Risk governance in the response to global health emergencies: understanding the governance of chaos in Brazil’s handling of the Covid-19 pandemic

Abstract

The Covid-19 caused by the SARS-CoV-2 virus has shown how inadequate institutional strategies interact with, and exacerbate, social inequalities, thus impacting upon the intensity of the harm produced and amplifying negative consequences. One of the lessons from this pandemic, which happens against the background of other, interconnected systemic crises, is the urgency of adopting a ‘whole-of-society’ approach to determining what does and what does not work in the context of a health emergency response. However, how can institutional performance in health emergency response be assessed? How to make sense of success or failure? We argue that the adoption of a risk governance approach sheds light on institutional performance in the response to health emergencies. Risk governance is particularly pertinent in situations where the potential for extreme consequences is considered high, where there are enormous uncertainties regarding the consequences and where different values are present and in dispute. Based on a documentary evidence review, we analyse the Brazilian response to Covid-19 by considering: (1) how the Brazilian federal government performed on its central role of managing the national response, (2) the reactions from other actors prompted by this performance and (3) the main observed effects emerging from this scenario. We argue that the Brazilian federal government response was weak in five risk governance parameters that are essential in a health crisis response: risk communication, transparency and accessibility of data, negotiation between actors, social cohesion and public participation and decisions based on technical and scientific evidence, resources and contexts. The neglect of risk governance parameters, combined with an attempt to spread doubt, confusion and disinformation—which could be termed a ‘governance by chaos’—is an important element for making sense of the effects and controversies surrounding Covid-19 in Brazil.

Risk, risk governance, global health, emergency, Covid-19, Brazil

Key messages

• Risk governance adds crucial elements to assess institutional performance during health emergencies.

• The response of the Brazilian federal government to the Covid-19 pandemic was weak in risk governance parameters that are essential in a pandemic response. This produced a range of effects that went beyond the individual harm associated with the disease.

• The ‘governance by chaos’ of the Brazilian government during the pandemic, that is, the neglect of risk governance parameters coupled with attempts to sow doubt and confusion, is an important element for interpreting the effects and controversies surrounding Covid-19 in Brazil.

Introduction

Given its long-term impacts and the fact that it happened against the background of other, interconnected systemic crises—e.g. climate emergency, the retreat of democracy worldwide and the crisis scientific knowledge—the Covid-19 pandemic may be understood as a materialization of emerging systemic risks (Aven and Renn, 2019; Schweizer, 2021), threatening collective futures (Leach et al., 2021). The term risk (here used interchangeably with systemic risk) is associated with potential/real threats to human health, nature, beliefs, social institutions, economics and cultural practices. Systemic risks originate in human-made or biological systems and are therefore embedded in complex relationships with socioecological, sociotechnical and cultural aspects (Schweizer, 2021). Through social processes of definition, they can be diminished, increased, minimized or dramatized (Giddens, 1999; Boyne, 2003; Renn, 2008; Beck, 2010). Risks, and the process of their assessment and management, reshape institutional relations (between state, market, science and civil society) and (re)establish hierarchies, relations of power and inequality (Giddens, 1999; Hannigan, 2006; Beck, 2010). Due to the societal disruptions they produce, and their transboundary and cross-sectoral effects, risks call for integrative/inclusive governance approaches (Collins et al., 2020) and for interventions comprising ‘both cooperation and creative, integrated approaches to assessment, communication, funding, and governance’ (Kruczkiewicz et al., 2021, p. 2).

Because of its wide social and political ramifications, the pandemic has also shown how inadequate institutional strategies interact with, and exacerbate, social inequalities, thus impacting upon the intensity of the harm produced and amplifying negative consequences (Ventura et al., 2020; Jasanoff et al., 2021). The complexity of the response and its effects underscore the need to develop and test tools that can shed light on different aspects of institutional performance. This is particularly pertinent given that the pandemic highlighted the crucial importance of a ‘whole-of-society’ response, where a variety of actors may interact with different purposes and disparate degrees of success. In this paper, we argue that a risk governance approach has the potential to help make sense of this complexity. We ask: what parameters of risk governance might be used to assess success or failure in the response to health emergencies? How can these parameters be mobilized in the analysis of national responses to health emergencies? What do they tell us about the role of different actors, their interactions and the effects produced by this interaction?

