This ability to transform scientific evidence into concrete public health decisions has placed Nogueira in a highly select group. His name appears on the list of the 107 Brazilian scientists with the greatest influence on decision-making worldwide, according to a report released by Agência Bori in partnership with Overton, which mapped researchers whose studies were cited in official documents, guidelines, and public policies around the world. He is part of a select group of 22 specialists in infectious diseases and vaccines who played a decisive role in responses to outbreaks of Zika, dengue, and COVID-19, in addition to influencing decisions related to Brazil’s National Immunization Program (PNI).

This international recognition comes alongside another recent distinction: the title of Distinguished International Fellow, awarded by the American Society of Tropical Medicine and Hygiene (ASTMH)—one of the highest honors in tropical medicine and global health. Maurício Nogueira also appears in a survey by Stanford University among the world’s most influential scientists, further reinforcing the international reach of his scientific work and the relevance of his contributions to virology and public health.

With a career shaped by the intersection of research, clinical practice, and public policy, Maurício Lacerda Nogueira has played a central role in responding to major epidemics in Brazil and abroad. He worked on studies during the Zika and COVID-19 crises, contributed to the development of new diagnostic techniques, and participated in the development of the dengue vaccine produced by Instituto Butantan—recently launched and considered one of the most important milestones in Brazilian public health science.

In an interview with Science Arena, he reflects on how science produced in Brazil can influence global health decisions, the structural bottlenecks that still limit innovation in the country, and the pathways for transforming scientific evidence into public policies capable of saving lives.

Science Arena: You have built a unique career in Brazil, combining cutting-edge science with influence on public policy. At what point did you realize that research needed to go beyond the laboratory to generate a real impact on public health?

Maurício Lacerda Nogueira – That was more a consequence than an intentional process. It was the result of work that has always been very closely connected to the healthcare system here in São José do Rio Preto. For the past 20 years, we have worked very closely with the local healthcare system and the local health department, providing information and transferring what we discover in the laboratory into public health practice. Over time, the projects become more complex and begin to influence policies, such as for vaccines. It was more a natural consequence of working closely with the healthcare system.

In your experience, what is currently the main bottleneck preventing scientific evidence from being transformed into concrete public health decisions in Brazil?

The main bottleneck is still the disconnect between healthcare services and academia. The COVID-19 pandemic showed that this was an absurd dichotomy and that we needed to work together. This has improved significantly in Brazil in recent years.

Epidemics such as dengue, Zika, and COVID-19 placed Brazil at the center of global science. What did these crises reveal about our institutional and scientific strengths and weaknesses?

Zika placed Brazil at the center of global science, and the country has very strong scientific capabilities: a highly qualified scientific community, young people engaged in science, motivated students who actively pursue opportunities, access to information, and infrastructure. But we also have enormous weaknesses, and the greatest of them is the complete lack of predictable funding. We remain heavily dependent on political circumstances, government priorities, and political transitions. We responded very effectively to Zika during a period of substantial funding, but we responded very poorly to yellow fever shortly afterward, because we were facing a period of extremely limited funding. 

Brazil’s response to the Zika epidemic received international recognition. What lessons from that period have we still failed to turn into lasting structural policies?

That is exactly the point: we have failed to turn them into permanent policy because we do not engage in long-term planning—everything is reactive and crisis-driven. When Zika began, the São Paulo Research Foundation (FAPESP) and the National Council for Scientific and Technological Development (CNPq), our major funding agencies, created programs and mobilized resources. Over time, these programs were scaled back. Then COVID-19 arrived, mobilizing resources again and creating new programs—including with private funding—but that also gradually disappeared. We do not have long-term strategic planning for science in Brazil.

During the COVID-19 pandemic, science became heavily politicized. How did that affect the dialogue between researchers, policymakers, and society?

The politicization of science during COVID-19 was the worst moment of all. In my 30 years of academic life in Brazil, that was the lowest point we reached. Scientists were persecuted, and there was a conflation of researchers’ personal identities and political views with the work they were carrying out. Scientists were targeted on social media and became victims of hate campaigns. This severely harmed communication and Brazil’s response, contributing to vaccine delays that ultimately cost lives.

