rounding up health


By Paulo Capel Narvai*

In those times when the earth was believed to be flat, the world was already haunted by demons, as Carl Sagan told. Almost 27 centuries after the first pre-Socratics began to consider the sphericity of the planet, among which a certain Pythagoras, the world is still tormented by ghosts and other animals. The miasma theory, almost two centuries after John Snow ended two cholera epidemics, without knowing the Vibrio cholerae, just turning off strategic taps in London, remains, for many, an explanatory model for this and other diseases.

It was not enough that, in 1522, Fernão de Magalhães completed the circumnavigation of the Earth, attesting to its sphericity, nor that Isaac Newton, in the following century, explained that gravity would allow us to inhabit any point on Earth – and not just the top of it. , so we don't fall into the void -, to get rid of ghosts and spirits that would make us sick, something that is still firmly believed.

Back in the 1990s, Carl Sagan chose a meaningful subtitle for his book The world haunted by demons (Companhia das Letras), dedicated to combating pseudoscientific and mystical explanations: science seen as a candle in the dark. He was concerned about the irresponsibility of the media with the propagation of beliefs and mysticism, in search of an audience and money. Sagan sought to reaffirm the positive and beneficial role of science and technology. He believed in the power of reason illuminating the world: “I do not know the extent to which ignorance in science and mathematics contributed to the decline of ancient Athens, but I do know that the consequences of scientific illiteracy are far more dangerous in our time than in any period” .

Em O Love in the Time of Cholera (Record), Gabriel García Márquez offers us the love story, which crosses time, between the telegraph operator, violinist and poet Florentino Ariza for Fermina Daza. It took 53 years of waiting, interspersed with Fermina's marriage to Juvenal Urbino, the doctor believed to be responsible for what Márquez considered to be the eradication of the cholera pandemic, which at the time killed thousands in Colombia.

It wasn't eradication. Love and times of cholera are still very current in this part of our round and blue planet. With some perplexity, we see the re-emergence in the early decades of the XNUMXst century of epidemics and pandemics that we thought were buried in that remote past to which García Márquez alluded. But they were just asleep. The resurgence gives us, however, the exact measure of the importance of fighting pseudoscience and, simply, ignorance, as they can kill. As much or more than viruses and bacteria.

This is what happens today in West Africa, which continues to be plagued by outbreaks of Ebola, a type of hemorrhagic fever that, in extreme cases, causes fatal bleeding. The lethality rate is high, exceeding 50% and reaching 90%. Between 2013 and 2015, one such outbreak hit Guinea, Liberia and Sierra Leone, killing more than 11.300 people. In February this year, a new outbreak in the Democratic Republic of Congo killed 502 people in six months. The lack of confidence in the guidance of health professionals is the main difficulty in controlling outbreaks.

Temer and Bolsonaro governments deepen the privatization of the SUS

There is no vaccine. The World Health Organization (WHO) recommends that countries organize health systems with equipped services and well-trained teams to perform Primary Health Care, as the best method of disease prevention.

In other words, doing what Brazil has been doing with our Unified Health System (SUS), present and organized in all municipalities. But the SUS has been, with great difficulty, surviving the attacks that are daily launched by companies interested in selling “health plans” and that, in the governments of Michel Temer and Jair Bolsonaro, have counted on the help of ministers of Health who, instead of commanding, organizing, strengthening and providing the SUS with the resources it needs, have become lobbyists for these companies. They do the opposite of what the WHO recommends – and the best science.

In this scenario, the re-emergence of diseases such as measles is not surprising, which, even with an effective vaccine, is out of sanitary control in Brazil. The accumulated in the country in the months of June, July and August 2019 registered 2.753 cases. Sanitary negligence killed four people. Only naive people, or people in bad faith, can attribute the deaths to the Morbillivirus.

At the origin of this negligence lies pseudoscience, whose lies, disseminated on social networks by irresponsible people, cause fear and insecurity in parents and guardians, but, above all, the disregard for the public institutions of the SUS. These, which suffer from chronic underfunding, are now on the verge of being simply defunded, as a result of what is known as the “EC of Death”, Constitutional Amendment 95/2016, which froze SUS resources for 20 years, correcting them by inflation, based on data from the 2017 budget. Economists forecast a loss of resources that, accumulated, could reach around R$900 billion by 2036.

One of the consequences of the validity of EC-95/2016 is the announcement, by the Bolsonaro government, of a 7% reduction in the budget for the purchase and distribution of vaccines, in 2020. The cut is equivalent to about R$ 400 million. The decision would have been inspired by anti-vaccine preaching by a “flat earth” ideologue of the federal government.

In times of measles, leprosy also resurfaces with force: after more than a decade of recording a drop in incidence, Brazil had a 14% increase between 2016 and 2018, with 25.215 new cases in 2016 and 28.657 in 2018, according to the Ministry of Health. Health.

The increase in the occurrence of leprosy, known as a “biblical disease”, is emblematic of these times of hatred, pseudoscience, ghosts and spirits haunting everyone's life, but, above all, projecting themselves on the State and influencing public policies.

Sagan is missed. But we also miss Oswaldo Cruz, Paula Souza, Sérgio Arouca and many others who, with their talent and public commitment, contributed so much to get us out of the cholera that, nevertheless, insists on not departing from our people.

*Paulo Capel Narvai Professor of Public Health at USP

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