With >35 million officially reported cases and >691 thousand deaths¹, in addition to an economy in tatters including rising unemployment, poverty, hunger and inflation, Brazil is widely considered as an example of institutional failure during the pandemic. The literature has begun to uncover how institutional actions and omissions on the part of the Brazilian federal government and the President Jair Bolsonaro had profound repercussions in the design, implementation and outcomes of the pandemic response (Calil, 2021; Jasanoff et al., 2021; Matta et al., 2021; Meningoti and Santana 2021; Senado Federal, 2021; Ventura et al., 2021).

According to the Brazilian 1988 Constitution, the federal government has the responsibility to coordinate public health efforts, including emergency preparedness and response. It does so by way of its Ministry of Health, which is responsible for regulating the organization and attributions of health services, public and private, in addition to promoting their implementation and coordination (Ventura et al., 2021b). The federal government also draws on other mechanisms, including the public unified health system [Sistema Único de Saúde (SUS)], which balances a centralized decision-making structure with state- and municipal-level flexibility in the implementation of policies, to meet the demands of a very heterogeneous population. During the pandemic, the federal government relegated the Ministry of Health to a secondary role, while other actors (not elected and not accountable) moved to influence decisions (Temporão, 2021). Vieira and Servo (2020) and Lotta et al. (2020) argued that Covid-19 accelerated the process of undermining the coordination tasks traditionally performed by the SUS.

Our paper sets out to illustrate the potential of a risk governance approach to understanding the Brazilian response to Covid-19. Specifically, we contribute to existing literature on the subject by assessing, against risk governance parameters, the well-documented failures in the performance of the federal government, which a parliamentary commission went so far as to term ‘crimes against humanity’ (Senado Federal, 2021). Moreover, our analysis broadens the discussion about institutional performance in the Brazilian case by going beyond the federal government’s actions and omissions. We explore the complex interactions between different levels of government and between government and other societal actors (like civil society, scientific institutions and media outlets). We zoom in on the controversies underpinning these interactions and unpack their multiple effects. Our analysis illustrates the potential of a risk governance framework in shedding new light on institutional performance during health emergencies.

Section 1 (Risk governance parameters)  provides an overview of the risk governance literature and the parameters described therein. The next section  presents the methodology. Section 3 (Findings)  details the findings, using risk governance parameters as a lens. In the discussion of our findings provided in the last section (Discussion), we characterize Brazil’s handling of the pandemic as a form of ‘governance by chaos’ and reflect on the potential of a risk governance approach to the analysis of the response to health emergencies.

Risk governance parameters

The risk governance approach was proposed with the goal of addressing complex situations associated with ecological, health and technological risks (Renn, 2008). It refers to ‘institutional structures and sociopolitical processes that guide and restrain collective activities of a group, society, or international community to influence or direct the course of events or people’s behavior when dealing with risk issues’ (Klinke and Renn, 2021, p. 545). For these authors, the risk governance concept should embrace a fundamental condition of uncertainty, complexity and ambiguity as major characteristics of the risk governing process. Indeed, Aven and Renn (2019) emphasize that risk governance is particularly pertinent in situations where the potential for extreme consequences is considered high, where there are enormous uncertainties regarding the consequences and where different values are present and in dispute. The Covid-19 pandemic meets these conditions.

The literature describes a set of parameters of risk governance. In this paper, we focus on five (Table 1): (1) transparency and accessibility of data, (2) risk communication, (3) negotiation between actors, (4) social cohesion and public participation and (5) decisions based on technical and scientific evidence, resources and contexts. These parameters were selected because they are closely connected with conditions considered essential for successful health emergency responses. They also respond to societal expectations of inclusion and participation towards more transparent decision-making (Schweizer, 2021) and collectively binding decisions (Van Asselt and Renn, 2011).

