Two years of misrule – The marks of destruction

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By PAULO CAPEL NARVAI*

Bolsonaro has not fulfilled even one of his inaugural promises. But he destroyed a lot and seems satisfied with his work.

Upon taking office, on the first day of 2019, the current President of the Republic stated that his mission in office would be “to restore and rebuild our homeland, freeing it definitively from the yoke of corruption, criminality, economic irresponsibility and ideological submission”. He also said that one of his priorities would be "to reinvigorate our democracy", but described his opponents as "enemies of the homeland, order and freedom". He announced “good schools”, which, according to him, corresponds to training “for the job market and not for political militancy”, and “good jobs” with “health, education, infrastructure and basic sanitation”, respecting “our Constitution ” and the “Democratic State”.

It committed itself to the creation of “a virtuous cycle for the economy (…) without ideological bias” and that would support “the agricultural sector” so that it continues “playing a decisive role, in perfect harmony with the preservation of the environment”. He promised a Brazil that would be seen by all “as a strong, vigorous, confident and daring country” and assured that his ministry had been formed “in a technical way, without the traditional political bias that made the State inefficient and corrupt”.

For the Ministry of Health, Luiz Henrique Mandetta (DEM-MS) was appointed.

Speaking at the inauguration, Mandetta said that “to structure the SUS, we will work with a career for Brazilian public health”, but reduced the process of its definition to “medical entities and associations” and its scope to “primary care” and “areas difficult to provide”. He assured that, together with the president, whose election would have made him “extremely happy”, they would write “a new page” in Brazilian health. “Where are we going?”, he asked and replied, “We are going to cut costs”. In an interview, he stated that the SUS has a “very large budget” and that, therefore, there are enough resources. What is missing, he said, is “good management”, because “there is a lot of drain, waste, money being spent unnecessarily”.

What marks, however, the current presidential term, in the middle of the government period, in health and in SUS?

Undoing.

In its first 24 months, the Brazilian government failed to fulfill even one of its inaugural promises. But it destroyed a lot. Still, he seems satisfied with his work. His supporters are also satisfied.

Despite so much satisfaction, “corruption”, a theme so publicized in the government and in its political bases, entered the president's family and reached the buttocks of Senator Chico Rodrigues (DEM-RR), caught by Federal Police agents with around R$ 30 stuck to his underwear. Awkward silence at the Planalto Palace, either because of the location and the volume seized, or because of the involvement of Bolsonaro's vice-leader in the Senate of the Republic.

The so-called “reinvigoration” of democracy corresponded to successive attacks on the Legislative and Judiciary powers. Both are institutional protections against authoritarianism, albeit fragile ones. They have also been powerless to contain the brazen subdivision of the Brazilian State: according to data from the Federal Court of Auditors, there are more than 6 military personnel in the exercise of civil functions in the federal government. It should be noted, in this regard, that many parliamentarians not only condone, but promote this harmful practice of political clientelism.

In the economic area, the “virtuous cycle, without ideological bias” comes down to the withdrawal of labor and social security rights and the intensification of the privatist rage that, every day, under evident ideological motivation, squanders public assets in exchange for bananas, generates unemployment and deepens the country's scientific-technological dependency.

The “preservation of the environment” was completely demoralized by the “passing of the cattle” announced by Ricardo Salles, Minister of the Environment, and received with repudiation at the international level.

Nothing relevant was formulated and implemented in public policies aimed at achieving “good schools” and “good jobs”, as no program was announced for this purpose. At the head of the Ministry of Education, there were successive holders who were characterized by a notable lack of knowledge of the sector they commanded, committing crass errors when using the Portuguese language and the most total insignificance. The exact measure of the political importance of generating “good jobs” is given by the extinction of the Ministry of Labor, created in 1930 by Getúlio Vargas, transformed into a mere secretariat de Work (pay attention to the “de” instead of “do”) at the Ministry of Economy. Unemployment figures indicate a worsening of this indicator. According to the IBGE, there were 14,1 million (13,1%) in the 3rd quarter of 2020, waiting for the “good jobs” promised in office.

