Produção Nacional
Revisado por pares
Bolsonaro's Ministry of Health's response to COVID-19 and other health challenges – Authors' reply
2023; Elsevier BV; Volume: 402; Issue: 10407 Linguagem: Inglês
10.1016/s0140-6736(23)01363-6
ISSN1474-547X
AutoresAdriano Massuda, Rafael Dall’Alba, Arthur Chioro, José Gomes Temporão, Márcia C. Castro,
Tópico(s)Public Health in Brazil
ResumoThe response from Jair Bolsonaro's former Minister of Health, Marcelo Queiroga, and former National Secretary of Primary Care, Raphael Parente, to our Comment1Massuda A Dall'Alba R Chioro A Temporão JG Castro MC After a far-right government: challenges for Brazil's Unified Health System.Lancet. 2023; 401: 886-888Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar is a clear demonstration of the method systematically used by Brazil's previous federal Government—the dissemination of lies and fake news to evade the facts and to construct a distorted reality. Rebutting the far-right rhetoric is a current challenge for health and democracy. In our Comment,1Massuda A Dall'Alba R Chioro A Temporão JG Castro MC After a far-right government: challenges for Brazil's Unified Health System.Lancet. 2023; 401: 886-888Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar we emphasised that rebuilding the Sistema Único de Saúde (SUS [ie, Brazil's Unified Health System]) after COVID-19 and tackling the major setbacks left behind by Jair Bolsonaro's administration must be a priority of the new Government of Luiz Inácio Lula da Silva and Brazil's civil society. Supported by official data, we presented the deteriorating health indicators of Brazil from the past 4 years—eg, Brazil accounted for 10·4% of global COVID-19 deaths, had its lowest vaccination coverage for all vaccines since 1995, and had a sharp increase in unmet health needs and maternal mortality rates. Based on Brazil's 2022 Health Governmental Transition report,2Comissão de Transição Governamental 2022Relatório do Grupo Técnico de Saúde—Produto 2.https://futurodasaude.com.br/wp-content/uploads/2023/01/GT-Saude_Relatario-Final1.pdfDate accessed: January 15, 2023Google Scholar we listed priorities for the new federal administration, highlighting the importance of restoring the authority of the Ministry of Health in the SUS governance, dismantled by Bolsonaro's government. Instead of contesting our data or refuting our arguments, Bolsonaro's former Minister of Health and former National Secretary of Primary Care created their own narrative. First, the authors argue that labelling the previous Government as far-right reflects a biased and partisan perspective. Commonly used as a political category,3Casarões GS Barros Leal Farias D Brazilian foreign policy under Jair Bolsonaro: far-right populism and the rejection of the liberal international order.Camb Rev Int Aff. 2022; 35: 741-761Crossref Scopus (24) Google Scholar the term was used to describe the political landscape in which the Brazilian health system operated in the previous Government. Second, the authors argue that given the increase in expenditures to respond to the COVID-19 pandemic, the Ministry of Health during Bolsonaro's Government was the one that did the most in the history of Brazil. Indeed, it was a historical fiasco, as shown by facts and official numbers. Brazil's Federal Government's catastrophic response to the pandemic bears a large responsibility for the loss of thousands of lives that could have been prevented. Its communication strategy actively discouraged adherence to protective measures, such as mask wearing and physical distancing.4Fonseca EMD Nattrass N Lazaro LLB Bastos FI Political discourse, denialism and leadership failure in Brazil's response to COVID-19.Glob Public Health. 2021; 16: 1251-1266Crossref PubMed Scopus (35) Google Scholar The former President undermined trust in vaccines and promoted the use of drugs without scientific proof, such as chloroquine, vitamin D supplements, and ivermectin.5Hallal PC Victora CG Overcoming Brazil's monumental COVID-19 failure: an urgent call to action.Nat Med. 2021; 27: 933Crossref PubMed Scopus (28) Google Scholar The lack of planning regarding vaccine procurement and distribution resulted in 38 million expired vaccine doses worth approximately US$400 million, as reported by the Federal Court of Accounts.6Tribunal de Contas da UniãoTomada de Contas Especial vai apurar desperdício de insumos e vacinas da Covid-19.https://portal.tcu.gov.br/imprensa/noticias/tomada-de-contas-especial-vai-apurar-desperdicio-de-insumos-e-vacinas-da-covid-19.htmDate: March 1, 