Providing Covid-19 vaccination to older people in Goias, Brazil: Experiences and further challenges
Goias was the second Brazilian state to start a vaccination campaign against COVID-19, and the governor (who happens to be a doctor) personally gave the first vaccine to an older person  (Photo 1). The focus has been on older people and front-line health workers. Vaccinations have been offered in a number of different settings, including drive through service points, health units, long-term care facilities (LTCFs) and sometimes at home. By 5 April 2021, 550,918 people in Goias had received at least one dose and 135,400 had received both . Vaccines have been provided to all older people living in the state’s 209 registered (LTCFs) , and people aged over 76 are now receiving their second dose . However, the general situation is still critical, with 12,118 confirmed COVID-19 deaths by 5 April and 489.522 cases confirmed in the last 4 weeks .
Photo 1 – The Governor of Goias, who is a medical doctor, applying the vaccine to a 73-year-old woman. Credit: TV Anhanguera. Available at: https://www.correiobraziliense.com.br/brasil/2021/01/4901117-goias-incia-vacinacao-contra-a-covid-19-idosa-e-vacinada-em-anapolis.html
Goias’ relatively rapid vaccination roll-out has led to a recent decline in COVID-19 deaths (in contrast to the increasing numbers of deaths in Brazil as a whole) [6, 7] and has permitted a partial relaxation of a strict lockdown implemented in February and March.
Despite its general success, the Goias vaccination campaign has not been without problems. Health workers report that some older people have refused to be vaccinated. This problem has been especially common among poor older people living in remote parts of the capital  and the state, as happened in other parts of the globe . There have been some exceptional cases of malpractice, including a nurse who administered an empty syringe – with no vaccine – to an older person. The case was widely reported in the local media and the nurse was subsequently fired [10; 11]. A municipal health secretary and her coordinator organized a list of names, including people from the private sector and their relatives and friends, given them fictitious positions in the public health systems, so that they could be vaccinated against COVID-19 without having to wait for their turn. After a denounce, a prosecutor judicially requested the resignation of the two civil servants involved .
There is a lack of information on elderly effective responses to vaccines against COVID-19 in Goias. It is known, for instance, that old people who live in LTCFs in Brazil can suffer adverse effects, as happened in Bauru, where six older people died after being fully immunized . Considering the emergency and temporary status of the approval of COVID-19 vaccines , as well as the fact that older people are the first to be vaccinate, notifications on vaccine’s side effects and safety conditions should be encouraged. Information should be verified, monitored, and made available to the public in a reliable way .
Efforts continue to be made to address these concerns, with front line health and social workers frequently engaging with social and mainstream media. Messaging seeks to emphasise the safety of the vaccines and refers to Brazilian research demonstrating their high levels of efficacy, including preliminary results showing its efficacy against the new variants [16, 17]. Experts also emphasise the importance of receiving both doses, referring to cases such as an 85 year-old man who recently died of COVID-19 shortly before he was due to receive the second dose .
The state government plans to accelerate the vaccination campaign in April, reaching the entire population aged 60 or more and then reaching out to people at younger ages with chronic diseases . Vaccine supply is not a major problem. On April 2, Goias received a further 241,800 units of CoronaVac, and 25,000 of AstraZeneca . Additionally, municipalities are making their own arrangements to jointly purchase vaccines .
As in all countries, vaccination will be a key part in the public health response to COVID-19. Despite the wider national crisis in Brazil, Goias state appears to have made good progress. However, this should not deflect attention from the other public health measures and behavioural changes that will be essential for managing the pandemic. For example, there is no available information about testing, surveillance and other protective measures in LTCFs across Goias. Sustainable responses to the COVID-19 pandemic will require institutional strengthening in public health, as well as closer integration with social assistance agencies supporting dependent older people.
Photo 2 – Credit: Goiania Municipal Health Secretariat). Available at: https://paisefilhos.uol.com.br/familia/gratidao-idoso-de-96-anos-se-ajoelha-para-tomar-vacina-da-covid-19/
In Goiania, an older man knelt down to receive the vaccine, as a way of thanking the front-line health workers and science for the vaccine .
 Goiás é o segundo estado a iniciar a vacinação contra a Covid-19 no Brasil. (2021). Accessed in 06/04/2021. https://bandnewsfm.band.uol.com.br/2021/01/18/goias-e-segundo-estado-brasileiro-a-iniciar-a-vacinacao-contra-a-covid-19/.
 Atualização sobre a Covid-19 em Goiás e doses da vacina já aplicadas – 06/04/2021 https://www.saude.go.gov.br/coronavirus/noticias-coronavirus/12723-atualizacao-sobre-a-covid-19-em-goias-e-doses-da-vacina-ja-aplicadas-06-04-2021
 Governo de Goiás conclui vacinação contra Covid-19 em instituições de longa permanência para idosos. Accessed in 06 April 2021. https://www.social.go.gov.br/noticias/682-governo-de-goi%C3%A1s-conclui-vacina%C3%A7%C3%A3o-contra-covid-19-em-institui%C3%A7%C3%B5es-de-longa-perman%C3%AAncia-para-idosos.html
 Goiânia começa a aplicar 2ª dose de CoronaVac em pessoas com 76 anos ou mais. 05/05/2021. https://g1.globo.com/go/goias/noticia/2021/04/05/goiania-comeca-a-aplicar-2a-dose-de-vacinas-contra-a-covid-19-em-pessoas-com-76-anos-ou-mais.ghtml
Photo 3 – Mr Juarez Barbosa taking the COVID-19 jab in his horse and cart at a Drive-through in the city of Ipiracanjuba, Goias. His niece told the press: “His passion is the horse. The only means of transport he uses is this buggy. In this very important moment, it couldn’t be different. He didn’t think twice when it was his turn to get the vaccine” 
Credit: The Mayor of Piracanjuba.
