De onde vieram as vacinas? [Questão de Saúde - Ep. 1]

November 14th is the day of waking up very early and taking your kid to get the second dose of the vaccine against infantile paralysis. If you're under 40 years old, then you have probably never seen a kid with poliomyelitis. For a long time, Brazilian infants were haunted by diseases that nowadays are eliminated, or are, at least, controlled by vaccination.

Our country used to be constantly ravaged by epidemics, especially by those harmful to children, such as smallpox, meningitis, measles, and polio. We used to call infectious diseases {\an8}"childhood diseases", {\an8}because every child was likely to catch them. {\an8}Although these diseases were very frequent {\an8}and have caused too many problems to our children, another problem we used to have concerning our quality of life, besides other diseases, was the problem of infant mortality.

It isn't true when one says there are diseases unique to infants. Today, the process of immunization begins the moment we are born and goes up to when we die, right? Science evolution has changed this scenario.

Today, thanks to the wide access to vaccination, parents no longer need to face such diseases as something their kids can't avoid. But after all, which advances have brought us here? A MATTER OF HEALTH Whooping cough, diphtheria, and tetanus are avoided with the DPT vaccine.

CURE OF COVID-19 {\an8}This is a new pact, a new alliance, we call a deep sanitarian reform in this country. WHERE DO VACCINES COME FROM? Before developing the vaccine against smallpox, humans have attempted many other ways of fighting this disease.

One of these attempts was the variolation. They used to get a small quantity of the pus obtained from sick people's wounds, and apply it to healthy people so it would allow healthy people to build resistance against smallpox. Even though variolation could be effectively protective, it was also very risky because it could end up causing smallpox, or even other diseases.

MODERN VACCINES The development of modern vaccines began with British physician, Edward Jenner's research. The decisive steps of his research were not taken in hospitals or laboratories, but among peasants in countryside England. Jenner did his research with cow milkers that had been infected by cowpox, a variant of smallpox that affects humans more lightly.

Curiously, these peasants seemed to develop resistance to human smallpox. Due to this research, in 1878, Jenner came to the conclusion he could artificially inoculate cowpox into people as a way of making them acquire immunity to human smallpox. And that's exactly where the term "vaccine" comes from, it's the Latin word for "cow", an animal that was very important to Jenner's research.

Although social media did not exist by the end of the 19th century, people heard the news about vaccines being cultivated in cows. Some people thought they'd turn into cows. The nonsense of turning into animals after being vaccinated started two centuries ago.

LABORATORY PRODUCTION Nearly 80 years later, another important step was taken by Louis Pasteur in the history of vaccine development. You've probably heard of him because of other discoveries, such as the process of milk and beer pasteurization. Other than that, Pasteur's research was essential to the elaboration of the first vaccines in a laboratory.

Back then, he conducted research on the virus of cholera doing his tests on chickens. He inoculated the virus into them, but the chickens frequently died after a while. One day, one of his assistants made a mistake by inoculating a more attenuated sample of the virus into one of the chickens.

This chicken was affected more lightly and it got surprisingly immune to cholera. Science's greatest advances are the result of hard work and dedication, but a bit of luck can also be of great help. Louis Pasteur's work was yet to have a decisive influence in the history of public healthcare in Brazil.

In 1887, a young doctor from São Paulo moved to Paris to study Bacteriology. His name was Oswaldo Cruz, and he became an important name in the history of Brazilian medicine. This is why the well-reputed Oswaldo Cruz Foundation, or Fiocruz, was named after him.

After two years studying at Pasteur Institute, Cruz returned to Brazil with the goal of applying, here, what he had learned at the French capital. By the 1900s, when it was founded the Serotherapy Institute in Rio and the Butantan Institute in São Paulo, both the result of a bubonic plague crisis that happened in Santos, these institutes were just small institutions dedicated to scientific research and vaccine production. These institutes, in the beginning of the 20th century, were the top of the line of scientific knowledge of that period.

When managing the Serotherapy Institute, Cruz dedicated himself to research, pharmaceutical manufacturing, and the formation of new sanitarians. Fiocruz is renowned worldwide. In 1925, the institution received a distinguished visitor.

So? Do you know the man in the picture? Today we're living with the Covid, we're seeing both Butantan and Fiocruz being able to produce vaccines.

Historically, this process began with the epidemics of the flu, meningitis, zika. . .

so these institutions whether they're producing, or forming public healthcare professionals, are essential for the development of our country. Cruz's research and interventions drastically changed the paradigms of Brazilian healthcare. However, in the following years, he would face a challenge he could not have foreseen.

THE VACCINE REVOLT The 1900s was a period of commercial development in Rio, especially for the elites. Mr Rodrigues Alves was elected as president aiming to transform Rio. Rio's urbanization, while leaving a legacy of beautiful buildings, of the Rio Branco Avenue, which was called the Central Avenue back then, also removed a large amount of working people from the city, people who, out of sudden, had nowhere to live and had no condition of working and living.

These people had to move to the hills, where the favelas emerged. So they were not happy at all with the actions taken by the president. In 1904, a huge epidemic of smallpox ravaged the city of Rio.

Oswaldo Cruz, who was coordinating the General Directorate of Public Health, forwarded to the National Congress a law demanding that the vaccination against smallpox to be mandatory. However, his actions did not stop there. In the following months, he conducted the largest public health campaign Brazil had ever seen.

A health police force was created. It had the power to disinfect houses, hunt mice and kill mosquitoes. In that period, the process of public vaccination was made through campaigns, which were activities organized as if they were military processes, so they could control diseases.

