Civil society, the COVID-19 pandemic, and universal access to medicines in Brazil: building a better framework

• Grant number: 22/07849-0
• Support Opportunities: Scholarships in Brazil - Post-Doctorate
• Effective date (Start): July 01, 2022
• Effective date (End): June 30, 2024
• Field of knowledge: Applied Social Sciences - Administration - Public Administration
• Principal Investigator: Elize Massard da Fonseca
• Grantee: Helena de Moraes Achcar
• Host Institution: Escola de Administração de Empresas (EAESP). Fundação Getúlio Vargas (FGV). São Paulo , SP, Brazil
• Associated research grant: 21/06202-0 - The politics of the health industry complex in times of change, AP.JP2

Abstract

The 1988 Brazilian constitution established the current Unified Health System, whose main principle is, amongst others, universal access to treatment and medications. Since then, although there have been periods characterized by expansion in the access to medications, such as the successful case of the National AIDS programme which effectively granted universal access to antiretrovirals (ARVs), Brazil - and in fact the global South - still faces significant challenges to guarantee universal access. These include, but are not limited to, patent laws, multinational pharmaceuticals' strategies to monopolize markets, lack of policies - or of coordination and political will - that would encourage national production of more affordable generic drugs, or of laws guaranteeing compulsory licensing in case of health emergencies. The COVID-19 pandemic has brought some of these issues to the fore, and universal health coverage has regained prominence as a global issue. Many have voiced their concerns about the inequity in access to vaccines and treatment between the global South and North, calling for international cooperation so that developing countries can have "access to the solutions that science brings" (Soulé and Toumin 2022). As of this writing, Brazil has had a relatively successful vaccination campaign, despite the denialist campaign by President Jair Bolsonaro. Still, before vaccination began, in 2021 Brazil became the global epicenter of the pandemic, with the notorious case of Manaus illustrating how local health systems could collapse. A parliamentary commission of inquiry assessing the actions of the Bolsonaro presidential administration in the COVID-19 pandemic found that the delay in purchasing/offering vaccines was one of the contributing factors for the thousands of deaths Brazil endured. Bolsonaro's actions, lack of coordination of a federal campaign, denialist approach to the pandemic and his attempts to discredit vaccination created an environment which facilitated the spread of the SARS-CoV-2. This unfolded in a country that is characterized by regional inequities and socioeconomic inequalities, and whose health system is chronically underfunded. It is against this background of political chaos and 'virtually absent state' that Brazilian civil society played a major role in helping alleviate the pandemic's socio-economic and health impact, particularly in vulnerable communities. Importantly, it advocated for new legislation that would allow the federal government to grant temporary compulsory licenses for the use of vaccine and drug patents in health emergencies, seeking to create laws expanding access to medication not only against COVID-19 but any future epidemics. Campaigns for universal access to drugs and treatment against other diseases were intensified during the pandemic, since the incidence of diseases like tuberculosis, which had been under control for a decade, grew significantly during COVID-19.The objective of this project is to understand civil society's political strategies to expand access to medications in the context of the COVID-19 pandemic. By 'civil society' I mean not only long-established Civil Society Organizations (CSOs) who have experience with health advocacy, but also grassroots organizations that have emerged during or before the pandemic and have become important actors. The emergence of new civic actors and their engagement with established CSOs and with local and federal authorities have become a global phenomenon during the pandemic. In this context, it is important to understand to what extent a new civic space has been created in order to fight for universal access, and in which ways civic actors have crafted new modes of organizing and interacting with authorities. Drawing on the post-structuralist theory of discourse, I aim to focus on the discursive strategies applied by CSOs, and the actors that engaged with them. I aim to understand political strategies applied, and [...]. (AU)