Time, as politicians like to say, is the ultimate judge. We now see the news that Dr. Marcus Lacerda, probably the scientist most heavily attacked during the pandemic, was appointed (on January 15, 2026) director of the Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization—an extremely important position that demonstrates the significance of Brazilian science on the global stage. The person who faced the harshest attacks now occupies one of the most important positions held by a Brazilian scientist.

Is working in virology in a tropical country more of a constant challenge or a strategic opportunity for Brazil to establish itself as a global leader?

Working in Brazil is an enormous opportunity. Tropical diseases are part of our daily lives and our reality. It is a challenge because the demands are more urgent, but it is also an opportunity: we have the ability to remain very close to the problems and respond directly to those demands. 

I remember a dinner several years ago at the American Society of Tropical Medicine and Hygiene, with researchers in the field of dengue. One said, “I conduct my research in Indonesia,” another said, “I always go to Colombia,” and another said, “I always go to Africa.” I joked, “I just cross the street—the hospital is right across from my laboratory.” That is a real advantage.

We face the structural problems inherent to Brazil: a lack of long-term funding and funding volumes that are far lower than what researchers in other countries can access. But we certainly do have strategic advantages.

You participated in the development of Butantan-DV, the dengue vaccine developed by Instituto Butantan. What does this experience reveal about the potential—and the limitations—of health innovation in Brazil?

The development of the Butantan vaccine is, in my view, one of the greatest achievements in the history of Brazilian science. It was a study that required substantial public investment, but it demonstrated Brazil’s ability to develop a vaccine and conduct a highly complex, long-term clinical trial. Instituto Butantan coordinated this effort with all participating centers, and we had the privilege of being part of it. This investment will have an enormous impact on public health in the coming years, as the vaccine reaches the Brazilian population and reduces the impact of dengue in Brazil.

Based on your international experience, how is Brazilian science perceived in global forums on virology and public health?

Brazil is highly respected in the fields of virology, public health, and tropical medicine. Proof of this is the appointment of Marcus Lacerda as director of the TDR. Until last year, I served as president of the American Committee on Arboviruses—meaning that a Brazilian was leading a committee within the American Society of Tropical Medicine and Hygiene. Brazil is consistently represented in organizations such as the Pan American Health Organization (PAHO), the World Health Organization (WHO), and the World Organization for Animal Health (WOAH). 

You are actively involved with international institutions, such as the University of Texas Medical Branch. How is Brazilian science viewed and received in those spaces?

It is highly regarded and recognized at universities abroad. At the same time, they are also aware of our shortcomings, especially the irregularity of funding. Working at the intersection between the Brazilian and international systems gives us a certain advantage.

What type of international collaboration do you consider most strategic today: large global consortia or more horizontal networks among countries facing similar challenges?

Both are important, each with its own characteristics. Large global consortia allow us to access resources and technologies that are not available through horizontal networks. Horizontal networks, meanwhile, connect us with countries facing similar challenges and problems—although, on the other hand, they also face the same resource limitations that we do.

Climate change tends to expand the reach of arboviral diseases. Is Brazil adequately preparing for this new epidemiological scenario?

Global warming and climate change have significantly affected the distribution of these arboviral diseases. We have seen dengue transmission in California, chikungunya in New York and France, and dengue in France and Japan—rising temperatures are leading to a wider spread of the mosquito and, consequently, of these diseases.

The same is happening in Brazil. Over the past two years we have experienced a major dengue epidemic in Porto Alegre, Rio Grande do Sul, in an area where there had previously been no circulation of the disease. What we are doing now is helping to train a generation of researchers, scientists, and public health professionals who were not prepared to work with these diseases because historically those diseases had not been present there.

Fortunately, we have the infrastructure, scientists, and public health professionals capable of providing that training—and that is exactly what has been happening.

Is Brazil’s surveillance system sufficient to anticipate outbreaks, or are we still operating reactively?

