COVID-19: The International–Domestic Nexus of a Catastrophic Pandemic Response

Brazil is experiencing one of the greatest tragedies in its modern republican history. After more than 21 years of military dictatorship (1964-1985), the country seemed to have consolidated its democratic regime between 1988 and 2016. Economic stabilization, the organization of a federal bureaucracy in several policy areas, the implementation of a wide range of inclusive social policies (conditional cash transfers, racial quotas in higher education, participatory budgeting, public consultations and councils, etc.), the conception of an autonomous foreign policy, and an international projection of global ascent based on regional leadership were some of the accomplishments that had caught the world’s admiring attention.

Since Dilma Rousseff’s controversial impeachment in 2016, however, the country has gone through a critical juncture, with political, economic, and social dimensions that have jeopardized the progressive construction of democracy and its evolving institutions. After polarized elections in 2018, Jair Bolsonaro was sworn in as Brazil’s president in January 2019, inaugurating a far-right and ultra-conservative administration, since then labeled “Trumpism in the Tropics.” Bolsonarismo has provided a fruitful landscape for the uncontrolled dissemination of the novel coronavirus across the country, with potentially dangerous consequences in South America and worldwide.

From Bridge-Builder to International Pariah: Brazil’s Global Status Change

Bolsonaro leads a coalition based on odd, but widely disseminated stances, including anti-communism, the defense of the patriarchy, militarism, economic neoliberalism, an Evangelical Christian alliance with Israel, and an unconditional external alignment with the United States of Donald Trump. During his presidential campaign in 2018, Bolsonaro had already promised a “new foreign policy” and a “new Itamaraty,” as Brazil’s Ministry of Foreign Affairs is known. He argued that the ministry should be at the service of values that have always been associated with the “Brazilian people.” Itamaraty should contribute to the “national liberation,” so that Brazil would finally be free of “ideological bonds.”

Bolsonaro’s government is divided into three main groups. The first is composed of members from the armed forces, who today hold more than 6,000 federal posts, including important political positions in the Office of the Vice President, the Office of the President, and even the Ministry of Health. Army General Eduardo Pazuello oversaw Brazil’s response to Covid-19 from May 2020 to March 2021.

According to political scientist José Murilo de Carvalho, since Brazil’s independence, five of the country’s seven constitutions (including the 1988 Constitution, the country’s current charter) have attributed some political role to the armed forces. However, Bolsonaro has appointed more military officers to civilian posts than any other administration, including during the military dictatorship. Today, the military clearly continues to exercise a “guardianship role” over Brazilian democracy. (1)

The second group is made up of technocrats who are in charge of economic and financial affairs and the agribusiness sector. They hold leadership positions in the Ministry of Agriculture and shape major decisions made by the Ministry of the Environment.

The last group is the so-called “ideological wing,” formed by the followers of far-right astrologist Olavo de Carvalho (who lives in the United States) and members of Neo-Pentecostal churches. They took over the Ministries of Education, Human Rights, and Foreign Affairs. Breaking with the country’s historical defense of human rights, Brazil has joined international alliances supporting a reactionary agenda of values, especially against the rights of women and the LGBTQI+ community.

Strikingly, after his nomination as Minister of Foreign Affairs and nearly a year before the coronavirus pandemic, Ernesto Araújo emphasized that Bolsonaro would liberate Brazil “through truth,” which would be revealed by God and not by science. Araújo (who tendered his resignation in March 2021) has defended positions against the United Nations and China, Brazil’s main trade partner and a key global supplier of surgical masks and active pharmaceutical ingredients that are necessary for vaccine production.

As the Biden–Harris administration rolls out progressive policies and Brazil’s 2022 presidential elections loom large — former president Lula da Silva may run as a strong opposition candidate — Brazil’s foreign policy will probably go through some changes. Bolsonaro has already replaced his Minister of Foreign Affairs, and his climate change and environmental policies are under domestic and international attack. Whether or not Washington will send extra funding to Brasilia based on promises of environmental protection measures is still an open question that should be closely monitored by civil society organizations in Brazil and the United States.

In the international health community, Brazil has historically played a very active role. The country’s “health diplomacy” has relied on the participation not only of Itamaraty, but also the Ministry of Health and respected institutions like the Fundação Oswaldo Cruz (Fiocruz) and Instituto Butantan. In recent decades, Brazil became a regional leader due to its national public healthcare system and drug access programs (in the fight against HIV epidemic, for example), defending health as a human right and not simply an intellectual property issue at the World Trade Organization. At the regional level, Brazil supported the União de Nações Sul-Americanas (UNASUR, Union of South American Nations) and the initiative’s Instituto Sul-Americano de Governo em Saúde (ISAGS, South American Institute of Government in Health).

