Vaccination Coverage Against Coronavirus Disease 2019 in People Living on Quilombos in Brazil and Its Association With the Human Development Index and the Quality of the Health System

Abstract

Since the slavery period in Brazil, the Quilombola population has faced problems related to social vulnerability and poor health. The coronavirus disease (COVID)-19 pandemic has made this social inequality more evident, and the postpandemic scenario has proved even more challenging with the difficult access to basic living conditions, including low vaccination coverage. In view of this, this study aims to present the epidemiological profile of vaccination against COVID-19 in the population living in quilombos in Brazil. An observational study was carried out using information from the National Health Data Network provided by the Brazilian Ministry of Health. Vaccination coverage was correlated with the human development index (HDI) and health quality indicators. In the Quilombola population, a total of 1 848 494 doses of vaccines were administered, mostly related to the first dose (45.43%) and the second or single-dose vaccine vials (42.17%), representing a vaccination coverage of 48.43% and 49.41%, respectively; in addition, a total of 159.26 doses were administered per 100 inhabitants. There was an imbalance in the vaccination coverage rate and the number of doses administered in relation to the macroregions of Brazil and the Federative Units. In terms of doses administered by age group, the highest concentration was observed among individuals aged 20–59, with over 100 000 doses administered within each group. In the Spearman correlation, the following coefficients were significant: (a) first dose with municipal health spending [CC = −0.57]; (b) second dose or single-dose vaccine vial with HDI [CC = 0.58], HDI–income [CC = 0.58], HDI–education [CC = 0.65], and municipal health spending [CC = −0.61]; and (c) the total number of doses with HDI [CC = 0.58], HDI–income [CC = 0.56], HDI–education [CC = 0.67], and municipal health spending [CC = −0.55]. The epidemiological profile of vaccination against COVID-19 in the Quilombola population in Brazil was associated with a wide variability in relation to macroregions and Federative Units, with few Federative Units vaccinating more than 50% of Quilombola individuals. Among the markers evaluated, the best HDI and the best quality of health services were associated with better vaccination coverage for the first dose, second dose, single-dose vaccine vial, and total number of doses administered in the Quilombola population, demonstrating that there is a relation between social and economic characteristics and the management of vaccines with a potential influence on the outcomes associated with the COVID-19 pandemic.