In the 150th anniversary of Oswaldo Cruz’s birth, Brazil faces public health challenges

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On August 5, 1872, Oswaldo Gonçalves Cruz was born in the city of São Luís do Paraitinga, in the Vale do Paraíba region, in the state of São Paulo. Son of doctor Bento Gonçalves Cruz and Amália Taborda de Bulhões, cousins ​​and born in Rio de Janeiro.

Bubonic plague, smallpox and yellow fever. These were just some of the many public health challenges faced at the beginning of the 20th century in the country, which marked the trajectory of one of the best known Brazilian scientists.

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In 1903, he was appointed Director-General of Public Health, a position similar to the current Minister of Health. During the government of President Rodrigues Alves (1902 to 1906), Oswaldo Cruz undertook to eradicate yellow fever in Rio de Janeiro, then the country’s capital, within three years. For this, he believed that the control of the transmitting mosquito was essential.

The bubonic plague was an especially worrisome health problem on ships and ports. To combat the disease, serum and vaccine were available, in addition to prophylaxis based on rodent control.

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The fight against smallpox, a disease that had an important growth in 1904, was also based on immunization. In the same year, the institution of mandatory vaccination – later revoked – motivated the so-called Vaccine Revolt.

Oswaldo Cruz divided the city of Rio de Janeiro into health districts, which would be monitored by professionals from the Board of Health. The Yellow Fever Specific Prophylaxis Service was created and the production of educational leaflets and the publication of “Advice to the People” began in the newspapers.

Mayor Pereira Passos, who planned the urban remodeling of the then federal capital, passed laws that provided for the removal of poor families, a policy that became popularly known as “boot down”. The sanitation law was known as the “Torture Code”.

Some measures authorized, for example, the forced entry of agents known as mosquito killers into homes to empty water tanks that served as a breeding ground for mosquitoes that transmit yellow fever.

Other actions included the subpoena to waterproof the floors of homes to prevent the spread of rats and fleas, as part of the actions against the bubonic plague. Food was inspected and compulsory notification of disease cases was instituted.

“He was a person who had a lot of political influence, who used it in favor of public health, but disregarding issues related to social inequality”, evaluates public health specialist Gonzalo Vecina, professor at the Faculty of Public Health at the University of São Paulo (USP) and former -director of the National Health Surveillance Agency (Anvisa).

The figure of Oswaldo Cruz synthesized an accumulation of dissatisfaction about the set of changes that took place at the time, being the target of popular reactions, in the press and in Congress. However, the result of the measures was the control of bubonic plague, smallpox and yellow fever in Rio de Janeiro.

The successes were presented at an important conference in Berlin, Germany, in 1907, a turning point that changed the public perception of the scientist.

Challenges for Brazil today

If at the beginning of the 20th century the country faced three diseases of great impact on public health, the Brazil of 2022 does not seem to be that different. Covid-19, monkeypox (Monkeypox) and dengue are just some of the diseases that affect Brazilians and increase the pressure on health systems.

“Public health problems will follow the characteristics of society at each moment, as the way in which we deal with the environment, with climate issues, with global warming, for example. They happen as a result of what human beings are doing to the planet”, says Tania Araújo-Jorge, director of the Oswaldo Cruz Institute (IOC/Fiocruz).

Sanitarian Gonzalo Vecina assesses that denialism and failures in communication by managers and health authorities have had a negative impact on the fight against diseases.

“On the one hand, we have developed very important weapons, such as vaccines, but there is a denialist and anti-vaccine movement that would make Oswaldo Cruz very worried”, says Vecina.

For the sanitarian, the key point for fake news to gain such space on social networks is in the well-elaborated construction of fake news, using elements that mix true and false information.

“Regarding vaccination, what I think we have today is a lack of capacity to summon. Vaccination coverage dropped, but not because of denialism, but because of the lack of ability to call people for vaccination”, says Vecina.

Diseases such as dengue, leishmaniasis, leprosy, rabies, parasitic diseases and Chagas disease are considered by the World Health Organization (WHO) as neglected diseases.

According to the WHO definition, diseases of this type are considered endemic in low-income populations and contribute to the maintenance of inequality in the world. In addition, low investment in scientific research by large companies and pharmaceutical companies widens gaps in diagnosis and treatment.

“Social inequality is the path that makes all these diseases very successful. How do you fight malaria, for example? With good houses. We will only be able to tackle neglected diseases properly, first with civilization, second with better medicines”, says Vecina.

Since the 1980s, dengue, caused by the mosquito Aedes aegypti, causes outbreaks and deaths in the country. In the first half of 2022, Brazil recorded more than twice as many deaths from the disease as in the whole of last year, according to data from the Ministry of Health.

