The work process of vector control workers in Brazil from a critical perspective on the ideology of sustainable development

Abstract

Objective  Reflect critically on the strategy to combat endemic diseases adopted in Brazil and how it relates to sustainable development.

Methods  This is an essay based on historical materialism and the concrete experiences of the vector control workers (VCW) of the state of Rio de Janeiro.

Results  The strategy for combating endemic diseases adopted in Brazil, focused on eliminating vectors through the use of agrotoxics (pesticides), including some banned in other countries, subjects the environment, the population and, mainly, the VCW category to exposure to harmful substances that cause various damages to health and life.

Conclusion  The VCW work process is a concrete demonstration that sustainable development is not actually practiced; it is, in fact, an ideology of the capitalist system.

Vector Control Workers; Occupational Exposure; Agrotoxics (pesticides; Occupational Health

Resumo

Objetivo  Refletir, de forma crítica, sobre a estratégia de combate às endemias adotada no Brasil e como ela se relaciona com o desenvolvimento sustentável.

Métodos  Trata-se de um ensaio fundamentado no materialismo histórico e nas experiências concretas dos agentes de combate às endemias/guardas de endemias (ACE) do estado do Rio de Janeiro.

Resultados  A estratégia de combate às endemias adotada no Brasil, focada na eliminação dos vetores por meio do uso de agrotóxicos, inclusive alguns banidos em outros países, submete o ambiente, a população e, principalmente, a categoria dos ACE à exposição a substâncias nocivas que causam diversos danos à saúde e à vida.

Conclusão  O processo de trabalho dos ACE é uma demonstração concreta de que o desenvolvimento sustentável não é de fato praticado; trata-se, na verdade, de uma ideologia do sistema capitalista.

Agentes de Combate às Endemias; Exposição Ocupacional; Agrotóxicos; Saúde do Trabalhador

Introduction

Although the notion of sustainability and sustainable development has been updated over the years, we believe that the document “Our Common Future”¹summarizes the principle of this ideology, which discusses how human actions and activities aim to meet the needs of the present without compromising the possibilities of future generations.

We refer to this notion as an ideology because, scientifically, we understand that, within the limits of capitalism, it is not possible to achieve sustainability or sustainable development. For this, we start from historical materialism, especially the laws of value and the tendency of the rate of profit to fall, developed by Karl Marx in “Capital”²,³, which shows that class struggles under the capitalist mode of production unequivocally generate concentration and centralization of power and wealth in the hands of few capitalists and misery and environmental degradation for the vast majority of workers (and subordinate countries in relation to the dominant ones, expressed in an unequal division of the international organization of labor).

Regarding the defense of “sustainability” or “sustainable development” within the structure contractions of capitalism by a significant number of the progressive sectors of our social formation, we believe it is necessary to make a few warnings: firstly, it is important to point out that the defense of democracy on the Brazilian left, especially political democracy, since as the hegemonic discourse throughout the 1980-90s⁴. In the retreat of working-class resistance (nationally and internationally) and experiences of building socialism, the ideology of dispute within the bourgeois state gained ground more and more in the imagination of left-wing organizations and their militants⁴. Secondly, the defense of sustainability is part of the neoliberal concept of encouraging individualism instead of to strategies of collective fight, which is increasingly being expressed by substantial part of the Brazilian left. Environmental education aimed at sustainable entrepreneurship is a typical example. From this perspective, while the dominant classes through their representatives in numerous world conferences on climate change, try to reach an agreement that seems increasingly distant and unattainable, it would be up to each of us to do our bit (preferably by generating extra income).

In this context, the work process of combating disease-transmitting vectors (arboviruses) in Brazil has had the same characteristics since the beginning of the 20th century: the focus on eliminating vectors using harmful substances to environment and to human and animal health.

This essay aims to critically reflect on the Brazilian strategy adopted to combat endemic diseases and how it relates to sustainable development.

Methods

The adopted methodological emphasizes dialogue between theory and empirical documentary material, allowing marxist critique to reveal ideological contradictions underlying the experience of “Multicentre integrative project: study of the impact on the health of vector control workers (VCW) due to exposure to agrotoxics (pesticides) in the state of Rio de Janeiro” and sustainability issue. This is not an empirical analysis based on experimental data, but rather a theoretical-conceptual examination illuminated by concrete experiences of VCW.

