Challenges of the COVID-19 pandemic: for a Brazilian research agenda in global health and sustainability

Deisy de Freitas Lima Ventura Helena Ribeiro Gabriela Marques di Giulio Patrícia Constante Jaime João Nunes Cláudia Maria Bógus José Leopoldo Ferreira Antunes Eliseu Alves Waldman About the authors

The declaration by World Health Organization (WHO) of the novel coronavirus (SARS-CoV-2) outbreak as a public health emergency of international concern on January 30, 2020 11. World Health Organization. Director-General's statement on IHR Emergency Committee on Novel Coronavirus (2019-nCoV), Genebra, 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-statement-on-ihr-emergency-committee-on-novel-coronavirus-(2019-ncov) (acessado em 28/Fev/2020).
https://www.who.int/dg/speeches/detail/w...
, has focused the scientific community’s attention once again on the field of global health. We are referring here to global health as a new terrain that reconfigures preexisting ideological, geopolitical, and methodological disputes in the international arena, forming a field that can both offer real opportunities in the search for equity 22. Biehl J, Petryna A. Peopling global health. Saúde Soc 2014; 23:376-89. while masking a wide variety of private interests and agendas 33. Taylor S. 'Global health': meaning what? BMJ Glob Health 2018; 3:e000843.. As occurred during the international emergency involving the congenital Zika virus syndrome, in which Brazil was the epicenter in 2016 44. World Health Organization. Statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations. https://www.who.int/en/news-room/detail/01-02-2016-who-statement-on-the-first-meeting-of-the-international-health-regulations-(2005)-(ihr-2005)-emergency-committee-on-zika-virus-and-observed-increase-in-neurological-disorders-and-neonatal-malformations (acessado em 28/Fev/2020).
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, the new declaration of emergency opened the way for scientific research on COVID-19 in high-impact international journals, which have prioritized and defended open access to their publications as a way of contributing to the international response 55. Carr D. Sharing research data and findings relevant to the novel coronavirus (COVID-19) outbreak. Wellcome Trust Statement. https://wellcome.ac.uk/press-release/sharing-research-data-and-findings-relevant-novel-coronavirus-COVID-19-outbreak (acessado em 28/Fev/2020).
https://wellcome.ac.uk/press-release/sha...
. Research on COVID-19 has also been induced by international agencies and universities under the auspices of major funders 66. Global Research Collaboration for Infectious Disease Preparedness. GloPID-R facing the COVID-19 emergency with its members and partners. https://www.glopid-r.org/glopid-r-facing-the-COVID-2019-emergency-with-its-members-and-partners/ (acessado em 06/Fev/2020).
https://www.glopid-r.org/glopid-r-facing...
. However, the history of health crises has shown that this priority will disappear when the COVID-19 emergency ends, thus reflecting a cyclothymic global investment strategy, the object of which is unpredictable, depending on the emergency at hand.

This article aims to reflect on the new boom in research output in the field of global health, based on two analytical elements that we consider essential. The first is the important shift in the Brazilian State’s role in international relations, particularly in international forums related to health and the environment, including a significant loss of leadership in the implementation of the Sustainable Development Goals (SDG) under the 2030 Agenda 77. Organizações das Nações Unidas. Transformando nosso mundo: a Agenda 2030 para o Desenvolvimento Sustentável, 2015. http://www.itamaraty.gov.br/images/ed_desenvsust/Agenda2030-completo-site.pdf (acessado em 28/Fev/2020).
http://www.itamaraty.gov.br/images/ed_de...
. The second is sustainability, with a fundamental focus on a research agenda in the field of global health. The term “sustainability”, which we assume is polysemous and controversial, is used in this article from a critical and interdisciplinary perspective, highlighting issues related to cultural diversity, solidarity with the planet (and its biodiversity), ethical values and equity, equal rights, justice, and autonomy 88. Silva Junior RD, Ferreira LC, Lewinsohn TM. Entre hibridismos e polissemias: para uma análise sociológica das sustentabilidades. Ambiente e Sociedade 2015; 18:4.. In its elementary sense, sustainability refers to the pursuit of economic and social development capable of focusing on current needs without jeopardizing the possibility of future generations meeting their own needs 99. World Commission on Environment and Development. Our common future. Oxford: Oxford University Press; 1987.. Meeting the current needs of some regions of the world has led to imbalances that hinder or even impede life altogether in other regions. However, we contend that a multidimensional interpretation of sustainability has enormous potential for addressing the challenges in late modernity, which are spreading in different domains and on different scales. Such challenges are characterized by uncertainties, ambiguities, and complexities 1010. Renn O. Risk governance: coping with uncertainty in a complex world. London: Routledge; 2008. and demand responses and interventions that take into account the need for profound changes in the socioeconomic systems, in the modes of production and consumption 1111. Loorbach D, Frantzeskaki N, Avelino F. Sustainability transitions research: transforming science and practice for societal change. Annu Rev Environ Resour 2017; 42:599-626. in various areas such as energy, agriculture, water, transportation, housing, and health. In addition, the continuity of public policies is indispensable for long-term solutions that effectively promote equality, cohesion, and social justice, through integrated, articulated or at least coordinated intersectoral policies.