We are still very reactive. We have a good surveillance system, but for a variety of reasons it remains reactive. One example of this is that both the Sabiá virus (a highly lethal Brazilian virus) and SARS-CoV-2 (the virus that causes COVID-19) were first identified in the private healthcare system, rather than the public system. This shows that there are still gaps in public surveillance at certain times, primarily due to a lack of resources. COVID-19 brought funding and training, but the surveillance system still needs to be expanded.

What lessons from these major epidemics have still not been fully incorporated into surveillance and public health emergency preparedness policies?

The lessons were incorporated. The problem is that they are forgotten or cease to be priorities. All the collaborative work carried out between the public healthcare system and universities during the pandemic has been abandoned. This is a problem in Brazil—it is not about creating plans, but about maintaining them over time.

How can we balance excellence in research with urgent public health demands without compromising scientific quality?

The way to balance research excellence with urgent public health demands without compromising scientific quality is straightforward: funding. We need adequate resources to carry out work that addresses local demands. But that depends on sustained funding.

As deputy director of graduate studies, what type of researcher does Brazil need to train to address the public health challenges of the coming decades and strengthen the connection between science and public policy?

It is difficult to provide ready-made formulas. The researchers we train must be of the highest quality, capable of asking the right questions and responding to public health demands. The health challenges are enormous and our resources are limited, so we must train a generation of researchers who are deeply committed to public health, to sound science, and to addressing the country’s needs.

What advice would you give to us, young scientists, who want to see our research influence sound public health decisions?

Young researchers must not compromise on excellence in their work. That is a key point. Asking relevant questions, working with realistic demands, and producing high-quality science is the right path forward.

If Brazil had a robust national science policy focused on public health today, which areas would you prioritize to maximize social impact and international influence over the next 10 to 20 years?

It is difficult to prioritize a single area, although we must do so because resources are limited. Brazil has a unique characteristic: while we have tropical diseases—dengue, chikungunya—we also face problems typical of developed countries, such as an aging population and cardiovascular diseases. 

Brazil needs to continue doing what it does best: creating major scientific infrastructures capable of driving significant change. We have centers such as the National Laboratory of Scientific Computing (LNCC), the Brazilian Synchrotron Light Laboratory (Sirius), and the future Biosafety Level 4 Laboratory (ORION)—highly advanced research infrastructures that will give Brazilian scientists the opportunity to conduct cutting-edge research across multiple fields of knowledge.

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This is the main conclusion of a scientific literature review conducted by researchers from HypoVax Global Knowledge Hub, an international consortium that brings together immunologists, clinicians, data scientists, and public healthcare specialists dedicated to the study of vaccine hyporesponsiveness—defined as a reduced or insufficient immune response to a given vaccine.

Inequalities beyond access

Among the researchers involved is immunologist Helder Nakaya, a senior researcher at Einstein Hospital Israelita who contributed toward the identification of studies containing immunological and omics data. In a post on his LinkedIn profile, Nakaya drew attention to a structural imbalance in global scientific research: 

According to Nakaya, “we are trying to understand a problem that mainly affects poorer populations using data that come mostly from wealthier ones.” 

HypoVax Global seeks to close this gap by fostering international collaborations, generating better quality data in underrepresented regions, and providing a more accurate picture of global immunological inequalities.

Evidence compiled in an international publication

In 2024, the consortium held an international workshop about vaccine hyporesponsiveness in the Netherlands. The discussions and evidence presented were outlined in an opinion article published in November in the journal The Lancet Microbe.

In clinical trials, for example, the effectiveness of the rotavirus vaccine after 12 months ranged from 44% to 77% in high- and medium-mortality countries—all of which are low- and middle-income—while it reached 94% in low mortality countries, all of which are high-income.

Significant variations were also observed in the response to the hepatitis B vaccine. Among children under 15 years in sub-Saharan Africa, seroprotection rates varied from 85% in South Africa to 64% in the north of the continent.

Single-country comparative studies reinforced the influence of the local context. In Gabon, children from rural areas presented lower antibody responses to the influenza vaccine than those from semi-urban regions. In Uganda, adolescents from rural areas demonstrated weaker responses to various vaccines than those from urban areas.

