Brazil Fights a Health War on Two Fronts: A Foretold Tragedy
For over a decade, Brazil’s public health system has fought for a cure against the disease of political corruption and the poor administration of funds. When the country reported its first coronavirus case on February 25, Brazilians found themselves even more vulnerable to an underfunded and ill-equipped public health system.
By the time Brazil declared a national emergency due to COVID-19 on March 20, other countries were already witnessing cruel losses to the virus: the worldwide death toll had surpassed 10,000 deaths. Though national responses to the virus varied, social distancing prevailed as the most effective method to reduce the risk of contagion.
Brazilians worried that the pandemic would further strain the deficient public health system, but hoped that the social and scientific lessons coronavirus taught other countries would be used to help reduce its severity in Brazil. They also expected that the president, Jair Bolsonaro, who ran for office in 2018 on an anti-corruption, pro-truth, and nationalistic platform expressed by his “Brazil Before All” campaign slogan, would work in the interest of the people.
But expectations were not high for Bolsonaro, who had already found himself entangled in scandals since his election in 2018, symptomatic of the contradictory way he runs his government. Brazilians did, however, expect a degree of respect for the global institutions at the frontline of the battle against COVID-19 and compliance with their regulations. Instead, Bolsonaro is now the leader of a coronavirus-denial movement.
Today, Brazil is fighting a health war on two fronts. On one side, the country battles the spread of COVID-19; cases are growing exponentially in a country challenged by the fragility of its public health system, the lack of medical equipment, and the social inequity in health, compounded by the housing challenges that affect Brazil’s poorest. On another, an intragovernmental pandemonium takes place in Brasília’s Palácio do Planalto, where Bolsonaro and his ministers have failed to provide a unified response to the pandemic.
In an interview with The Politic, Guga Chacra, a prominent Brazilian journalist and commentator for GloboNews, explained how Brazil now faces a uniquely difficult scenario. The Brazilian economy is still struggling to overcome a years-long recession, for which “the political crisis [during the pandemic] is a huge aggravating factor.” According to Chacra, “[this] caused the worst possible of perfect storms.”
In one of his first televised announcements on the arrival of the illness in Brazil, Bolsonaro described it as a “little flu,” incapable of afflicting someone like him, who has a “history as an athlete.” The “little flu,” he said, would be essentially asymptomatic for “90 percent” of infected Brazilians. He even suggested Brazilians are naturally endowed with immunological advantages, saying they might have already developed the antibodies for COVID-19 and that they “never catch anything,” not even when they “dive into sewage.”
Unfortunately, this groundless and neglectful rhetoric is not nearly as daunting as the political chaos plaguing Brazil and aggravating the health crisis. It started on April 16 when Bolsonaro fired the Minister of Health, Luiz Henrique Mandetta, who held a 76 percent approval rating, after a clash over response policies. While the president downplayed the dangers of coronavirus and supported the relaxation of social distancing measures in favor of the economy, Mandetta urged Brazilians to stay at home.
To replace Mandetta, oncologist Nelson Teich was appointed Minister of Health on April 17. He resigned from his post on May 15, less than a month into the job, and one day after Brazil’s death toll reached a record high of nearly 14,000 deaths. Like Mandetta, Teich disagreed with Bolsonaro’s desire to push states to reopen their economies. The breaking point for Teich was the president’s insistence on the larger use and availability of hydroxychloroquine to treat the coronavirus, which the newly appointed minister refused to accept due to lack of scientific evidence for the drug’s effectiveness.
Despite Teich’s noncompliance, the president obliged the Ministry of Health to approve the drug’s widespread use for patients in every stage of the disease. The only country to change health ministers twice during a pandemic, Brazil now lacks any responsible leadership. Bolsanaro wants a Minister of Health who will be a trusty political ally rather than a medical expert guided by scientific facts.
