SAO PAULO (BLOOMBERG) - Brazil hit the grim mark of half a million Covid-19 deaths on Saturday (June 19), a toll second only to the US that shows few signs of easing. Yet residents are spurning vaccines that they believe are substandard in favor of hard-to-find shots from Pfizer Inc.
In Sao Paulo, people demand the US company's shots at public clinics and often walk out if none are available. Some health-care centres have put up signs saying "no Pfizer shots" to save time. Many vaccination centres are empty, and the few that have Pfizer have massive lines.
Ms Maressa Tavares, a 29-year-old teacher, could have gotten her shot two weeks ago in Rio de Janeiro. But at the request of her father, she's holding out for Pfizer. "For me, it didn't make a lot of difference which one to take, but my father has very strong beliefs," she said.
Such reluctance is hobbling a vaccination campaign already plagued by shortages and delays. Failure to control the disease would harm not only Brazilians, who are dying at the rate of about 2,000 a day, but also threaten a global resurgence of the pandemic if the nation of 213 million becomes a breeding ground for new strains.
China's Sinovac and England's AstraZeneca account for about 96 per cent of shots available in the country, compared with just 4 per cent for Pfizer, according to government data.
"500,000 lives lost by the pandemic that affects our Brazil and the whole world," Health Minister Marcelo Queiroga said in a tweet. "I work tirelessly to vaccinate all Brazilians in the shortest time possible and change this scenario that has plagued us for over a year."
While doctors say residents should get any shot available, Sinovac's CoronaVac has a far lower efficacy rate than other vaccines, and President Jair Bolsonaro bashed its "origin" and initially refused to buy it. AstraZeneca saw its usage suffer worldwide thanks to rare blood clots, side effects and a still-pending approval in the U.S.
"At first, people were afraid to get CoronaVac, because it's Chinese, and now it's Astra because of the reactions," said Mr Luiz Carlos de Souza e Silva, a nurse who helps immunise people at a public clinic in Rio.
"People are really misinformed, the government took too long to come up with a vaccination plan, that creates a lot of fear."
Hesitancy isn't uniquely Brazilian. Dr Amesh Adalja, who studies pandemics at the Johns Hopkins Centre for Health Security in Baltimore, said it has existed ever since the smallpox vaccine was created in 1796.
More than two centuries later, US officials have promised everything from french fries to lottery prizes to persuade people. In Europe, Astra usage stalled after the blood-clot reports, and Uruguay even donated doses with approaching expiration dates because people didn't want them.
But nowhere are vaccines needed more than Brazil. The country has given out more than 86 million shots, but that covers less than 30 per cent of the population with a first dose and just 12 per cent with two, according to data compiled by Bloomberg.
Dr Adalja said misinformation on social media, combined with "denial from the highest levels of the government," have hindered Brazil's campaign.
If the virus continues to spread unchecked, Adalja said, new variants may emerge. Many have already appeared, including the highly contagious gamma, which was first documented in Brazil in November and has since spread to 64 countries. Vaccines appear effective against these variants, but countries with low vaccination rates could plunge deeper into crisis.
In Brazil, contagion remains high - and could worsen as winter arrives in the Southern Hemisphere. Some cities and states are reinstating lockdowns, but after some 15 months of slap-dash quarantines, such measures have become less effective.
"The virus is circulating like crazy, a lot of people are infected, few are vaccinated, and mostly just with first doses," said Dr Atila Iamarino, a biologist educated at the University of Sao Paulo and Yale who specialises in virology.
"Opting to wait for this or that vaccine is extremely dangerous."
The government began an organised campaign to push vaccination and masks only in May, more than a year after the virus arrived.
Mr Bolsonaro has minimised the crisis throughout. In the past week alone, he was the star of a motorcycle rally in his honour in Sao Paulo, criticised lockdowns and ordered the health ministry to study making masks optional.
Unlike the US, which earlier bet on several vaccines, Brazil opted to buy only Astra, which has an efficacy rate of about 63 per cent against symptomatic disease.
After delays, governors and mayors sought contracts of their own. As options ran out, the government finally struck an agreement for CoronaVac, a shot with an efficacy rate of about 51 per cent that Mr Bolsonaro has publicly disavowed several times.
After being criticised during a congressional probe for not buying 95 per cent-effective Pfizer vaccines, the president has begun to highlight arrivals of new batches - though he still questions the science behind them.
He said on Thursday that getting sick is a more effective way of protection, and has yet to get a shot himself. Experts say that even less effective shots are well worth taking, but Mr Bolsonaro's mistrust is reflected among his supporters.
Mr Edilson Pessanha, father of Ms Maressa Tavares, delayed his immunisation about three months until he could get the US vaccine. He said he feared CoronaVac.
"People prefer excellence," the 62-year-old farmer said. "I research and want what's best for me, what's best for our country, which is what's happening. Bolsonaro is doing what's best for us."
Dr Natalia Pasternak, a microbiologist who's become a vocal critic of the government's handling of the pandemic and testified before Congress, calls such people "vaccine sommeliers".
"It's the government's job to tell people they shouldn't be cherry-picking, they're all effective and the 'good' one is any you take," Dr Pasternak said in an interview.
Still, the pace has picked up recently. After a sharp drop in May, the average number of daily doses given has climbed to about 984,000 in June, according to data compiled by Bloomberg. The progress has made markets more optimistic for the outlook for Latin America's largest economy, sending stocks soaring. More doses are expected to arrive in the second half of the year.
But for now, experts see Brazil stuck as the virus rages. The country added 82,288 infections and 2,301 deaths in the last 24 hours. With more than 17.8 million confirmed cases, it ranks third in infections, trailing only the US and India. It's second in deaths, reaching 500,000 less than two months after crossing the 400,000 mark.
Fiocruz, an institution that monitors the disease, called the situation "critical" in a Thursday report. It said the average age of deaths has dropped below 60 for the first time, months after similar moves in cases and hospitalisations. Now, more than half of deaths occur in those between 20 and 59 years.
"It's absurd that we look at these numbers of daily deaths and think it's OK - this isn't OK," Dr Pasternak said. "A lot of people are seeing other countries going back to normal, and believe we're also there, but clearly that's not the case."