COVID-19 Crisis in Brazil: A Murderous Misconduct
Photo Courtesy of Alex Pazuello/Semcom
In Brazil, health care is a right. The country has been known for having a remarkable public healthcare system, the Sistema Único de Saúde (Unified Health System), which is inclusive of the entire population and provides a comprehensive array of services and drug coverage. The Brazilian system is especially brilliant with vaccinations: the National Immunization Program, created in 1973, has been successful in eradicating several diseases through its impressive coverage rates. During the poliomyelitis vaccination campaign, the program vaccinated approximately 18 million people in a single day. In healthcare, Brazil has been one to set examples.
Despite this impressive record, the country’s response to the Coronavirus pandemic has been strikingly terrible. Brazil’s death toll is among the highest in the world, transmission rates are completely out of control, and the vaccination campaign is moving at a very slow pace. What went wrong this time?
Professor Fernando Aith can provide some answers. The Professor works at the School of Public Health of the University of São Paulo (USP), where he is the director of the Center for Studies and Research in Health Law. Professor Aith is part of a research group that is currently developing a project called “Rights in the Pandemic: Mapping the Impact of Covid-19 on Human Rights.” The aim of the project is to understand how the Brazilian State dealt with the pandemic in the legal sphere. So far, the group has analyzed over 3,000 legal rulings issued by the federal government in response to COVID-19, and partial results have already been published. They concluded that there was intentionality on the part of the federal government in promoting the spread of the SARS-COV-2 in Brazil.
This interview was given on April 1st. Interview responses have been edited for clarity and length.
Camila Braga, CPR: From your research, what results have you found so far?
Professor Fernando Aith, School of Public Health, University of São Paulo: We interpreted the normative response by the federal government as indicating intentionality in promoting the spread of COVID. The intention was to open up the economy and promote herd immunity, thus solving the COVID crisis in Brazil. The problem is that for this strategy the number of deaths is incredibly high, as we are clearly seeing now. At the moment, Brazil’s COVID death toll has surpassed 350 thousand deaths. We have recently passed the 4,000 deaths in a day threshold. This is a result of the national government’s strategy of incentivizing the opening of the economy, disincentivizing wearing masks, not adopting the necessary measures to buy and distribute vaccines in a national immunization program. All of this is reflected in the legal sphere.
CB: Can you please explain further why you concluded the government’s response ineffectiveness in stopping the spread was intentional?
FA: There are four main things we need to look at. The first is that the federal government avoided providing emergency financial aid for the population, something that would help keep people at home. The stimulus we had in 2020 was done through approval in Congress, and because Congress pushed President Bolsonaro to accept it. We are currently seeing history repeat itself. Brazil needs a new lockdown and the federal government tried to block the approval of a new financial aid program. Now that it has approved one, it was one that will not solve anything. It does not include nearly enough people, and the amount distributed is strikingly low.
The second thing was a juridical war between the federal government and the states’ administration about lockdowns and what qualifies as essential services in Brazil. The national government had a very loose definition for it, and the states’ governments opposed it. The matter eventually got to the Supreme Court, and even though the national government lost the juridical dispute, a lot of damage had already been done. A very strong political message was sent by President Bolsonaro stating that the Coronavirus is not important, that it is just a “little flu,” that we don’t need to social distance, and that it is absurd to close the economy. This cannot be taken back easily.
The third important point is about taking precautions. The National Congress approved a federal law that mandated commercial establishments to supply masks and sanitizing supplies to employees and clients. This was a very basic law, but President Bolsonaro vetoed it. He also barred a measure that required people to wear masks at spaces with public use, such as churches and gyms. The argument was that these allegedly took away the freedom of individuals and hindered free economic initiative, and “it wasn’t the government’s place to interfere.” But when it comes to spreading the virus, the government not only should interfere, it must interfere.
The last thing that I want to mention is that the federal government omitted itself from its duty of protecting indigenous people from the pandemic. When mandated to do it by the Supreme Court, it postponed it as much as possible. When the national government passed a law obligating the federal government to provide drinking water, food, and medical assistance to indigenous people — food and water!— Bolsonaro barred it. This created the conditions for a genocide of the indigenous population through COVID. Bolsonaro has been denounced at the International Criminal Court because of it.
CB: But couldn’t the federal government’s stance be interpreted as mere incompetence and lack of good judgment?
FA: The thing is that the federal government knows exactly what it is doing, and knows that it goes against what is advised by public health institutions. Despite knowing everything, it keeps insisting on the wrong direction. That’s why we say there is intentionality.
Furthermore, it is not just political discourse. Bolsonaro is not simply saying barbarities to animate and entertain his far-right supporters. He not only talks, but he also acts and produces juridical norms that go against what is advised by the World Health Organization. Besides, he vetoes measures taken by Congress that are going in the right direction. There is nothing of incompetence about this, nor merely omission. We are talking about a very well-executed plan, but that goes in the opposite direction of what should be done in order to contain the cases and deaths.
CB: How would you describe the Brazilian situation today, especially from a global perspective?
FA: As a result of the government’s actions, 1 out of 4 people who die of COVID each day, die in Brazil. Out of the global death toll, more than 1 of each 10 deaths is of a Brazilian. Today, Brazil is constantly generating new variants because the transmission of the virus is completely out of control. Brazil is the new epicenter of the pandemic, with over 3,000 people dying each day. That’s more than a World Trade Center death toll each day. In Brazil, the number of people dying of COVID in a single day exceeds the number of people who die in terrorist attacks. This is mostly because of the intentionality of the federal government. It’s like it has been said about deaths in the US too: many of the losses could have been avoided. Of course, the pandemic is very serious, and many deaths would have occurred either way, but numerous could have been avoided if it wasn’t for the negligent policies of Trump and Bolsonaro.
