Opinion – Atila Iamarino: Brazil vs USA in the pandemic

The US has reached the mark of 1 million deaths from Covid-19. An impressive number that shouldn’t be surprising. If Brazil had a population equivalent to theirs, we would have surpassed this mark in February of this year. Our deaths were proportional in the pandemic until the beginning of 2021 when Brazil had a brutal shot. And now we’re approaching again. It is worth understanding the public legacy that explains part of this story.

Public infrastructure can deliver results for centuries, like the more than 80,000 kilometers of roads built by the Roman Empire over a thousand years ago. Current population, economic activity and even the presence of roads in the 2000s have a strong relationship with roads built to move Roman troops and supplies in the 5th century. Especially in Europe, where they continued to be used and maintained, which is still reflected in the prosperity of regions like Lyon and Paris in France.

And the same seems to have happened in South America, with roads from the Inca Empire that continued to be used by the Spaniards. In Peru, indices such as wages and even child malnutrition and school performance are even better in regions closer to the Inca Trails.

In the pandemic, we could see other results from public infrastructure. The US has spent the last century investing heavily in science and technology and reaped that benefit in the pandemic. This is where many fundamental tools for understanding Sars-CoV-2 came from. And at least two vaccines that we use, the Oxford/AstraZeneca vaccine and the Janssen vaccine, have had US government investment and were one of the first countries to start vaccinating their population.

But it was in vaccination that they ran into the lack of another public infrastructure: health. In a country without something like our SUS, without a health post to distribute vaccines against Covid, they had to hire pharmacy chains and supermarkets for this, at the cost of a lot of waste.

Where people may have to pay thousands of dollars for ambulance transport, there is also no culture of visiting the health post and getting vaccinated. This has given rise to much vaccine hesitancy and an anti-vaccine movement so virulent that it has stalled the population at two doses at 66% in the US. More than 650,000 deaths occurred there after vaccination began, most concentrated among the unvaccinated. And they will experience the same problem in the next pandemics. Without a public health system, even if they give masks and vaccines, unvaccinated people will continue to suffer.

Here, the ideological alignment with the federal government concentrated deaths before vaccines. But, thanks to more than a century’s investment in health policies and in institutions such as Butantan and Fiocruz, this infrastructure overcame the denial of the federal government and the anti-vaccination movement.

More than 77% of Brazilians took two doses and we no longer see waves of deaths like the ones the US still faces. We could have even fewer deaths if the federal government had not promoted the contagion by Covid.

Despite constant cuts, neglect and attacks by the federal government, our public infrastructure still benefits us. And saved thousands of lives in the pandemic. But to continue to deliver results, it needs to be maintained with funds, public awareness and the support of government officials. In the absence of this support, our childhood vaccinations continue to decline.

No Brazilian state has reached the measles vaccination target in 2021. Now that we will have to take care of millions with Covid sequelae, we will once again need health infrastructure for preventable diseases like measles and, probably, polio.