- Marcia Castroprofessor of demography and chair of the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. She also co-chairs the Brazil Studies Program at Harvard’s Center for Latin American Studies.
As coronavirus infections worldwide approach 10 million, nearly half can be found in the two largest countries in the Americas: the United States and Brazil, which now has the worst infection rate in the world and could surpass the U.S. death toll next month. “What we see in the country is a reflection of the leadership that we have,” says Marcia Castro, professor of demography, chair of the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health and co-chair of Harvard’s Brazil Studies Program, noting far-right President Jair Bolsonaro has downplayed the pandemic’s severity and undermined efforts to enforce protective measures. We also discuss the country’s participation in vaccine trials, the impact of the crisis on Brazil’s Indigenous population, and the spike in COVID in the three most populous U.S. states of California, Texas and Florida.
AMY GOODMAN: This is Democracy Now!, democracynow.org, The Quarantine Report. I’m Amy Goodman here in New York, with Nermeen Shaikh broadcasting from her home. Hi, Nermeen.
NERMEEN SHAIKH: Good morning, Amy. And welcome to our listeners and viewers around the country and around the world.
AMY GOODMAN: Well, as COVID-19 cases soar in the United States to a new single-day high, we look at how the pandemic is devastating the hemisphere’s two largest countries: the United States and Brazil. We’ll start south in Brazil.
As the number of confirmed coronavirus infections worldwide approaches 10 million, nearly half of all of them can be found in the Americas, in part because of an explosion of cases in Brazil, which now has the worst infection rate in the world. Some epidemiologists say the death toll of the pandemic in Brazil could pass the United States by next month.
This comes as a judge has ordered Brazil’s far-right President Jair Bolsonaro to wear a mask in public, or he’ll face a fine of nearly $400 per violation. Bolsonaro continues to attend massive political rallies across Brazil.
During a virtual briefing Wednesday, the World Health Organization’s Marcos Espinal said Brazil is not doing enough testing.
MARCOS ESPINAL: [translated] Brazil is a country that has many resources, that could increase the number of tests it’s conducting. Over the past few weeks, Brazil has made progress in increasing its testing for COVID, but Brazil still doesn’t arrive at 10,000 tests for each million residents, and it’s necessary that they do more.
AMY GOODMAN: Meanwhile, Brazil is joining other countries in testing an experimental coronavirus vaccine created by Oxford University. But the country’s health minister says the government has yet to strike a deal to get the vaccine if it works.
Well, for more, we’re joined by Marcia Castro. She’s professor of demography and chair of the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. She also co-chairs the Brazil Studies Program at Harvard’s Center for Latin American Studies.
Professor Castro, we welcome you to Democracy Now! Why don’t you start off by talking about the scope of the problem in Brazil, approaching only the United States, which is number one in the world when it comes to these coronavirus cases of infection and deaths. We’ll talk about the U.S. in a minute, but talk about what’s happening in your country, in Brazil.
MARCIA CASTRO: Good morning, Amy. So, I just want to start by saying that the frustrating thing about this story is that Brazil could be teaching a lesson to the entire world on how to respond to a pandemic by leveraging its history, its network of primary care, which is one of the largest in the world, and by using its universal healthcare system. And yet, what we see in the country is a reflection of the leadership that we have, so a leadership that has and continues to downplay the importance of the virus, that neglects science — and that’s an important point, as well — and that creates a situation that mayors and governors who want to give the right response to implement actions, they face this situation that they are doing something that goes against what the president says. So it makes it hard for the population to adhere to what they are trying to do.
And it also is a failure because we could have our community health agents — and we have almost 300,000 of those — being the backbone of the response. And yet, the primary care and the community health agents are not being used as part of the response. So, Brazil is not testing enough, as you said. Well, we are not doing contact tracing, either. So, the community health agents could be doing the contact tracing. They could be identifying the elderly, the people that are more vulnerable. They could identify those people that don’t have water at home.
That’s the other thing. So, Brazil is a country with lots of inequalities. We cannot expect that you’re just going to take whatever countries in Europe or high-income countries have done, and implement in Brazil and it’s going to work. It really has to be adapted to those inequalities of informal labor, people that can’t stop working; people that live in very high-density households, so there is no way they can do self-isolation; and people that don’t have access to water. And we keep going with inequalities — the number of hospital beds and physicians per population. Those numbers are worse in the states in the Amazon region. It’s not by chance that we see the regional pattern of deaths in cases in Brazil that we are observing.