Based on historical materialism - especially the laws of value and tendency of falling profit rate, developed by Karl Marx in “Capital” - and the concrete experience of the VCW in the state of Rio de Janeiro, we discussed the strategy for combating endemic diseases adopted in Brazil, through the use of agrotoxics, and how it relates to sustainable development, how discourse of sustainability is part of reproduction of capital logic and contributes to maintaining the social and environmental relations established by capitalist mode of production.

The expanded research community (CAP)⁵was used as a method for producing knowledge in the “Multicentre integrative project: study of the impact on the health of vector control workers (VCW) due to exposure to agrotoxics in the state of Rio de Janeiro”. The research, which is the subject of this reflection, was approved by the Research Ethics Committee of Sergio Arouca National School of Public Health (CEP/ENSP) under No. 03323018.4.0000.5240, on March 29, 2019.

Vector Control Workers: a story of harm and struggle

From the point of view of historical materialism, labor power is the main commodity of capitalist mode of production, since it produces surplus value. According to Federici⁶, a woman’s womb may have been the first machine of capitalism, the one that produces workers, the labor force. However, just as important as production is reproduction of this commodity. Every day, billions of workers worldwide have to wake up, eat, work, and go home. Therefore, health is fundamental and acquires a double meaning in the class struggle: as a condition for workers’ existence and life, therefore fundamental for their resistance and liberation; and as their energy reproduction, their labor power, potential for extraction of surplus value. It is from this dual perspective that we will approach the VCW work process.

With creation of “specific yellow fever prophylaxis service” by Oswaldo Cruz, then director-general of public health, in 1903, the actions to combat vectors were structured along typically military lines, characterizing actions as a war, workers as soldiers, mosquitoes as anemy, and agrotoxics, that is poisons, as main weapon. The workers were hired as temporary campaigners, i.e. when there was an increase in cases of endemic diseases⁷.

These workers’ history is marked by poor working conditions and lack of stable employment contracts⁸. It was only after many years of struggle that role of the VCW was regulated. They are civil servants linked to the Ministry of Health and municipalities in a position currently named “Endemic Disease Combat Agents” and their main task is to carry out surveillance, prevention, disease control and health promotion activities developed in accordance with Unified Health System (SUS) guidelines. Among these functions, they are responsible for combating endemic diseases using chemical and biological means, environmental management and other integrated vector management actions⁹.

Although their activities are regulated, VCW face various hazards in their work process, which lead to occurrence or complication of diseases and health problems⁸. The concept of harmfulness is used in a posture of certainty in relation to harm, rather than risk, which gives the idea of probability⁵. The Ministry of Health (MS), however, classifies these hazards as “risks” and divides them into: i- ergonomic and work organization risks, such as handling equipment, transporting and applying agrotoxics, manual lifting and carrying of weights, standing work with intense movement; ii- social risks, due to situations of threats or aggression, possible harassment, and exposure to situations of urban and rural violence; iii- physical, such as exposure to sun’s rays, heat, cold and noise; iv- biological, due to contact with the population, vectors, disease reservoirs, contaminated water, solid waste, and sewage; v- and mechanical and accident-related, such as falls from different heights, dog attacks, insect and venomous animal bites, traffic accidents, or accidents with equipment¹⁰.

In addition, Ministry of Health also includes chemical “risk” as one of the biggest concerns for this category of workers, since, from the 1950s onwards, vector combat began to be carried out with the use of synthetic agrotoxics, continuing to this day in the fight against yellow fever, malaria, Chagas’ disease, leishmaniasis, lymphatic filariasis, dengue fever, Chikungunya fever, and Zika virus; as well as use of agrotoxics to combat bubonic plague, typhus, and leptospirosis⁷,⁸.

The methodology for tackling endemic vector-borne diseases has always been the same: a “mosquito-centric” (focused on eliminating vectors) and chemical-dependent (using agrotoxics) strategy¹¹. In theory, the use of chemical substances to combat vectors is recommended in cases where less aggressive intervention tools are not available (biological, mechanical, and educational actions) and in cases of increased insect infestation rates indicated by entomological surveillance¹⁰. However, in reality, chemical control is still used today as a routine and prophylactic practice⁸,¹²,¹³.

The agrotoxics used in public health campaigns have changed over the years, due mosquito resistance to agrotoxics or emergence of new substances, but this practice is clearly ineffective in what it sets out to do, as the country continues to have high morbidity and mortality rates, especially from dengue¹³.

