A health worker prepares to vaccinate a child at a Covid-19 vaccine center in Rio de Janeiro on January 18.
Sao Paulo, Brazil CNN  — 

At the beginning of 2021, hospitals in Brazil’s Amazonas state were in a critical state, with ICUs filled to capacity and Covid-19 patients fighting for their lives.

“There were a lot of young people in the last wave getting worse too fast. We had 33- to 40-year-old patients in the ICU. And we had a bigger limitation of medical supplies. Every day we had a shortage of some kind,” said Dr. Luan Matos de Menezes, an ICU doctor at the Delfina Aziz Hospital in the regional capital of Manaus.

Today, it feels like déjà vu.

As the Omicron coronavirus variant continues to tear through the country at rapid pace, the hospital’s ICU is once again overwhelmed.

But one thing is different, Menezes says. This time, he feels that many of those patients are making a choice.

Although more than 86% of the adult population of Brazil is now fully vaccinated, take-up for boosters has been slow, along with lower rates for younger ages. Some infectious disease experts attribute this to the lingering effects of a disinformation campaign in which the country’s leadership has played a role. Without that protection, those Brazilians have been vulnerable to the latest wave of Omicron infections sweeping the country.

An ICU nurse in Marica, Brazil tends to a Covid-19 patient in January.

Menezes, who has been working at the hospital throughout the pandemic, says it is harder to have sympathy for these Covid patients. That’s because the majority of the people who are now ending up in the ICU are either unvaccinated or are only partially vaccinated – even though the vaccines have been available to them for months.

More than 80% of people hospitalized with Covid-19 across four Brazilian regional capitals – Rio de Janeiro, Belo Horizonte, Manaus and Brasilia – are either unvaccinated or partially vaccinated, according to local government figures.

And in Manaus, where Menezes works, nine in 10 people admitted to hospital are not fully vaccinated. “These are the people who opted not to vaccinate,” Menezes said.

Menezes also told CNN that many of the unvaccinated patients, who are often already seriously ill when they arrive to the hospital, ask for the vaccine when they are admitted.

But by that point, it is too late.

Brazil has already approaching 640,000 deaths due to the pandemic – the second highest national toll in the world, according to data by Johns Hopkins University.

And this year, the country continues to report record daily Covid-19 cases and deaths. On February 3, the number of daily deaths surpassed 1,000 for the first time since August 2021, according to data from the health ministry.

“Those of us who are at the Covid frontline are seeing a lot of people dying because they did not vaccinate,” said Menezes, who attributes that vaccine hesitancy to “a lot of false information being spread” regarding the vaccines’ efficacy and safety.

Many public health officials are looking at Brazilian President Jair Bolsonaro.

Brazilian President Jair Bolsonaro speaks in Brasilia in November 2021.

Bolsonaro, who says he is unvaccinated, has been widely criticized at home and abroad for playing down the severity of the virus, with a longstanding campaign to discredit vaccines under his leadership.

Despite this, many Brazilians have taken up the vaccine.

But hesitancy still persists, now reflected in booster shot rates and sluggish uptake rates in younger age groups.

Only 23% of Brazilians ages 12 and older have received their booster dose so far, compared with 94% who have gotten at least one dose.

In younger age groups, those rates drop even lower. Just 10% of children ages 5-11 have gotten the vaccine. They have been eligible to do so since January 17. But some of Bolsonaro’s allies appear set to derail that campaign.

On January 21, Marcelo Queiroga, Brazil’s health minister, and Damares Alves, minister for women and families, visited a family in Sao Paulo state whose child had died of cardiac arrest hours after receiving a Covid-19 vaccine in what some say was an attempt to discredit the vaccine. Sao Paulo’s State Health Secretary said that the child had a rare disease and that her death was not linked to the vaccine.

That same week, Queiroga had falsely claimed that thousands of people had died from adverse reactions caused by the vaccines – directly contradicting his government’s own data. He later said that those comments were taken out of context by the media.

But those comments were already out in the public realm.

Bolsonaro supporters demonstrate against Covid-19 vaccines outside the Pan American Health Organization headquarters in Brasilia on January 4.

Esther Solano, professor of international relations at Sao Paulo University, told CNN that the officials are intentionally creating confusion around vaccines.

“People feel very lost, they don’t know what is true and what is not. It is a strategy of confusion that greatly increases people’s distrust of institutions and the press about what is happening,” Solano said.

Dr. Raquel Stucchi, an infectious disease expert and professor at Unicamp University told CNN that Bolsonaro’s government had delivered “repeated messages questioning efficacy and security” of Covid-19 vaccines, including Bolsonaro himself, who raised the question as to why “one has to take three doses if before two were enough.”

Vaccine boosters and series of doses in vaccines are not unusual. Many vaccines require multiple doses to achieve full immunity, including the polio vaccine, which requires four doses, or the hepatitis vaccine, which requires three. These vaccines are a series, meaning that the second, third or fourth doses are needed to achieve full protection.

Dr. Isabella Ballalai, a pediatrician and vice president of the Brazilian Society of Immunizations, told CNN that Brazilian authorities should be concentrating on positive messaging around vaccines – and making it clear that those who are being hospitalized are largely either unvaccinated or partially vaccinated.

Sarah Santos Costa receives a dose of the Pfizer Covid-19 vaccine on January 17, 2022, as part of the first group of children under 12 to get the vaccine.

Ballalai cited robust public health messaging in the UK and the US as an example. Brazil’s public health messaging, she said, has been notably weak, with Bolsonaro and his health minister’s vaccine rhetoric only adding to the problem.

As Omicron first began to surge through the country, Bolsonaro claimed that it “hadn’t killed anyone.”

Such language – that Omicron is less harmful – could be contributing to people deciding not to get their booster doses, Stucchi said.

While studies have concluded that the Omicron variant is less likely to cause severe disease and hospitalization compared to the Delta variant, the problem, she said, is that people aren’t connecting the idea that the vaccines themselves are playing a part in ensuring that infections don’t develop into more serious cases.

“People assume that they don’t need to worry much about vaccination anymore. (But) what we know is that Omicron is lighter because of vaccination,” she said.

Ballalai is urging the country’s leaders to send clear and fact-based messaging. It’s the only way to stop the cycle, she said, and to keep future generations safe.

“If you don’t talk about it, Brazilians don’t see the risk. We no longer have the natural demand we saw in the 90s, where everyone looked for a vaccine – so as to not let their children die,” she said.