A partisan pandemic: state government public health policies to combat COVID-19 in Brazil

Abstract

IntroductionTo present an analysis of the Brazilian health system and subnational (state) variation in response to the COVID-19 pandemic, based on 10 non-pharmaceutical interventions (NPIs).Materials and methodsWe collected daily information on implementation of 10 NPI designed to inform the public of health risks and promote distancing and mask use at the national level for eight countries across the Americas. We then analyse the adoption of the 10 policies across Brazil’s 27 states over time, individually and using a composite index. We draw on this index to assess the timeliness and rigour of NPI implementation across the country, from the date of the first case, 26 February 2020. We also compile Google data on population mobility by state to describe changes in mobility throughout the COVID-19 pandemic.ResultsBrazil’s national NPI response was the least stringent among countries analysed. In the absence of a unified federal response to the pandemic, Brazilian state policy implementation was neither homogenous nor synchronised. The median NPI was no stay-at-home order, a recommendation to wear masks in public space but not a requirement, a full school closure and partial restrictions on businesses, public transportation, intrastate travel, interstate travel and international travel. These restrictions were implemented 45 days after the first case in each state, on average. Rondônia implemented the earliest and most rigorous policies, with school closures, business closures, information campaigns and restrictions on movement 24 days after the first case; Mato Grosso do Sul had the fewest, least stringent restrictions on movement, business operations and no mask recommendation.ConclusionsThe study identifies wide variation in national-level NPI responses to the COVID-19 pandemic. Our focus on Brazil identifies subsequent variability in how and when states implemented NPI to contain COVID-19. States’ NPIs and their scores on the composite policy index both align with the governors’ political affiliations: opposition governors implemented earlier, more stringent sanitary measures than those supporting the Bolsonaro administration. A strong, unified national response to a pandemic is essential for keeping the population safe and disease-free, both at the outset of an outbreak and as communities begin to reopen. This national response should be aligned with state and municipal implementation of NPI, which we show is not the case in Brazil.

The assistance gaps in combating COVID-19 in Brazil: for whom, where and when vaccination occurs

“…For its second dose, it was observed that healthcare workers remained leading in clusters of low VR in Brazil. This event was due, among other reasons, to the period covered by the study and to political and institutional disagreements [ 42 – 44 ], which ended up putting scientific negationism and ideological aspects ahead of vaccination objectives.…”

“…In addition, due to its continental dimensions and with multiple points of tension outside the political arena, Brazil needed to seek very efficient and coordinated logistical solutions for distribution and storage. In this sense, small failures accumulated throughout the process ended up causing delays and losses during the stages of immunisation, making the country quickly susceptible to the enormous human and material impacts of the pandemic during almost the entire year of 2020 [ 42 – 44 ]. This occurrence can be verified in the vaccination proportional to the population ranking [ 45 ], in which Brazil ranked 78th at the beginning of June 2021.…”

“…This occurrence can be verified in the vaccination proportional to the population ranking [ 45 ], in which Brazil ranked 78th at the beginning of June 2021. Moreover, factors such as failures of shared management between the public administration levels; disparity and conflict between the healthcare capacity offered by public and private health systems; and actions that contributed to the country's political and economic instability, hindering more accurate and anticipated decision-making [ 42 – 44 ].…”

“…The VR observed among healthcare workers in Brazil in the first months of immunisation was negatively distinguished from other large-sized countries, for example, with the rate found in the USA [ 51 ]. This event was related to the Brazilian government's difficulty in articulating the purchase of large quantities of vaccines in the first opportunities, which ended up not only delaying the vaccination for the priority groups but also overloading the vaccination sites, which had only CoronaVac available, therefore not meeting the massive demand [ 42 – 44 ].…”

Impact of layered non-pharmacological interventions on COVID-19 transmission dynamics in Yucatan, Mexico

“…At subnational level, all Mexican states implemented (at variable timing) these mitigation strategies, 13 and compared to other Latin American countries, Mexico and Brazil showed a delayed response after the first confirmed case. ( Touchton et al, 2021 )…”