The weak response to this pandemic is the result of years of weak responses to health problems as a whole. As in the past, the absence of leadership by government, added to xenophobia, misinformation, panic, disorder and chaos, deepens the current crisis in public health.
Bruno Leal interviews Marcos Cueto
Few months ago, for the first time, a person in China contracted Covid-19, it is not yet clear under what circumstances. Since then the virus, widely known as Coronavirus, has spread throughout the world, to the point where the World Health Organization (WHO) has declared a state of pandemic.
At the time of writing, more than 3.5 million people are infected, throughout more than 150 countries. In Brazil, the death toll is already at 12.000. Italy, once the epicentre counts its dead in the thousands. In Spain, the pandemic is also advancing, as well as in the United States. Public authorities predict a global catastrophe that could last for months.
Although pandemics are topics for microbiologists, experts in infectious disease and other medical experts, health and science historians also have views on such phenomena. In an exclusive interview with Café História, Peruvian historian Marcos Cueto, science editor of the Revista História, Ciências, Saúde – Manguinhos, of Casa Oswaldo Cruz (COC / Fiocruz) and professor at the same institution, explains that weak responses from different health systems to the current pandemic is due, among other reasons, to years of neoliberalist lack of investment.
“Neoliberal policies that have spread across the world since the 1980s have prioritised the reducing of the state, the privatization of services and public companies, the profits for private companies in the health sector, and the creation of tariffs on state social services; all under the false pretext that it would thus create well-being for all. With the neoliberal changes, many health systems adopted a type of “managerialism” , employing terms that until then were unknown in the health area. For example, patients became ‘ clients’ whom they had to satisfy with “efficiency “, “quality” and “productivity ”.
Not wishing to pursue any kind of “Grand Theory for Life”, that is, any idea from the past that “explains” or “illuminates” our actions in the present, but how can the history of science and health, especially the history of the great epidemics, prepare us for the crisis we are facing today?
This episode shows the great problems of history and contemporary society: health and illness are not just a matter for scientists and health workers. There is always a political dimension. This pandemic reveals how, in recent years, right-wing populist and authoritarian governments have attacked science and public health with gusto, while paring back resources for scientific research and public health systems. Weak responses to this pandemic are the result of years of weak responses to health problems as a whole. As in the past, today, the absence of leadership by government, added to xenophobia, misinformation, panic, disorder and chaos, deepens the crisis in health.
It seems to me that an important difference between this pandemic and others from the past, is the enormous availability of data and information. Every day, data about the disease, possible miraculous treatments and cures, scientific articles and specialists of all kinds appear on our mobile screens, telling us what to do and what not to do. Am I right? If so, to what extent does this new scenario help us understand science and health in a different way too?
For sure. In recent years, epidemics such as AIDS, H1N1, Ebola and Zika have also been all over the internet, but no doubt the intensity of this Covid-19 debate is much greater. In addition, the layperson’s knowledge and learning is wider. Similar experiences have brought into question the concept of “Citizen Science”, defined as the efforts of informed citizens unconnected to professional medical communities to understand and change health policy. Community leaders, health workers, activists, journalists and the lay public must intervene in the content and application of medical science and health. The ideal is to create mechanisms to improve not only environmental and health governance, but also to ensure community participation in decision-making and in social programmes.
We were shocked by the speed of Covid-19’s virulent spread, yet it’s gratifying in the midst of it all to see the remarkable solidarity between scientists and research institutes. There is an open exchange of information about the disease, which may speed up the race to find a cure or a treatment. Does the “open science” paradigm emerge strengthened from this global crisis?
Undoubtedly, open science will facilitate the rapid dissemination of results from new research and health experimentation. But world scientific journals that offer open access to articles are, in total, about 30%, a modest amount. Another problem is unfortunately, I think that collaboration between scientists and health workers is not being fully valued, due to politics. For example, discrimination against China by a Brazilian congressman who happens to be the son of the President of the Republic and by the President of the USA can prevent further collaboration with a country which controls a fundamental research base. Furthermore, in the Brazilian case, there is no effort to form a united front or to recruit the support of health professionals who played a prominent role in the previous Lula and Dilma administrations, as well as that of noted international organizations such as the Brazilian Association for Collective Health (Abrasco), an organization that had been criticizing the perverse effects of the freezing of resources, cost-cutting and the de-resourcing of the Unified (National) Health System (SUS).
Here, it is also important to recall the words of the editor of Science magazine, the researcher H. Holden Thorp, who recently criticized Donald Trump after the American president asked scientists to rush through a vaccine against Covid-19: “You’ve been attacking science for the last 4 years, cut its funding, called scientists liars and now you want speed? Science is not made overnight. ”
In a recent article published in História, Ciências, Saúde – Manguinhos (HCSM), you state that the Covid-19 pandemic of is the product, of among other things, the economic forces triggered by neoliberalism. How can the advance of neoliberalism help us to understand the cause of this crisis and its consequences?
Neoliberal policies which have been spreading across the world since the 1980s have stressed the shrinking of the state, the privatization of services and public companies, protecting the profit of private companies in the health sector, creating tariffs on state social services; all under the false pretext that they would thus create well-being for all. So many health systems adopted a misunderstood type of “managerialism” embracing terms that until then were unknown in the health service. For instance patients became “clients” to be dealt “ efficiency ”,“ quality “ and “productivity”.
Even more serious was the idea that health delivery had to be “cost-effective” and a clear contribution to economic growth, which questioned the concept of health as a citizen’s right and an obligation of the State. This led to the abandonment of comprehensive programmes in health systems. Prevention, equity, coverage and epidemiological surveillance were no longer priorities in health services.
How far can this pandemic affect the way health historians research? How can global history contribute to the analysis of Covid-19?
Global history certainly allows us not only to compare the health systems of Brazil and Europe, but also to observe those of Brazil’s neighbours. In its response to Covid-19, the Brazilian government is far behind Argentina and Peru, leaderships which hold a much more focused view.
Social history has been central in the last few decades of Health and Healthcare, trying to illuminate fundamental aspects of the past. But after this epidemic, we might prioritise the history of health policy towards events that move contemporary society or involve the environment, women and neglected disease. Equally, health historians must engage more actively in social and scientific debate to interact with audiences beyond the academic world.
Marcos Cueto is a historian, the scientific editor of Revista História, Ciências, Saúde – Manguinhos, and teacher at Casa de Oswaldo Cruz, Fiocruz. He has written works on epidemics in Peru and Latin America and co-authored, with Theodore M. Brown and Elizabeth Fee, a volume called The World Health Organization, a History (New York: Cambridge University Press, 2019).
Bruno Leal is the founder and editor of Café História. He lectures in Contemporary History at the University of Brasilia, and holds a PhD in Social History (UFRJ 2015). He taught in the Dept of History of UFF, and holds post-doctoral qualification in Social History from UFRJ. He researches on nazi war crimes, and law in the post-war period, with a special emphasis on the fate of nazi war criminals. He coordinated the interdisciplinary nucleus for Jewish and Arabic Studies at UFRJ and NIEJ from 2011 to 2018. He belongs to the Brazilian Public History Network and the Association for the Digital Humanities
How to cite this interview
CUETO, Marcos. What does a health historian have to say about the Coronavirus pandemic? Marcos Cueto interview with Bruno Leal. In: Café História – History made with clicks. Translation by TiraTEXT. Available at: https://www.cafehistoria.com.br/what-does-a-health-historian-have-to-say-about-the-coronavirus-pandemic/. Published: Mar 30 2020. Access: [inform date].