The COVID-19 pandemic and the disaster of the response of a right-wing government in Brazil

COVID-19 left a trail of millions of cases and thousands of deaths in Brazil. In the last two years, the country has undergone enormous changes that have brought about a remarkable deterioration in the lives of Brazilians. Brazil registered the second highest number of deaths from COVID-19 in the world, second only to the USA. The Brazilian federal government’s policy to fight the epidemic was catastrophic! Now, we are faced with a massive economic decline, the return of hunger to a vast swathe of the poor, a disastrous rise in unemployment, and a concerted attack on science and education, two sectors meant to mitigate the epidemic.

Pandemics such as COVID-19, AIDS, Mers, Sars, Zika, dengue, chikungunya, and others are consequences of the greatest environmental degradation that has occurred on our planet in recent decades^[1]. Instead of reducing its attacks on our forests, the Brazilian government has promoted one of the largest destructions of the Amazon Forest in the history of the country. It made it easier for land grabbers, miners, illegal loggers, and enemies of indigenous peoples to practice their crimes freely. Mining is seriously affecting indigenous populations, destroying their territories, and poisoning their rivers, and has brought coronavirus to these populations that have suffered the highest mortality rates from COVID-19 in the country^[2].

Since the pandemic began, the Ministry of Health in Brazil has had four ministers, none of whom have been able to lead a coherent COVID-19 response. Many deaths and widespread suffering could have been avoided if effective leadership had been permitted. Brazilian research documented that, in addition to boycotting prevention practices, the nation’s president actively contributed to the spread of the pandemic in the country. He rejected the seriousness of the virus, did not provide testing, did not organize a primary care response addressing the pandemic, created diplomatic crises that interfered in the purchase of vaccines, encouraged the use of drugs without proven scientific efficacy, and tried to prevent the implementation of non-pharmaceutical measures by governors and mayors, certainly enhancing SARS-CoV-2 spread throughout the country^[3]. Those most affected by these deliberate actions were the elderly, blacks, indigenous populations, quilombola communities, and those who live with greater racial and socioeconomic vulnerability.

Despite all the ineptitude, after an unnecessary delay of six months, vaccines arrived in the country, although not in sufficient quantity. Vaccination advanced thanks to the response of the National Immunization Program, which despite administration enemies, was effective in states and municipalities. After delays, errors, and suspicions of corruption investigated by the COVID-19 Parliamentary Inquiry Commission in the Federal Senate, more than 67%^[4] of Brazilians were vaccinated, surpassing the USA. The coverage achieved in Brazil contrasts with the premeditatedly erroneous way in which President Bolsonaro dealt with the pandemic. The success also recalls and reinforces the confidence that Brazilians have in their robust public health system, the Unified Health System [Sistema Único de Saúde (SUS)]. We beat polio, measles, H1N1, established the National Program for the Control of HIV/AIDS as a global model, and made remarkable progress in reducing infant and maternal mortality. Despite enormous setbacks and difficulties, including substantial defunding, SUS still fills most Brazilians with pride. We all know that the pandemic would be even more devastating if we did not have SUS.

The challenges, however, remain enormous. More than 20 million Brazilians have not yet taken the second dose of the vaccine and are therefore not adequately protected. It is urgent that health authorities actively search for these people and vaccinate them, and several municipalities have shown that this is possible.

However, even after we improve control of the pandemic, underfunded SUS will continue to be overloaded, dealing with both the health demands and consequences of COVID-19 and with pent-up demand for the remainder of the disease spectrum. For this reason, we call for the repeal of Constitutional Amendment 95, which froze public spending in 2016 for 20 years. Even with all the assaults on policy, budget, and staffing, SUS was effective in ensuring that vaccination reached all parts of the country. The smallness of the current government stands in the shadow of the accomplishments of SUS.

We cannot forget that the pandemic hit us during a political and economic crisis imposed on our country with the 2016 parliamentary coup, deepening existing inequalities. The Brazilian Dietary Atlas^[5] makes it clear that in the period between 2004 and 2013, hunger and the risk of hunger were on a downward trend, while between 2017-2018, there was an increase in hunger that continues to grow.

The vulnerability of the workforce is central to these negative effects. Difficulties in securing employment and even survival mark the current historical moment in the country. The termination of labor rights and guarantees in the 2017 labor reform amplified the inequalities and repercussions of the current health crisis. While by law, formal workers would receive government benefits for time off, many workers who were no longer protected by the law were unable to comply with COVID-19’s restrictions and were forced to work in environments conducive to infection. Excluded from the formal labor market, they began to depend on temporary and insufficient cash transfer programs, and many joined those living with extreme food insecurity.

Today, we have desperate families looking for food scraps in the garbage or buying bones to cook. Brazil has about 13 million unemployed people and another 50 million in informal or new jobs with lower wages. On the other hand, we saw the concentration of income increase during the pandemic: 1% of the richest Brazilians became owners of half of the country’s wealth. These are the sad records, along with COVID-19 cases that Brazil insists on breaking.

Not collecting, hiding, and manipulating data has also become a specialty of this government. Bolsonaro tried to replace the Amazon rainforest deforestation measurement system to hide the objective data. While his environment minister signed commitments at the recent COP26 meeting, the country registered record deforestation and delayed the release of deforestation monitoring data by the National Institute for Space Research. In health, amidst the pandemic, in mid-2020, the Ministry of Health concealed the total number of people infected with SARS-CoV-2 and the accumulated number of deaths in the country, trying to erase the disastrous effect of its strategy to encourage the transmission of COVID-19 among Brazilians. With the 2021 Demographic Census, the president pursued the same strategy. First postponed due to the pandemic in 2020, it is now further postponed until 2022, alleging lack of funds. Postponing the census pushes down the road the publication of the dramatic and negative effects of the government’s pandemic policies. Additionally, the administration has cut 30% of potentially embarrassing questions in the census. These questions include family income and costs, other socioeconomic variables, sex and gender identities, diversity and inclusion, and labor conditions, among others likely to demonstrate the failure of government policies. Interrupting these repeated measures demonstrates the government’s willingness to abandon science and best practices in its purely political pursuits.

In the education sector, the chaos was no less. The government’s attacks on science, universities, and research funding agencies are belligerent and merciless. The two main pillars of Brazilian science, CAPES, and CNPq have had their budgets cut by 73% since 2015^[6]. Together these two agencies had a real reduction of almost 10 billion reais in their budgets, and the 2021 budget is almost ¼ of that of 2015. In addition, the university entrance exam that democratized access to Brazilian universities (ENEM) is affected, with the lowest number of students taking the exam in recent history. These students represented fewer minorities and fewer poor students than in the past, implying a greater exclusion of these students from the University.

The COVID-19 pandemic has not ended, nor has the federal government’s disastrous policies. As health specialists, we are sure that the way out of the current health crisis must be collective. Vaccines and non-pharmaceutical interventions such as masking and distancing are required on a broad scale to manage new infections. SUS must be strengthened to respond to current and future challenges. We defend the long history of investment in Brazilian research, public universities, and science. This investment, paying off for COVID-19, Zika virus and microcephaly, dengue, chikungunya, HIV, Tb and malaria and numerous other diseases, with Brazilian researchers in the first rank of responders, has no reason to be destroyed. It is our responsibility to demand that the federal government fulfill its duty to guarantee health and education for all, rights inscribed in our Federal Constitution.