Amid Pandemic, Ministry of Health Completes 50 Days Without Permanent Incumbent

RIO DE JANEIRO, BRAZIL – On Saturday, July 4th, the Ministry of Health completed 50 days without a definitive head for the position. The position is temporarily filled by General Eduardo Pazzuello and President Jair Bolsonaro has not given any indication that he is looking for a name for the portfolio that has among its missions to tackle the novel coronavirus pandemic.

With the second highest number of deaths and cases of the novel coronavirus in the world, Brazil accounts for 63,254 deaths and over 1.5 million confirmed infections.

This is the first time since 1953 that the Ministry has been left with no incumbent for such a long time. In that year, Antônio Balbino served as interim between August and December, while he was also the head of the Ministry of Education (MEC). The two portfolios had just been separated.

At other times, Bolsonaro has been more agile. When Sérgio Moro resigned from the Ministry of Justice and Public Safety, he was replaced by André Mendonça within five days. Economist Carlos Decotelli also took over the MEC five days after Abraham Weintraub left the post. The Education portfolio was again left without a Minister five days after Decotelli was appointed, but in this case his replacement should be announced soon.

This was the case in the Health portfolio when Luiz Henrique Mandetta left the post. Nelson Teich took over the following day. Under the interim command of General Pazuello, the Ministry abandoned its support for stricter social distancing and began to recommend treatments for Covid-19 that lacked the approval of medical and scientific bodies, such as hydroxychloroquine. The portfolio also lost experts with decades of experience in the SUS (NationalHealth System) and appointed military officers to strategic positions.

Despite his interim role, Pazuello is considered by colleagues in government and local health secretaries to be more influential and powerful than Teich, who resigned on May 15th. The first steps of the Ministry of Health under his interim management opened the door to a sudden change in the federal government’s position.

On May 20th, the body published guidelines permitting the use of chloroquine since the first symptoms of the novel coronavirus, despite the drug’s lack of efficacy against the disease. The measure was a demand of Bolsonaro that disregarded advice from the Ministry’s own experts and health organizations.

The Ministry also ceased to support the benefits of social distancing and to draw up quarantine strategies. The portfolio shields itself with the misguided argument that the Federal Supreme Court (STF) has stripped the federal government of such regulatory power. Pazuello and his subordinates have said that it is up to states and municipalities to devise these measures.

For physician Sergio Cimerman, scientific coordinator of the Brazilian Society of Infectology (SBI) and columnist for Estadão newspaper, the Ministry is “brainless”. “Pazuello is forming his team and taking positions. But he’s not based on any scientific community. When we lack a federal body that gives direction to health action plans, we become very lost. The population panics,” he said in a debate on the disease broadcast by Estadão on Thursday, July 2nd.

At the same event, the Ministry’s ex-Secretary of Health Regulation, Wanderson Oliveira, stressed “concern” over the Ministry’s timing. According to him, an epidemiologist, the response to Covid-19 became “erratic, schizophrenic, fragmented over time”. In addition to the pandemic, Oliveira alerts to the risk of disrupting monitoring of already known diseases such as dengue, influenza and measles.

Pazuello’s greatest exposure to criticism occurred in early June, when the Ministry changed the format of statistics disclosure to meet Bolsonaro’s goal of lessening the impact of the death toll. The plan was to withhold deaths from earlier dates that were still pending confirmation on the date deaths were announced. The Ministry’s data website was eventually taken offline, but the release was reinstated following heavy pressure from the legislature, civil society and the Federal Supreme Court (STF).

Gulnar Azevedo, a physician and president of the Brazilian Association of Collective Health (ABRASCO), says the Ministry’s “disarray” in the fight against Covid-19 adds to the lack of control over the pandemic in the country. “There is a total lack of leadership that can accommodate the process. The Minister is temporary. A military officer who was not trained for this,” she said.

Despite the surge in cases (from 218,000 to over 1.5 million) and deaths (from 14,800 to over 60,000) in the Pazuello administration, the President has repeatedly stated that the interim Minister is a good leader and could be made permanent. “We have a shortage in Health, but Pazuello is doing very well. The management part is exceptional. Something never before seen in history. We know he’s not a doctor, but he has a fantastic team in the Ministry,” he said on June 25th, in a broadcast on social media.

Pazuello has joined the President in a pro-government rally in Brasília, with crowds, and has been seen without a mask at an event at the Planalto Palace. Both situations conflict with the advice of health authorities to prevent the spread of the virus.

Secretaries of States and Municipalities, overall, prefer Pazuello to his predecessor, Teich. According to SUS officials, given that the hope that the Ministry will coordinate a quarantine strategy is lost, Pazuello’s commitment to dialogue and his agility to provide resources and equipment is a consolation.

The interim Minister is also in good standing in the political environment. Over the past two weeks he has welcomed President Bolsonaro’s allies and leaders of the Centrão, a party bloc that has been awarded patronage posts and funds to vote together with the government in the Congress. He recently met with Senator Ciro Nogueira and deputies Arthur Lira, Marcel Van Hattem, Fábio Rabalho, Ricardo Barros, Hugo Leal and Giovani Cherini.

However, Pazuello dispenses with statements to the press. Since he took over as the head of Health, he has not attended any press conference – not even the one announcing the most positive aspect of his management: a research and production partnership for the vaccine being developed by Oxford University and the AstraZeneca pharmaceutical company.

Team

The general was taken from the Armed Forces “talent pool” to join the Ministry of Health. First, he held the post of executive secretary in Teich’s management. During this time he was already considered by local secretaries as the true Minister of Health.

Since Mandetta’s departure on April 16th, experts with over a decade of experience in the SUS have left the Ministry. Former secretary Wanderson Oliveira, who has been with the Ministry since 2001, is one such instance.

Under Pazuello’s interim command, strategic positions in the portfolio were assigned to the military. There are over 20 appointees, 14 of them on active duty. They are mainly in positions in data management, human resources, budget, logistics and contracts.

The interim Minister also changed five of the seven Health Secretaries’ posts. Elcio Franco Filho, a reserve officer, was appointed as the “number 2” executive secretary of the Ministry.

The PL (Liberal Party within the Centrão bloc) has appointed Arnaldo Correia de Medeiros, PhD in biochemistry, as Health Monitoring Secretary (SVS), a key post in the development of a strategy to fight Covid-19 and other diseases. Colonel Luiz Otavio Franco Duarte became Specialized Attention Secretary (SAES), in charge of the country’s bed funding, among other issues.

A follower of Olavo de Carvalho, the ultra-right regarded as the “guru of Bolsonarism”, physician Hélio Angotti Neto was appointed secretary of Science, Technology, Innovation and Strategic Supplies (SCTIE). The portfolio handles the analysis of new treatments for the SUS and development of the pharmaceutical industrial park.

An “anti-abortion” activist, physician Raphael Câmara de Medeiros Parente took over the Primary Care Secretariat (SAPS), which organizes basic care initiatives in health care facilities.

In addition to the new secretaries, Pazuello retained doctor Mayra Pinheiro, Secretary of Labor and Education Management (SGTES) in the Ministry. Affiliated to Novo party, Pinheiro is a supporter of President Bolsonaro and has become the Ministry’s spokesperson on chloroquine. She is joined in the portfolio by Colonel Robson Santos Silva, Special Secretary of Indigenous Health (SESAI).

Asked to comment on Pazuello’s administration, the Ministry of Health said it “made a commitment” to ensure “effective actions” against Covid since the outbreak of the pandemic. The portfolio also stated that it is working with qualified experts, thus maintaining the “normality of the portfolio’s activities”.