Apr 20 2023 | Nº. 63

Editorial

On Thursday, April 20 during the Fourth Major Economies Forum on Energy and Climate, President Joe Biden announced he would be asking Congress for $500 million for Brazil’s Amazon Fund to combat deforestation. This was ten times what he had initially proposed in February during President Luiz Inácio Lula da Silva’s visit to Washington DC. At the time, Biden had said more money would follow. The higher value announced this week might well have come anyway, but it is impossible to consider the offer apart from the events of the last week. Many worried about the state of US-Brazil relations in the wake of Lula’s visit to China. In addition to his warm embrace of Xi Jinping’s government, Lula also reiterated his belief that blame for Russia’s war on Ukraine does not rest exclusively with the Kremlin. At one point, US National Security Council spokesman John Kirby even accused Lula of "parroting Russian and Chinese propaganda,” a harsh criticism made on the record. 

Lula’s theory of the case, however, has long been not only that Brazil should resist choosing sides in the budding cold war between Washington and Beijing but that Brazil stands to gain materially from an independent streak on the world stage. In that context, the $500 million Biden proposed on Thursday was seen as a reaction to Lula’s China visit. 

Diplomatic events this week served as a reminder that the world is very different now than it was twenty years ago when Lula first won the presidency. China is no longer a rising power — it is already a global power in its own right. Russia is now a clear enemy of the West, which it was not in 2002. In steering an independent course, Lula must navigate a more complicated set of global relations. Independence is a clear strategy, despite what some of his critics suggest. If it can deliver real material gains for Brazilians, it will likely be considered a success. If living standards do not improve for Brazilians over the course of this administration, however, Lula’s foreign policy will likely play into a narrative that he is too old and backward to lead Brazil into the next decade. Despite some concerns about where Brazil stands, new trade deals with China and a hefty offer to fight deforestation from the Biden administration indicate Lula should not be dismissed as a capable steward of Brazil’s international standing.

Highlights

• MINISTERIAL DOWNFALL. General Gonçalves Dias, the government minister in charge of the Institutional Security Office, resigned on April 19. In doing so, he became the first member of Lula's cabinet to leave his or her position in the first three months of the new government. The general presented his resignation after CNN aired images from the closed-circuit TV of the presidential palace showing Dias and other members of his team talking and even serving glasses of beer and water to the extremists involved in the invasion of the building on January 8.

• OBSCURE POINTS. It is not yet clear why these images have only been made public now, if they were filmed on January 8. Why did Dias act in way indicating complicity with the coup plotters in front of closed-circuit cameras that he knew were there? The Institutional Security Office, commanded by Dias, has been a well-known stronghold of Bolsonaro’s supporters, but the general was seen as someone who had Lula’s confidence, having handled the security of the Brazilian president in his two previous terms.

• CONGRESSIONAL INVESTIGATION OF THE COUP. The publication of these images and the fall of Dias gave new impetus to opposition parliamentarians who had been gathering signatures to set up a joint commission of members of the the Senate and the lower house to investigate what took place on January 8. Initially, the Lula government saw this congressional investigation as a threat because it could serve as a stage for pro-Bolsonaro congressional members to create or reinforce their conspiracy theories. The most popular of these conspiracies insists that the Lula government tried to set up the security forces so that they could be accused of supporting the coup attempt, as a way to incriminate Bolsonaro and his followers. To avoid the circulation of these false claims, government supporters had been opposing the creation of this congressional investigative committee. But the nebulous episode involving Dias altered the scenario, causing congressional representatives and senators loyal to Lula to change their minds and start defending the establishment of the committee in the hope of further exposing the nature of the coup attempt by Bolsonaro’s supporters.

• COUP MAKERS IN COURT. In a majority decision, the Brazilian Supreme Court decided on April 19 to indict a first group of 1,390 people accused of involvement with the failed coup attempt of January 8. The group is only a part of those denounced for planning, financing, and executing the anti-democratic actions of far-right militants linked to former president Jair Bolsonaro.

• MORO CHARGED. Senator Sergio Moro, a former Operation Car Wash (Lava Jato) judge who was responsible for Lula's arrest and later had a brief stint as Bolsonaro's minister of justice, was charged with slander on April 17. (Because he is a sitting senator, the case is heard before the Supreme Court.) The complaint concerns a comment he made at a social event that Supreme Court Judge Gilmar Mendes was corrupt and capable of granting a detainee freedom for a bribe. The complaint was surprising because it was made by the Attorney General's Office, a body that became famous for having been silent in relation to numerous cases involving Bolsonaro and politicians close to him over the last four years.

• APPROACHMENT WITH RUSSIA. Russian Minister of Foreign Affairs Sergei Lavrov made an official visit to Brasília on April 17, where he was received by Brazilian Foreign Minister, Mauro Vieira. The trip is part of a tour of the region that also includes Nicaragua, Venezuela, and Cuba. Lavrov said that Russia and Brazil have convergent views on the war in Ukraine. The Russian highlighted aspects of Lula's speech and those of Celso Amorim, a special presidential advisor on foreign affairs, which are closer to Moscow's positions in relation to the conflict.

• U.S. PRESSURE. Jake Sullivan, US National Security Adviser, had a telephone conversation with Amorim the day after Lavrov's visit. In addition, John Kirby, Coordinator of Strategic Communication of the National Security Council at the White House, criticized Brazil for, according to him, repeating Russia's arguments about the war. Amorim rejected the criticism and, in an interview with a Brazilian newspaper, stated that US support for the defense of democracy in Brazil was not a pact and that there is no obligation on the Brazilian side to follow American positions.

