Last October, I wrote about my experiences with the nascent skepticism movement in Brazil. In August of 2019, I traveled to São Paulo to speak at a number of events organized by the newly formed Instituto Questão de Ciência (IQC; Question of Science Institute), and I was introduced to a remarkably energetic group of science advocates. At the time, IQC had been in operation for less than a year, but the group had already launched a website, an online journal, and a social media campaign, and they had organized an impressive schedule of conferences, lectures, and public appearances.
IQC is led by President Natalia Pasternak; Carlos Orsi, a prolific science writer who serves as communications director and editor of the institute’s website and journal; Marcelo Yamashita, who also runs the Institute of Theoretical Physics of Unesp, a major Brazilian university; and the psychologist and lawyer Paulo Almeida. The organization also has a board of advisors with representatives from a wide range of sciences, as well as philosophy and medicine. Prior to the coronavirus epidemic, the IQC spent much of its time fighting the unproven alternative medicines that are fully embedded in Brazil’s national health service. Despite having no scientific evidence to back it up, homeopathy—the nineteenth-century system of medicines so diluted that they are all essentially placebos—is promoted by many Brazilian doctors, and the costs of these placebo treatments are covered by the national healthcare system. For their launch event, IQC invited Edzard Ernst, the world’s foremost critic of homeopathy and other alternative medicine techniques, to speak. Pasternak and others frequently speak out about these and other pseudoscientific topics as well. As remarkable as the launch of IQC has been, the organization’s work accelerated drastically when COVID-19 came to town.
Brazil’s Response to the Coronavirus Threat
Praised for its nimble and innovative responses to earlier health crises, including HIV in the 1990s and Zika in 2015, Brazil is on the verge of overtaking the United States for the distinction of the world’s worst management of the coronavirus crisis. As in the United States, the current epidemic has been politicized to the detriment of the public’s health. Brazil’s president, Jair Bolsonaro, is a populist leader in the style of Turkey’s Recep Tayyip Erdoğan, Hungary’s Viktor Orbán, the United Kingdom’s Boris Johnson, and the United States’ Donald Trump, and his response to the coronavirus crisis has been similar to Trump’s. Bolsonaro has frequently challenged the recommendations of his health ministers and downplayed the need for isolation, calling the COVID-19 “a little flu.” Throughout the epidemic, he has rarely used a mask and has kept up a very active schedule, traveling to meetings throughout the country. He often goes into crowds without a mask, and, until very recently, he continued to shake hands and hug people. Similar to in the United States, Brazilian governors and mayors have stuck more closely to the health recommendations, stressing the need for sheltering in place and social distancing. Also similar to in the United States, President Bolsonaro has attacked their policies. When the nation’s health officials give science-based information, Bolsonaro has responded in anger, and he fired Brazil’s health minister in April. That health minister’s replacement resigned less than a month later, and the current interim minister is an army general. Bolsonaro has contravened health recommendations by declaring gyms, barbershops, and beauty salons essential services and, like Trump, by promoting the anti-malarial drug hydroxychloroquine despite the absence of evidence that it is effective in the treatment of COVID-19. On July 7, Bolsonaro announced that he had tested positive for COVID-19, and after his diagnosis took hydroxychloroquine in a live Facebook event.
Due to clashes with President Trump, federal health officials in the United States have had to be very diplomatic in their statements to the public. Although Trump cannot fire him, Dr. Anthony Fauci, the highly respected director of the National Institute of Allergy and Infectious Diseases, has been somewhat sidelined. More recently, the Trump administration has made deliberate efforts to undermine Fauci, distributing examples of what they described as his “mistakes.” Of course, SARS-CoV-2 is a newly discovered virus, and many of the early hypotheses about how it would behave have proven wrong. As scientists have learned more, their guidance has become clearer.
As bad as the current situation in the United States may be, if anything, things are even worse in Brazil. This is where the Brazilian skeptic group IQC comes in. With mixed messages coming from government authorities and health professionals, the Brazilian public has a desperate need for clear, science-based information. Fortunately, Natalia Pasternak, the president of IQC, is a microbiologist by training and a research scientist at the University of São Paulo. She was no stranger to the media before the current pandemic, frequently appearing on television and in print media to talk about homeopathy and other forms of pseudoscience. But the coronavirus outbreak has made Pasternak an extremely visible spokesperson for sanity and science. She has appeared several times a week on Jornal Nacional, the most-watched TV newscast in the country, as well as other news programs, and she writes a weekly science column in O Globo, a Rio de Janeiro newspaper whose website is the fifth most popular in the country.
