Brazil's lack of COVID vaccines — and skeptical president — didn't stop this doc : Goats and Soda Dr. Gabriela Kucharski's city of Toledo had virtually no vaccines. And it's a bastion of support for Brazil's vaccine skeptic president. Here's why that didn't matter.

How this Brazilian doc got nearly every person in her city to take a COVID vaccine

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In the U.S., vaccinations with the new omicron boosters are moving slowly. In fact, a survey found about half of Americans have rarely heard of them. But in Brazil, the attitude to COVID vaccines could not be more different. NPR's Nurith Aizenman traveled there to bring us one city's remarkable success story, which begins with an unexpected call.

NURITH AIZENMAN, BYLINE: Dr. Gabriela Kucharski heads the health department of Brazil's southwestern city of Toledo. She had just dropped off her son at elementary school and was driving to the office when her phone pinged. It was a researcher from a nearby university.

GABRIELA KUCHARSKI: And I remembered that I stopped the car. And I said, hello, how are you? What do you need? Can I help?

AIZENMAN: The researcher explained that Pfizer was looking to pick a city for a big experiment. They wanted to see if you could stop COVID by vaccinating every single person there in one fell swoop.

KUCHARSKI: And so I think, oh, my god, I'm not hearing this.

AIZENMAN: This was back in May of 2021, the thick of the delta wave. And while mRNA vaccines were already plentiful in wealthy countries like the U.S., in middle-income countries like Brazil, supplies of any type were limited. Toledo was also still reeling from a giant COVID wave.

KUCHARSKI: We don't have enough hospital beds of intensive care here in Toledo or anywhere else. Wherever you went, nobody had them.

AIZENMAN: Toledo is a prosperous city. It's a regional center of agribusiness with a fairly small population of 145,000 people. But COVID had overwhelmed it. Kucharski was forced to set up makeshift ICU beds. Even those weren't always enough.

KUCHARSKI: In some moments, they called me and they said, we have another person that we needed to put in intensive care. And we didn't have another place to put this person. And we think, my God, what is going to happen because we don't have anything else to do?

AIZENMAN: Do you think people died as a result of that?


AIZENMAN: Now this Pfizer experiment promised literal salvation. For weeks, Kucharski and a deputy worked on an application to make the case that Toledo should be the city for this study. Finally, at the end of their umpteenth video pitch meeting with Pfizer, an official let drop that, yeah, we're going to pick Toledo.

KUCHARSKI: We hugged. And we cried. And we said, my God, I can't believe this. We're going to vaccinate everybody.

AIZENMAN: Of course, they'd only cleared the first hurdle - securing enough vaccine. Now came step two - convincing every single person in Toledo to take it. And on this point, it's worth noting a parallel with the United States. Brazil's president is Jair Bolsonaro. And like his U.S. counterpart during the start of the pandemic, Donald Trump, Bolsonaro had expressed a lot of skepticism about pandemic precautions. Miguel Lago is executive director of the Institute for Health Policy Studies, a Brazil-based think tank.

MIGUEL LAGO: Bolsonaro has been, since the beginning, promoting this kind of distrust.

AIZENMAN: Especially around vaccines.

LAGO: And he said many times that he wouldn't get vaccinated.

AIZENMAN: Lago says usually when Bolsonaro takes such a public position on an issue...

LAGO: His speech shapes the actions and the choices of millions of Brazilian people. Because he's very popular.

AIZENMAN: Including in Toledo. This city is a Bolsonaro stronghold.

You're a Bolsonaro supporter, I take it?


AIZENMAN: I get a sense of how deep the love runs here when I get a tour from the city's secretary of economic development, Diego Bonaldo.

DIEGO BONALDO: (Speaking Portuguese).

AIZENMAN: He's full of praise for Bolsonaro's economic promises...

BONALDO: (Speaking Portuguese).

AIZENMAN: ...To cut taxes and regulations. And when it comes to the COVID vaccine, Bonaldo doesn't fault Bolsonaro for questioning it.

BONALDO: (Speaking Portuguese).

AIZENMAN: It's his right, he says. In the United States, the politicization of the pandemic has had a big impact on vaccination rates. People in counties that lean Republican are significantly less likely to be vaccinated than those in counties that lean Democratic. But this is where the parallel between the U.S. and Brazil ends. Take Bonaldo - when it came to deciding whether he should get the vaccine, all that anti-vax talk from his hero, President Bolsonaro, didn't give him a second's pause.

BONALDO: (Speaking Portuguese).

AIZENMAN: The moment the vaccine was available, he took it. And pretty much everyone else in Toledo felt the same way.

KUCHARSKI: It was amazing.

AIZENMAN: Back at her office, Dr. Kucharski pulls up a video montage she had made...

KUCHARSKI: I have this on the Instagram.

AIZENMAN: ...Setting to music the scenes across the city the morning the Pfizer vaccinations were set to begin.


KUCHARSKI: Did you see the line?

AIZENMAN: People are camped out in lawn chairs. Officials open the doors to a vaccination site, and the crowd starts to file in, dozens, then hundreds of people. Within six days, almost a third of the city's population had turned out. Within a month, almost everyone had gotten their first dose. And three months after that, by the start of 2022, 91% of Toledo residents age 12 and up were fully vaccinated. The results of the Pfizer study won't be ready until at least next year. But Kucharski says the benefit of the vaccinations was immediately clear. When the next COVID wave hit, the death rate in Toledo was 10 times lower. Kucharski starts to dab her eyes.

KUCHARSKI: I saw this already, I think, 10 times. And I always cried because I remember every sick person and everybody who died and we couldn't vaccinate. Sorry.

AIZENMAN: And this sentiment speaks to a difference between Brazil and the United States that may explain why the politicking around vaccines had so much less impact on people in Toledo. In a wealthy country like the U.S., people can count on being first in line for cutting edge new vaccines. In Brazil, procuring all sorts of vaccines has been a decades-long struggle. Here's Miguel Lago again.

LAGO: Since the '70s, people are - what they dream about is getting vaccines.

AIZENMAN: So most people value them too much to believe any doubt mongering. Lago says this attitude has also been cemented by another distinguishing feature of Brazil. It's got universal health care, a network of neighborhood clinics where, since childhood, people have been getting free routine vaccinations year after year.

LAGO: It's more integrated in our daily lives. So I think this has shaped our culture around vaccination that is important.

AIZENMAN: In Toledo, the public clinics helped the city keep up the momentum as it rolled out boosters and most recently as it started expanding vaccination to kids under age 12. More than half have now gotten their first shot compared to a third of the U.S.' younger kids. The public buy-in is palpable on a recent morning, at a Toledo clinic where 11-year-old Gustavo Correia...

GUSTAVO CORREIA: (Speaking Portuguese).

UNIDENTIFIED NURSE: (Speaking Portuguese).

AIZENMAN: ...Is burying his face in his mother's shoulder while a nurse presses a needle into his arm...

UNIDENTIFIED NURSE: (Speaking Portuguese).

AIZENMAN: ...His second COVID shot.

GUSTAVO: (Speaking Portuguese).

AIZENMAN: It hurts, he says. His mother, Elizandra Correia, chuckles.

ELIZANDRA CORREIA: (Speaking Portuguese).

AIZENMAN: "He's the one who insisted that we come in," she says.

GUSTAVO: (Speaking Portuguese).

AIZENMAN: "I was afraid of getting COVID again," he says. When he got it last year, he felt so lousy. So he says...

GUSTAVO: (Speaking Portuguese).

AIZENMAN: "I wanted to get vaccinated."

Nurith Aizenman, NPR News.

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