Considering the history of agrotoxics use in public health campaigns in the state of Rio de Janeiro and Brazil, the most widely used organochlorine insecticides between the 1950s and 1990s were: dichloro-diphenyl-trichloroethane (DDT), hexachlorocyclohexane (HCH), and hexachlorobenzene (BHC)¹⁴. As shown by Silveira¹⁵and Vidal¹⁶, after period of practically exclusive organochlorines use, VCW were exposed to a many agrotoxics from different chemical and toxicological classes, such as: anticholinesterase carbamates (bendiocarb) and organophosphates (temephos, fenitrotione, and malathion); coumarins (coumatetralyl, flocoumafen, brodifacoum, and warfarin); benzoylureas (novaluron and diflubenzuron); pyrethroids (cypermethrin, permethrin, pralethrin, deltamethrin, bifenthrin, lambda cyhalothrin, and etofenproxi); neonicotinoids (imidacloprid and clothianidin); pyridyloxypropyl ether (pyriproxifem); spinosyns A and D (spinosad); and the biological larvicide Bti.

Combating vectors strategy with these poisons has been used for decades without solving the problem, as well as causing damage to environment, population, and workers exposed to harmful substances that have varying degrees of toxicity to various systems and organs. Many of these substances have a high potential for causing cancer and endocrine disruption in humans and have been banned for years in developed countries with more restrictive regulatory laws⁸,¹⁷.

This is what Bombardi¹⁸,¹⁹shows in his research and calls the “circle of poison and chemical colonialism”: Brazil imports toxic substances that contaminate its land, workers, and population, to produce and export food products and commodities. The strategy used in Brazil to combat endemic diseases, organized by the Ministry of Health, with products recommended by the World Health Organization (WHO) and the Pan American Health Organization (PAHO)¹¹, has for decades been part of this perspective of chemical colonialism, resulting, as we will show, in a process of illness and death for the workers who carry it out, as well as contaminating the environment and the population.

VCW health and safety standards: the unsustainable limits of the law

It seems important, before starting to describe the set of rules governing VCW work process, to support a thesis due to historical materialism, which are rights as a product of relations of production, and as a product, it seeks to regulate these relations of production, while at the same time leaving them out and omitting them²⁰. Having made this warning, we think we should take a double view of legislation: i - as a conquest of the workers’ struggle; ii - as a condition for reproduction of social relations of production, which are omitted from legislation. In other words, if it is impossible to achieve a agrotoxics-free society, we seek to regulate it, which is an achievement at struggle limits, because it would be worse without it, but which also, in general, enables the “safe”, “rational” use of these agrotoxics which, as we will show below, is not possible under the living and working conditions of VCW.

Thus, as a workers’ struggle result and as a way of minimizing damage to health/life (health/life, because disregard for health is synonymous with disregard for life) caused by exposure to various hazards, occupational safety and health measures have been adopted, as recommended in regulatory norms (NR), with the most current guiding document being the “Manual on health protection measures for vector control workers”¹⁰.

In addition, NR-31 recommends that the following risk control measures be adopted: elimination of the hazard, substitution of the hazard, engineering controls (collective protection measures), administrative controls, and individual protection measures (personal protective equipment - PPE)¹⁰.

Therefore, in the logic of combat, the first measure to be adopted should be to replace the use of agrotoxics with alternative vector control strategies. However, as this does not happen, the next step is to adopt collective protection measures, even though they are inadequate and insufficient for the VCW work process. Workers face precarious working infrastructure conditions; inadequate resources and physical spaces; incorrect storage of materials used in vector combat; lack of a fixed workplace for workers who make home visits; and lack of efficient training and information about the products used, which can lead to damage to health due to lack of knowledge about their harmful effects²¹.

As for PPE, according to NR-06, the employer must provide them sanitized and in perfect conditions for use, as well as being responsible for their decontamination and replacement whenever necessary¹⁰. However, this does not occur in VCW’s reality, who suffer from a lack of PPE and/or the use of inappropriate PPE, which is responsibility of public government, as Ministry of Health or the State or Municipal Health Department.

A VCW survey in Rio de Janeiro state showed that the majority of workers had not received training or did not consider it adequate or sufficient; they do not use PPE because they do not receive it from their employer; they wear their own clothes and vests during agrotoxics application work, which they wash in their own homes (themselves, their partners or others), which is a worrying fact because it also exposes those who handle the contaminated clothes. There were reports that their skin often comes into contact with agrotoxics, especially their hands, face, arms and forearms; and that they experience different symptoms of acute poisoning after contact with agrotoxics used in public health campaigns, such as: headache, skin irritation, malaise, burning nose and mouth/difficulty breathing and vomiting, stomach pain, diarrhea or nausea¹⁶.