In health, the destruction of the best that the country has achieved since the promulgation of the 1988 Constitution, such as the Unified Health System (SUS) and various public health programs, has been horrifying Brazilians and foreigners. Of the thousands of soldiers who left the barracks for the offices of the ministries, there are those who, without professional training and disqualified to carry out sanitary and epidemiological functions, were placed in strategic positions in the national command of the SUS.

They have been the protagonists, on a daily basis, of messes that, in addition to characterizing administrative negligence, have already become part of the sector's anecdote and jargon. People no longer speak, for example, of planning, but of “planning”; primary care was replaced by “primary health care”; the word yesterday gave rise to the enigmatic (for civilians) expression “D minus 1” (and, of course, the term tomorrow, too complex for communication between civil servants, gave rise to an unbelievable “D plus 1”), both of which reveal the remarkable military sagacity and its enormous capacity to create indecipherable codes for common mortal plainclothes.

But this play on words, so much to the liking of propagandists with no ethical commitment to the public interest, only serves to cover up the scenario of destruction of national policies and public health programs under the responsibility of the Ministry of Health.

While the “expense ceiling” defined by Constitutional Amendment 95/2016 aggravates the scenario of underfunding of the public health system, the list of destruction of SUS policies and programs grows. I do not want to bore readers with lists, it being enough to point out in this regard, the mischaracterization of the national mental health policy and the disorganization of the national immunization program (PNI). In mental health, the replacement of the anti-asylum logic that has successfully managed and recognized this public policy in recent decades with its opposite, which seeks to support actions in this area by strengthening the role of the psychiatric hospital as an intervention axis, has been under way. SUS, complemented by “therapeutic communities”, mostly controlled by religious organizations.

It is a very serious setback in the actions that Brazil has been developing in mental health and, for this reason, the object of many and very harsh criticisms from professionals of various specialties in this area. In the PNI, vaccination coverage rates have never been so low on all fronts and age groups, with imminent loss of sanitary control of diseases such as measles, tetanus, diphtheria and whooping cough, among others. The re-emergence of poliomyelitis (infantile paralysis) is even considered.

The career of the SUS State, multidisciplinary, inter-federative, unique, nationwide and coordinated by the federal government, remains a chimera of health professionals, as no step was taken in this direction, failing to fulfill the promise of the then PSL candidate, reiterated by Mandetta when he took office, of a “State career”, even if restricted to doctors and primary care.

The old policy, so criticized during the 2018 election campaign, was not only maintained, but deepened in practices of political compromise and the traditional give-and-take. The “ideological bias” that the current rulers saw in the actions of the opponents, had the sign, let’s say, inverted: an attempt was made to ideologize and partisan Anvisa, reaching the point that professional servants of the regulatory body came out in defense of maintaining the agency as a health agency of the Brazilian State and not at the service of this or that government. Even so, Bolsonaro has been insisting on using the agency to threaten disaffected governors and mayors, considered by the Planalto as “enemies of the homeland, order and freedom”. Of course, the government, whose vice-leader in the Senate hides money in his underwear and whose leaders practice “cracks”, sees itself as “the Motherland” being attacked.

One of the changes that the government intended to implement in these first 24 months concerns the mechanisms for transferring SUS resources from the Union to the municipalities. With the “Previne Brasil” program, launched on 12/11/2019, it was intended to replace the model based on demographic criteria and available services, with another whose basis would be the registration of individuals, associating it with the “performance” of the teams of health.

The proposal was well received by many SUS municipal managers and could represent a welcome improvement in financial management mechanisms, but its implementation, carried out vertically, with little participation and, above all, without the necessary technological support and resources that make it possible, has been disastrous, with the federal government proving to be incapable of promoting the intended registration, through efficient articulations with States and Municipalities. A series of delaying ordinances is being necessary so that municipalities do not have their resources cut by the federal economic area, in the midst of the COVID-19 pandemic. The National Health Council considers that the government should simply back down and give up the proposed change, such is the confusion created in this process.