Brazil faces unique challenges in the fight against SARS-CoV-2. Although nationalized medicine is available to all citizens, a large segment of the population is very poor. In the slums surrounding large cities, such as Rio de Janeiro and São Paulo, many people live packed together in small areas that provide a fertile environment for the virus to spread. Although some of the earliest outbreaks were in wealthier areas of the big cities, recent studies show that the coronavirus infection rates are much higher in the slums than in other parts of the country. For example, one study found an infection rate of 28 percent in Cidade de Deus, the slum made famous by the 2002 movie City of God. By comparison, São Paulo, the largest city in Brazil, had an infection rate of 9.5 percent. Because the slums have not received adequate assistance from the government, some activists are mobilizing to provide food and “coronavirus kits” to local families. But infections and deaths continue to rise.
The need for good science-based health information is quite dire. Pasternak was shocked to find that many doctors in Brazil knew very little about scientific methods. She debated two doctors about the use of hydrochloroquine and discovered that they knew nothing about how a clinical trial was conducted. They claimed they were sure the drug worked based on anecdotal evidence and their own clinical experience. Pasternak’s debate with the two doctors became a viral video in Brazil when she explained the need to blind doctors in a double-blind placebo-controlled study. When they said they could see results with their own eyes, she said, “That’s why we blind you!”
In the long run, improving the public image of science in Brazil will require broad cultural changes. In a talk about the current situation presented in English for Skeptics in the Pub UK, Pasternak expressed the opinion that science needs a democracy to thrive, and, as a result, members of IQC consider supporting democracy a part of their mission. For obvious reasons, Pasternak holds little hope for the encouragement of either science or democracy as long as the current regime is in power in Brazil. (Pasternak’s Skeptic in the Pub presentation can be seen here.)
A Place Where Science Is Valued
In dramatic contrast to both the United States and Brazil, New Zealand has arguably mounted the most effective response to the novel coronavirus threat of any country. The leadership attacked the coronavirus “hard and early,” and on June 8, Prime Minister Jacinda Ardern announced that 40,000 people had been tested in the previous seventeen days and none of them were positive for SARS-CoV-2. New Zealand hospitals had not treated a COVID-19 patient for twelve days. Having reached this milestone, Kiwis returned to a kind of freedom of movement and economic activity that remains unimaginable in many other places—certainly here in the United States. Since reopening, New Zealand has averaged between zero and three new infections per day. As I write this, the country’s total deaths due to COVID-19 stand at twenty-two. Adjusted for population, that would be equivalent to 1,456 deaths in the United States—approximately one percent of our actual total—and as New Zealand’s COVID-19 fatalities have stalled, deaths continue to rise in the United States and Brazil.
Prime Minister Ardern confessed to have done “a little dance” when New Zealand reached a goal that allowed for reopening the country. Later in the month, she made a point of praising the role of science communicators:
I would like to make a special mention of our science communicators. Without our communicators who publicly inform, explain, teach, decode, counter misinformation, and debate science matters, many would remain in a space where they don’t have information they need, leading to poor choices being made at really crucial times. Our communicators have become household names—and rightly so—over recent months helping our nation comprehend the challenge that COVID presented. However, it is not only in times of catastrophe that we need our science communicators and experts. They are equally important in leading public engagement on how science will be used by New Zealand in the future. I want to acknowledge and thank all our science experts and communicators for making a difference for our team of five million, particularly during difficult times and to those who will lead us into an exciting future.
Just when we thought we couldn’t possibly admire @jacindaardern any more than we already do…
— Sheril Kirshenbaum (@Sheril_) June 30, 2020
New Zealand Prime Minister Jacinda Ardern makes a statement in praise of science communicators and science experts.
We have probably come to a point where most developed countries have access to good science experts and science communicators—the kinds of professionals a nation needs to inform the public during a health emergency. Certainly, this is true for both the United States and Brazil based on their past performances and on the sound information coming from people such as Anthony Fauci and Natalia Pasternak. So, what explains the dramatic differences between successful and unsuccessful countries? Every public health threat is different, but it seems obvious that much of the difference can be attributed to national leadership. Some countries, such as Sweden and, briefly, the United Kingdom, adopted a risky herd immunity strategy that did not work. Others, such as the United States, Brazil, and, briefly, the United Kingdom, contradicted the experts and did not respond with an aggressive science-based public health approach. Almost without exception, countries that have embraced science and mobilized quickly have had much better results and, as of this writing, are well along in their economic recovery process. Scientists and science communicators cannot do the job alone. Real success requires leadership at the highest levels of government. In the meantime, Natalia Pasternak and the IQC in Brazil and Dr. Fauci in the United States will continue to do their best to provide good information to the public despite the national leadership failures around them.