHODS: We quantified vaccine hesitancy in Puerto Rican parents and legal guardians who were at least 18 years old using the Parent Attitudes about Childhood Vaccines survey, their attitudes towards a possible SARS-CoV-2 vaccine, and the correlation between vaccine hesitancy and socio-demographic factors. The subjects were recruited through social networks and by distributing the online survey among pediatricians in Puerto Rico. RESULTS: We identified a vaccine hesitancy prevalence of 38.3%, higher than has been found by other similar studies. The results also demonstrated a significant association between vaccine hesitancy, income, and the type of legal guardian. Participants with a household income less than $75,000 and a legal guardian were more likely to be vaccine-hesitant. Most participants surveyed (80.8%) would not immediately vaccinate their children against SARS-CoV-2, independent of vaccine-hesitancy status, citing general worries of vaccine safety and side effects. CONCLUSION: Our results demonstrate the need for better vaccine-education campaigns in Puerto Rico and the challenges that SARS- CoV-2 vaccine fears pose to the proper control of the COVID-19 pandemic. It should be noted that at the time of the survey described herein, a COVID-19 vaccine had yet been developed.

Viruela: de la primera vacuna al nacimiento del primer movimiento antivacunas / Smallpox: from the first vaccine to the birth of the first anti-vaccine movement

El último caso de viruela, la peor plaga que ha enfrentado la humanidad, fue diagnosticado hace 45 años y con él la enfermedad fue erradicada del planeta. Una hazaña épica iniciada a finales del siglo XVIII por Edward Jenner, el hombre que inoculó a su propio hijo con el pus de las lesiones de una ordeñadora que sufría viruela bovina, una enfermedad benigna antigénicamente relacionada con la viruela y que le confería inmunidad. Pocos años más tarde, en 1803, partía de España la "Real expedición filantrópica de la vacuna", llevando la vacuna a América y Asia, transportándola de brazo en brazo. A pesar del éxito de la vacuna, Jenner y la sociedad victoriana sufrieron los primeros movimientos antivacunas que hoy, en el contexto de la pandemia del COVID-19, son catapultados por los sitios de noticias falsas que socaban el conocimiento científico.

The last case of smallpox, the worst plague that humanity has faced, was diagnosed 45 years ago, marking the end of this disease in our world. It is a fascinating story that started in the late 18th century with a man called Edward Jenner. He made a name for himself by inoculating his son with the secretion of pus from the hand of a milkmaid sick with cowpox, a benign disease antigenically related to smallpox, and his inoculum conferred immunity. A few years later, in 1803, the "Royal Philanthropic Vaccine Expedition" left Spain, carrying the vaccine to the Americas and the Orient and passing the inoculum from arm to arm. Despite the vaccine's success, Jenner and Victorian society found themselves up against the first anti-vaccine backlash. In today's COVID-19 pandemic, these movements are now being super-charged by fake news websites, undermining scientific knowledge.

Hashtag as a new weapon to resist the COVID-19 vaccination policy: a qualitative study of the anti-vaccine movement in Brazil, USA, and Indonesia.

In 2019, the World Health Organization (WHO) named the anti-vaccine movement one of the top 10 global health threats. This trend has shown that it can diminish public faith in government and increase public distrust of scientific results in the health sector, including the use of the COVID-19 vaccine. The purpose of this study is to examine the anti-vaccine movement on Twitter social media platform, which uses Hashtag to protest vaccination regulations in the COVID-19 pandemic. The content analysis, relationship analysis, and word cloud analysis models were used in this study, which used a descriptive qualitative approach. The primary data source for this study is Hashtag, which are used to focus on three aspects. First, establish which information in Brazil, the United States, and Indonesia leads the anti-vaccine COVID-19 narrative. Second, how does the Hashtag link between each country work? Third, which narrative dominates the use of Hashtag in each of the three countries? According to the findings of this study, in Brazil, 69.2% of Twitter Hashtag associated to the COVID-19 vaccination were negative, compared to 59.4% in the USA and 62.8% in Indonesia. In general, the Hashtag used in the three countries to oppose COVID-19 vaccination policies have a clear and significant relationship. In Brazil, the Hashtag #covidiots was the most popular, while in the United States, #covivaccine was the most popular, and in Indonesia, #antivaccine was the most popular.

