New Brazilian health minister Marcelo Queiroga // File Photo: Brazilian Government.

Brazilian President Jair Bolsonaro this month named Marcelo Queiroga as his new health minister, the country’s fourth since the Covid-19 pandemic struck a year ago. Brazil has recently seen consecutive record highs of daily deaths from coronavirus as the country continues to struggle amid the unrelenting spread of a particularly contagious strain of the virus, known as P.1. Will new leadership at the health ministry bring significant change in the government’s health policy and response to the pandemic? What is the government doing, and what else should it do, to protect particularly vulnerable groups, including Indigenous communities in the Amazon? To what extent is an uncontrolled health crisis in Brazil, with potentially more dangerous mutations of the coronavirus, likely to hinder global efforts to contain the pandemic, and could Brazil face international pressure as a result?

Nestor Forster Jr., Brazil’s ambassador to the United States: “Since the beginning of the pandemic, President Jair Bolsonaro has been leading a relentless effort to protect both the lives and jobs of Brazilians. By March 25, 30 million doses of vaccine had been distributed to states, and with 16 million administered, Brazil ranks fifth in the world for total inoculations. We have already begun producing the vaccine domestically, and the first shipment from the Covax facility Initiative has been received. The development of a Brazilian-made vaccine is approaching the testing phase. Vaccine priority groups in Brazil include health care personnel, the elderly and Indigenous peoples, of whom 70 percent have been vaccinated. The armed forces have been deployed to ensure access to vaccines in remote areas, such as riverside villages in the Amazon. Covid-19 cases are on the rise worldwide, and in Brazil the upward trend is being addressed through greater access to ICU beds and an increased supply of oxygen and respirators to hospitals. To face the economic consequences of the crisis, the federal government implemented the largest social assistance program in the Southern Hemisphere. In 2020, the Brazilian federal government spent more than 320 billion reais ($56 billion) in cash transfers to rescue 68 million people from the effects of extreme poverty. In total, more than 8 percent of Brazil’s GDP was allocated to counter the pandemic. Brazil has been working in close cooperation with U.S. authorities, including by sharing information on Covid-19 variants in regular meetings coordinated by the White House with chief science officials from partner countries.”

Gabriela Lotta, professor of public administration at the Getúlio Vargas Foundation (FGV): “Brazil is a clear example of the power of the virus when there is a denialist president who refuses to face the pandemic. The fourth minister of health, who recently took office, has already announced that he will represent continuity from the previous, military minister. More than that, he announced that he will continue to follow the president’s orders. Therefore, it seems that the shift in ministers will not bring about change. The country is adrift. We have a new strain circulating freely and a population that no longer adheres to preventive measures, which the president has discredited. The vulnerable population is increasingly poor and exposed to the virus. Mayors and governors do not want to assume the cost of decreeing a lockdown by themselves. In the meantime, we have surpassed 3,000 daily deaths and have a collapsed health system—without ICUs, without oxygen and, soon, without medication. The purchase of vaccines remains slow. In this context, the only possible solutions are the purchase and urgent application of vaccines and enacting a coordinated lockdown throughout the country, with support from an income transfer program. For both measures, the federal government’s adhesion is necessary, but the president shows no signs that he will do so. Brazil has become a global threat with possible mutations of the virus. The international community should increase pressure on the Brazilian government to adopt the required measures and provide support with medicines, oxygen, vaccines and health professionals. Brazil is experiencing a real humanitarian tragedy, aggravated by government decisions.”