In addition, PPE cannot be a substitute for collective protection measures, since even with the use of PPE in accordance with the recommendations of manufacturers and health agencies, there is no total protection, and it is therefore essential to avoid exposure²².

NR-07, on the other hand, deals with “Occupational Health Medical Control Program” (PCMSO), which the main objectives are to prevent work-related health problems and detect possible exposures, with periodic examinations being one of the recommended measures, the responsibility for which lies with the body to which the worker is linked, which must guarantee medical monitoring and periodic clinical examinations every year, and complementary (laboratory) examinations every six months¹⁰.

VCW face a very dramatic scenario due to employer’s failure to fulfill its duty, since periodic exams have not been carried out for decades⁸. This led one of unions representing the category to file a lawsuit against the Ministry of Health in November 2018, requesting that periodic exams should be carried out as a matter of urgency, due to the high number of illness cases, retirements due to permanent incapacity for work and death due to serious illnesses. In December of same year, Federal Court of Rio de Janeiro ruled in favor of workers, ordering the Federal Government to carry out medical examinations on VCW linked to the MS in Rio de Janeiro state within 90 days.

However, the deadline was not met and workers continued to miss periodic exams, as MS has since appealed the decision, claiming that responsibility for carrying out the exams lies with the municipalities to which the VCW are assigned. In May 2023, the court decision was reiterated and a fine was imposed for failure to meet the established deadlines, however, to dateⁱ , the VCW have not been summoned to take the periodic exams.

The Brazilian vector combat model and “sustainable development” under the order of capital

Although international agreements on “sustainability” do not have character of internal law in signatory countries, but rather function more as letters of intent, they play an extremely important ideological role, omitting the relations of production that generate them and, worse, every time they are updated (and they are constantly), they move an army of “well-meaning” people who seek to save humanity from the arms of capitalism, or give it a new conciliatory guise, such as the fashionable acronym ESG (Environmental, Social, and Corporate Governance).

Today, sustainable development is a very broad concept that encompasses global actions aimed at economic development, in a way that protects environment and climate and guarantees a reduction in social inequalities. Let us see that, in a simple discourse analysis, to remove the veil of impartiality, we could ask: economic development for whom? Under what relations of production? Why reduce social inequalities and not end them?

In the most current version of “sustainability” initiatives, the United Nations (UN) 2030 Agenda and its 17 Sustainable Development Goals (SDG) were created in 2015, with the aim of uniting all member countries around these goals.

Vector control work as a public health strategy would be directly interrelated with some SDG, such as SDG 3 which aims to “Ensure healthy lives and promote well-being for all at all ages”; SDG 6 which aims to “Ensure availability and sustainable management of water and sanitation for all”; SDG 8 which aims to “Promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all”; and SDG 11 which aims to “Make cities and human settlements inclusive, safe, resilient, and sustainable”²³.

Furthermore, as might be expected, the SDG corroborate the fundamental rights guaranteed by UN Universal Declaration of Human Rights, various international conventions and Brazilian Federal Constitution, with regard to guaranteeing “human dignity”, safety and health of “every” human being, including the workplace, and protecting environment through “less” harmful practices, which include reducing use of substances that are harmful to humans, animals and environment²³.

As a signatory to 2030 Agenda, Brazil has adopted specific internal targets, such as: reducing number of deaths and illnesses from hazardous chemicals, such as agrotoxics; reducing human and environmental contamination, and air, water, and soil pollution; eliminating, as a public health problem, epidemics such as malaria, neglected diseases, and arboviruses transmitted by Aedes aegypti and other communicable diseases; supporting research and development of health technologies and innovations for communicable and non-communicable diseases, providing access to these technologies and innovations incorporated into SUS, including medicines and vaccines, to entire population; access to adequate and equitable environmental sanitation and hygiene for all; reducing the per capita negative environmental impact of cities, including paying special attention to air quality and municipal solid waste management; achieving universal and equitable access to safe and affordable water for human consumption for all; and guaranteeing access for all to decent, adequate and affordable housing basic services and urbanization of precarious settlements in accordance with the targets set out in National Housing Plan, with special attention to groups in situations of vulnerability²⁴.

Despite these internal targets, Brazilian state, which economy is based heavily on agribusiness, has been the world’s largest agrotoxics market since 2008²⁵, many of which contain numerous substances that have already been banned in other countries, including several with carcinogenic potential¹⁵,¹⁷and are sprayed using airplanes²⁶,²⁷.