And it’s a shame that they could be very different if we actually use what we have. We don’t have to reinvent the wheel, but just use the network of healthcare resources the country has. And we are neglecting to do this.
NERMEEN SHAIKH: Professor Castro, you’ve mentioned — you just talked about these community health centers and how they could be used for this, to combat this pandemic. But I’d like to ask about, first of all, the region that’s been the worst affected by the pandemic in Brazil, namely the Amazon, and whether such community health centers exist in the region. I mean, the situation is so bad. We spoke to world-renowned Brazilian photographer Sebastião Salgado last month, and he said that the Indigenous population of the Amazon are effectively facing a genocide, if the government doesn’t intervene. They are so vulnerable and have died in such large numbers. So, could you talk about access to health services in the Amazon, why the region has been disproportionately affected, and also the accelerated rate of deforestation that’s presently occurring and how that’s impacting the spread of the virus?
MARCIA CASTRO: Yeah, that’s a very important point, Amy. So, what we have is, the region already has the worst indicators in terms of health services. So, it is the place in Brazil where you have the lowest numbers of hospital beds per person, physicians per person. Many municipalities don’t have hospitals and ICU beds; then it’s even worse. So, you already start the pandemic having fewer resources in those places.
In addition, we have several communities in the region that have the other inequalities that I mentioned. Overall in the Amazon region, 43% of the population don’t have access to water. But in some states, it’s even higher than that. Then there is a completely separate healthcare for the Indigenous populations, and those have lost a lot of the physicians in the past few years when a large program that existed in Brazil that brought foreigner physicians to work in those underserved areas was completely dismantled. So, again, you keep adding those layers, right?
So, since this new president took term, there is not a lot of attention in terms of preserving the environment. In fact, last year, we saw rampant deforestation, a horrible fire season. And this year, we already overpassed the deforestation from last year, and we still have about a month and a half to go of the cutting season. So, whenever you have this deforestation, you have contacts of those people that want to exploit the land with Indigenous areas. We see that it’s exactly in the Indigenous reserves where we are seeing most of the damage. And those areas are supposed to be preserved, and then they used to be. So, you have Indigenous people dying because of this encounter, but, on top of this, now they are being infected because those — the people that come into the area may bring the virus, as well. They can bring any pathogen. And it’s not just deforestation, we have to remember. There’s also mining, which is another activity that exposed Indigenous people to that.
So, over all Brazil, we have 110 Indigenous areas that have been affected with COVID. We have about 7,200 Indigenous people that have been infected, and the number keeps rising, and about 330 deaths that already have been reported.
Now, what happens also is that because a lot of municipalities don’t have hospitals, don’t have beds, the health system work with a sort of regionalization scheme. So, whenever people need hospital care, need to be hospitalized, there is a reference municipality that takes all those people. What we saw in Manaus, which was the first capital in the Amazon region that really had a completely overloaded of the health system, is that once the capital is completely overloaded and they cannot even provide hospitalizations for people living in the capital, they can’t serve all the municipalities that depend on them. So, the very high number of deaths that we observed in those areas, part of them could have been avoided if we had enough hospital services available.
But, above all, they could have been avoided if we provided a better response. So, the community health agents, they are all over Brazil. They basically act on the community. They know the people they serve. And each team has about one physician, one nurse and around six community health workers. They go to house by house to provide care. And they have very good coverage in the poor and vulnerable areas, so in the north and northeast. But again, once the pandemic started, those community health agents were not provided with protective equipment, so they can’t go on the street. And they were not provided with training, either. So, those people that could be right there on the ground helping to identify symptoms, helping to isolate people, and therefore helping to do contact tracing, and therefore helping to flatten the curve so we could have avoided this overload in the hospital system, they were not working.
So, it’s not just about the inequalities. They do play a role. It’s not just about the low provision of health services in the area. They also play a role. But it’s about the completely chaotic response that basically exacerbated all those inequalities, all of them combined, and created the situation we saw in Manaus, then we saw in Belém. And right now Porto Velho, another capital in the Amazon, it has more than 90% occupancy of hospital beds, so we can start hearing from this capital pretty soon.
