Margareth Dalcolmo and Paulo Chapchap on Vaccines and Public Health in Brazil: Politics vs. Science

Monday, Mar 8, 2021

On Friday, February 26, 2021, the Brazil LAB hosted an online discussion on the theme of “Vaccines and Public Health in Brazil: Politics vs Science,” featuring Margareth Dalcolmo, pulmonologist, researcher, and professor at the National School of Public Health of Brazil’s Oswaldo Cruz Foundation (Fiocruz), and Paulo Chapchap, Director of the premier Hospital Sírio-Libanês in São Paulo and president of the non-profit Todos pela Saúde (All for Health), an alliance of health experts seeking to address the covid-19 pandemic and its effects on Brazil’s highly unequal society. The discussion was moderated by Arminio Fraga, economist, former president of the Brazilian Central Bank, and Brazil LAB Advisory Board Member. 

In the wake of Brazil’s sustained position as the country with the second largest number of covid-19 deaths in the world, the experts unpacked a range of interlocking issues surrounding the impact of the coronavirus on Brazillian society. Dalcolmo and Chapchap tackled topics such as the structural reasons for the current dire situation in the country, the politics and concerns behind “vaccine diplomacy,” and the present political and judicial response in Brazil to the relative absence and delays of vaccination. One of the main topics of the conversation was the lack of health responses in light of Brazil’s globally renowned public health care system (SUS) –– with its extraordinary history of successfully tackling complex pandemics, like HIV/AIDS, in recent decades. 

Dalcolmo and Chapchap were unequivocal in asserting that the health aspects of the pandemic cannot be considered separate from the social, economic and cultural contours of Brazillian society. For Chapchap, the Brazillian state’s response to the pandemic and vaccination efforts are beleaguered by “poor leadership, lack of coherent data-driven and scientifically oriented health policy, misleading communication and societal behaviour” in response to the pandemic. Dalcolmo, in turn, elaborated on disagreements among Brazillian civil society and class differences among the Brazilian middle class and its poorer population. Both experts concurred that SUS entered the coronavirus pandemic weakened due to lack of funding, lack of adequate human resources, administrative inertia and modelling problems associated with scientific infrastructure in Brazil. Dalcolmo also drew attention to the fact that while Brazilian science and scientists –– and institutions such Fiocruz and the Instituto Butantan –– have responded with vaccine research in record time, the absence of a robust vaccine procurement system and political responses ranging from denial to laxity have shortcharged Brazillian people. 

In response to Dalcolmo and Chapchap, Fraga posed a range of questions and interventions about current tensions between science and politics in Brazil, risks to vaccination arising out of wider political and local civic factors, the role of the private sector in vaccination efforts in Brazil, and the failure of Brazilian diplomacy and geopolitics in leveraging international health coalitions. Chapchap responded to these interventions by highlighting varied scales at which structural and systemic lacunae plague the Brazillian state’s response to vaccination efforts. “The private sector taking hold of vaccine distribution [in the absence of state efforts] is wrong from a scientific, moral and public health perspective. Social responsibility of distributing vaccines has to be shouldered by the Brazillian state,” Chapchap said. “The problem of vaccines can only be leveraged if we formally think about them in the context of equity… Brazilian society needs to be conscious that it has a right and responsibility to be vaccinated; such civic consciousness is missing is Brazil,” Dalcolmo added. 

The discussions that followed the presentation included graduate students and faculty from Princeton, and members of the general audience. Concerns were raised about the ways in which political denials are animating anti-vaccine movements in the country, medical corruption, and concrete demographic risks arising out of fears of virus mutations. Responding to these issues Chapchap argued that “the political implications [of delayed vaccines] are significant – if we take too long to vaccinate we run the risk of being isolated in the world from a geopolitical perspective, we are going to be toxic for the rest of the world.” Dalcolmo ended her presentation on a note of hope arguing that in just over one year the world witnessed the extraordinary organization of 181 groups producing vaccines. “Two positives can come out of this pandemic: first, people and the world are reckoning with the capacity of Brazillian scientists to produce knowledge and research in creative and collaborative ways. Second, Brazil can have a new civic and political culture…it’s time for richer and private initiatives and classes to participate…it’s not correct to leave the entire burden of the pandemic on the government,” she said. 

The event was co-organized by the Institute for Health Policy Studies and co-sponsored by the Center for Health and Wellbeing, the Program in Latin American Studies, the Department of Spanish and Portuguese, and the Department of Anthropology.