However, Bolsonaro’s foreign policy has created a breach in the trajectory of this health diplomacy at both regional and international levels. For example, Brazil abandoned its long-standing position in favor of patent flexibility, moving away from countries like India and South Africa. The president adopted an unprecedented alignment with the United States, especially with the Trump administration, isolating Brazil from many multilateral forums. When Covid-19 hit, the country was already under the weather.

A Covid-19 Disaster: A Crime Against Humanity?

Brazil has been a global hotspot for the pandemic since the beginning. The Bolsonaro administration followed the Trump White House in verbally attacking China and the World Health Organization (WHO), while hesitating to join the Covid-19 Vaccines Global Access (COVAX), the main multilateral tool for guaranteeing access to vaccines. The Brazilian government only joined this international effort after considerable domestic pressure and in a very limited fashion. (2) At the regional level, Brazil withdrew from UNASUR and ISAGS just as the country and the region became the epicenter of the Covid-19 crisis.

Since the outbreak of the pandemic, the Bolsonaro administration has adopted a series of erratic responses, often in opposition to WHO international guidelines. Bolsonaro has promoted scientific denial, insulted and ignored health officials, and defended the early use of ineffective drugs against Covid-19. Backed by Neo-Evangelical churches and the military, he has made the widespread use of chloroquine his primary health policy. While insisting on a false dichotomy between economy and health, the strategy of the Brazilian government has been to try to achieve herd immunity through contagion. The lack of political coordination at the federal level has also resulted in conflicts and power disputes between states and cities, on the one hand, and among the executive, legislative, and judicial branches, on the other. Nevertheless, despite Bolsonaro’s fierce hostility, many states and cities have adopted restrictive measures to curb transmission of the SARS-CoV-2 virus.

The contentious handling of the epidemic by the federal government is likely to have contributed to Covid-19’s rapid spread within the country’s most vulnerable populations. According to two surveys from 2020, high-prevalence areas are poorer and less well served by health and other public services than the rest of the country. Prevalence among Indigenous populations was more than four times higher than among white people, and prevalence in the poorest socio-economic quintile was more than twice as high as in the richest quintile. In addition, antibody prevalence had a rapid initial escalation in Brazil’s northern and north-eastern regions, the two poorest regions in the country. (3) The north-eastern region is the only one where Bolsonaro lost the elections in 2018 and remains a stronghold of support for Lula and more pro-poor and progressive policies.

In this context, Brazil was the target of a precautionary measure by the Inter-American Commission on Human Rights for the protection of the Yanomami and Ye’kwana, two Indigenous Peoples that have been facing a situation of emergency since the upsurge of the Covid-19 pandemic. The rapid increase of cases in their territory has been aggravated by the presence of about 20,000 miners in the area and acts of violence perpetrated by miners and illegal loggers against the Indigenous population.

Since late 2020, the situation has gotten worse. The death rate has risen from 2 to 3.3 percent, plunging Brazil into an unprecedented health emergency. According to Fiocruz, late March 2021 saw a record number of more than 3,000 deaths daily due to Covid-19. (4) That same month more than 60,000 Brazilians died, and nearly one-third of all daily Covid-19-related deaths in the world were in Brazil, although the country makes up only 2.7 percent of the world population. (5)

In addition to a record number of fatalities, Brazil is dealing with the spread of a more-contagious coronavirus strain that may result in reinfection. The Gamma variant has become a serious cause of concern to neighboring countries and around the world. (6)

This catastrophic situation has provoked the collapse of the country’s national public healthcare system, the Sistema Único de Saúde (SUS, Unified Health System). Fiocruz has reported lines for access to hospital beds (especially in the ICU), scarcity of supplies and essential drugs for patients with Covid-19 and other conditions, and exhausted healthcare professionals. As of early April 2021, Brazil had vaccinated only 13 percent of the population over 18 years old with the first dose and less than 4 percent with the second dose. (7)

Brazil’s catastrophic response to the pandemic has been aggravated by fiscal policies of austerity. The “expenditure ceiling” approved by a constitutional amendment in 2016 prohibits the increase of federal spending on health, education, and social security for more than the annual inflation rate for the next 20 years. Analysts are calling this strategy of overcoming an epidemic with minimal regulation and costs “epidemiological neoliberalism.” (8)