Analyzing the reality based on these assumptions, what we see in practice is that the set of internal targets for achieving the SDG, as well as the SDG themselves, are ideological instruments that guarantee the “good” intentions of Brazilian state, but what we see, in addition to the facts described above, is: the lack of an agrarian and urban reform policy; low investment of public resources in development and production of vaccines for neglected diseases; and in improvements to urbanization, environmental sanitation (sewage, urban drainage, and solid waste collection), and water supply, which leads the most vulnerable populations to unsafe household water storage and inadequate waste disposal. All these conditions are very favorable for the emergence of breeding sites and reproduction of disease-transmitting vectors²⁵.

Regarding “good intentions”, especially with regard to work processes and workers’ health, it is interesting to note that another internal goal of the SDG is to guarantee “decent” work and “reduce the degree of non-compliance with labor legislation”, with regard to registration, working conditions, health, and safety standards at work, with an emphasis on workers in vulnerable situations²⁴. Thus, the term “decent work” was formalized by International Labour Organization (ILO) in 1999 and integrated into the SDG as a fundamental condition for overcoming poverty, reducing social inequalities, ensuring democratic governance and sustainable development, encompassing opportunities for men and women to obtain productive and quality work, with freedom, equity, security and human dignity²⁸.

Based on all data and discussions presented so far, ideological content of these propositions is notorious, since a standardization (even in the form of a goal) that presents “decent work” as an objective to be achieved hides the real relations of production (relations of exploitation) faced by the working class as a whole. Here, the VCW are important elements in this picture, as they are part (not the only ones) of the working class that gets poisoned, intoxicated and dies.

Workers falling ill and dying: the unsustainable farce of the lack of causal links

It is worth highlighting in this discussion the difficulty that workers exposed to agrotoxics find in proving existence of a causal link between exposure, both acute and chronic, to products and damage to their health. Although the scientific literature shows that these substances are related to damage to different body’s systems, the poor training of health professionals toxicological knowledge often leads to failure to investigate and prove the causal link between exposure and intoxication/disease, resulting in underreporting of cases agrotoxic poisoning among workers²⁹.

This scenario is even more serious when it comes to chronic exposure. In this sense, De-assis et al.³⁰and Nogueira, Szwarcwald, and Damacena³¹have demonstrated health damage related to occupational exposure of farmers, mainly: hematological and immunological alterations, respiratory and hearing problems, endocrine and neurological alterations, infertility, subclinical effects (genetic damage and biochemical alterations), and, of greater concern, risk of developing some types of neoplasms.

Establishing a causal link between exposure and health problems is important, as it provides basis for limiting agrotoxics use. For example, the well-established causal link between exposure to organophosphates and neurological damage led the Ministry of Health, through the “Health Surveillance of Populations Exposed to agrotoxics” (VSPEA) program, to publish a document called “Brazilian Guidelines for Diagnosis and Treatment of Acute Poisoning by Agrotoxics”, one of whose chapters deals with late-onset neuropathy and chronic neuropsychiatric disorder induced by organophosphates³².

Although research on VCW is scarce, existing studies show that exposure to pyrethroids was significantly associated with neurological deficits³³and glucose dysregulation³⁴; exposure to DDT was associated with neuropsychiatric symptoms³⁵; and exposure to organophosphates is associated with increased oxidative stress, susceptibility markers linked to oncogenesis and aging cell³⁶,³⁷, and changes in lipid metabolism, which can cause obesity and cardiovascular diseases³⁸.

The evaluation of working conditions and health of VCW in state of Rio de Janeiro showed, with statistical significance, that the time spent applying agrotoxics is associated with the development of essential tremor in this professional category at a very early age (from 40 years onwards)³⁹; that activity involving contact, handling, or application of agrotoxics in the past, previous acute intoxication and use of malathion was associated with common mental disorders (symptoms such as insomnia, irritability, forgetfulness, etc.) in a group of exposed workers¹⁶; and that the quality of sleep of VCW is classified as unhealthy, especially for women, and that work process contributed to worsening⁴⁰. In addition, a survey of agrotoxics used in vector combat in the state showed that malathion, alpha-cypermethrin, bifenthrin, permethrin, cypermethrin and diflubenzuron metabolites have carcinogenic potential according to International Agency for Research on Cancer (IARC) and/or the United States Environmental Protection Agency (US-EPA)¹⁵.

