Health experts welcome Brazil COVID-19 inquiry findings
Authors: Lise Alves
Journal: The Lancet (2021)

A senate investigation has recommended indictment of officials including President Jair Bolsonaro over the handling of the COVID-19 pandemic. Lise Alves reports from São Paulo. A Brazilian senate committee investigation approved on Oct 26 a 1200-page report that recommends the indictment of over 80 people and two companies on charges of inciting an epidemic, crimes of responsibility, delays in negotiating the purchase of vaccines, and marketing of dubious treatments that have no scientific backing. Among those charged are Brazil's President Jair Bolsonaro, three of his sons, and some current and former cabinet members. According to the report, “the constant minimization of the severity of COVID-19, the creation of ineffective mechanisms for the control and treatment of the disease, the lack of political coordination, the lack of educational campaigns on the importance of non-pharmacological measures, personal behavior against these measures, and the omission and delay in the acquisition of vaccines were some of the conducts of the head of the Federal Executive Branch that unquestionably attacked public health and administrative probity.” Medical experts told The Lancet that the report tried to show and clarify all the negligence and mistakes witnessed in the handling of the pandemic. “The CPI [Congressional Investigation Committee] was useful in the sense of deconstructing certain myths that had been built around the virus and the treatments, demystifying information conveyed by government officials and the President himself that were untrue”, said Margareth Pretti Dalcolmo, pulmonologist and researcher at the Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro. For Pedro Hallal, epidemiologist and professor at the Federal University of Pelotas, Rio Grande do Sul, said the report also helps bring some closure to the many affected by the pandemic. “I see it as very positive. The report brings justice to the more than 600 000 families who are in mourning in Brazil. The report is in line with our views, as scientists, that there were failures, some of them intentional, which can help explain the fact that Brazil has a mortality rate five times higher than the global average”, Hallal told The Lancet. According to Cesar Eduardo Fernandes, president of the Brazilian Medical Association, the report was ample, investigating “everything that should be investigated, and addressing all the points that raised doubts and concerns.” “It [the senate] did a proper job. It identified what needed to be investigated...so that those responsible may eventually be punished”, Fernandes said in a telephone interview. The report, which comes after a 6-month investigation into the Government's handling of the pandemic, accuses President Bolsonaro of crimes against humanity. Bolsonaro criticised an earlier version of the report at a rally 2 weeks ago: “Nothing has been produced, apart from the hatred and bitterness seen in some of us. But we know we are absolutely not to blame. We did the right thing from the first moment.” For medical experts the delay in purchasing vaccines, false statements about the virus, the campaign for unproven medical treatments, and the belief that obtaining herd immunity through widespread infection was the best solution were some of the most important issues exposed by the senate committee investigation.“Brazil, which today vaccinates 1 million people per day, started vaccinating in February of 2021 only 300 000 people per day, because they lacked vaccines”, says Hallal. “This shortage of vaccines at the beginning was directly responsible for a lot of deaths”, he explains, adding, “The worst moment of the pandemic in Brazil was March, April, May, when vaccines, if administered, would have reduced the number of deaths.” During the congressional investigation, evidence was shown that approximately 101 emails from biopharmaceutical company Pfizer were sent to the Brazilian Government offering COVID-19 vaccines. According to the Congressional report, none of the emails were answered by the Bolsonaro administration. Although clinical trials of CoronaVac and the Oxford–AstraZeneca vaccines were done in Brazil, the Government, Dalcolmo says, was slow to capitalise. “Brazil carried out the phase 3 studies at an appropriate time, but it should have made the procurement of these vaccines at that time, and it did not. Brazil made a procurement for vaccines in the COVAX system of only 10% of the Brazilian population and not 30% or 40% it should have purchased”, she said. “The delays hurt a lot. We had interruptions of deliveries of IFAs [raw material to produce the vaccines] and delays in the arrival of ready-made vaccines”, adds Dalcolmo. “If we had vaccinated people sooner, we would have reduced the number of deaths for sure.” Fernandes agrees. “If this delay was due to some negative Government intervention, which made the purchase difficult because they wanted to have some [monetary] advantage in the purchase of these vaccines, it is a crime.” Earlier massive vaccination drives would not only have decreased deaths in Brazil but also worldwide, says Hallal. “How many people in the world died due to lack of control of the variant that emerged in Manaus? These deaths were a consequence of denialism and not by chance.” False statements, such as that COVID-19 was similar to a cold, that the vaccines were harmful (including Bolsonaro's suggestion that vaccination could turn recipients into crocodiles), and about the efficacy of drugs such as chloroquine were also noted as important issues investigated in the report. “I think the spread of information which cast doubts against vaccines, which are our most powerful weapons in combating this virus, was one of the things that harmed people the most. This discourse did a lot of harm to the country as a whole”, says Dalcolmo. Hallal notes that doubt is part of science. “Science starts with doubts. The fact that Bolsonaro had doubts whether lockdown worked or not, whether chloroquine worked or not, whether vaccines would work or not, is acceptable”, he says, but adds that “the moment these questions were answered by science, Bolsonaro never had the humility to change his mind, to accept the data of science”. As for the discussion over the use of a cocktail of drugs, including ivermectin, chloroquine, and azithromycin, scientifically unproven to treat COVID-19 and dubbed in Brazil “Kit Covid”, medical experts interviewed by The Lancet had mixed feelings. “The Kit Covid has ceased to be controversial for a long time. This discussion is a waste of time. This discussion is obsolete; however, it continues to be encouraged”, says Dalcolmo. Hallal said: “The problem is not necessarily the ingestion of [non-proven] medications, but the false sense of security that was passed on. Many people believed they could be exposed to the virus because if they caught it there was a drug cocktail that the President boasted would save them”. The discussion surrounding the promotion of herd immunity was also seen as important by medical personnel. “The strategy of allowing everyone to get contaminated in order to do away with the pandemic was tried in some other places around the world, like the UK and Sweden”, says Hallal, adding, “but these places soon realised they were wrong and changed their stance. Brazilian officials, however, never changed their position.” As for the practical results of the report, experts say that the consequences are likely to affect future policies and health crises, not the COVID-19 pandemic. “I hope that the senate investigation's result can work at the collective unconscious level of the population, by increasing the belief of the importance of trusting scientific data. The world needs to be prepared; Brazilians need to be prepared for the next epidemics”, states Dalcolmo. “I think that this report, even if it takes a while, will generate punishments at the responsibility level, at the criminal level, which will lead other administrators, when faced with similar situations, not to make the same mistakes. The great lesson of this report for future leaders is listen to science”, concludes Hallal. Others, like Fernandes, are wearier. “For the first time in my life I saw doctors making decisions based on ideological principles, political principles, and partisan principles rather than what the medical society recommends”, he says. According to Fernandes, part of the damage done with misleading statements and mismanagement of the pandemic by the Bolsonaro Government is likely to be permanent. “There are still many people who are convinced that the Government did the right thing in terms of Kit Covid, vaccines, etc. I find it very difficult to reverse these convictions”, he says. Fernandes points out that days after the first draft of the report was released, President Bolsonaro shared a video on social media linking the COVID-19 vaccine to an increase in the incidence of AIDS. “Things have not changed”, he warns. Due to the video, Senators added to the final report calls for President Bolsonaro's removal from all social media indefinitely. The negative repercussions led the video to be deleted by YouTube, Facebook, and Instagram. The indictment recommendations in the final senate investigative commission report will be forwarded to the country's Attorney General's office and Brazil's Supreme Court for further legal inquiries. The charges against President Bolsonaro for crimes against humanity will be sent to the International Criminal Court.