Brazil's polio vaccination campaign struggles as coverage falls below 95% target

On a Saturday morning in August, Gilvanda Costa de Sousa brought her four-year-old daughter Maria Isabely to a health clinic in Fortaleza's Vila Velha neighborhood. A community health worker had told her about "Day D"—a special vaccination push happening that morning—and the seamstress wanted to make sure her daughter's immunization record was current. It was a small act, but it reflected something larger: Brazil's struggle to protect its youngest children from polio, a disease that can paralyze.

The National Vaccination Campaign for polio and routine immunizations runs through September 9 across the country, with an ambitious target: reach at least 95 percent coverage among children ages one to four with the oral polio vaccine. In Fortaleza alone, the municipal health department mobilized all 116 health clinics for the effort. The campaign offers a full menu of childhood vaccines—BCG, hepatitis B, rotavirus, pneumococcal, meningitis C, measles, yellow fever, and others—plus COVID-19 shots and vaccines for adolescents under fifteen. But polio is the centerpiece. The vaccine itself requires just two drops, administered orally. Simple. Effective. Yet the city and the nation have been unable to reach the target for years.

Beatriz Coelho, the nurse in charge of vaccinations at the Maria Aparecida clinic, explained the problem plainly: a survey by the municipal and regional health departments had documented what she called an "evasion" of children who should be getting vaccinated. The pandemic had disrupted routine clinic visits. Families stayed home. Children missed doses. Now, across Brazil, more than 14.3 million children under five remain the target population for this campaign—many of them incompletely protected. Since 2016, coverage has remained stubbornly below the 95 percent threshold. The measles vaccine, which protects against measles, rubella, and mumps, has faced the same problem; its coverage began declining in 2015.

Poliomyelitis itself is a viral disease that strikes children and adults alike. In severe cases, it causes paralysis of the lower limbs. Vaccination is the only prevention. Yet hesitancy has grown, and Coelho identified a factor that went beyond simple logistical barriers: politics. She noted that vaccination rates among adolescents and, more recently, among three-year-olds—who began receiving shots in Fortaleza in July—have been visibly affected by what she called "the political question." Some parents, even those who acknowledged the importance of keeping their own vaccines current and their children protected, expressed doubt about COVID-19 vaccination for their youngest.

Gilvanda, by contrast, had no such reservations. She had vaccinated Maria Isabely against COVID-19 despite hearing rumors and concerns from others. "People say things happen, this happens, that happens," she said, "but thank God she got it and felt nothing." With the other vaccines, she added, there was no hesitation: "I give all of them, never let them fall behind." Maria Socorro Viana, a housekeeper and mother of five, carried the same conviction. She brought her two youngest sons, ages fourteen and twelve, to the clinic that Saturday. "I always took care of my children," she said simply. When COVID-19 vaccines arrived, "we took them."

But not everyone shared that clarity. One father at the clinic, while recognizing the importance of vaccination, remained uncertain about COVID-19 shots for his youngest daughter. The hesitancy was real, visible, and—according to the health workers on the ground—increasingly shaped by forces beyond medicine. As the campaign pushes toward its September deadline, the question is whether two drops of vaccine and a day of intensified outreach can overcome the deeper currents pulling families away from the clinic.