Elisangela Santos does not understand why everyone in her neighborhood is being told to get the yellow fever vaccine this year.
Yellow fever has been a problem for a long time in parts of Brazil, yet the 44-year-old school employee is suspicious.
"Every year, it's something else," Santos said as she waited next to a health center in the city of Sao Paulo. “They (Officials) invent another thing to make Brazilians spend money,” she told the Associated Press.
The yellow fever vaccine is free at public health centers across the country. Santos’ suspicion that someone must be profiting from the vaccine is a sign of Brazilians’ current high levels of mistrust in the government.
The low levels of trust have resulted, in part, from a series of corruption cases. Another issue is a badly designed communications campaign for the vaccine. In addition, Brazil’s decision to give partial doses, so as to stretch supplies, has led to claims that the vaccine is weak or even dangerous.
That misinformation is keeping many people away from the public health campaign. Health workers are trying to vaccinate more than 23 million people in areas of Sao Paulo, Rio de Janeiro and Bahia states that until recently were not considered at risk for yellow fever.
Nearly six weeks into the campaign, the Health Ministry reported that 76 percent of the target population has been vaccinated. That is far short from its goal of 95 percent.
The fear about the vaccine is likely to make the last 20 percent very difficult to reach. They are affecting the efforts of South America’s biggest nation to contain its largest yellow fever outbreak in more than 30 years.
The fear and suspicion could lead to more cases in Brazil's major cities. The country hasn't had an outbreak in major population centers since 1942.
Luiz Antonio Teixeira Junior is Rio de Janeiro’s health secretary. He said the disease could reach the cities if they have more cases of yellow fever and "the Aedes aegypti mosquito starts to become infected and transmits yellow fever.” He noted the government is doing everything it can to stop yellow fever from entering the cities.
Yellow fever has long been a problem in large parts of Brazil, but the disease has been spreading in recent years. This is the second outbreak in two years in places where vaccinations for the disease were not common.
During the 2016-2017 outbreak, more than 770 people were infected. During the 10-year period before, Brazil had fewer than 10 cases each year.
In the current outbreak, health officials have already confirmed 846 cases, of which 260 have died.
The outbreak is causing problems for the health system just a few years after officials battled Zika, which was linked to birth defects in babies born to infected mothers.
While unconfirmed claims sometimes were a problem during earlier campaigns, the rise of the WhatsApp messaging service is creating more misinformation, said Igor Sacramento. He works as a researcher for Fiocruz, Brazil's leading public research institute.
WhatsApp is one way the government shares health information, said Sacramento. Since WhatsApp messages come from friends and relatives, people place a high value on the information, and that means people often accept it without looking at facts, he said.
One report on Whats App says a mutation in the yellow fever virus has made the vaccine ineffective, even pointing to a study published by Fiocruz. That is not true, and the group released a statement saying that changes in the disease have not change the vaccine's effectiveness.
Even some health experts believe some of the claims. Some have refused to give partial doses, noted Ana Goretti, the acting coordinator of the immunization program at the Health Ministry.
The ministry and all of Brazil's medical organizations are preparing to release information that says the partial dose is safe and effective.
The vaccination efforts have also been unorganized. Earlier this year, there were hours-long waits at some health centers before people simply stopped coming. Many people outside a health clinic in Jardim Miriam said the first clinic they went to did not have the vaccine.
Stopping misinformation and fears about the vaccine is important because yellow fever does not seem to be moving away from coastal areas. The Health Ministry is considering asking for all Brazilians to get vaccinated and earlier this year the government decided that all children should get the vaccinated.
The ministry and state health departments are using Twitter and Facebook to advertise the vaccination campaign. They share links to information about the vaccine and the disease. Members of the ministry's social media team have also answered questions about the vaccine on the ministry's Facebook page.
But they have not been using social media or WhatsApp to fight unconfirmed claims. Instead, officials say they usually talk to the local press to explain that the vaccine is safe, effective and necessary. Health workers in Sao Paulo and Rio have also gone door to door to tell people to get vaccinated.
The claims have scared off Manoel da Silva's family. The 57-year-old retiree said his adult children and his wife are refusing to get vaccinated. His family told him they heard stories of people who were sickened by the vaccine and concerned about the partial doses.
"There are lots of things on the internet," said da Silva. He added that his family thinks the campaign is a trick because of the partial doses.
Scientists have said that the one-fifth dose works and the World Health Organization has said it can be used in emergencies.
It is still unclear how long the protection lasts. Brazilian officials say they have scientific information that shows the vaccine is good for at least eight years, but others have said it may be less. More studies are expected.
The yellow fever vaccine, like all vaccines that use live virus, can cause sickness.
Susan McLellan is a professor of infectious diseases at the University of Texas Medical Branch. She says the yellow fever vaccine may even cause more vaccine-linked disease than other live virus vaccines. But “in a high risk setting, you're a lot safer with the vaccine than the disease," said McLellan.
Da Silva, whose family does not want to get vaccinated, said he, too, was worried, but decided to get the vaccine.
"I heard about people getting sick" from the vaccine, he said, "but if a mosquito bites me, I'm already at risk."
I'm Susan Shand. And I'm Dorothy Gundy.
Sarah DiLorenzo reported this story for the Associated Press. Susan Shand adapted her report for VOA Learning English. George Grow.
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Words in This Story
outbreak – n. a sudden rise in the number of cases of a disease
dose – n. the amount of a medicine, drug, or vitamin that is taken at one time
mosquito – n. a small flying insect that bites the skin of people and animals and sucks their blood
transmit – v. to infect someone else with a virus or disease
defect – n. a physical problem; something that causes weakness; a lack of something needed for something to operate perfectly
mutation – n. a change in the genes of a plant or animal that causes physical characteristics that are different from what is normal