Data provided by Nucleus of the Ministry of Health in Rio de Janeiro shows a large increase in deaths and professional leave due to illness for VCW in the state between 2010 and 2018. A major concern is the number of deaths from cancer and early deaths, at a productive age, with an average age of approximately 55 years, with main causes of death being diseases of circulatory system (39%) and cancer (15%). Cancer is the second leading cause of death among VCW, but in general population it is in tenth place. In addition, the life expectancy of Brazilian population is approximately 76 years, meaning that VCW are dying, on average, 21 years earlier than general population⁸.

Workers encounter even more barriers to ensuring occupational safety and health measures when, despite scientific evidence, they depend on establishing the causal link between exposure to agrotoxics and health problems, which is currently based on classic cause-effect biomedical epidemiology. This model is not effective in explaining the causality of atypical diseases, i.e., those in which work can cause a latent disorder or aggravate a pre-existing disease, such as those caused by agrotoxics, which have a much more complex link to be determined, and whose mediations are not so direct⁴¹.

In addition, the list of work-related diseases, which should be updated periodically by the MS, was updated after 24 years, through Ministerial Order GM/MS No. 1,999/2023. The number of diseases related to exposure to agrotoxics at work has increased, but in a general and unclear way, without highlighting the specificity and degree of relationship between the class or chemical substance and diseases caused. The lack of clarity opens even more gaps for the causal link to be just an abstract instrument, without effective applicability, since, according to the multicausality paradigm, other risk factors can also cause most diseases.

To mitigate the problem, in clear and cynical recognition of unhealthiness and harmfulness of the VCW’s work, state provides for monetary compensation with payment of bonuses regulated by NR-15, which deals with “unhealthy activities and operations”. According to this NR, VCW are entitled to an additional medium-risk degree of unhealthiness for handling organophosphate agrotoxics, which is equivalent to 20% for workers under ‘the Brazilian Consolidation of Labor Laws (CLT)’ and 10% for civil servants under the Single Legal Regime (Regime Jurídico Único – RJU), levied on their salary, according to Law No. 13,342/2016. These are the “extra” prices paid to workers, so that they are continually exposed to toxic substances that cause them illness and death, in the name of ineffective protection of population’s health.

In the society of capital, representatives of financial power hold political power and labor rights are fruit of struggle of working class. If we consider that VCW has reduced life expectancy by 27% on average, we can see who is really winning with this unsustainable policy of death⁸.

In addition, by appropriating labor power, capitalist system exposes workers in general and VCW in particular to the most diverse unhealthy and dangerous conditions, expropriating them of their strength/health/life, and making them easily disposable and replaceable parts for others available on the market.

Conclusion

Our aim in this work was to criticize the ideology of sustainable development in the light of a concrete analysis of VCW’s work process, using historical materialism as a theoretical foundation. In this analysis, we concluded that VCW’s work process was born and still remains today organized in a militarized way, with a focus on combating vectors, characterizing the actions as a war, where workers are the soldiers (replaceable), the mosquitoes are enemies and the agrotoxics are the main weapon.

In this history, we have tried to clearly demonstrate that the set of campaigns in favor of so-called sustainable development - of which 2030 Agenda and SDG are only the most recent - as well as the set of laws and norms that seek to regulate the VCW work process, are insufficient to ensure workers’ health and Brazilian population as a whole. Furthermore, we revealed, as well as being insufficient, they act as an ideological veil, making it difficult to understand the concrete reality and calling society to actions that only mitigate the extremely violent effects imposed by capitalist relations of production.

With workers’ example who combat endemic diseases, we are trying to show that the working class feels the impossibility of a sustainable capitalist society and that this experience should illuminate our struggle perspectives.

Acknowledgements

To the vector control workers, especially Eliza Abrantes and Luiza Dantas, in memoriam.

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• Data availability:
  The entire data set supporting the results of this study has been published in the article itself.
• Presentation at a scientific event:
  The authors declare that the study has not been presented at a scientific event.
• i
  March 2025. We believe it is important to add in this footnote: The authors consider it important to inform that, after many years of struggle by the VCW, at the end of the editing of this text, in April 2025, Ministry of Health began the calls for periodic exams for the category.
• Funding:
  The authors declare that the study was not subsidized.

Edited by

• Editor-in-Chief:
  Leila Posenato Garcia

Data availability

The entire data set supporting the results of this study has been published in the article itself.

Publication Dates

• Publication in this collection
  07 July 2025
• Date of issue
  2025

History

• Received
  30 July 2024
• Reviewed
  27 Feb 2025
• Accepted
  28 Feb 2025