Biological and clinical factors associated with hyporesponsiveness

The immune response to vaccines is shaped by multiple factors:

• Genetics: different ethnic groups living in the same location may present different responses and varying rates of antibody decline.
• Comorbidities: children with celiac disease exhibit lower levels of antibodies after hepatitis B vaccination and lose protection more rapidly.
• Prematurity and malnutrition: premature infants and malnourished children exhibit weaker responses to vaccines such as hepatitis B, measles, and oral poliovirus.
• Concomitant infections: nursing infants with symptomatic malaria infection present reduced responses to Hib, measles, meningococcal C, Salmonella, and tetanus vaccines.

Another important factor is the interval between doses. Schedules with longer intervals tend to induce more robust immune responses. Evidence shows that antibody levels against the acellular pertussis vaccine are significantly higher when administered at 2, 4, and 6 months, compared with accelerated schedules, such as 2, 3, and 4 months.

Pathways to reducing vaccine inequalities

According to the authors, the findings support the idea that biological and contextual conditions profoundly shape vaccine effectiveness. As a result, the rational development of new vaccines should seek strategies to modulate innate immunity, either through pre-vaccination interventions or the use of more effective adjuvants.

To make this possible, it is essential to expand the availability of diverse databases, with more inclusion of specialists and populations from low- and middle-income countries—precisely where vaccine hyporesponsiveness is most prevalent.

Artificial Intelligence tools and advanced data integration techniques are highlighted as resources with transformative potential for identifying predictive biomarkers, optimizing vaccine formulations, and generating actionable evidence tailored to the specific challenges of each population.

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The meeting addressed the state of preparedness for a next pandemic, learnings from the COVID-19 pandemic, and the viability and progress of the “100 Days Mission” launched by the UK government during the G7 in 2021. 

The most sobering learnings from the last pandemic was that 1.6 million people died before vaccines were available. Cases in an outbreak with human-to-human transmission spread logarithmically. 

Modelling data showed that 800 million infections and 8 million deaths could have been avoid in the COVID pandemic if vaccines would have been available within 100 days of availability of genome sequence. 

It’s an ambitious but possible goal

The “100 Days Mission” which has been endorsed by the G7 and G20 nations aims to have a vaccine developed, tested and emergency use authorized within those 100 days.

This is a moonshot goal as development time for a vaccine takes typically about 5-10 years, or even 25 years as for the first malaria vaccine. Are the 100 days achievable? 

If a new disease were from the Paramyxovirus or Orthopoxvirus family (or “disease X”) where we do not even know what it is, the world is not ready. 

The success of the 100 Days Mission is  based on 5 critical pillars all of which have to be established in a pre-pandemic period: 

1. Creating libraries of vaccine prototypes and platforms:

The unprecedented success of the COVID-19 vaccine availability within 326 days was only possible because of prior scientific work on other coronavirus family members such MERS and SARS-CoV1. 

Identifying pathogen families with pandemic potential, selecting one prototype within the family and then initiating R&D and platform selection work will be critical for a jump start in a next pandemic. This concept was  also embraced by WHO by moving away from the previous Blueprint list of a dozen pathogens to a family library approach. 

2. Establishing a global surveillance systems:

Early detection of pathogens with pandemic potential in the environment such as in wastewater even before an outbreak occurs is critical to avoid the evolution to outbreak to pandemic.  

Unfortunately many governments did not even build or  scale back their surveillance efforts.  

There is also reluctance by some countries to share epidemiological and genetic data for geopolitical and stigmatization reasons, but mainly because of lack of benefit back from recipient HICs. 

This is still one of the pending issues being addressed in the global Pandemic Agreement currently in late stage consultation with WHO member states.  

3. Global clinical trial and laboratory networks:

They need to be established and qualified in interpandemic time to ensure immediate readiness in an outbreak.

Lack of qualified trial sites, immunology laboratories in many low and middle income countries was one of the issues in the last pandemic and was aggravated by a complete breakdown of supply logistics. 