Regarding the yellow fever, they'd isolate the sick and wipe out the mosquitoes through gases they'd put in houses. Regarding the smallpox, vaccination campaign generated the revolt we know as the Vaccine Revolt. They wouldn't ask for permission to enter the houses.

They wanted to check for Aedes. And for mice, because the bubonic plague still existed. So it created an adverse environment.

People began to rise against such measures because they received no explanation. A huge and loud rebellion took place on the 4th of November of 1904. Rebels set barricades and clashed against the police of Rio.

It seemed to be a civil war. The Vaccine Revolt, and even other epidemics that happened in the 20th century, show us the need of making information available to people. Information allow people to have an adequate judgement on the measures being taken, so they can join them.

Nowadays, vaccines are a national passion. Brazilian people have turned the immunization day into a large celebration. But it didn't happen overnight.

This change was achieved after a long path of campaigns. NATIONAL CAMPAIGN TO ERADICATE MENINGITIS 1966 TO 1971 SMALLPOX ERADICATION CAMPAIGN SMALLPOX ERADICATION CAMPAIGN The Smallpox Eradication Campaign {\an8}involved intense vaccination activities, as well as surveillance actions. {\an8}About this subject, Fiocruz researcher, Gilberto Hochman, {\an8}made an interesting statement: "60 years after a revolt against mandatory vaccination, instead of setting barricades, people in Brazil not only left their homes but also formed lines and crowded public squares in order to be vaccinated.

" Actually, vaccination in Brazil has turned into a major celebration. And this happened because of many policies developed throughout the 20th century. After several epidemics, the idea of taking the vaccines and campaigns to the countryside, to popular celebrations, to the pilgrimage in the Northeast, they took health practices to these places.

So the acceptance of these practices became widespread in Brazil. After centuries of research, and several attempts of fighting smallpox, this terrible disease was finally defeated. {\an8}This success opened up space for much more audacious possibilities.

{\an8}If we were able to mobilize people and eradicate smallpox, why couldn't it be done to other diseases? A COUNTRY AGAINST POLIO Poliomyelitis is a synonym of infantile paralysis. An acute and contagious disease that affects the nervous system and leaves serious permanent damages.

In 1980, the whole country was mobilized to fight polio, since vaccinating children was mandatory. But the logistical difficulties were enormous. Brazil has the dimension of a continent.

And there was no internet in the 1980s, communication technologies weren't advanced, our roads weren't good, and our air traffic wasn't very developed. So the WHO, the Pan-American Health Organization, and other health institutions said it wouldn't work. But it worked.

Brazil's decision of massively vaccinating, and the effort of the people in taking their children to get immunized made it possible for the campaign to reach them. Therefore, it was created the National Vaccination Day. In the first attempt, in the Northeast of Brazil, there were no vehicles for transporting the vaccines.

But a police chief said he could get the vehicles. So they used the stolen cars seized in the police station yard, hotwiring them in order to fulfill a public mission. It was impossible to land in some Amazon's regions.

So the pilot would fly over the region and radio his position. And, when the people down there knew where the plane was, they'd extend cloths, communicating the position to the pilot. The pilot would fly low.

Someone in the plane would throw a polystyrene ball with the vaccines in it, like some kind of bowling. Once upon a time, in a castle far, far away, a very nice little boy was born. He's the symbol of every child's good life and health.

His duty is to prevent diseases, and that's why he vaccinates everyone against infantile paralysis, measles, whooping cough, tetanus, diphtheria, and tuberculosis. The last register of polio in Brazil was in 1989, and this was achieved partly because of the famous mascot that later became a synonym of vaccination. Zé Gotinha was created by the designing artist Darlan Rosa, under a request made by Unicef and the Ministry of Health.

{\an8}A contest was made to choose its name, {\an8}and it mobilized students from all over Brazil. {\an8}It was so successful that today he is not only a symbol of fighting infantile paralysis but also of our National Immunization Program. Making the immunizers available to people and making people trust the vaccines were huge challenges, and we still face them today.

More challenges were to come. The National Vaccination Day has showed us that in our country, healthcare must be planned from inside out. This inside consists of over five thousand municipalities, each one with its own characteristics.

But how can we plan a national policy in a country with such varied realities? A NEW PATH FOR PUBLIC HEALTH On March, 1986, an indoor arena in Brasília was crowded with people searching for an answer to this. This was the 8th National Health Conference.

{\an8}Back then, health secretaries felt like people wanted {\an8}to participate, they wanted to know the ideas that were being spread, for a new alternative project for health policies. People were enthusiastic, willing to contribute. {\an8}We, healthcare professionals, must be associated to the Brazilian people, not divorced from them.

We must break the wall that separates us from society and open communication channels with the people. We should even learn how to talk to them. There are times when I remember that speech, when he says how bad can authoritarian governments be.

If you choose any part of that speech you'll find a story to tell. We have to start transforming the way we speak, and to change the way we listen, so that, when our union and the society talk to each other, we may understand them. And when we say how important it is to eradicate transmitted diseases in our country, we can say it clearly and objectively, so our people can understand it.

This is a new pact, a new alliance, we call a deep sanitarian reform in this country. The conference took four days, but it took almost two decades of preparation. The foundations for a unified and decentralized health system had been built by the sanitarian movement since the 1970s.

And it found an essential reinforcement during the 8th Conference: the enthusiasm of the people that had recently recovered the country's democracy. As a result of the conference, a daring project was designed. In the following year, it was integrated into the nation's most important document.

This system belongs to the people. The document of freedom, of dignity, of democracy, of social justice in Brazil! May God help us and may it be complied!

Enthusiasm, real passion! It gave us goosebumps of emotions. {\an8}By the people's will, {\an8}the largest public healthcare system in the world was being built.