2023Date accessed: June 22, 2023Google Scholar Additionally, the COVID-19 Parliamentary Commission of Inquiry revealed allegations of corruption in vaccine procurement and negligence during the oxygen shortage in Manaus.7Senado FederalComissão Parlamentar de Inquérito da Pandemia.https://download.uol.com.br/files/2021/10/3063533630_relatorio_final_cpi_covid.pdfDate: October 26, 2021Date accessed: June 22, 2023Google Scholar Third, the authors' Correspondence argues that state and municipal health funds had an excess of over R$30 billion, implying that subnational governments received more financial resources from the federal level than they were capable of effectively using. However, it is important to clarify that a substantial portion of this amount represents the cash flow of funds of intergovernmental transfers,8Viana AL Heimann LS Lima LD Oliveira RG Rodrigues SD Mudanças significativas no processo de descentralização do sistema de saúde no Brasil.Cad Saude Publica. 2002; 18: S139-S151Crossref Google Scholar rather than actual surplus resources, as inaccurately suggested by the authors. It is worth noting that this false accusation aligns with the confrontational policy adopted by Bolsonaro's Government towards governors and mayors, replacing the previously collaborative management approach that underpinned the SUS governance historically.9Abrucio FL Grin EJ Franzese C Segatto CI Couto CG Combate à COVID-19 sob o federalismo bolsonarista: um caso de descoordenação intergovernamental.Rev Adm Pública. 2020; 54: 663-677Google Scholar Fourth, the authors claim that the Workers' Party policies were focused on abortion. This blatant display of lies and misinformation is a clear manifestation of the rhetoric used by far-right populism.10Iamamoto SA Mano MK Summa R Brazilian far-right neoliberal nationalism: family, anti-communism and the myth of racial democracy.Globalizations. 2021; 20: 782-798Crossref Scopus (8) Google Scholar It is a fact that Bolsonaro's Government constantly attacked sexual and reproductive rights. Initiatives targeting indiscriminate caesarean deliveries, breastfeeding promotion, and comprehensive sex education for teenagers were disrupted or attacked.11Diniz CSG Cabral CDS Reproductive health and rights, and public policies in Brazil: revisiting challenges during Covid-19 pandemics.Glob Public Health. 2022; 17: 3175-3188Crossref Scopus (1) Google Scholar The argument that policies to decrease caesarean sections disregard the decision-making power of women in childbirth is in fact a demonstration of a complete lack of knowledge of the implications of non-medically indicated caesarean section on child development. Finally, Bolsonaro's former Minister of Health and former National Secretary of Primary Care claim that our Comment aimed to justify the horrors that will come. This absurd statement intends to evade the perverse legacy left by the Government they served. In fact, Bolsonaro's Government is currently being prosecuted for various crimes, including crimes against humanity for incitement of genocide of Indigenous peoples and irresponsible attitudes in the management of the COVID-19 pandemic, at the International Criminal Court.12Delgado M As acusações que pesam contra Bolsonaro.https://www.dw.com/pt-br/as-acusa%C3%A7%C3%B5es-que-pesam-contra-bolsonaro/a-64684213#:~:text=Est%C3%A3o%20sob%20investiga%C3%A7%C3%A3o%20os%20seguintes,de%20Estado%2C%20amea%C3%A7a%20e%20persegui%C3%A7%C3%A3oDate: Feb 13, 2023Date accessed: May 29, 2023Google Scholar All authors participated in the 2022 Health Governmental Transition Commission; AM was sub-rapporteur, RD'A was University of Brasilia's Research Professor, AC was coordinator, JGT was rapporteur, and MCC was technical support. AM, AC, and JGT have held positions in Brazil's Ministry of Health in the past. Bolsonaro's Ministry of Health's response to COVID-19 and other health challengesAs former Minister of Health and former National Secretary of Primary Care of the Brazilian Ministry of Health, we have notes to make regarding Massuda and colleagues' Comment.1 To begin, we are surprised that this Comment was published in such a prestigious journal. The authors demonstrate bias towards the subject when they use the pejorative “far-right” in the title.1 It is a manifestation of partisan political nature. This Comment is a demonstration of the narrative being used by the current government to justify the future chaos in Brazilian health care that is about to take place. Full-Text PDF
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