Available at https://g1.globo.com/go/goias/noticia/2021/02/12/idoso-de-90-anos-vai-de-charrete-se-vacinar-contra-a-covid-19-em-piracanjuba.ghtml
 Covid Panel at the Goias State Health Secretariat (data changes constantly) – Accessed in 07 April 2021. https://extranet.saude.go.gov.br/pentaho/api/repos/:coronavirus:paineis:painel.wcdf/generatedContent
 Goiás pode ter chegado a platô da 2ª onda da Covid-19. Accessed in 06 April 2021. https://sagresonline.com.br/goias-pode-ter-chegado-a-plato-da-2a-onda-da-covid-19/
 Consórcio de veículos de imprensa a partir de dados das secretarias estaduais de Saúde (2021). Mortes e casos de coronavírus nos estados. Accessed in 06/04/2021. https://especiais.g1.globo.com/bemestar/coronavirus/estados-brasil-mortes-casos-media-movel/
 1/3 dos goianienses não pretende se vacinar contra a covid-19. Accessed in 06/04/2021. https://diariodegoias.com.br/1-3-dos-goianienses-nao-pretende-se-vacinar-contra-a-covid-19/
 MasoudfiAT, et al. (2021) KAP-COVIDGLOBAL: a multinational survey of the levels and determinants of public knowledge, attitudes and practices towards COVID-19. BMJ Open 2021;11:e043971. doi:10.1136/bmjopen-2020-04397.
 Em Goiânia, idosa recebeu vacina apenas após denunciar que primeira dose não foi injetada, diz filha. https://www.opopular.com.br/noticias/cidades/em-goi%C3%A2nia-idosa-recebeu-vacina-apenas-ap%C3%B3s-denunciar-que-primeira-dose-n%C3%A3o-foi-injetada-diz-filha-1.2195859
 Profissional que simulou vacinação em idosa é afastada, em Goiânia. https://www.poder360.com.br/coronavirus/profissional-que-simulou-vacinacao-em-idosa-e-afastada-em-goiania/
 Prefeito de Ceres afasta servidoras que autorizaram lista de fura-filas. https://www.opopular.com.br/noticias/cidades/prefeito-de-ceres-afasta-servidoras-que-autorizaram-lista-de-fura-filas-1.2229509
 Lar de idosos registra seis mortes por Covid-19 em Bauru. https://g1.globo.com/sp/bauru-marilia/noticia/2021/03/24/lar-de-idosos-registra-seis-mortes-por-covid-19-em-bauru.ghtml
 Uso emergencial: confira votos, relatório e apresentações da reunião. https://www.gov.br/anvisa/pt-br/assuntos/noticias-anvisa/2021/confira-materiais-da-reuniao-extraordinaria-da-dicol
 Soiza, RL; Scicluna, C; Thomson, EC. (2021) Efficacy and safety of COVID-19 vaccines in older people. Age Ageing. 2021 Feb 26;50(2):279-283. doi: 10.1093/ageing/afaa274. https://pubmed.ncbi.nlm.nih.gov/33320183/
 Vacina do Butantan atinge 100% de eficácia para casos moderados e graves https://butantan.gov.br/noticias/vacina-do-butantan-atinge-100-de-eficacia-para-casos-moderados-e-graves
 Pesquisa comprova que vacina do Butantan é eficaz contra novas cepas do coronavírus. https://www.saopaulo.sp.gov.br/noticias-coronavirus/pesquisa-comprova-que-vacina-do-butantan-e-eficaz-contra-novas-cepas-do-coronavirus-2/
 Idoso pega Covid-19 e morre pouco antes de receber 2ª dose de vacina, lamenta irmã. https://g1.globo.com/go/goias/noticia/2021/03/26/mulher-perde-o-irmao-para-a-covid-19-horas-antes-de-se-vacinar-contra-a-doenca-em-goiania-desolada.ghtml
 GO: Caiado prevê 100% das pessoas acima de 60 anos vacinadas em abril. https://www.metropoles.com/brasil/go-caiado-preve-100-das-pessoas-acima-de-60-anos-vacinadas-em-abril
 Caiado recebe mais 266,8 mil vacinas para a 2ª dose. Accessed in 06/04/2021 https://www.goias.gov.br/servico/95-covid-19/124691-caiado-recebe-mais-266,8-mil-vacinas-para-a-2%C2%AA-dose-contra-covid-19.html
 Senador Canedo e mais 4 municípios buscam aquisição direta de 600 mil doses de vacina contra a Covid-19. Accessed in 06/04/2021https://radiobandeirantesgoiania.com.br/senador-canedo-e-mais-4-municipios-buscam-aquisicao-direta-de-600-mil-doses-de-vacina-contra-a-covid-19/
 Gratidão! Idoso de 96 anos se ajoelha para tomar vacina da Covid-19. https://paisefilhos.uol.com.br/familia/gratidao-idoso-de-96-anos-se-ajoelha-para-tomar-vacina-da-covid-19/
 Idoso de 90 anos vai de charrete se vacinar contra a Covid-19 em Piracanjuba. https://g1.globo.com/go/goias/noticia/2021/02/12/idoso-de-90-anos-vai-de-charrete-se-vacinar-contra-a-covid-19-em-piracanjuba.ghtml