In an interview with The Politic, Dr. Albert Ko, Department Chair and Professor of Epidemiology and Medicine at Yale who has coordinated research on urban slum health in Brazil, commented on Bolsonaro’s clash with his ministers: “[During] a public health emergency, perhaps the most important thing is that policies are not driven by ideology—[they must] be driven by data and by evidence…. Mandetta was insisting on evidence-based strategies for prevention, and because of that clash, was fired. And now [with Teich], we have a similar situation happening.”
Dr. Ko emphasized that “stability and confidence” are some of the most important leadership qualities during a health emergency. A lack of good governance can be very dangerous for the people, “and what is happening as a cause of that is very bad for the situation in Brazil.”
Brazilian journalist and director of the GloboNews travel documentary series Que Mundo é Esse, André Fran, told The Politic that “[Bolsonaro’s] government had already been demonstrating anti-scientific and anti-research tendencies, and it happened to be caught in a pandemic caused by a virus we still don’t have a vaccine or cure for.” Fran added that it is unacceptable that while there are plenty of examples of effective measures used to tackle the virus in other countries, such as enforcing lockdowns, emphasizing the importance of social distancing, and mandating the use of masks, the leader of the largest economy in Latin America still responds with ignorance and incompetence.
The instability of the Bolsonaro administration grew on April 24, when Sérgio Moro, the judge-turned-national-hero responsible for the success of “Operation Car Wash” (a criminal investigation conducted by the Federal Police of Brazil that sent over 150 political leaders and businessmen to jail for corruption and fraud), abruptly resigned from his post as Justice Minister.
Moro accused Bolsonaro of encroaching on the autonomy of the Federal Police by attempting to meddle in investigations that involved his family members. To hinder the investigations, the president fired the chief of the Federal Police and planned to replace him with a personal contact who would provide him access to confidential documents. Moro’s presence in Bolsonaro’s administration gave credibility to the president’s tough-on-crime credentials. Consequently, his resignation jeopardized the integrity of the government’s anti-corruption discourse. Even though this incident holds significant juridical ramifications, the most immediate consequence is the unstable image that Bolsonaro puts forward during a national emergency.
The source of the former Justice Minister’s accusations against the president was a video of a cabinet meeting on April 22. It was aired on May 22, following the authorization of Justice of the Federal Supreme Court (STF), Celso de Mello. In the meeting, the president states that he “will interfere in the ministries,” refusing to be surprised by press releases because he does not have access to information from the Federal Police or the Brazilian Intelligence Agency. He also stated he would not “wait to see his family get f*****” in order to change security, security chief, or minister.
The meeting was also alarming due to the claims made by Bolsonaro’s ministers, showing that responding to the pandemic was not a priority for the government at the end of April, when Brazil was close to confirming 50,000 coronavirus cases. The Minister of the Environment suggested that the government should take advantage of the media’s focus on COVID-19 to “change [environmental] rules and regulations.” The Minister of Education said that all the STF ministers should be arrested, and Teich feared that the new coronavirus would “impede” prioritizing the economy.
In a tweet, Tabata Amaral, the federal deputy of the state of São Paulo, said that “the two hour-long meeting showed that the government’s primary concern is to strengthen its own image, increase political violence, attack minorities, and weaken democratic institutions. Plans to save lives during the pandemic? [There were] none. This is the true face of an inhumane government.”
Fran criticized Brazil’s federal government for failing to respect the separation of powers among its branches. “Many times,” he said, “the presidency is understood as a source of hierarchical power, in which the president rules supremely over state governments and so on. [That] is absurd and [represents] complete incomprehension” of the different functions of each branch. Most Brazilian state governors, who are the ones effecting social distancing policies for their respective states, emphasize the importance of restrictive measures to tackle the pandemic, opposing the president’s desires. Fran explained that the president’s “lack of ability to create dialogue (with governors),” was setting an “alarming” tone to the pandemic response.
Chacra also explained the effect of Bolsonaro’s behavior on the country’s international representation.
