Vaccine ageism and crimes against humanity.

A few days ago, the British Medical Journal published an opinion piece: “Crimes against humanity in Brazil’s covid-19 response—a lesson to us all” (https://www.bmj.com/content/375/bmj.n2625). It reports on a national senate inquiry that finds parts of Brazil’s national government, including President Bolsonaro guilty of crimes against humanity as a result of their wilful obstruction of polices that might have limited the pandemic’s death toll. The piece concludes that:

“the international community has a duty to acknowledge that this is a crime which, although inflicted on the people of Brazil, has targeted and threatened the whole of humanity.”

There can be no argument against this powerful denunciation of those responsible for Brazil’s public health catastrophe. However, some other countries’ performances have been even worse, especially since vaccinations became available. This prompted me to write the following piece that the BMJ has just posted here https://www.bmj.com/content/375/bmj.n2625/rapid-responses

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Dear Editor,

I commend the Brazilian senate inquiry and the authors of this piece for publicising the many failures of Brazil’s federal government in its response to the COVID-19 pandemic. I share their view that the national president’s behaviour constitutes crimes against humanity, which could not go unpunished.

Nevertheless, I feel it is essential to draw attention to one aspect of Brazil’s pandemic response that is not specifically dealt with in the article. Whilst it is true that the federal government’s initial procurement of COVID-19 vaccines was unjustifiably delayed, the country’s subsequent vaccination campaign has been a considerable success. This can be seen both in terms of overall levels of coverage achieved and more specific rates for the most vulnerable groups. Currently, around 65 per cent of Brazilians have received two doses of vaccine (https://graphics.reuters.com/world-coronavirus-tracker-and-maps/countries-and-territories/brazil/) Roll-out was particularly fast for people at older ages and for indigenous groups: by early July over 85 per cent of indigenous people and of people aged 70 or more were fully vaccinated (https://veja.abril.com.br/saude/mais-de-86-dos-idosos-acima-de-70-anos-estao-totalmente-vacinados/ ; https://www.correiobraziliense.com.br/brasil/2021/06/4931494-populacao-indigena-lidera-indice-de-vacinacao-no-brasil.html). In comparison, most other middle-income countries, including India, Mexico, Thailand and South Africa, have achieved lower rates of overall coverage and have done less to prioritise the most vulnerable. For example, In Bulgaria, as of 26 October 2021, only 21.0 per cent of people aged 80 or more had been fully vaccinated, compared to 31 per cent of people aged between 60 and 69 and 19.7 per cent of those aged 25 to 49 (https://ourworldindata.org/grapher/covid-fully-vaccinated-by-age?tab=table&country=~FRA).

Of course, none of the credit for Brazil’s relative success in vaccinating its population should go to President Bolsonaro. Instead, it is a testament to the dedication and hard work of the county’s public health agencies, both at the national and local government levels.

Had Brazil’s vaccination campaign taken the same approach as these other countries, the numbers of confirmed COVID-19 deaths is likely to have been closer to a million than to the actual level of around 600,000.

Yes, Bolsonaro deserves to be put on trial for his criminal actions. But what about those responsible for the calamitous vaccination campaigns of other countries, which are responsible for millions of avoidable deaths? The international community has had almost nothing to say about that.