150 years ago, Oswaldo Cruz was born. The public health doctor, who has become a symbol of public health in Brazil, faced challenges such as the bubonic plague, smallpox and yellow fever in the early 20th century.
With a pioneering vision of research, teaching and management, the scientist took the first steps towards building the institution that today bears his name and continues his legacy.
Based in Manguinhos, in the city of Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz) has facilities in ten Brazilian states and the Federal District. In all, there are 16 scientific and technological institutes, in addition to regional offices and a representation in Africa, located in Mozambique.
With more than 12 thousand employees, Fiocruz is responsible for the production of vaccines, medicines and basic and applied research on diseases of importance in public health, such as Covid-19, dengue, flu, malaria, yellow fever, measles, leprosy and leishmaniasis. .
The vaccine portfolio of the Institute of Technology in Immunobiologicals (Bio-Manguinhos/Fiocruz) is composed of 12 products, including immunizers against Covid-19, yellow fever, poliomyelitis, and the MMR (measles, mumps and rubella).
On average, 120 million doses are delivered annually to the National Immunization Program (PNI) of the Ministry of Health. With the coronavirus vaccine, this number increases even more. From 2017 to 2021, more than 701 million doses of vaccines were delivered to the Brazilian population.
Considered the largest official pharmaceutical laboratory linked to the Ministry of Health, the Institute of Technology in Pharmaceuticals (Farmanguinhos/Fiocruz) supplies more than 30 essential medicines to the Unified Health System (SUS). The list includes drugs for the treatment of HIV and diseases such as malaria, tuberculosis and Parkinson’s, as well as antivirals, vitamins and immunosuppressants.
The Oswaldo Cruz Institute (IOC/Fiocruz) carries out research, development and innovation in 72 laboratories, generating knowledge about transmission, treatment, control and prevention of various diseases, such as AIDS, tuberculosis, malaria, yellow fever, dengue, Chagas disease, leishmaniasis , leptospirosis, hepatitis, leprosy and meningitis, among others.
In an exclusive interview with CNN the president of Fiocruz, Nísia Trindade Lima, addresses the country’s main challenges in the context of public health and highlights the current context of the emergence of new health emergencies.
CNN: Covid-19, hepatitis of unknown cause, monkeypox: are we living in a period of more disease?
Nisia Trindade Lima: The scenario described is worrying because it lists a series of epidemics that have emerged in the last two years. Before Covid-19, it is important to remember, we had the H1N1 epidemic in 2009 and the Ebola epidemic between 2013 and 2016, the Zika health emergency, with such a severe congenital syndrome, the change in the geographical pattern of occurrence of the yellow fever, not to mention the dengue epidemics that have impacted Brazilian and Latin American cities for more than thirty years.
Many researchers have been claiming that this greater occurrence of epidemics may be the hallmark of this beginning of the century. Although we are better able to identify these emergencies, there is no doubt that they have occurred more frequently, due to social factors, especially urban agglomerations and increasing inequalities, in addition to the intense flow of people and goods, characteristic of an economy globalized. In fact, we should talk about socio-environmental factors, or socio-environmental determinants, an established term in the area of public health.
The effects of climate change, with global warming, and deforestation strongly impact the current scenario and the future, pointing to new patterns of pathogen circulation, reemergence of already known diseases.
We have more scientific and technological instruments for detecting possible new emergencies and responding, with resources coming from science. However, the scientific and public policy agenda for anticipating and preparing societies needs to be comprehensive, involving all areas of knowledge and overcoming the false dichotomy between the biological and the social.
CNN: Oswaldo Cruz faced major health problems of his time, such as the bubonic plague, yellow fever and smallpox. Today, what are our main challenges?
NT: Faced with the pandemic scenario and the likely emergence of new health emergencies, we need to take three types of measures: response, reconstruction and preparedness. The pandemic is not over and we need to continue to face it through the advancement of vaccination in Brazil and in the world, at the same time that surveillance needs to follow the mutations of the virus in a context of high transmission. It is still necessary to rebuild societies, deeply impacted by the virus and which have seen inequalities deepen even further.
Finally, it is necessary to be much better prepared for new emergencies, with the adoption of a set of measures, among which I highlight the strengthening of the health and social protection system in Brazil, the strengthening of the SUS; continuous investments in Science, Technology and Innovation; and the decentralization of the production of health goods at a global level, such as vaccines, medicines and diagnostic tests, including to expand their access, in a more equitable way.
