by Incorporation of the vaccine into the SUS still depends on Conitec’s endorsement, which will evaluate aspects such as efficacy, safety and economic impact
In early March, the National Health Surveillance Agency (Anvisa) approved the registration of Qdenga, a new dengue vaccine produced by the pharmaceutical company Takeda. The release of the immunizer, intended for a wide audience, raised the expectation that the epidemic of the disease transmitted by the mosquito aedes aegypti come to an end.
Experts heard by metropolises believe that the vaccine will be an important tool in controlling the disease that has such an impact on the country, but claim that the dengue epidemic will only be resolved with careful planning for the implementation of the vaccine.
“It is possible to think, on a distant horizon, that dengue can be controlled by the vaccine”, says the vice-president of the Brazilian Association of Collective Health (Abrasco) Cláudio Maierovitch, researcher at the Oswaldo Cruz Foundation (Fiocruz) Brasília.
Factors such as cost and availability of doses can interfere with this path. An interesting strategy would be to start vaccination in regions with greater transmission of the virus and in groups more vulnerable to infection, and consider other immunization options, such as the vaccine being developed by the Butantan Institute.
Maierovitch believes that the incorporation of other vaccines, such as Butantan, would enable an increase in available doses, in addition to lowering prices. “We are talking about competition in the market and a public laboratory that will not have to pay for the use of technology”, he evaluates. In an ideal scenario, the two immunizers would be used in the vaccine campaign.
The vice-president of the Brazilian Society of Immunizations (SBIM), Renato Kfouri, does not believe that the approval of Qdenga, alone, is enough to control the dengue epidemic in Brazil. “There is no expectation that the vaccine will end the disease, not least because there will not be doses for everyone and, even if it did, we will not achieve high coverage. It’s no use putting it at an age where people don’t get vaccinated, like adults, for example”, he ponders.
Qdenga
The approved immunizer demonstrated high protection against the four serotypes of the virus in clinical tests. It differs from the previously approved vaccine, Dengvaxia, in that it can be applied to anyone aged 4 to 60 years, regardless of whether they have had previous contact with the virus.
“Immunization with Dengvaxia is complex. It requires a pre-vaccination test to find out if the individual has already been exposed to the dengue virus, which practically makes its use in public programs unfeasible”, says Kfouri.
Incorporation into the SUS
Usually, the process of incorporating a vaccine or drug into the Unified Health System (SUS) begins with a request from the manufacturer. In the case of Qdenga, the demand was exceptionally reversed. It was the Ministry of Health that requested the documents for the company, due to the epidemiological scenario in the country.
The folder awaits the delivery of the data so that the possibility of purchasing the vaccines is evaluated by the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec).
In this analysis, still without an established date or deadline, Conitec considers aspects such as efficacy, effectiveness, safety and economic impact of the new technology based on the best available scientific evidence.
“The inclusion of the vaccine to control dengue in the SUS is a priority for the Ministry of Health, which closely monitors the epidemiological scenario of arboviruses in the country”, informs the folder to the metropolises.
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Implementation Strategies
Maierovitch suggests that vaccination take place in a staggered manner, as doses become available. “It’s possible to think about a gradual introduction, starting with places with a high incidence of dengue and repeating it every year”, he says.
For Kfouri, one of the priorities must be to carry out a study to understand which age groups should be prioritized to obtain the best impact on disease control.
Data from the Ministry of Health show that the region with the highest incidence of virus transmission in 2023 is the Midwest, with 254.3 cases per 100,000 inhabitants. Then come the Southeast and South regions, with 214.7 and 98.2 cases per 100,000 inhabitants, respectively.
Dengue in Brazil
Dengue is still a disease that claims many victims in Brazil. In 2023 alone, 73 deaths caused by the infection were reported. Another 64 are still under investigation, according to the Ministry of Health. The total number of cases grew by 43.8% until March this year, compared to the same period last year.
“In 2022, unfortunately, we broke the sad record for the number of deaths and cases: we passed 1,000 deaths, with more than 1.5 million cases. It is a disease that has seasonality close to the rainy seasons, and there is enormous difficulty in controlling the transmitting mosquito”, says Kfouri.
Among the characteristics that make it difficult to control the disease, the SBIM vice president highlights problems in basic sanitation, open dumps and many areas where it is difficult to maintain good environmental hygiene and, consequently, prevent the proliferation of mosquitoes through the eggs.
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