Almeida M. Brazil and a tragedy foretold. HPHR. 2021;48.
The way Brazil handled their pandemic crisis has been an active matter of discussion worldwide. Researchers across the country, as well as the international press, have highlighted that the grim outcomes the country is experiencing are largely a consequence of the current administration’s approach to minimize the impact of the pandemic, undermining science and neglecting basic public health needs.
Fifteen months into the pandemic, while many parts of the world are starting to see a return to normalcy, in Brazil, an unjustifiable delay in vaccine availability and refusal to implement or advocate for mitigating strategies has led to a continuous surge in the number of cases and deaths.
The country comprises numerous areas of highly vulnerable populations, marginally protected by a fragile healthcare and social system. Behind the mantra of “The economy must come first”, individuals were discouraged from staying home, avoiding crowds, or even wearing masks (1).
As a consequence, Brazil’s healthcare system is on the verge of collapse, with a peak daily incidence of over four thousand deaths this past April, leading to a cumulative number of half a million perished citizens. Notably, these numbers are likely underreported in light of difficult access to testing, massive delays in releasing results, and sub-notification. At the beginning of June, 2020, the Brazilian government announced the suspension of shared pandemic numbers on their official website (2-4). According to one study, Brazil’s numbers are likely 12 times higher than the official count (5).
Essential supplies, including masks, oxygen, respirators, and medications necessary for intubation are lacking even in large metropolitan areas due to President Bolsonaro’s failure to negotiate with distributors. In a country with one of the largest public health and vaccination programs on the planet, hospitals have been at capacity, ICU beds are constantly filled, and access to vaccines remains an arduous and helpless battle.
According to the former president of Pfizer in Brazil, Mr. Bolsonaro declined multiple offers the company has made to sell its vaccine, at times for half the price paid by other countries. Brazil’s former health secretary reportedly said he saw “no need for Pfizer vaccine” (6). Still according to the drug company, Pfizer made its first proposal to sell vaccines to the Brazilian government in mid-August, 2020, with a plan to deliver 70 million doses by December of that year (7). Those initial attempts were unfruitful, as were another fourteen offers by the company, all dismissed by the Brazilian leader, who maintained the discourse that he wouldn’t get vaccinated himself, adding that “it [the shot] might actually turn people into crocodiles” (8).
Facing international pressure, the country has purchased a cheaper and, according to its own manufacturer, less efficacious alternative (9).
The first doses of the Pfizer vaccine arrived in Brazil on April 29th, 2021, more than eight months and 400,000 deaths after the company’s first offer. The distribution efforts remain precarious and inequitable and, as of this writing, just over 11% of Brazil’s 210 million people have been immunized, largely with the less effective vaccine.
Even the new, highly transmissible variants to which Brazil is now hostage couldn’t deter the country’s superspreader events, such as Carnival or countrywide public demonstrations in defense of the current administration. These recent events have resulted in yet another wave, one that, at a personal level, affected me the most as it took the life of my father-in-law.
This poem is dedicated to him.
Thirteen months of lockdown and isolation
You still died
(or were you killed?)
Your fears and safeguard
Prudence and sacrifice
All infertile attempts
Impotent gestures in the face of the unthoughtful vote
Of a people brewed for years in a kakistocracy
From where yeasts of neglect and death sprout
Five hundred thousand bodies pile up
Silenced in their futile wait
Screams and sobs that would never be heard
Inaudible like the countless pleas for science
The many offers of vaccines
[Fourteen offers of millions of doses, all inaudible]
None of them would ever get to you
Or to your fellow countrymen
Myriad supplications, all muffled — like your lungs
From the loneliness of your bedroom, no one heard you
No one saw you weep or suffocate in the
Patient trust you kept in your torturing homeland
To where you insisted to always return
Now a valley of tears
Murderer, it offered you nothing but a hecatomb
A doomed destiny —
Without a voice
Without a shot.
Marcela Almeida is a psychiatrist specialized in Women’s Mental Health; a Medical Educator; and a Latina. Her research interests include diversity and inclusion, healthcare disparities, immigration, medical education, and women’s mental health.