Covid-19 in Brazil: the government has failed to prevent the spread of the virus

Under the leadership of president Jair Bolsonaro, the federal government in Brazil has failed to implement a systematic plan to prevent the spread covid-19. Instead, under the pretext of shortening the public health crisis and protecting the economy, the Brazilian government has pursued a herd immunity strategy. We led a study that gathered and analyzed laws, judicial decisions, speeches, and public statements by federal officials. We found that these records suggest that the government pursued a three-prong approach to achieving herd immunity through widespread contagion of the public.

Firstly, the president signed decrees that defined religious services, the construction industry, beauty salons, barber shops, and gyms as essential services so they could remain open even under lockdown. He vetoed a series of legislative measures to limit the spread of covid-19, such as the mandated use of face masks in prisons; the requirement that businesses which stay open during the pandemic supply employees with free personal protective equipment; the mandated use of masks in closed spaces (this was rejected on the grounds that it would encroach on the right to privacy in one’s home); and protections for indigenous communities—including the provision of drinking water, hygiene and cleaning products, hospital and ICU beds. The president also excluded various occupations from an emergency financial aid programme, effectively forcing people to keep working during the pandemic, while also blocking Congress’s proposed financial reparations to families who lost members on the frontlines of pandemic healthcare. These are just some of the measures that Bolsonaro has vetoed.

Secondly, state and municipal government responses to the pandemic have been systematically obstructed. The president himself defined this as his “war” against government leaders who adopted disease containment measures. A few examples of this are: the unjustifiable delay of emergency funds to states and municipalities; the use of only a small portion of the pandemic response funds allocated by congress; and, through the Ministry of Health, the systematic mismanagement of purchases and distribution of fundamental items like diagnostic tests, personal protective equipment, respirators, oxygen, vaccines, and syringes. Despite tremendous pressure from businessmen and politicians, state and local governments have managed to avoid the collapse of Brazil’s national public healthcare system (SUS)—with shocking exceptions, like the city of Manaus. 

Finally, there has been a barrage of propaganda against public health. This has taken the form of political discourse that employs economic, ideological, and moral arguments, and disseminates disinformation and scientifically unverified      information with the purposes of discrediting health authorities, weakening public adherence to science-based recommendations, and encouraging political activism against the public health measures needed to contain covid-19. 

The president has not only held crowded public gatherings and travelled extensively around the country to preside over ceremonies like ribbon-cuttings; he has also systematically pushed the public toward contagion saying: “You’ll all catch it someday. What are you afraid of? Face up to it and, further, “There’s no use trying to escape it, escape reality. We have to quit being a country of sissies. Furthermore, he has pitted health against the economy. He incited supporters to invade hospitals to show that reports about overcrowded hospitals and the shortage of respirators were allegedly fake news. He has tried to discredit vaccines, claiming that they cause death and disabilities, and saying that “If you turn into a crocodile, it’s your problem.” He has also attempted to convince the public that the disease is vanishing. In December he said, “We’re now at the tail end of the pandemic.”

His recommendation in the early stages of the pandemic that people use ineffective medicines, such as hydroxychloroquine, is an important element of this propaganda campaign. This recommendation was issued by the Health Ministry—but not before one minister was fired, and another stepped down. This longstanding, well-funded ministry had an exceptional technical staff that had weathered transitions of power for decades, but is now headed by a general, while more than twenty key posts are held by military officers, most lacking any public health training or background

Brazil has already surpassed 10,000,000 confirmed cases of covid-19 and 250,000 deaths, and the disease remains uncontrolled. Worldwide, one out of ten covid-19 deaths has occurred in Brazil; the SUS has spent a fortune on treating hospital in-patients, especially on ICUs, threatening the sustainability of the system; healthcare workers are exhausted; and, with the disease disproportionately impacting the most vulnerable, the pandemic has exacerbated Brazil’s already sharp social inequalities.

We recently read Kamran Abbasi’s editorial in The BMJ, which asks whether the behaviour of government rulers during the pandemic may constitute a crime. We wondered what is the purpose of having international or national laws and judiciaries if these do not serve to criminalize and punish public agents for decisions which cause the death of hundreds of thousands of people? Or which expose millions more to unpredictable consequences, under the unproven argument that it will protect economic activity? It is our opinion that current international and Brazilian law offers grounds for immediately launching a debate on whether to hold Brazilian rulers accountable at civil and criminal levels. In fact, perhaps the absence of any such debate would merit the label “complicity.” 

Deisy Ventura, Professor, Director of the PhD Program in Global Health and Sustainability at Public Health School, University of Sao Paulo, Brazil

Fernando Aith, Professor, Director of the University of São Paulo Health Law Research Center

Rossana Reis, Associate Professor at the Institute of International Relations, University of São Paulo

Competing interests: none declared.