Brazil’s COVID Response is Becoming a Global Liability

RIO DE JANEIRO - Almost one year ago to the day, President Jair Bolsonaro stood, testily, outside the presidential palace as a team of journalists pressed him on the threat of the then-novel coronavirus.

As he waved off their questions, one journalist jumped in. “But COVID-19 could cause more than 200,000 deaths in the country.”

“What country?” Bolsonaro scoffed. “We need to get rid of this sense of fear and panic and terror from people’s heads. My God, you have to face the virus!”

One year later, a punishing third wave has catapulted Brazil past the 300,000 death mark. As the country continues to break its own daily records for COVID-19 case and death rates, health experts worry that it has created an ideal environment for the virus to mutate. If unchecked, new variants could even harm vaccine efficacy, prolonging the pandemic at a global level.

Once known for its successes in combating malaria and quashing the HIV/AIDS epidemic, Brazil’s COVID-19 mismanagement has seen it fall from being a public health reference to international pariah. “Brazil has an excellent history in immunization,” said Conrado Estol, a neurologist based in Buenos Aires. The country managed to vaccinate 18 million children in a single day during its anti-polio campaign in 1980, he pointed out. 

"Brazil is a country with an excellent scientific capacity, and we are being criticized,” said Ana Tereza Vasconcelos, a geneticist and program coordinator at the Bioinformática Laboratory. “It is sad that we are being seen this way by other countries, but they are absolutely right." 

“It has been horrifying to watch,” said Andrea Taylor, assistant director at the Duke Global Health Innovation Center (GHIC). Taylor stressed that higher-income countries had fallen into similar crises of uncontrolled transmission. “That said, the Brazilian government’s response has been incredibly chaotic, its messaging completely divorced from the science of epidemiology.”

Since calling the pandemic a “measly flu” more than a year ago, Bolsonaro has since pushed a combo of mask-use skepticism and enthusiasm for unproven treatments like hydroxychloroquine and ivermectin (an anti-parasite pill). As the pandemic’s death toll soared, Bolsonaro would periodically question official data, pointing to comorbidities or shrugging off the deaths entirely. 

“It has been the denial of the president and his team in their management of the pandemic that has brought us to this point,” said Ethel Maciel, a professor and epidemiologist at the Federal University of Espirito Santo. 

“We never had a true lockdown,” said Rômulo Neris, an immunology PhD candidate at the Federal University of Rio de Janeiro. As a result, Brazilians have, for the most part, remained out and about over the last year. Since peaking at 62 percent in March of 2020, Brazil’s isolation index, as tracked through smartphone GPS data, has remained consistently below 50 percent, according to Inloco, a tech startup that developed the index to measure the efficacy of social distancing measures. 

Experts had predicted in April 2020 that 75 percent isolation would be necessary to avoid an eventual health system collapse. Still, the president continues to publicly critique social distancing measures, disparaging local governments’ attempts to enforce stay-at-home policies as recently as yesterday. 

Intensive care units now sit at above 80 percent occupancy in 25 of Brazil’s 27 states, and the country has broken daily records for COVID-19 deaths several times over the last week. 3,869 Brazilians died on March 31 alone.

With nearly 67,000 deaths in a single month, March 2021 has become Brazil’s deadliest so far. The country is now responsible for around a fourth of all COVID-19 deaths in the world each day. 

Vaccination efforts have seen frequent stoppages for lack of supplies, the result of a lack of federal leadership and Bolsonaro’s continued insistence that vaccination would be optional and maybe unnecessary. Though currently fifth in the world in total vaccine doses applied, the one-time vaccine poster child (Brazil even has its own vaccine mascot, known as Zé Gotinha) ranks 60th for doses per 100 people, just below Mongolia.

“Given all of the installed health capacity that we have in Brazil, this vaccination campaign is embarrassing,” said Maciel. 

The proportionally low vaccination rate has allowed the virus to rage unchecked, leading to the creation of variants like P.1, born in the Brazilian state of Amazonas, just months ago. 

Traced to the Amazonas capital of Manaus no earlier than December 2020, the highly transmissible P.1 became the dominant strain in Amazonas in a matter of months, quickly spreading to other states. It now accounts for some 83 percent of cases in Rio de Janeiro, according to the Fiocruz Health Institute, and is present in at least 15 countries, according to the WHO. 

“We can’t let it keep circulating,” said Felipe Naveca, a virologist and vice-director of research at Fiocruz‘s branch in Amazonas. Naveca lost his father to Covid in May 2020 only to watch the state overrun with new cases in January 2021. Still, he emphasized that P.1 was just one possible variant, and new mutations — driven by high transmission — could lead to even more dangerous variants. “The virus will continue to evolve if we give it a chance. That is what we saw here in Amazonas.”

“It doesn’t matter what lineage it is,” agreed Vasconcelos, who said she had lost another colleague to COVID just before speaking with VICE World News. “The more people there are transmitting the virus to one another, the more mutations we are going to see.”

Preliminary studies suggest P.1 may be capable of causing reinfection, and Fiocruz has registered three cases in which the P.1 variant reinfected people who had previously tested positive for COVID-19. While such reinfection may not have been the cause of new waves in Brazil, said Naveca, new mutations could lead to variants adapted to effectively bypassing anti-bodies. “It seems like the virus is testing possibilities, looking for a way to evade the immune response.”

That could mean trouble for vaccination campaigns. 

Though currently available COVID-19 vaccines appear to be effective against P.1, further mutations are likely to adapt more problematically, leading to an extended crisis — even among countries well along in their vaccination campaigns. That could create a protracted scenario in which the world is “chasing variants with boosters,” according to Taylor.

“We need to have a coordinated global response, and Brazil has shown us this viscerally,” said Krishna Udayakumar, director at Duke’s GHIC. If allowed to freely circulate elsewhere, other countries with high transmission rates could soon follow in Brazil’s footsteps. “We could end up playing an indefinite game of whack a mole.”