Now, I also want to make a point that the fire season is about to start in about a month or so. And if we had this high level of deforestation, the fires will come, because that’s usually the process. The wood now is on the floor. Whatever they couldn’t sell, they are going to burn. And whenever we have the fire season, we have an increase in respiratory conditions. We have an increase in the demand for hospitalizations because of respiratory conditions. And we have an increase in the mortality of children under the age of 10. Now, this is a very — it’s a horrible combination. Increasing respiratory conditions may make people more susceptible to a severe COVID-19 infection.
So, we can have an overlay of two huge problems that will create, again, another collapse in the hospital system. So, we’ve been trying to raise awareness of this and try to avoid a fire season like we had last year, because this would be devastating. And the effects wouldn’t stay just in the Amazon. What happens in the Amazon does not stay in the Amazon. And as we saw last year, the smoke, and therefore all the particulates that comes from the forest fires, they can travel. And they can go to other areas, and therefore affect other people in Brazil, as well.
AMY GOODMAN: Professor Castro, earlier this month, the iconic Amazon Indigenous Kayapó Chief Paulinho Paiakan died of COVID-19. He was 66 years old. He was a lifelong defender of the Amazon rainforest, who in the 1980s led the resistance against the Belo Monte hydroelectric project, an environmentally destructive massive complex of dams planned to be built on the Xingu River in the heart of the Amazon, the project successfully suspended at the time but later reinstated. In recent years, Paiakan had warned against Brazilian President Jair Bolsonaro’s calls to open the Amazon for agriculture and mining, which brings us back to the president and his policies and now the fact that he’s being fined by a judge for himself not protecting himself, very similar to his ally, President Trump. But his policies in the Amazon and what they’re doing now, Professor Castro?
MARCIA CASTRO: Well, it’s unfortunate because when you see what’s being done in the Amazon now, we’re basically losing about 20 years of achievements, of really being able to make protected reserve forests, protected Indigenous areas. We had a forest code that was really a model. We were able to reduce deforestation to the lowest levels and maintain them there. And we are losing this. We are losing this at rampant rates. That’s bringing a lot of deaths. A lot of the deaths of local leaders, Indigenous peoples or people that are just trying to protect the forest are not even advertised.
So, the situation is very complicated, because those are big business people. They are making money by clearing the forest. And the local producers, the local communities, it’s very hard for them to fight against those people, especially when they are backed up by the government. Recently, the government basically pardoned fines that people had to pay because of deforestation. That sends a bad message. So, if you’re not going to be penalized, if you’re not going to be held accountable, let’s go ahead and do more.
So, what we are seeing in the environmental agenda in Brazil is very concerning. Recently, there have been different groups that wrote letters to international people that basically import agro — related to the agribusiness in Brazil, import products from Brazil. And now I hope this is going to create some discussion at the federal level, because if there’s one thing they don’t want to damage, it’s the agribusiness in Brazil. And if the big importers decide to stop buying the products because they are causing a lot of deforestation or a lot of changes in the balance, in the environmental balance, in the Amazon, then that could create a reaction. But if nothing happens, if they just can profit in ways that are really not understandable, because we have enough data to show that during the years when deforestation is going down, the Amazon was extremely productive, the agribusiness was extremely productive. So we can make the Amazon to be productive and profitable without having to remove more forest cover. But again, they are big fish, and it’s hard for local communities to fight against them.
NERMEEN SHAIKH: Well, Professor Castro, you mentioned earlier that Brazil has, of course, less resources to be able to do the kinds of things, to take the measures that countries in Europe have taken, like social distancing and quarantines and wearing masks and so on. And now, of course, COVID is spreading at an accelerated rate in developing countries and the poorer countries of Latin America, South Asia and Africa, where there is also a massive shortage of medical equipment, including the most urgent for fighting COVID, namely oxygen. And in one country in Latin America, and perhaps not the only one, in Peru, now oxygen is being sold on the black market for up to a 1,000% markup. Meanwhile, Yemen, which was already the poorest country in the world before 2015, the Saudi-led coalition bombing of the country, COVID is also spreading there, and unlike most of the world, 25% of the people who contract COVID-19 in Yemen die. That’s five times more than the global average. So, if you could talk a little bit about — you’ve been working, attending a conference that looks at the development of a vaccine for COVID-19 and how to ensure access to the vaccine in the countries that have been most vulnerable to its spread, including Brazil. So, could you tell us where that stands now?