Feature Article

by Pamella Liz

The Impact of the Four Years of Bolsonaro's Government on the Brazilian Unified Health System (SUS) and the Perspectives for the Coming Years. A Summary of a Dismantling

During the four years of former Jair Bolsonaro's presidency, the government-run Unified Health System (SUS, which was undermined since its creation, underwent one of its worst administrations. Due to its hidden death logic of the "herd immunity" strategy, in which the economy was placed ahead of the lives of Brazilians, Brazil has had more than 700,000 deaths from COVID-19. This very number represents the crimes committed against the population, including the dissemination of false news, fraud in bids to obtain vaccines, and encouragement of ineffective treatments by the government. Among the most widespread alleged miracle solutions was the use of hydroxychloroquine and ivermectin, which had already been discarded as a treatment by scientists and health authorities.

Even before being elected, throughout his campaign, the former president already announced plans to privatize the health sector, which was already operating well below its capacity due to the spending ceiling imposed by the government of President Michel Temer (2016-18). The situation of underfunding and the scrapping of the Unified Health System, which in itself was evident and worrying, turned into an unprecedented tragedy when the pandemic struck: Brazil has 2.7 percent of the world's population and 11 percent of the deaths from COVID-19 worldwide.

In addition to the serious situation with regard to the pandemic, the criminal nature of Bolsonaro's management left a trail of measures to dismantle and cause to fail the Brazilian health system as a whole. Amidst the various fake news propagated against the COVID-19 vaccine, the sharp drop in all vaccine coverage over the last few years was also evident. Until 2015, Brazil maintained vaccination coverage of more than 95 percent for all vaccines in the national immunization plan. Unfortunately, today we have inadequate vaccination coverage for children under one year of age, and diseases that have already been eradicated, such as poliomyelitis and measles, are re-emerging in the country. During the Bolsonaro government, there was also an increase in waiting lists for elective surgeries; a lack of essential supplies and medicines in health units, especially during the pandemic; the dismantling of the health industrial complex (which caused the huge crisis in the production of vaccines for COVID-19, the lack of masks, and other PPE); the weakening of Primary Care and Family Health Strategy; and the mischaracterization and criminalization of the More Doctors program, which is essential to overcoming the lack of care in remote regions of Brazil.

The logic in favor of privatization, combined with contempt for the most vulnerable, led to the tragedy experienced by the Yanomami indigenous community, who suffered from malnutrition, infant mortality, and mercury contamination, caused by illegal mining in indigenous territories, a crime of genocide denounced at the International Criminal Court in The Hague. In addition, a huge number of pregnant women died from COVID-19. The lethality rate for pregnant women in Brazil was eleven times higher than the average for Latin America and the Caribbean during the first year of the pandemic, and nothing was done by the government in relation to this situation, other than recommending that women not get pregnant.

Looking to the Future without Forgetting the Past

The effects of Bolsonaro's criminal management are devastating. However, today we have hope of breathing freely again in a democratic environment. After the election of President Luiz Inácio Lula da Silva, health has once again become a priority for the government, and a lot of work is being done to rebuild the SUS and the Ministry of Health. In the last days of December 2022, Nísia Trindade Lima, the new minister of health, received a final report from the Transition Team Working Group on the Health Situation regarding the state of the health system left by the previous administration. The document also contains the solutions devised by the team to overcome the dismantling of the health sector, among which the following stand out: an emphasis on the commitment to the National Health Council (CNS), which is fundamental for public control and participatory management of the SUS; the strengthening of the health authority and technical capacity of the Ministry of Health, with greater attention to cybersecurity; restructuring of the Health Economic and Industrial Complex; recovering the high vaccination coverage through the National Immunization Program (PNI); strengthening the country's capacity to respond to public health emergencies; tackling accessibility to specialized care; and implementing a new concept of Primary Attention to Health (Atenção Primária à Saúde, APS), which seeks to reorganize primary care in the country. The government also intends to launch restructured versions of the most popular medical and pharmacy programs.

We still have a lot to do, bearing in mind the extent of the problems we have acquired. However, the prospects are positive, and the Brazilian health system, despite the attacks, still has the capacity to return to being a global example of comprehensive care.

We will certainly return to the SUS that we once had, an example of excellence with regard to vaccination, especially childhood vaccination, HIV/AIDS treatment, tobacco control, and access to urgently needed medicines. More than 70 percent of the Brazilian population depends exclusively on the SUS to meet their health needs; therefore, protecting the largest public, universal, and free health system in the world must be the center of the reconstruction of Brazilian democracy. As Sergio Arouca said during the Eighth National Health Conference, which gave rise to the SUS: “Democracy is health!”

Pamella Liz is a social scientist and public health specialist. She is currently a postdoctoral intern at the School of Public Health of the University of São Paulo (FSP-USP), where she works on the international project "Social Mobilization as a Policymaking Lever"? A Trans-Atlantic Covid-19 Dialogue on Community Action and Decentralized Governance," carried out simultaneously in Brazil, Canada, Germany and Peru. Her research analyzes media and scientific representations, and the life stories of people and groups in precarious and vulnerable situations from the perspective of gender, race, class and collective health studies. In 2020, Pamella was a research assistant in the Global Urban Studies Program at Rutgers University, and in 2021 she was a postdoc fellow in the Epidemic Ethics Group (Oxford University), led by the World Health Organization (WHO).

Feature articles express the opinions of the author and do not necessarily reflect the opinions of the editors or WBO.