Researchers from the Federal University of Uberlândia (UFU) state that the fight against the vector and the prevention of dengue must be focused on social determinations, encompassing particular characteristics of the environment and community where individuals are inserted.

The fight against the disease “depends fundamentally on partnerships between the population, government actions and society in general, establishing networks of social mobilization capable of promoting permanent, intersectoral actions, overcoming the difficulties and limitations of the punctual, vertical educational model, with isolated actions. and episodic, centered on periods of outbreaks and epidemics”, say specialists João Carlos de Oliveira and Gizele Martins Rodovalho, in a statement.

Bottlenecks in scientific training

The institute that gave rise to the Oswaldo Cruz Foundation had as its premise the production of serums and vaccines. However, since the beginning of activities, the institution’s vocation was also marked by research and teaching.

“The institutional model that Oswaldo Cruz had in mind was that of the Pasteur Institute, which was an institution that, at the same time as it had this production of serums and vaccines, carried out research. Their production was the result of the research they were also doing,” says historian Ana Luce Girão, a researcher at the Casa de Oswaldo Cruz (COC/Fiocruz).

Today, all Fiocruz units develop graduate programs stricto sensu with doctoral, academic or professional master’s degrees. Altogether, there are 32 programs included in ten areas of evaluation by the Coordination for the Improvement of Higher Education Personnel (Capes).

“Oswaldo Cruz was the seed of the thought that you need science and research to face public health problems, to be able to look at these issues and build solutions and public policies. He inspires and will inspire all the generations to come”, says Tânia.

In July, federal educational institutes sought support from parliamentarians to avoid a R$200 million cut next year. The National Council of Institutions of the Federal Network of Vocational, Scientific and Technological Education (CONIF) estimated a 12% cut in the 2023 budget by the Ministry of Education.

Federal universities were notified of a 12% budget cut. According to the National Association of Directors of Federal Institutions of Higher Education (Andifes), the expectation is that the funds intended for funding will fall to R$ 4.7 billion next year.

The difficulty to enter and remain in postgraduate courses in the country leads to a phenomenon known among the academic community of “brain drain”, which is the search for work and research opportunities outside Brazil.

“If this generation that is now between 20 and 40 years old is not welcomed within their own country, what will the generation between 6 and 10 years old say. We have problems that range from training science teachers to encouraging them to stay in the country. But how to stimulate if there are no contests, if postgraduate scholarships are totally out of date? It’s a very big structural problem”, says Tania, who is also a researcher at the IOC’s Laboratory of Innovations in Therapies, Teaching and Bioproducts.

During his youth, Oswaldo Cruz was an assistant in the laboratory of Benjamin Antônio da Rocha Faria. When the laboratory was converted into the National Institute of Hygiene, he worked as an assistant to Professor Rocha Faria between 1890 and 1893.

He graduated in medicine in 1982 and started a small clinical analysis laboratory on the ground floor of his house, as a wedding gift from his father-in-law.

In late 1899, the bubonic plague was an emerging disease in the country. Like researchers Adolpho Lutz and Vital Brazil, Oswaldo Cruz was asked to study the situation in the port of Santos, on the coast of São Paulo, where the cases attracted attention.

The paths of Oswaldo Cruz and Manguinhos, which today houses the headquarters of the Oswaldo Cruz Foundation (Fiocruz), in Rio de Janeiro, crossed in 1899.

The bubonic plague, which initially affected the port of Santos, had also reached Rio de Janeiro. By order of Mayor Cesario Alvim, the Municipal Vaccine Institute started to produce the serum and vaccine for the disease.

The activities were under the leadership of Baron Pedro Affonso, a renowned surgeon in the city who had been director of the Santa Casa da Misericórdia General Hospital in Rio de Janeiro.

Shortly afterwards, the city government, claiming that it could not afford the costs, transferred the task of production to the federal sphere. The activity would be carried out at the new Federal Serotherapy Institute, officially created in May 1900 under the General Directorate of Public Health, within the scope of the Ministry of Justice and Internal Affairs.

In 1900, Oswaldo Cruz took over the technical direction of the newly created institute and became head of the anatomy, pathology, chemistry, biology and bacteriology laboratory service at the General Polyclinic of Rio de Janeiro.

In 1902, the baron of Pedro Affonso requested his resignation and Oswaldo Cruz assumed the general direction of the Instituto Soroterápico Federal. The following year, he was appointed Director General of Public Health. The actions to combat the bubonic plague, smallpox and yellow fever earned Oswaldo Cruz international recognition.

The Instituto Seroterapico Federal, whose name was changed in 1907 to Instituto de Patologia Experimental, is renamed Instituto Oswaldo Cruz.

(With information from the “Oswaldo Inspira” project, from the Oswaldo Cruz Institute (IOC/Fiocruz)

Source: CNN Brasil

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