Initiatives such as the Bill and Melinda Gates Foundation clinical trial readiness during which 21 sites in Latin America were qualified within 4 months serve as example that these tasks are feasible. 

However, both trial sites and labs need to be kept “warm” outside of a pandemic through a constant flow of trials to not loose capabilities and ensure pandemic readiness.

4. Regionalizing vaccine manufacturing:

It would be a global game changer for access. Various initiatives to establish manufacturing capacity in Africa are underway by consortia of philantrophy but also by private industry such as the mRNA company Biontech which is establishing a modular facility in Rwanda. 

Again, like with labs and clinical sites, those new manufacturing sites need to be kept warm through constant workflow.

5. Identification of immunological markers of protection:

This measure would be important to be able to license vaccines based on immunological rather than clinical efficacy data.

Global collaboration, trust, agility, risk taking and above all equity is what scientist need to embrace to be better prepared for the next pandemic. A threat to anyone of us is a threat to all of us. And thus, failure of the “100 Days Mission”is not an option.

Opinion articles do not necessarily reflect the views of Science Arena or Hospital Israelita Albert Einstein.

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Aimed at healthcare professionals and researchers from the fields of biotechnology, pharmaceuticals, regulation, communication, and quality control, the course builds upon the Italian university’s master’s program in vaccinology.

The classes include specialized training in biotechnological applications for vaccine development.

The course will be divided into three modules, covering the following:

• Preclinical development and laboratory analysis
• Clinical development
• Manufacturing and quality control

The modules will be led by Teresa Lambe (University of Oxford), Sue Ann Clemens (University of Siena, University of Oxford, and Science Arena columnist), and Sarah Gilbert (University of Oxford) respectively.

The course also includes a series of lectures to be held in Rio de Janeiro between March 17 and 24, details of which will be shared with candidates after enrollment.

More information about applying can be found on the Institute for Global Health website.

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One was immunologist Ricardo Gazzinelli, head of the Vaccine Technology Center (CTVacinas) at the Federal University of Minas Gerais (UFMG), which went on to develop the SpiN-Tec-MCTI-UFMG COVID-19 vaccine candidate.

The other, also an immunologist, was Jorge Kalil of the University of São Paulo (USP), who chose to create a vaccine applied in the form of a nasal spray.

In an interview with Science Arena, Kalil—who was director of the Butantan Institute between 2011 and 2017—described the development process of the nasal vaccine, explaining the reasons and highlighting the difficulties of doing science in Brazil. One of the challenges is the “brain drain” phenomena, which he classified as “a great shame.”

“We need scientists and technologists capable of working along the entire production chain, from the discovery of the molecule to the development of the product,” says Kalil, who is a professor at USP’s School of Medicine and director of the immunology lab at the university’s Heart Institute (InCor).

Science Arena – In May, you took part in the TEDxUSP event, where you highlighted the challenges of creating a nasal vaccine for COVID-19. How did the process begin?

Jorge Kalil – At the beginning of the COVID-19 pandemic, the MCTI chose me and Ricardo Gazzinelli, head of CTVacinas, to develop SARS-CoV-2 vaccines. Gazzinelli was in charge of the SpiN-TEC studies, while my group chose to try to develop a nasal vaccine. I assembled a team of people I had worked with at InCor and USP’s School of Medicine, as well as people from the Institute of Biomedical Sciences at USP and the Federal University of São Paulo [UNIFESP], who I felt could help achieve this objective.

Why did your group choose this path, to develop a nasal vaccine?

The starting point was our prior knowledge of the SARS-CoV-1 virus, which emerged in 2002 and also causes Severe Acute Respiratory Syndrome [SARS], and which despite being highly lethal, was successfully controlled in China.

There was an important immune response called neutralizing antibodies, which prevented the virus from entering the cell to multiply. We knew that these antibodies acted against the spike protein used by the virus to invade cells.