CB: Speaking of the US, what were the similarities and differences between Trump’s COVID-19 response and Bolsonaro’s response?
FA: They were very similar. Pushing to reopen the economy, minimizing the seriousness of the disease, ridiculing wearing masks, promoting treatments not supported by scientific evidence such as hydroxychloroquine. But there’s one big difference: Trump did not stand against vaccine production and technological innovation. As soon as possible, Trump started negotiating the purchase of vaccines from the companies that were developing them. In this aspect, Bolsonaro was very different.
CB: How did Bolsonaro act in regards to vaccination?
FA: He hindered every discussion on the national level to purchase or independently develop vaccines. He played against the Instituto Butantã that was developing vaccines in São Paulo in partnership with the Chinese biotech Sinovac. The AstraZeneca vaccine that the Fiocruz is producing today could only be produced because Fiocruz is relatively independent of the presidency, Bolsonaro had no role in it. He even turned down offers by Pfizer and other biotech companies. By now, Brazil should have received at least 70 million Pfizer vaccines that were offered to us in August of 2020. These were turned down by the president. Now we are joining a queue, and who knows when that many vaccines will be made available here. This was the big difference between Bolsonaro and Trump.
CB: Since the pandemic started, we have had four different health ministers, from moderates to radical denialists such as Pazuello, who spent almost a year in the position. It is unquestionable that the health minister is a very important figure in the response to the pandemic, but how much is actually within their power? What can a health minister do within the government?
FA: Traditionally the health minister has a great deal of autonomy, they “own the pen” within the ministry. They have access to a substantial budget, the ministry has great capillarity within Brazil, and so the minister has the potential to do a lot. What we have observed lately, however, is that despite this great potential, President Bolsonaro does not allow them to do much. He has already overthrown two ministers – Mandetta and Teich – for attempting to take measures that he did approve of, such as promoting social distancing and wearing masks, as well as discouraging hydroxychloroquine use. The current minister, Queiroga, started off with a certain stance and now has already grown closer to Bolsonaro’s. He is not as aggressive as the president, but he is still not doing what is expected of the ministry he leads, which would be to promote a coordinated national action to combat the pandemic. These kinds of initiatives are still barred from the ministry, as we are seeing.
CB: With the Armed Forces being an integral part of Bolsonaro’s government, how much of the blame for Brazil’s disastrous Covid response falls in the lap of the military as an institution? What could (or should) they have done? What were their mistakes?
FA: They have a high degree of responsibility, and the Armed Forces will need to face the consequences of their poor performance. The former health minister Pazuello, being an active military officer, is a clear example that it is impossible to dissociate the Armed Forces from the tragedy that is Brazil’s COVID response. Secondly, the military was a great partner of Bolsonaro in the production and distribution of hydroxychloroquine, a medication that does not treat COVID and can even cause death if used improperly. Thirdly, the Armed Forces are prepared to fight wars, so they supposedly have the capability of putting together highly complex field hospitals that could be used by the population. Yet, they have done nothing.
Not only have the Armed Forces contributed through actions and omissions for us to get to this point, but they are also providing a terrible example of lack of social solidarity through not opening up their hospitals to the population. The public health system is collapsing, with no available Intensive Care Unit beds and queues of hundreds of people. Meanwhile, the hospitals of the Army, Marine, and Aeronautics have their ICUs with plentiful free spots. They are receiving a superior amount of resources than the public health system, have beds available, and still refuse to accept non-military patients.
The Armed Forces participated in almost no initiatives that aimed to combat the pandemic in Brazil, and in the few that it participated in, whether it was taking over the health ministry or producing hydroxychloroquine, it was a tragedy.
CB: How do you think the pandemic will impact the Sistema Único de Saúde [Unified Health System], both now and in the longer term?
FA: I believe that in the short term SUS will suffer a lot. It is currently overwhelmed, underfinanced, healthcare workers are exhausted, and the pandemic is not showing signs that it will get better anytime soon. After the COVID is under control, SUS will be hit once again: people are currently postponing their routine treatments, check-ups, and elective surgeries in order to avoid exposing themselves to an even greater health risk. When the number of cases lowers, the system will be overloaded by the repressed demand from patients with several other health conditions, such as cancer, heart disease, and high blood pressure. For a while, SUS will function at the limit of its capacity.
In the longer term, I see a very good possibility that the pandemic will make the Brazilian population and politicians recognize the importance of the Sistema Único de Saúde. This could push them to increase the budget and invest more in the system.
Another thing that I would like to point out is that the decentralized institutional engineering of SUS is remarkably intelligent, [since it] combines services provided by the national government, the states, and the municipalities. Even if one part fails, the others keep the system working, which is a valuable source of protection for the citizens against bad rulers. We can see the importance of it now, when the federal government is failing the population, and yet SUS manages to live on.
CB: Do you have any closing remarks?
FA: I just want to say that both Brazilians and the international community should pay special attention to what is happening in Brazil right now. The country has become a center for sanitary and political instability, which inspires a lot of concern from us, Brazilians, who are at the forefront of this fight, trying to avoid the worse: the collapse of our democracy along with the collapse of our health system. The pressure by the international community has been essential in holding back the president, at least a little bit, and in pushing the other powers to hinder the equivocated initiatives by the president. It is very important that the international community pays attention and mobilizes international mechanisms to avoid the worsening of the situation in Brazil.
Camila Braga is a staff writer for CPR and a first-year student at Columbia College, planning on majoring in Political Science and Latin American and Caribbean Studies. A proud Brazilian, Camila is passionate about her country’s culture and history.