The Brazilian city of Manaus has begun vaccinating against COVID-19, which gives some hope as the local health system is under strain amid a surge in infections and dwindling oxygen supplies.

The Amazon state government began distributing doses of vaccine to communities on Tuesday, with the first phase of vaccinations targeting health workers, the elderly over 80 and indigenous people in around 265 villages.

Governor Wilson Lima presided over a ceremony that kicked off the vaccination campaign on Monday evening in Manaus, home to about 2.2 million people and the capital of the Amazon that launched the vaccination campaign and received 256,000 starting doses of COVID-19 vaccines.

Vanda Ortega, 33, a member of the Witoto ethnic group and a nurse technician, received the first dose of CoronaVac, the vaccine developed by Sinovac.

“I want to thank God and our ancestors,” said Ortega, who is also a volunteer nurse in her indigenous community.

More Brazilian states gave their first COVID-19 vaccinations on Tuesday, when the government distributed around six million pre-filled doses of the vaccine from China’s Sinovac for emergencies on Sunday after it was approved. The country also approved the UK’s AstraZeneca vaccine.

Relatives of patients hospitalized or receiving medical care at home gather to buy oxygen and fill bottles at a private company in Manaus [File: Bruno Kelly/Reuters]Brazil has reported more than 211,000 deaths related to the novel coronavirus – the second highest number in the world after the US – and more than 8.57 million COVID-19 cases since the pandemic began, according to data from Johns Hopkins University.

The country’s Amazon state is particularly hard hit by an increase in infections.

Brazilian Health Minister Eduardo Pazuello said last week that the hospital system in Manaus is collapsing as health facilities are understaffed and oxygen is rapidly running out.

According to official figures, Amazon has recorded at least 232,000 cases of COVID-19 since the pandemic began.

Manaus hospitals have admitted few new COVID-19 patients, leaving many at home with the disease and some dying.

Many doctors have had to decide which COVID-19 patients will be given oxygen while desperate family members searched for oxygen tanks for their loved ones.

According to official figures, the city receives an average of four Brazilian Air Force flights a day to boost oxygen supplies, as well as one shipment a day from the city of Belem near the mouth of the Amazon.

Delays expected

Brazil is also battling bureaucracy in China to free up the export of active ingredients for vaccines developed by AstraZeneca and Sinovac Biotech, three people familiar with conversations told Reuters on Tuesday.

The problem could slow down the country’s vaccination campaign.

The sources, speaking anonymously due to diplomatic sensitivity, said the bureaucracy in China was holding back the supplies Brazil needed to finish and distribute millions more cans from its own biomedical facilities.

“It’s a new situation and there is a bureaucratic problem. The Chinese are still defining procedures that take time, ”a source said. “There is also a relative supply shortage.”

Federal government-funded Brazilian biomedical center Fiocruz said it could not deliver finished doses of the AstraZeneca shot until March as it awaited the first shipment of active ingredients from China.

The institute had aimed for a million doses by mid-February.

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