MARCIA CASTRO: Yes. That’s a very good question. So, Brazil now is going to test two vaccines. So, there is an agreement that was signed with a Chinese pharmaceutical company and with a vaccine from Oxford. And then there are also groups in Brazil developing different types of vaccines. So there’s a different effort in different fronts.
Now, the key issue for low- and middle-income countries will be, if we imagine a scenario, hypothetical scenario, that we get a good vaccine — whatever “good” means, that’s a different discussion — and it’s ready to be produced at scale and then for a vaccination at scale. So, the first item, production at scale, right? So, if the production is going to be restricted to the high-income countries, it does raise the question: Who is going to get it first? And we saw this before, when we had the H1 and N1, that the rich countries got the vaccine first, because they could pay for it or they were producing it, and then the others had to wait. That is the first discussion. That’s why it’s so important for those agreements, international agreements, that are being made, so that countries can have access to all the science behind the vaccine development, but they also can have access to the vaccine being produced.
Brazil is unique in the sense that they do have at least two public institutions — and I’ll go back to this point in a moment — but they have Butantan Institute, and they have a FIOCRUZ, that they already produce most of the vaccines distributed in the country. They can do it. However, it depends what type of coronavirus vaccine we’re going to have. There are different types of them, and each one of them demands a different type of industrial plant to be able to produce. So, again, what countries should be doing now — and there are some European countries doing this — is the ones that have the industrial capacity to produce the vaccine, they should be trying to find ways to expedite the industrial production, so the moment something is ready, they can do it. Again, not every country will be able to do this, and they will depend on the countries producing the vaccine to have access to it.
The second thing is, it depends on how the vaccine will be distributed. Is it a type of vaccine that is very stable and easy to carry? Is it a type of vaccine that is not very stable and it’s going to be much more tricky to go around the country and to the very isolated areas to distribute? We don’t know that yet. But that can bring challenges to the whole logistic process of doing vaccination at scale.
The other thing is, we don’t know how many doses we’re going to need. And we don’t know how countries, inside each country, they will prioritize who is going to get first. Now, again, the case of Brazil is interesting because we do have a universal health system. Everybody gets access to care and to vaccination for free. You don’t pay a penny for it. So, in theory, every person in Brazil will be eligible to receive this vaccine once it’s available. But if it takes a long period of time to produce the vaccines— right? We have 8 billion people in the world. So, how long is it going to take to produce 8 billion doses? Well, if you can only produce 1 billion per year, you can imagine that we’re going to have to set priorities, both on inside each country who is going to get first and how countries will make agreements on how many doses they are going to receive.
So, the vaccination at scale is going to be extremely complicated. And I think that with the support from Gavi, from WHO, we have to find ways to make this as equitable as possible, so we don’t see another situation where the most vulnerable takes the heavier burden in the vaccination scheme.
AMY GOODMAN: Professor Castro, we only have a minute, and I want to ask you about this massive spike of coronavirus infections in the United States. In the most populous states, in Texas, California and Florida, which make up a quarter of the U.S. population, they’re seeing the largest spike in the history of this pandemic. This comes as the White House now says it will no longer fund federal testing sites. And you have President Trump refusing to wear a mask in public. You have dozens of Secret Service agents who were with him in Tulsa, now in self-isolation. That’s just one example. A spike in Tulsa, where he was. Very quickly, if you can say what you think needs to happen in this country?
MARCIA CASTRO: Well, honestly, what we need is better leadership, because if we keep putting people, through rallies, in a closed environment where people don’t wear masks, if we keep sending the message that that’s no big deal, while people are dying — and dying a lot — then, you know, I can’t think of any way to solve the problem of the only two countries that have more than a million cases, other than having better leadership, a leadership that can trust in science.
AMY GOODMAN: Well, Professor Marcia Castro, we want to thank you for being with us, professor of demography and chair of the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health, also co-chairs the Brazil Studies Program at Harvard’s Center for Latin American Studies.
When we come back, the Reverend William Barber, co-founder of the Poor People’s Campaign. Stay with us.
AMY GOODMAN: “Hold On Just a Little While Longer,” the Virtual Choir during the Mass Poor People’s Assembly and Moral March on Washington on Saturday, organized by our next guest, Reverend William Barber.