In relation to international emergencies, we defend a permanent research agenda that takes into account not only the evolution of specific diseases, but the impact of crises on the health of populations, in addition to research on the social, environmental, economic, and political causes of epidemics. As with the reaction to the international emergency involving the Ebola virus in West Africa from 2014 to 2015, an important share of the research on COVID-19 has involved discourses with a highly normative content that tend to emphasize the search for vaccines and other technologies, as well as the need to build effective international surveillance systems prepared to produce an immediate and focused response to contain epidemics. Without denying the importance of these studies and activities, the literature on the relationship between global health and the Anthropocene clearly identifies the limits of technological solutions to respond to the emergence of new pathogens, also influenced by major political and institutional dysfunctions 1212. Hirschfeld K. Microbial insurgency: theorizing global health in the Anthropocene. Anthropocene Review 2020; 7:3-18..

We contend that it is essential promote research on emergencies continuously and systematically, and not only when such emergencies are occupying the headlines and triggering panic. Beyond the rapid responses to emerging issues, it is necessary to invest in interdisciplinary research on priority public health problems that do not call the attention of local or global political leaders, either because they are endemic, they do not rapidly change the population’s morbidity and mortality rates, and/or they have little potential to spread to the wealthy countries.

In this sense, in order to design a sustainable international response to public health emergencies, it is indispensable to study the lessons from the five previously declared international health emergencies, two of which are still under way: poliovirus in regions with armed conflicts since 2014 and Ebola in the Democratic Republic of the Congo since 2019. Relatively little is said about either of these emergencies. It is necessary, first and foremost, to explain why the spotlights are on certain diseases and not others. Knowledge production should extrapolate the purely technological and biomedical perspective of emergencies and take into account the macrostructural issues in health-disease processes and their social determination 1313. Nunes J, Pimenta DN. A epidemia de Zika e os limites da saúde global. Lua Nova 2016; 98:21-46.. On this point, the contribution of the social and human sciences should not be overlooked.

In the case of the congenital Zika virus syndrome, for example, sustainability appears as an important key in the emergency’s analysis. First, because detection and containment of the disease were only possible thanks to a permanent structural element, Brazilian Unified National Health System (SUS). Clearly, the response to emergencies is only possible with well-structured health systems, with surveillance and research capacity led by a critical mass of well-trained professionals, prepared for action in these three watersheds. Second, because the greatest dysfunctions in the Brazilian response are related to the deficit in sustainability in sanitation and vector control. Only 52.36% of the Brazilian population as a whole (and 26.7% of the population in Northeast Brazil) have access to sewage disposal. Rising temperatures and poor sanitation conditions favor proliferation of the mosquito vectors. Thus, sustainable sanitation measures would produce more beneficial results than vector control with pesticides, which take a heavy toll on human and animal health. Measures in defense of the rights of children affected by the congenital Zika virus syndrome, as well as the women’s sexual and reproductive rights, are important elements in the research agenda. Effects that can curtail people’s rights before, during, and after emergencies also deserve researchers’ attention. COVID-19 has already triggered discrimination on grounds of national origin 1414. Shimizu K. 2019-nCoV, fake news, and racism. Lancet 2020; 395:685-6., besides unjustifiable restrictions on individuals’ international mobility 1515. Habibi R, Burci GL, Campos TC, Chirwa D, Cinà M, Dagron S, et al. Do not violate the International Health Regulations during the COVID-19 outbreak. Lancet 2020; 395:664-6.. Deconstructing the one-off nature of approaches to emergencies also requires the study of their environmental origins and the potential repercussions of the international response (or lack thereof) on the environment, health, and local development.