Discurso antivacina no YouTube: a mediação de influenciadores / Anti-vaccine discourse on YouTube: the mediation of influencers / Discurso antivacunas en YouTube: la mediación de influenciadores

Este artigo apresenta resultados de uma pesquisa sobre o discurso antivacina em 14 vídeos mais relevantes no YouTube exibidos em 2018 e 2019, considerando a quantidade de visualizações, likes, dislikes e comentários. O estudo identifica argumentos e sentidos construídos pelos mediadores, a partir da perspectiva natural, que associa a vacina à ideia de veneno, riscos e morte; e da perspectiva política, que aciona liberdades individuais e planos de poder para redução populacional e lucro da big pharma. Na interseção entre as duas perspectivas, aspectos religiosos compõem a moldura dos discursos. A análise qualitativa e quantitativa aponta a necessidade de investir em estratégias de comunicação que esclareçam e desconstruam as informações falsas ou distorcidas disseminadas. Também sinaliza a importância de diálogo com um público descrente com instituições políticas, científicas e midiáticas, em que a ameaça de punição pela lei não é obstáculo para recusa ou hesitação vacinal.

This article presents results from a research on anti-vaccine speech in 14 of the most relevant YouTube videos showed in 2018 and 2019, considering the amount of views, likes, dislikes, and comments. The study identifies arguments and meanings constructed by the mediators, from the natural perspective, which associates vaccine with the idea of poison, risks and death; and the political perspective, which triggers individual freedoms and power plans for big pharma's population reduction and profit. At the intersection between the two perspectives, religious aspects make up the frame of the discourses. The qualitative and quantitative analysis points to the need to invest in communication strategies that clarify and deconstruct the disseminated false or distorted information. It also signals the importance of dialogue with an unbelieving public with political, scientific and media institutions, where the threat of punishment by law is no obstacle to vaccine refusal or hesitation.

Este artículo presenta los resultados de una investigación sobre el discurso antivacunas en los 14 videos de YouTube más relevantes mostrados en 2018 y 2019, considerando la cantidad de visitas, me gusta, disgustos y comentarios. El estudio identifica argumentos y significados construidos por los mediadores, desde la perspectiva natural, que asocia la vacuna con la idea de veneno, riesgos y muerte; y la perspectiva política, que desencadena las libertades individuales y los planes de poder para la reducción de la población y las ganancias de las grandes farmacéuticas. En la intersección entre las dos perspectivas, los aspectos religiosos constituyen el marco de los discursos. El análisis cualitativo y cuantitativo apunta a la necesidad de invertir en estrategias de comunicación que aclaren y deconstruyan la información falsa o distorsionada difundida. También señala la importancia del diálogo con un público incrédulo con instituciones políticas, científicas y mediáticas, donde la amenaza de castigo por ley no es un obstáculo para el rechazo o la vacilación de la vacuna.

Covid-19, the anti-vaccine movement and immunization challenges in Brazil: a review / Covid-19, o movimento anti-vacina e os desafios da imunização no Brasil: uma revisão

AIMS: The COVID-19 pandemic suddenly and significantly increased hospitalizations for pneumonia with systemic inflammatory disease. Since its appearance, COVID-19 has affected more than 200 countries, with more than 90 million cases and almost 2 million deaths. So far, there is no quality evidence regarding the specific pharmacological therapy for COVID-19; most treatments usually involve off-label use of existing drugs and have unproven efficacy. The global effort converges on the development of a vaccine; however, the greatest challenge is to achieve collective immunization in the face of increasing vaccination hesitancy. METHODS: This study investigated the impact of vaccine hesitancy movements on the goal of COVID-19 immunization in Brazil. An integrative bibliographic review was performed with an electronic search on PubMed and SciELO that yielded 13.535 articles. Inclusion and exclusion criteria were applied which included 29 interventional and descriptive studies. RESULTS: The results of the 29 studies revealed that the most frequent reasons for hesitation is skepticism about the true interests of the industry and politicians, the lack of trust in research, and inaccurate information on social media. CONCLUSION: The main factors that lead the population not to believe in vaccines were the real interests of industry and politicians, lack of confidence in research, and the amount of false information that circulates massively on social media and because of that it is possible that Brazil will face some challenges in achieving collective immunity due to the anti-vaccine movement.

