The public health strategy

Image: Silvia Faustino Saes


The pandemic has revealed many opportunistic, populist and even fascist policies

ὁ Ἡράκλειτός φησι τοῖς ἐγρηγορόσιν ἕνα καὶ κοινὸν κόσμον εἶναι τ ῶν δὲ κοιμωμένων ἕκαστον εἰς ἴδιον ἀποστρέφεσθαι

A young lady comes to the manicure. Sitting higher than the attendants, she suddenly confuses height with superiority, takes off her mask and breathes on the others: “I already vaccinated! Who has not been vaccinated yet, that fight“. They all look at each other. The salon owner finds her another mask and points to the mandatory sign, very clear in the room. But the message is well given: for madam, the vaccine is a personal, private, individual guarantee, it is not a public thing. It doesn't matter if the other people in the room weren't vaccinated. What matters is: whoever wants, “let him fight”.

The young lady's speech is not casual. Not many days ago, the President of Brazil said that he would recommend the Minister of Health to issue a document stating that those already vaccinated and contaminated could dispense with the mask. Faced with the denialist and meaningless recommendation, Queiroga did what other previous medical ministers might not have done, justifying the president's words and even putting words that even came out of his mouth.

But this speech by the president – ​​and that of the young lady – is very important and says a lot about how Brazilians see and fight the pandemic. Because, in a pandemic like this one, in scientific and epidemiological terms, the mask has few useful if not seen as tactic within a strategy general public health. And that defines everything.

It defines everything, first of all, because when Brazilians wear a mask, many do not understand that this is a health strategy. act, and they understood that it is simply an individual measure. The Brazilian has heard the term “PPE” (protective equipment) somewhere. individually) and understood that wearing a mask is aimed at self-protection. I wear a mask to protect myself from COVID in the same way that I put on my coat so I don't get the flu in the cold or the umbrella so I don't catch a cold. After all, don't people wear a mask to protect themselves in a hospital too? Here's the proof.

And that reveals everything: if wearing a mask is an individual and not a public measure, that means, deep down, that I'm not living like I'm in a pandemic, the things I do and my customs are not oriented as if a pandemic were right in front of my nose. And it would not be useless to note how so many false treatments, from ozone in the anus to “early treatment” with vermifuge and anti-lice, were so successful in Brazil. After all, despite their falseness, they were well understood as individual care measures along with other individual measures, constituting a care network whose meaning boils down to the private sphere. Eu I take chloroquine, ivermectin, propolis, vitamin and I even use a mask to me to protect.

This would even be one of the keys to explaining how Brazil is one of the few countries where people still talk about chloroquine (of course there are other factors, such as Fake News).

In any case, this all indicates an immense lack in terms of journalism and, especially, scientific dissemination. For, even if the function of the mask is not simply individual, this is how millions of people have understood it and this is how they use it – and that when use it, because if the mask is nothing more than an individual matter, this also makes the decision to use it (even with the nose out).

It is as if, in the midst of a pandemic, an entire society forgot about the pandemic and population elements themselves.

Take, for example, the vaccines we've had since we were children: they were never seen as a simple individual matter. I can take the vaccine and still get the disease (I always learned that no vaccine was ever an absolute guarantee for me), but I never took the vaccine just because it would protect me, but because, even without understanding it right, I was always told that taking it it's needed. But why is it necessary? Well, because if people don't take it, practically eradicated diseases come back and spread, whether eu guarantee my own vaccine, or not.

Since there was the possibility of universalizing the vaccine, I was never exactly obliged (in the sense of constrained) to vaccinate myself, nor were my parents ever literally obliged to do so (and only because vaccines were so successful and universalized is they emerged the anti-vaccine movements). But the fact is that people were vaccinated, not because they “decided” or not to get vaccinated, but because vaccinating was always necessary, inevitable, a simple population phenomenon like drinking chlorinated water or answering the IBGE researcher (I never “chose” any vaccine, just as I never paid attention to the chlorine brand in my water). A new disease appeared or the expected date and… vaccine.

It is precisely this that is decisive regarding the individual use of the mask or the “decision” to get vaccinated in this pandemic. Mask and vaccine are little seen as a public and collective issue. Take the case of the mask: in epidemiological terms, wearing a mask has never been just personal care, because as a purely personal care in the COVID pandemic, it is not absolutely effective. Now the mask is essentially effective as collective care.

This is the element of what we call public health. If I wear a mask, I reduce in something of the probability of getting infected, but I reduce very the chance of infecting someone else. This means that a population network of people wearing a mask is a very effective protection network, not individual but collective.

In practice, it means saying: I have no absolute guarantee that I will not get infected, but I have a certain guarantee that the pandemic rates will reduce immensely, or not increase as they would if people did not wear a mask. Moral of the story? Because I and others wear a mask, my chances of getting sick become minimal, they decrease much more than if I alone decided to wear a mask (a bit like I already knew about collective immunity in cases of measles or infantile paralysis).

And then we understand how the mask is one among other public health tactics, and why its meaning should never have been merely individual. But there's more: wearing a mask should be just one of the other tactics in an overall strategy, the most important of which is social isolation.

Anyway, once again we understand why people are more likely to use dewormer and create superbugs with useless medication, instead of isolating themselves in a pandemic. It is also possible to understand why speeches flirting with fascism say that governors and mayors interfere with individual freedoms when they preach isolation or fine masks. After all, everything is seen as just individual... And if everything only affects the me, so it's each one for himself and God for all (and who has never heard the saying that only “those who can” isolate themselves?).

It is no wonder that, even with the advancement of the vaccine, in a certain sense Brazil has not vaccinated millions of people, but only social atoms, since the issue does not seem to be population-based (collective immunity) but rather private (each one “fighting for yours”). Just be in a vaccine queue and listen to the gossip. If the central concern is “which vaccine will be mine”, if vaccines have preference defined by chains of WhatsApp, it is because many people understood that the problem is individual and not collective (not even caring that this is a false problem). It is also not uncommon to see people going to the vaccine booth just to deny it. And if there are so many cases of nurses pretending to apply the vaccine to save the dose, it is because the measure does not concern everyone, but the my vaccine. If the vaccine is a decision my, I can then maintain the same individual conduct (for or against transmission), not caring about others but placing the vaccine alongside the other items of my private care network. After all, whoever wants to “fight”.

This all says a lot about Brazil. The pandemic has revealed many opportunistic, populist and even fascist policies. But it has also revealed what kind of people it is that makes fascism and populism possible. It is the people who become atomized, lose the element of collective solidarity and, sometimes, do not even understand – or worse, neglect – what public health means.

*Marcio Luiz Miotto Professor of the Philosophical Foundations of Psychology at the Fluminense Federal University.


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