You are here

Article Text

Article menu
Epidemiology
Original research
Impact of the first year of COVID-19 vaccination strategy in Brazil: an ecological study
  1. Soraida Aguilar1,
  2. Leonardo S L Bastos1,2,
  3. Paula Maçaira1,
  4. Fernanda Baião1,
  5. Paulo Simões1,
  6. José Cerbino-Neto3,4,
  7. Otavio Ranzani5,6,
  8. Silvio Hamacher1,2,
  9. Fernando A Bozza3,4,7
  1. 1 Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
  2. 2 Tecgraf Institute, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
  3. 3 Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
  4. 4 D'Or Institute for Research and Education, Rio de Janeiro, Rio de Janeiro, Brazil
  5. 5 Barcelona Institute for Global Health, ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
  6. 6 Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  7. 7 Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
  1. Correspondence to Dr Fernando A Bozza; bozza.fernando{at}gmail.com

Abstract

Objectives No consensus exists about the best COVID-19 vaccination strategy to be adopted by low-income and middle-income countries. Brazil adopted an age-based calendar strategy to reduce mortality and the burden on the healthcare system. This study evaluates the impact of the vaccination campaign in Brazil on the progression of the reported COVID-19 deaths.

Methods This ecological study analyses the dynamic of vaccination coverage and COVID-19 deaths in hospitalised adults (≥20 years) during the first year of the COVID-19 vaccination roll-out (January to December 2021) using nationwide data (DATASUS). We stratified the adult population into 20–49, 50–59, 60–69 and 70+ years. The dynamic effect of the vaccination campaign on mortality rates was estimated by applying a negative binomial regression. The prevented and possible preventable deaths (observed deaths higher than expected) and potential years of life lost (PYLL) for each age group were obtained in a counterfactual analysis.

Results During the first year of COVID-19 vaccination, 266 153 517 doses were administered, achieving 91% first-dose coverage. A total of 380 594 deaths were reported, 154 091 (40%) in 70+ years and 136 804 (36%) from 50-59 or 20-49 years. The mortality rates of 70+ decreased by 52% (rate ratio [95% CI]: 0.48 [0.43-0.53]) in 6 months, whereas rates for 20–49 were still increasing due to low coverage (52%). The vaccination roll-out strategy prevented 59 618 deaths, 53 088 (89%) from those aged 70+ years. However, the strategy did not prevent 54 797 deaths, 85% from those under 60 years, being 26 344 (45%) only in 20–49, corresponding to 1 589 271 PYLL, being 1 080 104 PYLL (68%) from those aged 20–49 years.

Conclusion The adopted aged-based calendar vaccination strategy initially reduced mortality in the oldest but did not prevent the deaths of the youngest as effectively as compared with the older age group. Countries with a high burden, limited vaccine supply and young populations should consider other factors beyond the age to prioritise who should be vaccinated first.

  • COVID-19
  • Public health
  • EPIDEMIOLOGY

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data, including individual participant data, is publicly available with de-identification and anonymisation of patients. The data sources are described in the manuscript and in the supplementary material (online supplemental table S1). The raw data and code used for the analysis are available in a GitHub repository, with publication (https://github.com/noispuc/ICODA_COVID_VaccineStrategy).

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2023-072314

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. All data, including individual participant data, is publicly available with de-identification and anonymisation of patients. The data sources are described in the manuscript and in the supplementary material (online supplemental table S1). The raw data and code used for the analysis are available in a GitHub repository, with publication (https://github.com/noispuc/ICODA_COVID_VaccineStrategy).

    View Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • X @lslbastos, @otavio_ranzani

    • Contributors FB is the guarantor. SA, LSLB, PM, FB, PS, JC-N, OR, SH and FAB participated in the design and concept of the study. SA, LSLB and PM did the data curation. SA, LSBL, PM, FB, OR and FAB designed the data analysis. SA, LSLB, PM, FB, PS, SH and FAB performed the data analysis. SA, LSLB, PM, FB and FAB wrote the first version of the manuscript. LSLB, PM, FB, SH and FAB supervised the study. All authors had full access to data, participated in data interpretation, revised the manuscript and approved the final version of the manuscript.

    • Funding This work is part of the Grand Challenges ICODA pilot initiative, delivered by Health Data Research UK and funded by the Bill & Melinda Gates Foundation and the Minderoo Foundation. This study was also supported by the National Council for Scientific and Technological Development (CNPq), the Coordination for the Improvement of Higher Education Personnel (CAPES) - Finance Code 001, Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ), the Pontifical Catholic University of Rio de Janeiro. OR is funded by a Sara Borrell grant from the Instituto de Salud Carlos III (CD19/00110). PM acknowledges suppor from the CNPq (Grant 311519/2022-9). OR acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the ‘Centro de Excelencia Severo Ochoa 2019-2023’ programme (CEX2018-000806-S) and support from the Generalitat de Catalunya through the CERCA programme. All authors carried out the research independently of the funding bodies. The findings and conclusions in this manuscript reflect the opinions of the authors alone.

    • Competing interests SH and FAB are funded by the CNPq and FAPERJ. PM is funded by CNPq (422470/2021-0) and FAPERJ (E-26/211.645/2021 and E-26/201.348/2022). OR is funded by a Sara Borrell fellowship from the Instituto de Salud Carlos III (CD19/00110), acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the ‘Centro de Excelencia Severo Ochoa 2019–2023’ programme (CEX2018-000806-S), support from the Generalitat de Catalunya through the CERCA programme and received a research grant from the Health Effects Institute for research unrelated to this manuscript. OR was also a member of the Data Safety Monitoring Board in the REVOLUTION and STOP-COVID trials, testing treatments against COVID-19, and is currently a member of the Data Safety Monitoring Board of the RENOVATE trial, testing respiratory support strategies in patients with acute respiratory hypoxaemic failure.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.