We therefore already knew that most studies would be directly focused on a vaccine that would inhibit this protein. Then the virus began to mutate and variants emerged. It is also important to note that CoronaVac [produced by the Chinese company Sinovac and bottled by the Butantan Institute], a complete vaccine that uses an inactivated form of the virus, was a poor immunizer with an efficacy of around 50% that hadn’t been tested on older individuals, who are the most susceptible to the disease.

We then moved on to the RNA vaccines, which were much better. Armed with all this knowledge, even at the beginning of the pandemic, we thought about developing an intranasal vaccine, because the virus enters through the nose.

So was the fact that the virus entered through the nose the biggest motivator?

Yes. Our vaccine induces a response in the mucosal cells, something that does not occur with intramuscular vaccines. The trick is to inactivate the virus as it enters, before it multiplies in the mucosa, which is something that facilitates transmission to other people. Intramuscular vaccines do not prevent infection and mild illness because the virus still has a chance to multiply.

How has the development process gone so far? And at what preclinical or clinical stage is the nasal vaccine now?

During the preclinical phase, we injected the virus into the nostrils of animal models and the virus quickly disappeared due to the secretory IgA immunoglobulin (a type of antibody) in the nose. Now, we are preparing the antigen.

In Brazil, there are not yet any companies with an industrial development capacity. But we invested US$4 million in a contract with a foreign company to take the antigen and place it in cells. We will be able to begin the clinical phase, with human trials, by the end of 2024.

In the preclinical phase, you observed a 100% response rate. Is there any guarantee that the result will be the same in humans?

In mice, the response rate was 100%, but even though they are genetically very similar to humans, there is still genetic, social, economic, and hygienic heterogeneity. There are many factors that can alter the response we will obtain in clinical human trials.

In addition to this heterogeneity, what other obstacles are there?

The challenges we have faced so far are often related to underfunding. The research grants on offer are very small.

Another aggravating factor was that because of the pandemic, countries did not want to export laboratory supplies. The supplies and inputs we needed are not produced in Brazil and they were taking a long time to arrive from abroad, with many suppliers facing rules that they must prioritize local laboratories in their own countries.

In total, including industrial scale production, we received R$40 million, which is around US$8 million. Meanwhile, in the USA, a call for research proposals was issued worth approximately US$500 million for each research group seeking to develop a vaccine. It’s like David versus Goliath.

If the next steps are successful and the nasal vaccine proves to be effective, what can we expect?

Our vaccine will be a game changer because it is extremely easy to administer, people are not resistant to it, and it protects against both infection and transmission. That means we will be able to control the disease. To do that, we need to convince politicians to invest in it.

In Brazil, we don’t have a culture of belief that we can solve our own problems. We always think that we need someone from the outside to do this for us.

We have a dengue vaccine, which I started working on when I was director of the Butantan Institute in São Paulo. We’ve done all the industrial development, the phase 2 clinical trials, and we started phase 3 trials in 2016.

But it wasn’t given enough impetus. This vaccine should have been ready by now. Dimas Covas, who was the director of Butantan, did not make testing this [dengue] vaccine enough of a priority.

The Butantan vaccine should already be protecting the millions of Brazilians who continue to contract dengue fever, including a significant number who die.

How is Brazil’s performance in vaccine production compared to the rest of the world? What are our strengths and weaknesses?

We still do not have the capacity to develop and produce vaccines for viruses that pose major threats. Until this happens, we remain extremely reliant on other countries. Brazil does not invest enough to be technologically independent.

We do very few phase 1 and 2 clinical trials. All developed countries have this capability. China doesn’t develop new technologies just because labor is cheap. That’s a common misconception. What China has is an efficient education and training system for technical and scientific workers. They do everything in China, and they can do it cheaply because they know how to make the best use of the materials.

Brazil needs to learn that a large country—and one that intends to be a great nation—must prioritize science and technological development.

Unfortunately, what we have seen in recent times is that the best brains in Brazil usually get tired of things here and leave. I have a huge number of former students who mostly live in three places: around New York, in the Boston region, and in the state of California, especially in San Francisco and Los Angeles. It’s a great shame that we lost these people.