Paulo M. Buss, president of the Latin American Alliance of Global Health: “This week, Brazil surpassed 300,000 deaths from Covid-19. The pandemic has reached new records of cases and deaths, and the country is now the global epicenter of the disease. The health system is exhausted, with a lack of intensive-care beds and critical inputs such as oxygen and devices and medicines for intubation. The more contagious P.1 variant, which originated in the Amazon, is already spreading across Brazil and represents a real threat to the global control of the pandemic, due to the uncertainties regarding existing vaccines’ response to the variant. Vulnerable populations such as Indigenous people in the Amazon and the poor in urban areas are still waiting for the small emergency aid that the federal government has promised to pay. In this bleak situation, the appointment of a fourth health minister fails to offer much hope. He has already declared that the Ministry of Health is executing policies, but the presidency is formulating these policies, which have already proved harmful and have contributed substantially to the current chaos within the health system. However, a crisis committee was recently announced during an event with Bolsonaro and the presidents of the legislative and judicial branches. The committee includes the minister of health and representatives of Congress, governors and mayors. Reacting to popular outcry, including from civil society groups and business elites, the president of the Chamber of Deputies made a threatening speech shortly after the meeting, demanding changes in Bolsonaro’s behavior. This strained political environment will be decisive for eventual changes in facing the pandemic—to be seen in the next chapters of this sad national soap opera.”

Monica de Bolle, senior fellow at the Peterson Institute for International Economics: “Brazil’s dismal handling of the pandemic has now led to a full-blown humanitarian crisis. Health systems across the country have collapsed—intensive-care units in nearly every state are full and are running out of needed resources for intubation and treatment of Covid-19 patients. Vaccination is moving at an extremely slow pace, and there continues to be a lack of doses for the population at large. The government has made no serious efforts to buy more vaccines from pharmaceutical companies other than AstraZeneca and Sinovac. The latest change in leadership at the helm of the health ministry is unlikely to change this scenario. Brazilian President Jair Bolsonaro has rejected calls for a national lockdown, which the country desperately needs to contain viral transmission. Viral transmission is therefore likely to remain unabated, particularly with the prevalence of the highly transmissible P.1 variant of concern that emerged in Manaus late last year. Little to nothing is being done to help the vulnerable population—Indigenous communities in the Amazon have been completely abandoned and are not a focus of current policies. The uncontrolled health crisis in Brazil is already affecting neighboring countries, as the P.1 variant spreads across the region. Moreover, the uncontrolled pandemic will likely lead to the emergence of yet other variants of concern, presenting a threat not only to Latin America, but to the rest of the world as well. At this juncture, Brazil should already be facing international pressure to change its behavior with respect to the pandemic. The extremely dangerous situation warrants not only warnings, but also possibly sanctions to force the government to change course.”

Valéria Guimarães de Lima e Silva, professor at ESCP Business School in Paris: “The new leadership at the Brazilian Ministry of Health may improve the government’s response to the pandemic, mainly by two means: first, by bringing a science-based approach to the fight against the pandemic and, second, by mainstreaming distribution and access to the vaccine for the population. In relation to the first, the new minister, Marcelo Queiroga, has created a special secretariat within the Ministry of Health to establish protocols to be applied in the fight against the pandemic. A technical group of experts will comprise this secretariat, led by Carlos Carvalho, a doctor who has been a vocal critic of the use of chloroquine in the treatment of Covid-19, a medicine that President Jair Bolsonaro has promoted. As to the second point, Queiroga has said vaccination of the population will be multiplied by more than threefold in the short term (from the current daily 300,000 to a target of one million vaccines per day). The success of the new team will depend on the extent to which it will be allowed to carry out its mandate without the president’s direct interference, which has already led to the dismissal of three health ministers during the pandemic. As Bolsonaro faces decreasing political support due to his management of the pandemic, it remains to be seen whether the current context could provide a positive setting for the new technical team to autonomously and efficiently advance efforts to curb the pandemic. Enhanced protection of Indigenous populations would require concerted efforts with other areas of the government, to avoid the invasion of their territory as is currently occurring. Brazil, which has been fertile ground for the development of new variant, is viewed as a global danger to international efforts to curb the pandemic. Political and economic pressure by foreign countries is a real possibility, should the current handling of the pandemic persist once major economies have vaccinated a majority of their populations.”

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