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Desde março de 2020, quando a Organização Mundial de Saúde declarou que o mundo vivia uma pandemia de covid-19, acompanhamos um quadro sanitário sem precedentes nos últimos 100 anos. As medidas atuais contra a doença têm como objetivo o controle da transmissão e envolvem ações individuais e coletivas de higiene e distanciamento físico, enquanto a busca por uma vacina se apresenta como a esperança para vencer a pandemia. Considerando o contexto social de clamor por uma nova vacina, este ensaio crítico discute o paradoxo e as contradições da relação indivíduo-sociedade no contexto da covid-19 à luz da hesitação vacinal como fenômeno histórico e socialmente situado. Este ensaio aponta que as tomadas de decisão sobre (não) vacinar ou sobre (não) seguir as medidas preventivas e de controle da propagação da covid-19 são conformadas por pertencimentos sociais e atravessadas por desigualdades que tendem a se exacerbar. A infodemia que cerca a covid-19 e a hesitação vacinal refletem a tensão entre o risco cientificamente validado e o risco percebido subjetivamente, também influenciada pela crise de confiança na ciência. Percepções de risco e adesão a medidas de saúde extrapolam aspectos subjetivos e racionais e espelham valores e crenças conformados pelas dimensões política, econômica e sociocultural. ; Since March 2020, when the World Health Organization (WHO) declared that COVID-19 was a pandemic at global level, we are facing an unprecedented health crisis over the past 100 years. While the search for a vaccine represents the hope to overcome the pandemic, measures were established to control the disease transmission through individual and collective actions of hygiene and physical distancing. Based on the popular clamor for new vaccines, this critical essay discusses the paradox and contradictions of the individual-society relationship in the context of COVID-19 considering vaccine hesitancy as a historical and social phenomenon. We also argue that decisions on (not) vaccinating or (not) following COVID-19 control and preventive measures are influenced by social belonging and traversed by inequalities that tend to exacerbate. COVID-19 surrounding infodemic and vaccine hesitancy reflect the tension between scientificallyvalidated and self-perceived risk, besides being impacted by the crisis of confidence in science. Perceiving risk and adhering to precautionary measures extrapolate subjectivity and rationality, and mirror values and creed shaped by the political, economic, and sociocultural dimensions.

Due to social distancing guidelines and the displacement of both human and material resources to fight the covid-19 pandemic, individuals seeking healthcare services face certain challenges. Immunization programs have already been a worrisome topic for health authorities due to declines in vaccine uptake rates and are now especially affected by the covid-19 pandemic. Disbelief in science, dissemination of fake news about vaccines, socioeconomic vulnerability and social inequality are some of the challenges faced. This commentary article discusses the impacts of the covid-19 pandemic on immunization programs in Brazil. In light of advances (and notability) of Brazil's national immunization program, established in the 1970s, the programs face challenges, such as the recent drop in vaccine uptake rates. In addition to this health crisis, there is also Brazil's current political crisis, which will undoubtedly require assistance from researchers, policymakers and society to be fixed.

AbstractIntroductionPre‐exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals).MethodsBetween July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in‐person follow‐up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in‐person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent‐to‐treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period.ResultsOf 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25–months of use: 4.90; 95% CI: 1.32–18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40–6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24–2.94) and decreasing for those who reported higher‐risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29–0.88). After an average follow‐up period of 1.6 years (95% CI: 1.5–1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45–0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in‐person and telehealth (p = 0.486) or at pre‐ and post‐telehealth follow‐ups (p = 0.245). Sexually transmitted infections increased between the pre‐follow‐up and post‐follow‐up choices and were not associated with in‐person or telehealth (p = 0.528). No HIV infections were observed.ConclusionsOur findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.