CNN: How does denialism impact the fight against diseases in the country and in the world?
NT: One of the preparatory measures that I consider essential addresses the issue of trust in institutions. It is about changing the paradigm of science communication towards closer relations between science and democracy. Professor André Botelho, current president of the National Association of Graduate Studies and Research in Social Sciences, has excellent article About the subject. The argument is that science needs to be at the service of social challenges, and through a more open dialogue. This means keeping close to the public, clearly exposing the possibilities, limits and time of science.
For this building of trust between society and institutions, including scientific ones, it is necessary that they produce public goods, and I believe that knowledge should also be a public good. Brazil has a beautiful tradition of scientific dissemination, which is very clear in the work of the SBPC [Sociedade Brasileira para o Progresso da Ciência]. It is now a question of bringing scientific dissemination even closer to a dialogical perspective, of public communication and of defending the virtuous relationship between science and democracy.
CNN: In Brazil, in recent years, we have seen outbreaks of measles, yellow fever and dengue. Why is it still a challenge to fight against secular diseases in the country?
NT: The aforementioned diseases have different causes, but, in common, they show how social and environmental aspects impact health. O measles had been eliminated in Brazil in 2016, but it returned with the drop in vaccination coverage in the last five years. We now have the risk that other diseases will re-emerge. The worsening of living conditions in recent years is one of the elements for the lower demand for vaccination.
To help reverse this process, we have at Fiocruz the Reconquista de Altas Coverages Vaccinais project, coordinated by Bio-Manguinhos, and we actively participate in the Vacina Mais campaign, promoted by the councils of municipal health secretaries and secretariats, the Pan American Health Organization and Fiocruz.
Finally, dengue, a neglected disease, has as some of its factors the precarious sanitation in some regions, a consequence of rapid urbanization, and the insufficiency of control programs. We see that social and environmental conditions help to explain the persistence of these diseases.
CNN: Neglected diseases such as Chagas’ disease, leishmaniasis, leprosy, rabies and parasitic diseases still have a significant burden in Brazil. Why is it difficult to face the problem?
NT: First of all, it is important to think about neglected populations, not just neglected diseases. This helps us to understand the problem, as it raises the question of these people’s access to health services and products.
The concentration of the production of health goods in high-income countries, often in an approach that does not prioritize the public interest, the absence or insufficiency of social protection and health systems with universal and free access, such as the SUS, in most cases In some countries, these are some elements that help to explain why there are still so many people suffering from preventable diseases for which there is a cure.
CNN: When diseases that are endemic in African countries, such as monkeypox, start to affect developed nations, there is a different mobilization of the scientific community. How do you evaluate this context?
NT: This problem is related to the previous question, since, in addition to neglected populations, we can have entire neglected regions. At some point, not too long ago, these diseases were designated as “tropical”, precisely because they occur in peripheral regions, which, in the light of the present, is a confession of regional negligence.
It is possible that the tragic experience of the pandemic has sensitized us to the fact that the health of one depends on the health of all. I want to believe so. A phrase by sociologist Klaus Eder has come to my mind: ‘societies learn, but the world is difficult to change’. I hope we move towards a change.
CNN: A phenomenon known as ‘brain drain’ describes researchers leaving Brazil in search of opportunities in other countries. What is the importance of investing in research and teaching at this moment in Brazil?
NT: This is one of our concerns at Fiocruz. Retirements have been happening, without proper replacement. If we consider what I said in this interview, we need to not only replace, but expand the participation of researchers and promote the inclusion of young researchers. An expansion, both to respond to neglected diseases, characteristic of low- and middle-income countries, and to prepare for the scenario of new, more frequent health emergencies. It is necessary to make this transition and only with the prospect of a recognized career, with adequate equipment and supplies for the full realization of their potential, will these researchers remain.
It’s not just about brains, but about commitments and values of young people who want to contribute to the country they grew up in. This human element is irreplaceable and I believe it is a concern of scientific institutions as a whole in the country. At the same time, there is another phenomenon that precedes the flight: the abandonment of the scientific career due to precarious conditions and lack of career opportunities, a kind of loss of brains, of creative power, within the country itself.
Source: CNN Brasil