The pandemic, by the way, is a separate chapter in the negligence that marks the pattern of federal actions in the SUS, as I recorded in articles (epidemiological flat earthism, Doria's Gambit, and Letter to Oswaldo Cruz, among others) here n'the earth is round. The synthesis of these articles, in essence shared by several analysts of the policy to face the COVID-19 pandemic in the country, is that the federal government deliberately and criminally failed to coordinate actions and operations at the national level and, more than that , has been actively contributing to disorganize this effort from States and Municipalities.

The federal government has been sabotaging the interventions of other federative entities, under evident ideological motivation and the uncontested leadership of the President of the Republic, a notorious denialist and anti-vaccinationist. The consequence is that, in doing so, it disregards the decisions of national health conferences and resolutions of the National Health Council and, failing to use resources from specific budget allocations, is at the origin of the spread of the pandemic, with the uncontrolled increase in the number of cases and Deaths.

It is epidemiologically useless that Planalto propagandists seek to reframe words and speak of millions of “cured from COVID-19”. The absurd fact is that the Brazilian government was in charge of purchasing and controlling the national production of syringes to inject vaccines, only on the last day of 2020. For almost a year, even knowing that dozens of researches for the production of anti-COVID-19 vaccines were under development in several countries, and even in Brazil, the federal government did nothing to scale the installed capacity in the country and coordinate its production and distribution in our territory. Bar managers would do better.

In this regard, many think that Bolsonaro's main difficulty is accepting the value of science, given the president's low affection for this type of knowledge. They assume that he “has his head” in the period of the civil-military dictatorship and aspires to recreate something similar to that historical context, opposing those who look to the future. In a sense, they are right. But they are wrong.

His main opponent is not in contemporaneity, nor in the recent past, when he politically approved State terrorism and the placing of bombs in events commemorating Labor Day, such as the Riocentro attack, on the night of April 30, 1981, but way back in the timeline.

There are women and men who are ahead of their time.

Bolsonaro is, on the contrary, one of those men who are far, far behind their time. It's not that he wants to go back to the 1970s, or that he prefers the Estado Novo, or even the Old Republic. For him, to be a man behind his time is to go back even further and, reaching the period before Independence, to place himself at the turn of the Colony to the Empire.

His main conflict is with Dom João VI and, therefore, with the idea of ​​a modern State in Brazil.

With some imagination, it is possible to see him chatting with Dom João VI on sleepy Rio afternoons. The Emperor, after the Acclamation around 1818, trying to convince him of the right decision to establish a Vaccine Board in 1811, so that the State would institutionally deal with this matter and be able to prevent the occurrence of smallpox (Dom João VI he certainly still felt the pain of having lost his brother Dom José, whom he had succeeded to the Portuguese Crown, to smallpox in 1788).

And we see Bolsonaro shaking his head, denying and sketching a half-smile, nervously. The King doesn't understand me, he thinks.

And we see Dom João VI insisting that the vaccine was the future, that it would be the sanitary redemption of Brazil or something like that.

But the president of the Republic was skeptical, counterarguing that “this is how it is, some will die, but the country cannot stop” and such.

However, it doesn't take much imagination to notice the monarch's wide and incredulous eyes turned towards Bolsonaro, as if he were wondering about the future of his kingdom. But not. It is not possible to know what Dom João VI is thinking at that moment.

What is known, however, is that the Junta Vacínica was consolidated and that, contrary to a disconsolate Bolsonaro, the Instituto Vacínico do Império was created in 1846.

Back to the future, and having a man far behind his time at the head of the Republic, the Brazil of January 2021 must agree with Mandetta that “a new page” is being written in Brazilian health. An evil page. It should also be recognized that the former Minister of Health was right about something else: in addition to resources, as “there is a lot of drain, waste, money being spent unnecessarily” and even hidden in senator underpants, the SUS lacks “good management”. ” federal. And how to miss. It is not difficult to foresee that, if we continue in this direction, these two years of destruction will be followed by two more years of demolition – which could, without a doubt, turn into six years.

If it is already a nightmare, capable of haunting Dom João VI, how can this dark future be called? Will we be able to react?

*Paulo Capel Narvai is senior professor of Public Health at USP.

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