OBJETIVOS: A pandemia de COVID-19 aumentou repentina e significativamente as hospitalizações por pneumonia com doença inflamatória sistêmica. Desde o seu surgimento, a COVID-19 afetou mais de 200 países, com mais de 90 milhões de casos e quase 2 milhões de mortes. Até o momento, não há evidências de qualidade em relação à terapia farmacológica específica para COVID-19; a maioria dos tratamentos geralmente envolve o uso off-label de medicamentos existentes e sem eficácia comprovada. O esforço global converge para o desenvolvimento de uma vacina; entretanto, o maior desafio é conseguir a imunização coletiva diante do aumento da recusa à vacinação. MÉTODOS: Este estudo investigou o impacto dos movimentos de recusa à vacina no objetivo de imunização com COVID-19 no Brasil. Foi realizada uma revisão bibliográfica integrativa com busca eletrônica no PubMed e SciELO que resultou em 13.535 artigos. Foram aplicados os critérios de inclusão e exclusão que incluíram 29 estudos de intervenção e descritivos. RESULTADOS: Os resultados dos 29 estudos revelaram que os motivos de hesitação mais frequentes são o ceticismo sobre os verdadeiros interesses da indústria e dos políticos, a falta de confiança em pesquisas e informações imprecisas nas redes sociais. CONCLUSÃO: Os principais fatores que levaram a população a não acreditar nas vacinas foram os reais interesses da indústria e dos políticos, a falta de confiança nas pesquisas e a quantidade de informações falsas que circulam massivamente nas redes sociais e por isso é possível que o Brasil enfrente alguns desafios para alcançar a imunidade coletiva devido ao movimento anti-vacinas.

Estrategias de aceptabilidad de la vacunación contra el virus del papiloma humano: una revisión sistemática / Acceptability of strategies for human papillomavirus vaccination: A systematic review

Resumen El cáncer de cuello uterino es la cuarta causa de cáncer en mujeres, siendo el virus del papiloma humano (VPH) su mayor factor de riesgo. Este virus produce, además, otros tipos de cáncer e infecciones que afectan a hombres y a mujeres. La vacuna del VPH ha mostrado eficacia y seguridad en su prevención, sin embargo, se han evidenciado barreras que disminuyen su aceptación en las comunidades. El objetivo de este estudio es identificar las estrategias más efectivas en la intervención comunitaria con el fin de mejorar la aceptabilidad de la vacunación contra el VPH. Se realizó una revisión sistemática en Cochrane, Scopus, Embase, Medline y Google Académico de junio a julio de 2019, sin restricciones temporales, en idioma inglés y español. Se incluyeron ensayos clínicos que evaluaran estrategias para mejorar la vacunación contra el VPH. Se revisaron 22 estudios que evaluaban estrategias de intervención comunitaria y se identificaron, principalmente tres: el uso de información y formación de tipo virtual, el involucramiento tanto de padres, madres o cuidadores como del personal sanitario, así como el involucramiento de los hombres y de las personas de orientación sexual diversa como población objetivo.

Abstract Cervical cancer is the fourth leading cause of cancer in women, with the human papillomavirus (HPV) being its major risk factor. This virus also produces other types of cancer and infections that affect men and women. The HPV vaccine has shown efficacy and safety in its prevention, however, barriers have been evident that decrease its acceptance in communities. The objective of this study is to identify the most effective strategies in community intervention to improve the acceptability of HPV vaccination. A systematic review was conducted in Cochrane, Scopus, Embase, Medline, and Google Scholar from June to July 2019, without time constraints, in English and Spanish. We included clinical trials evaluating strategies to improve HPV vaccination. We reviewed 22 studies evaluating community intervention strategies, and identified mainly three: the use of virtual information and training, involvement of parents and/or caregivers as well as health personnel, and involvement of men and people of diverse sexual orientation as a target population.