While the National Congress did vote to raise the amount of the Emergency Aid Bill, the federal government’s major response to Covid-19’s social and economic impact, this increase required political pressure from civil society organizations and support from deputies and senators of progressive political parties. Between April and December 2020, 68 million Brazilians received five payments of R$600 (approximately US$120) and four payments of R$300 (approximately US$60). In 2021, at the peak of the pandemic, the new aid program should pay four more installments of approximately R$250 (US$50) to 45.6 million people, 22.6 million less than last year. (9)

But even this support is insufficient. Brazil’s substantial gains guaranteeing the human right to adequate food from 2004 to 2013 were quickly canceled for a large part of the population in a very short span of time. A recent survey has shown that 55.2 percent of Brazilians (approximately 116.8 million) face some degree of food insecurity. In 2020, some 19 million Brazilians were suffering from severe food insecurity. (10)

So far, the Bolsonaro administration’s gamble on achieving herd immunity, combined with scientific denial and epidemiological neoliberalism, has caused an impressive increase of poverty and hunger and nearly 500,000 Covid-19-related deaths as of June 2021. Brazil has registered approximately 1,756 deaths per million, far surpassing Peru (1,722), the United States (1,731), and Mexico (1,646). In light of this tragedy, the federal government’s behavior may constitute a crime against humanity.

Conclusion: A Dismal Perspective

The legacy of the current critical juncture may be dreadful for Brazil. Domestically, health conditions and the pandemic continue to affect the population, particularly Brazilians who are Black, Indigenous, poor, and marginalized. Internationally, the country can no longer play its traditional bridge-building role in multilateral negotiations and risks becoming an outcast in global health and climate change issues. From best practice exporter in the field of social policies to an international pariah, Brazil reveals how the connections between neoliberal austerity policies, authoritarian leadership, and bad foreign policy decisions can result in catastrophic responses to global health challenges like the Covid-19 pandemic.

Carlos R.S. Milani is Associate Professor at the Instituto de Estudos Sociais e Políticos (IESP, Institute for Social and Political Studies) of the Universidade do Estado do Rio de Janeiro (UERJ). He was a visiting scholar at the Center for Latin American Studies in 2017.

Tiago Nery works as an international advisor at Fiocruz and is an associated researcher at Labmundo, the Laboratório de Análise Política Mundial (World Political Analysis Laboratory). He received his Ph.D. in Political Science from IESP-UERJ.

At a July 2021 inquiry on Brazil’s pandemic response, nameplates are replaced by updated numbers of the over 500,000 lives lost due to Covid-19. (Photo by Pedro França/Agência Senado.)


1. Carvalho, J.M. (2019). Forças Armadas e política no Brasil. São Paulo: Todavia.

2. Ventura, D.F.L., & Bueno, F.T.C. (2021). De líder a paria de la salud global: Brasil como laboratorio del “neoliberalismo epidemiológico” ante la Covid-19. Foro Internacional, LXI:2 (244). p. 427-467. Available at Accessed on April 15, 2021.

3. Hallal, P.C., Hartwig, F.P., Horta, B.L., Silveira, M.F., Struchiner, C.J., Vidaletti, L.P., Neumann, N.A., Pellanda, L.C., Dellagostin, O.A., Burattini, M.N., Victora, G.D., Menezes, A.M.B., Barros, F.C., Barros, A.J.D., Victora, C.G. (2020, September). SARS-CoV-2 antibody prevalence in Brazil: Results from two successive nationwide serological household surveys. The Lancet Global Health, 8:11 (E1390-E1398).

4. Fiocruz (2021). Boletim Observatório Covid-19: semanas epidemiológicas 12 e 13. Available at Accessed on April 15, 2021.

5. Ventura, D.F.L., Aith, F., Reis, R. (2021 April 5). The catastrophic Brazilian response to covid-19 may amount to a crime against humanity. The BMJ. Available at: Accessed on April 15 2021.

6. Andreoni, M., Londoño, E., Casado, L. (2021, March 3). Brazilʼs Covid crisis is a warning to the whole world, scientists say. The New York Times. Available at:       Accessed on April 15, 2021.

7. Fiocruz (2021).

8. Ventura,  et al. (2021).

9. Bava, S.C. (2021, April 1). Para enfrentar a fome. Le Monde Diplomatique Brasil.

10. Rede Penssan (2021). Inquérito nacional sobre insegurança alimentar no contexto da pandemia da Covid-19 no Brasil. Available at Accessed on April 15, 2021.

The contents of this magazine were developed under a grant from the U.S. Department of Education. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.