Table 1.

Summary of risk governance parameters

Risk governance parameter	Description
‘Transparency and data accessibility’	Transparency is synonymous with open decision-making by a government, encouraging openness. It implies access to public information, enhancing citizen trust and accountability. Data accessibility means that information is shared, factually accurate and publicly presented. It increases community resilience and promotes the integration of the public in the public health system
‘Risk communication’	Effective and open dialogue between all social actors involved in risk situations. Exchange of information, advice and opinions between experts, community leaders, staff and people at risk
‘Negotiation between actors’	Adoption of fair procedures to avoid reinforcing the power of the strongest actor. Balancing risks and benefits to avoid top-down interventions
‘Social cohesion and public participation’	Social cohesion comprises the degree of social connectedness, solidarity and trust between different community groups within a society. Participation implies the sharing of decision-making powers, ensuring that government institutions act responsibly to citizens
‘Decisions based on scientific evidence, context and resources’	Evidence is defined as information used to support or justify a decision. Context comprises the range of internal and external factors based on where a decision is made and applied. Resources include staff, information, technology and funding

Source: Authors. Elaborated from the literature.

Transparency and accessibility of data

Transparency is synonymous with open decision-making by a government (Ball, 2009). Data are crucial to inform pandemic preparedness/prevention/response, as well as in the evaluation of health programmes and services (Moreno et al., 2009). During emergencies, it is expected that the governments comply with high ethical standards in the way that they manage data and communicate information (Calgua, 2022). Transparency is therefore relevant to the efficiency of governance and to the accountability of the political settlement between state and society (O’Malley et al., 2009; Erkkilä, 2020; Hyland-Wood et al., 2021).

Accessibility of data means that information is shared, factually accurate and publicly presented. During emergencies, the availability of data is crucial for epidemiological studies, health surveillance and research and development of adequate public policies (Moreno et al., 2009). While states legitimately fear that reporting and sharing information may have negative political and economic consequences (Lencucha and Bandara, 2021), developing strategies for information sharing increases community resilience, while integrating the public more firmly in the public health system as a whole (Myers, 2021).

Risk communication

Risk communication is a practice that promotes effective and open dialogue between social actors (Leiss, 1996; Lundgren and McMakin, 2000; Covello and Sandman, 2001; Di Giulio et al., 2013). It requires skills and strategies to communicate clearly about uncertainties, provide people with the insights they need to make decisions or judgements, mitigate the effects of the threat and enlist public trust and cooperation (Renn, 2008; Hyland-Wood et al., 2021). It should embrace four goals: (i) to foster understanding of risks among different publics, (ii) to assist people in changing their daily behaviours, (iii) to promote trust and credibility towards institutions that handle risks and (iv) to provide procedures for effective and democratic risk management (Renn, 2008).

The World Health Organization (WHO) considers risk communication as an integral part of emergency responses, involving the exchange of information between experts, community leaders, officials and people at risk (WHO, 2018). Recent epidemic outbreaks reveal persistent challenges and gaps (Krause et al., 2020; Parajuli et al., 2020; Hyland-Wood et al., 2021). A recent challenge has to do with ‘infodemics’ (WHO, 2020; Myers, 2021), a term which includes the spectrum of misinformation (e.g. false claims, misleading use of data, unverifiable rumours and conspiracy theories) (Jamison et al., 2020) and disinformation, when false information is intentionally spread to deceive people (Wardle, 2020).

Negotiation between actors

Negotiation is a dynamic process in which fair procedures are adopted to avoid reinforcing the power of the strongest actor (van den Hove, 2006). While leadership is central to the management of risk situations, complex problems—and their rapidly changing societal and economic context—require a close attention to the involvement of multiple stakeholders and potential conflicts that might emerge (Renn, 2008; Hyland-Wood et al., 2021). In the negotiation process, a range of actors (e.g. governments, public authorities, civil society and private sector) should agree on how to balance risks and benefits, avoiding top-down interventions and fostering inclusive processes of problem definition and governance (Schweizer, 2021).

