By Matthew Flynn
Brazil’s efforts to address the SARS-COV-2 pandemic within its borders rank among the worst. Much of the blame falls on President Jair Bolsonaro who has consistently dismissed the disease as a “little flu” and touted ineffective treatments, such as using hydroxychloroquine as a prophylactic.18 Once a model for addressing infectious disease like its HIV/AIDS programs, the country has now become a pariah nation. Competent public health administrators have exited the Health Ministry as retired and active military officers assumed key positions throughout government. Three health ministers have come and gone since the start of the pandemic. A recent constitutional amendment-imposed limits on the budget of its continental-size public health system premised on universality and right to health. By threatening the judicial branch, governors, and mayors who disagree with his views, Bolsonaro’s authoritarian tendencies have even put the country’s democracy at risk. Political disputes, ideology, and poor planning have also marred Brazil’s efforts to acquire, produce, and distribute vaccines.
Due to high infection rates and competent research scientists, the country became a favored location for conducting clinical trials, including those by Johnson & Johnson, Pfizer and partner BioNTech, AstraZeneca/Oxford, and China’s Sinovac Biotech. The latter two companies, in fact, established partnerships with Brazil’s two large vaccine manufacturers—federally controlled Biomanguinhos (part of the FioCruz health research institute) and São Paulo state government’s Butantan Institute, respectively. The Ministry of Health depended on Biomanguinhos-AstraZenaca/Oxford effort that would eventually include the transfer of the technology to produce the active principal ingredient (API) locally. But delays in completing clinical trials and in importing the API have set back production. Meanwhile, Butantan quickly ramped up output of its CoronaVac vaccine using imported API’s from Sinovac and accounted for 80% of all the doses administered during the first three months of its national vaccination program.
While public-private partnerships to build local capacity and guarantee supplies of strategic health inputs follow recent industrial policies, politics and messaging have plagued coordination for effective vaccine roll out.19 Bolsonaro, who employed anti-China rhetoric prior to the pandemic, denigrated CoronaVac as a way to undermine his political foe and rival, the governor of São Paulo state. That the Chinese-developed vaccine only showed an initial 50.4% efficacy against COVID-19 buttressed the president’s attacks and suspicions of Brazil having to rely on second-tier treatments, although later studies and spacing between doses revealed much higher levels of efficacy, especially against severe cases and hospitalization. The president’s own vaccine hesitancy further compounded the situation. By mid-April only 4% of Brazil’s population had been fully vaccinated, putting the country in 73rd place in world rankings. In the past, Brazil vaccinated 92 million people against H1N1 in three months in 2009 and had quickly distributed useless hydroxychloroquine throughout the country.20
Needless to say, slow vaccine rollout fails to address the scale of what MSF calls a “humanitarian catastrophe” in Brazil. With more than 3,500 COVID-19 related deaths daily in April 2021, Brazil overtook the US with the highest mortality rate among countries with populations over 70 million. The country’s health system was verging on collapse with hospitals running out of oxygen and intubation kits. More contagious virus variants have proliferated and intensive care units have witnessed an influx of younger patients. Inequitable access to vaccines mars other social determinants made apparent by the disease. Apart from successes in targeting some indigenous communities, those districts with higher incomes and whiter skin color have obtained better access to vaccines, although the lower class and Afro-descendent populations have suffered higher COVID-19 mortality rates (Flynn forthcoming).21
Meanwhile, the country scrambles to secure more vaccines and imported APIs for locally produced vaccines. The private company União Química established an agreement to produce Russia’s Sputnik V vaccine, but regulatory officials have yet to approve it and Brazil allegedly faced pressure from the United States not to. After rebuffing offers from Pfizer last year over contract terms, the Ministry of Health finally agreed to purchase 100 million of its doses that will only arrive in the second half of 2021 and whose distribution is limited due to the need for an ultra-cold chain. A mere 1 million doses arrived at the end of March for the COVAX purchasing facility. Despite having several research and university labs spearheading several pre-clinical initiatives to produce a vaccine locally, the paucity of resources and industrial bottlenecks have constrained efforts to develop a vaccine locally (South Centre 2021).22 Only Butantan, through an international R&D collaboration, announced clinical trials of ButanVac that would be produced 100% nationally but only available towards the end of the year in best case scenario.
Politically, there is growing disillusionment with government leadership and efforts. While there is increased interest to suspend patents on Covid-19 related treatments locally, Brazil has not supported a patent waiver at the World Trade Organization. Recently, federal lawmakers want to allow private companies to side-step the public health system and acquire vaccines directly from suppliers—a move that would exacerbate vaccine apartheid. For his part, an isolated Bolsonaro must now deal with a congressional investigation of his administration’s handling of the pandemic. He may also face an election against his arch-political rival, former president Luiz Inácio “Lula” da Silva, released from jail when courts overturned his corruption charges and now calling Bolsonaro’s government as “genocidal.”
Matthew Flynn is an Assistant Professor of International Studies and Sociology at Georgia Southern University.
18 Flynn, Matthew B., André Pereira Neto, and Leticia Barbosa. 2020. “Democracy (Still) on the Edge: An Analysis of Brazil’s Political Response to the Covid-19 Crisis.” Duck of Minerva. Retrieved July 3, 2020 (https://duckofminerva.com/2020/05/democracy-still-on-the-edge-an-analysis-of-brazils-political-response-to-the-covid-19-crisis.html).
19 Flynn, Matthew B. 2015. Pharmaceutical Autonomy and Public Health in Latin America: State, Society and Industry in Brazil’s AIDS Program. 1st edition. New York, NY: Routledge.
20 Mazza, Luigi, and Renata Buono. n.d. “Cloroquinas, vacinas e mortes.” Revista Piauí. Retrieved March 22, 2021 (https://piaui.folha.uol.com.br/cloroquinas-vacinas-e-mortes/).
21 Flynn, Matthew B. forthcoming. “Global Capitalism, Racism, and Social Triage During COVID-19.” Kalfou.
22 South Centre. 2021.”Covid-19 Vaccines: Experience of Butantan Institute, Brazil,” March 23, South Centre Web Presentation.