The Impact of the 4 Years of Bolsonaro on the Brazilian Health System
Pamella Liz is a social scientist and public health specialist. She is currently a postdoctoral intern at the School of Public Health of the University of São Paulo (FSP-USP), where she works on the international project "Social Mobilization as a Policymaking Lever? A Trans-Atlantic Covid-19 Dialogue on Community Action and Decentralized Governance," carried out simultaneously in Brazil, Canada, Germany and Peru. Her research analyzes media and scientific representations, and the life stories of people and groups in precarious and vulnerable situations from the perspective of gender, race, class and collective health studies. In 2020, Pamella was a research assistant in the Global Urban Studies Program at Rutgers University, and in 2021 she was a postdoc fellow in the Epidemic Ethics Group (Oxford University), led by the World Health Organization (WHO). This text was originally written for issue 63 of the WBO Newsletter, published on April 21, 2023. Fill in the form at the bottom of the text to access and subscribe to the WBO weekly newsletter in English.
A Summary of a Dismantling
During the four years of former Jair Bolsonaro's presidency, the government-run Unified Health System (SUS, which was undermined since its creation, underwent one of its worst administrations. Due to its hidden death logic of the "herd immunity" strategy, in which the economy was placed ahead of the lives of Brazilians, Brazil has had more than 700,000 deaths from COVID-19. This very number represents the crimes committed against the population, including the dissemination of false news, fraud in bids to obtain vaccines, and encouragement of ineffective treatments by the government. Among the most widespread alleged miracle solutions was the use of hydroxychloroquine and ivermectin, which had already been discarded as a treatment by scientists and health authorities.
Even before being elected, throughout his campaign, the former president already announced plans to privatize the health sector, which was already operating well below its capacity due to the spending ceiling imposed by the government of President Michel Temer (2016-18). The situation of underfunding and the scrapping of the Unified Health System, which in itself was evident and worrying, turned into an unprecedented tragedy when the pandemic struck: Brazil has 2.7 percent of the world's population and 11 percent of the deaths from COVID-19 worldwide.
In addition to the serious situation with regard to the pandemic, the criminal nature of Bolsonaro's management left a trail of measures to dismantle and cause to fail the Brazilian health system as a whole. Amidst the various fake news propagated against the COVID-19 vaccine, the sharp drop in all vaccine coverage over the last few years was also evident. Until 2015, Brazil maintained vaccination coverage of more than 95 percent for all vaccines in the national immunization plan. Unfortunately, today we have inadequate vaccination coverage for children under one year of age, and diseases that have already been eradicated, such as poliomyelitis and measles, are re-emerging in the country. During the Bolsonaro government, there was also an increase in waiting lists for elective surgeries; a lack of essential supplies and medicines in health units, especially during the pandemic; the dismantling of the health industrial complex (which caused the huge crisis in the production of vaccines for COVID-19, the lack of masks, and other PPE); the weakening of Primary Care and Family Health Strategy; and the mischaracterization and criminalization of the More Doctors program, which is essential to overcoming the lack of care in remote regions of Brazil.
The logic in favor of privatization, combined with contempt for the most vulnerable, led to the tragedy experienced by the Yanomami indigenous community, who suffered from malnutrition, infant mortality, and mercury contamination, caused by illegal mining in indigenous territories, a crime of genocide denounced at the International Criminal Court in The Hague. In addition, a huge number of pregnant women died from COVID-19. The lethality rate for pregnant women in Brazil was eleven times higher than the average for Latin America and the Caribbean during the first year of the pandemic, and nothing was done by the government in relation to this situation, other than recommending that women not get pregnant.
Looking to the Future without Forgetting the Past
The effects of Bolsonaro's criminal management are devastating. However, today we have hope of breathing freely again in a democratic environment. After the election of President Luiz Inácio Lula da Silva, health has once again become a priority for the government, and a lot of work is being done to rebuild the SUS and the Ministry of Health. In the last days of December 2022, Nísia Trindade Lima, the new minister of health, received a final report from the Transition Team Working Group on the Health Situation regarding the state of the health system left by the previous administration. The document also contains the solutions devised by the team to overcome the dismantling of the health sector, among which the following stand out: an emphasis on the commitment to the National Health Council (CNS), which is fundamental for public control and participatory management of the SUS; the strengthening of the health authority and technical capacity of the Ministry of Health, with greater attention to cybersecurity; restructuring of the Health Economic and Industrial Complex; recovering the high vaccination coverage through the National Immunization Program (PNI); strengthening the country's capacity to respond to public health emergencies; tackling accessibility to specialized care; and implementing a new concept of Primary Attention to Health (Atenção Primária à Saúde, APS), which seeks to reorganize primary care in the country. The government also intends to launch restructured versions of the most popular medical and pharmacy programs.
We still have a lot to do, bearing in mind the extent of the problems we have acquired. However, the prospects are positive, and the Brazilian health system, despite the attacks, still has the capacity to return to being a global example of comprehensive care.
We will certainly return to the SUS that we once had, an example of excellence with regard to vaccination, especially childhood vaccination, HIV/AIDS treatment, tobacco control, and access to urgently needed medicines. More than 70 percent of the Brazilian population depends exclusively on the SUS to meet their health needs; therefore, protecting the largest public, universal, and free health system in the world must be the center of the reconstruction of Brazilian democracy. As Sergio Arouca said during the Eighth National Health Conference, which gave rise to the SUS: “Democracy is health!”
