S？O PAULO, BRAZIL — In a world struggling to convince people to take the coronavirus vaccine, the news was striking.
S？o Paulo, the largest city in the Western Hemisphere, announced late last month that it had succeeded where others had failed. One hundred percent of its adult population had been fully vaccinated against the coronavirus — a remarkable rate in an era characterized by an intransigent and growing global anti-vaccine movement that has hobbled vaccination efforts from Europe to the United States.
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In this city of 12.3 million, the story has gone differently. For months, day after day, long and orderly lines formed outside the city’s vaccination stations. Young and old, rich and poor, highly and barely educated: People showed up when their names were called. Then returned weeks later for the second dose. “The world’s vaccine capital,” the city has dubbed itself.
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This, in a country led by President Jair Bolsonaro, who has gone to great lengths to undermine confidence in the vaccines and to this day has not himself been vaccinated. “Let me die,” he said this month. “The problem is mine, all right?”
That Brazil ultimately chose public health over politics has stunned researchers, defying political expectations. In few other places has this been more evident than in S？o Paulo, which went heavily for Bolsonaro in the 2018 presidential election, but was first to start lining up for vaccines.
“I don’t know of any other major city with this vaccination rate,” said Denise Garrett, vice president of applied epidemiology at the Sabin Vaccine Institute in Washington. “I don’t think one exists.”
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There are caveats. Population estimates in S？o Paulo — a sprawling urban center dotted with the low-income, irregular communities known as favelas — are anything but exact. City officials opened vaccination posts to anyone willing to roll up their sleeves, which drew people from other cities. All of it has left city officials with an unusual final accounting:
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S？o Paulo has not, to be precise, vaccinated 100 percent of its residents. It has, according to officials, vaccinated 101.6 percent of them.
Then there is the biggest uncertainty of them all: omicron. Past variants of the coronavirus have devastated Brazil, killing more than 616,000 people — a death toll exceeded only by that of the United States. Many here fear the new variant, which has now been detected in S？o Paulo, could deepen the losses. Highly transmissible, but possibly less deadly, the new variant appears capable of defeating the natural immunity of people who’ve had a prior infection and the adaptive immunity acquired by people who’ve been immunized, though it’s unclear to what extent.
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The extraordinary success of S？o Paulo’s vaccination campaign has laid the groundwork for what amounts to a large-scale experiment. The coming weeks will help show how the new variant will behave in a massive urban environment where virtually everyone has been vaccinated, and whether its spread will be slowed by S？o Paulo’s vaccination firewall.
“What we hope, especially with our high rate of vaccination, is that, even in the worst-case scenario, there will only be an increase in the number of cases,” said Alexandre Naime Barbosa, head of the epidemiology department at S？o Paulo State University. “We don’t expect there to be a rise in hospitalizations and deaths precisely because the vaccines’ principal efficacy is to reduce the individual risk of dying or being hospitalized.”
One thing, however, has been immediately clear: Even before the arrival of omicron, the coronavirus wasn’t fully beaten back. It has continued to circulate in S？o Paulo — though at a far lower rate — putting an end to any notion that the current vaccines alone will stop the coronavirus.
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“People can say, ‘Well, you’ve vaccinated everyone, so the pandemic is over.’ But no, this isn’t true,” said Jarbas Barbosa da Silva, assistant director of the Pan American Health Organization. “Not until the community transmission has stopped, and this isn’t the case, unfortunately.”
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Part of the reason is the vaccines themselves. In the early days of the pandemic, while Bolsonaro downplayed the threat of the coronavirus, S？o Paulo state officials aggressively pursued vaccine options. They soon announced a partnership between the local research institute Butantan and the Chinese biotech firm Sinovac to produce its vaccine in Brazil. Gov. Jo？o Doria then went further, declaring that vaccination would be mandatory in Brazil’s most-populous state.
But the shot turned out to be far less effective than hoped. Its efficacy rate against infection was barely more than 50 percent. It meant that the disease would continue to spread, even among people who were vaccinated. But in the end, this was the vaccine that the government had, so people started lining up. And then more people. And more.
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Even the skeptics.
Last December, S？o Paulo resident Cardoza da Plaime wasn’t so sure about the vaccine. “It’s not trustworthy,” he said the time. But now, a year later, he’s changed his tune: “I took it. Both doses.”
Bolstered by shipments of Pfizer and AstraZeneca vaccines, the immunization program in S？o Paulo drastically reduced the spread of a virus. At the height of the outbreak, the city hospital system was admitting more than 2,000 covid patients every day, filling more than 90 percent of beds in intensive care units. Now only 27 percent of public ICU beds are occupied by coronavirus patients. In a city that has buried nearly 40,000 coronavirus victims, deaths are down to an average of 13 per day. The private health-care association has stopped counting its covid intake numbers. The numbers are too low.
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“We’ve been given hope,” said Evaldo Stanislau de Araújo, an infectious-disease physician at S？o Paulo’s Hospital das Clinicas, the biggest hospital in Latin America. “The vaccine has changed everything. Today we still see covid cases, but they are mild.”
But many still aren’t taking any chances, least of all the city — which has canceled its New Year’s Eve party plans and extended its mask mandate.
Carlos Aguiar, 56, didn’t mind. Standing along Avenida Paulista on a recent cloudy day, he said he had every reason to believe everyone around him was vaccinated. But he still felt more comfortable wearing a mask. It had become “normal,” he said.
“Everyone is vaccinated, and I don’t think there is any danger,” he said. “But we have to take care of ourselves, logically. I don’t think it’s necessary to use a mask outside, but the government says we have to, so we’ll do it.”
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In another part of town, a man in a public park took off his mask to catch his breath. Manoel Varela, 40, had thought that life would get back to normal when everyone got the vaccine. Masks off, covid defeated — everyone freed from fear. But it hasn’t turned out that way. He also agreed with the cancellation of city’s New Year’s Eve party and the continuation of its mask policy.
“The vaccine protects you, but not completely,” he said. “Now a more aggressive variant has appeared, so we’re doing more to protect ourselves over here — using masks and washing our hands.”
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