“Brazil’s image is getting eroded abroad above all due to the president’s behavior,” he said. “Many perceive Bolsonaro as a denialist, as opposed to science—and [his] attitudes often end up overshadowing the policies of many Brazilian state governors in the fight against COVID-19. Bolsonaro’s behavior prevails over the actions of many state governments that have been seriously trying to implement policies following the recommendations of the World Health Organization.”
The state of Minas Gerais in southeastern Brazil, for instance, where the state government has emphasized strict social distancing measures, has just under 7,000 cases, even though it is the fourth largest Brazilian state. Simultaneously, in more densely populated states such as Rio de Janeiro, where nearly 40,000 cases have been confirmed, young state deputies such as Renan Ferreirinha have been working tirelessly to approve statewide lockdown orders and were able to make the use of masks mandatory. The young Tabata Amaral was the author of a bill approved on May 22 providing specific measures to prevent domestic violence during the pandemic.
More recently, the president has indicated that he may be willing to change his behavior and foster a greater sense of unity between the federal and state governments. On May 21, Bolsonaro met with state governors to discuss the Ministry of Economy’s proposal to freeze public servant salaries—excluding those of police forces, teachers, and social workers—until the end of 2021 and in turn pass a financial aid package of $22.5 billion to help states combat COVID-19 on local levels. The president asked for a consensus, and all parties publicly endorsed the proposal.
João Doria, the governor of São Paulo with whom Bolsonaro had been exchanging attacks for months, expressed that the meeting was mostly defined by its tone of cordiality between the president and governors. It may have been a turning point for Brazil’s political relationship with the coronavirus.
“I want to exalt and praise the way in which this meeting is being conducted,” Doria said in an interview with O Globo. “Brazil needs to be united to overcome the crisis, [to] help and protect the health of Brazilians…Let’s go in peace, president. Let’s go [in peace] for Brazil, let’s go together.”
Even though the political unrest may be subsiding, the challenges that still await state governors are two-fold. In addition to a public health system that approaches its saturation point, the lack of urban planning in some of Brazil’s largest states and cities, such as Rio de Janeiro and São Paulo, also directly affects the health crisis. According to the Brazilian Institute of Geography and Statistics (IBGE), six percent of Brazil’s population lives in tightly-packed slums known as favelas, a consequence of the country’s housing deficit and poor income distribution. In these overcrowded communities—some of which house up to 39,000 residents per square kilometer—social distancing is essentially impossible.
According to a survey conducted by Brazilian newspaper O Globo, 8 in every 10 favela residents need to “seek food and personal hygiene products outside the regions where they live.” This increases the flow of movement in these communities, creating favorable conditions for the spread of the easily transmissible coronavirus.
Dr. Ko described how the issue of urban proximity is aggravated by the problem of “the social gradient in health.” This refers to a collinear relationship between socioeconomic status and health conditions. When he first came to Brazil, Dr. Ko researched the spread of meningitis, which has caused epidemics throughout Rio de Janeiro, São Paulo, and Salvador, and concluded that the people most vulnerable to the disease were those living in the poorest communities—the ones lower down on the social gradient of health status.
“Not only are they living in poorer environments,” he said, “but they are also more susceptible to the severe complications caused by COVID-19—especially those who carry lung disease, diabetes, or obesity. Those are major problems in our poor communities, both in the United States and in Brazil.”
Public health outcomes, exacerbated by socioeconomic inequalities, become even more tragic when, as Chacra put it, the notion of “every man for himself” comes to define a deadly pandemic. Chacra expressed his concern for “the lack of global leadership or a coalition of international leaders” in the fight against coronavirus. A people politically anesthetized and exhausted by Brazil’s last turbulent decade, Brazilians might not have the energy—or the backing—to hold Bolsonaro accountable for the public health tragedy that already overwhelms the country.
Bolsonaro’s threats to the independence of his ministries and state governments reveal the limits of the country’s rapidly eroding democracy. Unless his administration embraces scientific understanding and responsible governance in favor of the Brazilian people, the tumultuous political events and tragic pandemic response might only be the beginning of the storm.