In this sense, despite the great attention attracted by some international emergencies, they are only one watershed in a far wider terrain. The field should include: a critical view of international cooperation in the health field; the study of the double burden of poor nutrition that involves both undernutrition and obesity and that demands orientation on human rights in food and health 1616. Buse K, Patterson D, Magnusson R, Toebes B. Urgent call for human rights guidance on diets and food systems. The BMJ Opinion 2019; 30 oct. https://blogs.bmj.com/bmj/2019/10/30/urgent-call-for-human-rights-guidance-on-diets-and-food-systems/.
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; the impact of climate changes, with special emphasis on the relations between global and local phenomena, situated at the interface between health and the environment; research on the States’ foreign policies in the field of health and the power dynamics in international organizations; and the interrelations between migrations and health, among other topics.

Climate changes represent an unprecedented emergency that threatens the future of human rights, placing in jeopardy the strides in development and poverty reduction achieved in the last 50 years 1717. Human Rights Council. Climate change and poverty. Report of the special rapporteur on extreme poverty and human rights. https://reliefweb.int/report/world/climate-change-and-poverty-report-special-rapporteur-extreme-poverty-and-human-rights (acessado em 28/Fev/2020).
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, increasing the asymmetries between the States, with repercussions especially for the low and middle-income countries. Climate changes are also present in the concept of the global syndemic of obesity and malnutrition as a major challenge for humans, the environment, and the planet, linked to common factors in the food crop systems, transportation, urban design, and land use 1818. Instituto Brasileiro de Defesa do Consumidor. Sindemia global: obesidade, desnutrição e mudanças climáticas: relatório da Comissão The Lancet. https://alimentandopoliticas.org.br/wp-content/uploads/2019/08/idec-the_lancet-sumario_executivo-baixa.pdf (acessado em 28/Fev/2020).
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. With increasingly globalized food crop systems, mechanisms for the regulation of foods assume a crucial role in the international food and nutritional security agenda that needs to be reaffirmed as a global health issue 1919. Ribeiro H, Jaime PC, Ventura DFL. Alimentação e sustentabilidade. Estud Av 2017; 31:185-98..

Hugely important is the command of the methodologies employed in the global health field, expanding the capacity of Brazilian researchers to engage in dialogue with the field’s international literature, both to question it and to join the critical schools that have emerged around the world, especially in the developing countries. From the point of view of international academic cooperation, the initiatives in South America and the Global South should be prioritized. Promising methodological paths can be explored, such as studies on the circulation, dissemination, and global transfer of public policies. Methodological training to conduct case studies and the improvement of comparative case study methodologies are also highly relevant.

Finally, it is necessary to study the role played by Brazil in recent decades as leader of a critical vision in global health policy, with an outstanding foreign policy in this field qualified by the principles and experience of the SUS 2020. Buss PM. Cooperação internacional em saúde do Brasil na era do SUS. Ciênc Saúde Colet 2018; 23:1881-90.. The about-face now resulting from the rise to power of extreme rightwing forces in the Federal Government has undermined Brazil’s historical leadership role on themes of the utmost importance (HIV/AIDS, intellectual property, access to essential drugs, South-South cooperation, regional integration, etc.) and led to a shift in Brazil’s position, now defending the agenda of the most conservative sector of the U.S. Republican Party. The new correlation of forces in Brazil’s Executive Branch (resistant to approaching the climate issue) and the political support for predatory agricultural practices also tend to aggravate this scenario. This makes critical studies on the implementation of the 2030 Agenda even more important. The Brazilian Administration has now joined an international alliance with particularly harmful potential for the health of the world’s underprivileged populations and the environment.

In a scenario of discredit to education and science, it is even more important for researchers in the global health field to be alert to the themes in which Brazil’s new international action has the most intense repercussions, such as issues related to democracy and human rights, and within these, especially gender issues. Challenging the Northern Hemisphere’s predominance in the global health research agenda and incorporating sustainability as a reference capable of backing a critical view of the cycles of interest dedicated to the field, Brazilian researchers can both confront the automatic importation of normative research output tied to the developed world’s interests and contribute to the consolidation of global health approaches in which people and the environment truly take first place 22. Biehl J, Petryna A. Peopling global health. Saúde Soc 2014; 23:376-89..

References

Publication Dates

  • Publication in this collection
    22 Apr 2020
  • Date of issue
    2020

History

  • Received
    02 Mar 2020
  • Accepted
    26 Mar 2020
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