According to official government statistics, more than 685,000 people have died from COVID-19 in Brazil, placing it among the countries with the most deaths. As infections soared in Brazil between 2020 and 2021, the country spread the SARS-CoV-2 coronavirus beyond its borders, exporting the virus 10 times more often than importing it, a study has found. published in Natural microbiology last month1. The findings suggest that the nation – the largest in Latin America – was an epicenter of COVID-19 and that the policies implemented by its government and its leader Jair Bolsonaro failed to stem the virus.
The report comes as Brazil prepares to elect its next president in October. Bolsonaro is up for re-election and faces 11 opponents, including former President Luiz Inácio Lula da Silva, who ruled the country from 2003 to 2010. It remains to be seen whether Bolsonaro’s questionable response to the pandemic will work against him. during the elections. Public health researchers have denounced his refusal to implement lockdown measures, his spreading false information about vaccines and his support for ineffective drugs such as hydroxychloroquine to fight COVID-19.
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“For most of the pandemic, the government has failed to come up with a coordinated response, giving way to a wave of misinformation — sometimes spurred on by federal government leaders,” says Otávio Ranzani, an epidemiologist at the University of São Paulo. and at the Barcelona Institute for Global Health in Spain.
Many presidential candidates, including Bolsonaro, promise to strengthen Brazil’s healthcare system, known as SUS. But the country also grapples with other issues, including food security and economic inflation, which could outweigh pandemic concerns when Brazilians head to the voting booth. According to a recent study by the Getulio Vargas Foundation, a higher education think tank based in Rio de Janeiro, one in three Brazilians would not be able to afford to eat properly in 2021 – the highest proportion in more than a decade.
Still, it’s exciting that health care is being discussed in this presidential election, said Rosana Onocko Campos, president of the Brazilian Collective Health Association in Campinas, São Paulo. “This is the first time I’ve seen the vast majority of candidates say they agree that increased federal funding for SUS is needed,” she said.
According to Natural microbiology study, SARS-CoV-2 was introduced to Brazil mainly from Europe in early 2020, before the country had implemented response measures. But between then and September 2021, the nation spread the virus to many countries; the largest number of virus exports went to other South American countries, ten of which border Brazil (see “Super spreader”).
To draw these conclusions, the team sequenced 3,800 SARS-CoV-2 genomes from people infected in eight Brazilian states and a neighboring country, Paraguay. The researchers also analyzed genome sequences in the popular GISAID data repository – more than 13,000 from Brazil and around 100 from Paraguay – to understand which coronavirus variants were prevalent and at what times, between 2020 and 2021. And they have compared their sequences with more than 25,000 global sequences to draw conclusions about viral spread. They found that Brazil most often exported the Gamma variant, which first appeared within its borders.
The main objective of the study, explains lead author Marta Giovanetti, a visiting virologist at the Oswaldo Cruz Institute in Rio de Janeiro, “is to discuss the role of population mobility and the emergence of the first variants of concern ” in Brazil.
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For public health and computer scientist Marcelo Gomes, the findings make sense, as COVID-19 infections in Brazil remained at a consistently high level from 2020 to September 2021, making transmission to other countries possible. Gomes is based at the Oswaldo Cruz Foundation in Rio de Janeiro, of which the institute is a part.
The SUS has been overwhelmed by COVID-19, revealing a resource shortfall, Onocko says. “We need to requalify services and staff to increase technical capacity for faster service [and have] better coordination between federal, state and local governments. It will take an extraordinary effort,” she says.
Acknowledging that the SUS has been overwhelmed during the pandemic, Bolsonaro has pledged a 250% increase in funding for healthcare workers if re-elected. He and Lula – who are leading in the polls – are committed to strengthening Brazil’s post-pandemic response, and Lula wants to improve women’s access to public services for disease prevention and treatment.
However, how these promises would be implemented and paid for is unclear to many researchers. “The proposals are superficial and do not go into concrete steps on how they will face the challenges we face,” says doctor Gonzalo Vecina Neto, who headed the Brazilian Health Regulatory Agency between 1999 and 2003.
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Vecina fears that while candidates have acknowledged the impact of the pandemic and made various pledges in response, public health concerns are being overshadowed by the economy and other issues as the election nears. “I feel like we are forgetting what happened,” he says, “and we are now facing new outbreaks such as monkeypox without having learned enough from the pandemic.”
Others agree. Ranzani says he wants more emphasis on strengthening SUS and Brazilian research in election discussions. “It is fundamental for us to deal with what the pandemic has caused and is still causing.”
The Brazilian presidential election takes place on October 2. If none of the candidates obtains more than 50% of the vote, the two heads of the list will move on to the second round, which will take place on October 30.