Were the preliminary results of the nasal vaccine trials published in a scientific journal? If not, when will this happen?

We have not yet published the results, because we want the vaccine to remain Brazilian. If it were crucial data that would allow us to contain the disease, we would have disclosed it. But because other vaccines already existed, it was not essential for us to share our preliminary results. We are now finalizing the patent so that we can publish a scientific article, which is currently being written.

What perspective does the world need to take in order to immunize the entire population?

There is a huge global effort for places in Africa and Asia to be able to produce vaccines. What we saw during the pandemic was that after the vaccines were developed, rich countries quickly immunized 90% of their populations with two doses, while poorer nations were only able to achieve 2% coverage. And they were the richest 2% of that population.

We want equity in healthcare. It is essential to have multiple vaccine platforms that can be used against different antigens. The antigen is super important, as it is the target of the vaccine. And this can only be achieved by doing basic research with viruses and understanding the immune response. We need continued investment in science and technology, so that we do not keep falling at the same hurdle.

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The Pan American Health Organization (PAHO) Guide to aid healthcare professionals in addressing the main messages and responses regarding vaccine safety. The document references questions about vaccine development, clinical trials, and approval, as well as the importance of high vaccine coverage and adverse event monitoring.

WHY IT IS WORTH READING:

With the growing wave of misinformation about vaccines, one of the major shortcomings reported by healthcare professionals is the lack of reference materials to quickly answer questions, mainly those regarding vaccine efficacy and safety.

Since 2019, the World Health Organization (WHO) has been warning that vaccine hesitancy will be one of the decade’s ten biggest public health issues, and Brazilians, who were so certain of the effectiveness of our National Immunization Program (PNI), thought we were immune to it all.

The COVID-19 pandemic arrived and, along with it, the politicization of healthcare and vaccines. Defenders and critics, supporters and detractors, a veritable debate featuring “opinions” from all sides.

All of this has shaken one of the main pillars of a successful PNI. The distrust is not limited to the vaccine itself, but also to the public system of the state and government that runs it.

The effects were and are still being felt today, not only in relation to COVID-19, but also other vaccinations.

This PAHO guide, published in 2021, is an extremely useful tool to help all healthcare workers have a clearer and more informed discourse. It is an excellent piece of support material.

The content addresses these vaccine development questions, their clinical trials, and approval processes, as well as the importance of high vaccination coverage and adverse event monitoring.

Questions and answers, myths and truths, key messages, all communicated in a light and intuitive manner, with the main goal of dissipating doubts, changing opinions, and validating knowledge, through trustworthy and safe information, based on scientific proof, reducing vaccine reluctancy and increasing adhesion to the vaccination programs.

Several studies show that healthcare workers are the most reliable sources of information about vaccines and immunizations for the entire population and for healthcare service users.

It is essential that everyone is prepared to answer questions and clarify doubts, avoiding confrontation in an empathetic way, providing clear and accurate information.

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The authors carried out a literature review of existing studies on compounds developed by public institutions. They also combed through databases for information on patents, FDA-approved drugs and vaccines, public research funding, and licenses and royalties paid by pharmaceutical companies to researchers and institutions holding patents on drugs approved in the last four decades.

By combining all these data, the team identified 364 compounds developed by or in partnership with the public research sector, of which 23 were used to create vaccines.

They also found that almost half of the compounds (43%) approved in the period were intended to treat different types of cancer and infectious diseases, which usually receive little attention from the pharmaceutical industry.

Institutions in the USA, Canada, and the UK accounted for most of the discoveries, especially the National Institutes of Health (NIH), the USA’s leading research funding agency, which was responsible for 27 of them.

Next were the University of California and Emory University, with 21 and 18 discoveries respectively.

The authors of the review argue that the results help deconstruct the notion that the private sector is solely or primarily responsible for identifying drug and vaccine candidates and for transforming them into new products.

The researchers reached the same conclusion for the USA specifically in a previous article published in 2011. “Our new research shows that the same trend applies to other countries as well, and for the first time, we have identified the institutions and the drugs and vaccines they have contributed.”

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