In emergency disease outbreaks, the use of state power and the implementation of measures to minimize negative impacts depend on trust between citizens, authorities and sources of expertise, as well as an ethics of care, respect and empathy (Jasanoff et al., 2021; Leach et al., 2021). The decision-making process also requires a multilevel and multi-actor perspective, one that integrates the interplay between the different levels of government and expert bodies, private sectors and representatives of the civil society (Lidskog et al., 2020; Schweizer, 2021).

Social cohesion and public participation

Social cohesion comprises the degree of social connectedness, solidarity and trust between different community groups within a society (Jewett et al., 2021). A range of factors can promote social cohesion, including government interventions (e.g. financial stimulus and social protections) and government protocols for communicating risks and required measures. Other critical factors impede social cohesion, including government centralization of power, inequitable distributed resources and narrowly defined recovery programmes at the national levels (Jewett et al., 2021).

Social cohesion also pertains to people’s participation (Galego et al., 2021). Participation implies sharing decision-making powers (Dagnino et al., 2006) and ensuring that government institutions act responsibly towards citizens, creating possibilities for individuals to participate in decisions that affect their lives (Ashford and Rest, 1999). There is an extensive literature focused on the role of public participation in risk situations (e.g. Renn, 2008; van Asselt and Renn, 2011; Aven and Renn, 2019; Webler and Tuller, 2021), which highlights that: (a) public participation must be guided by principles of fairness, competency and transparency and (b) the organization and the practice of public participation should be connected to context (Marston et al., 2020).

Decisions based on technical and scientific evidence, resources and contexts

Evidence is defined as information used to support or justify a decision; context comprises the range of internal and external factors based on where a decision is made and applied and resources include staff, information, technology and funding (Dobrow et al., 2006). In public health, there is a widespread understanding that scientific/technical knowledge should play a central role in decision-making (Brownson et al., 2013). Public policies and decision-making should be developed on the basis of rigorous factual and scientific evidence, data and analytical skills, as well as relevant resources and contexts (Florin, 2014).

However, in the case of emergencies, it is often difficult to collect sufficient and timely expertise to inform and support decisions. Moreover, as Jasanoff et al. (2021) argue, conflicting expert advice is the norm and not the exception in crisis situations. Finally, political interests may facilitate or constrain the use of evidence (Nelkin, 1979; Jasanoff, 1987; 2003; 2004; 2009; Dobrow et al., 2006; Saweritz 2007; Lemos et al., 2012). Governments often invoke certain technical information to prioritize courses of action, to legitimize their own responses and to justify their decisions—a process that in some cases aggravates negative impacts (Weible et al., 2020).

Table 1 summarizes the risk governance parameters we consider integral to public health emergency responses.

Methodology

Our study is based on document research and analysis, which is widely used in studies of public health for its role to inform histories of health policy/decision-making and unpack knowledge to provide insights into social phenomena (Abott et al., 2004; Lawson, 2018; Gorsky and Mold, 2019). This paper is based on content analysis (Bardin, 1977; Bauer, 2002; Mendes and Miskulin 2017) of the following set of documents:

(1) A total of 3962 news items and reports collected from January 2020 (when the first cases of the new coronavirus were registered) to October 2021 [when a Parliamentary Commission of Inquiry (PCI) concluded the investigation into the country’s handling of the pandemic] in three major digital news portals in Brazil regarding Covid-19 topics: public health, counting of cases and deaths, treatments (including vaccines), politics, economics, epidemiology, testing and lockdown. The criteria for inclusion of the news articles in our data collection considered the following themes: (1) public health policies adopted; (2) monitoring of the number of deaths/cases and criteria for disclosing data adopted by the federal government; (3) treatments and procedures (including vaccines); (4) political conflicts with different spheres of government and other social actors; (5) economic performance indices and emergency aid and (6) indications and controversies from health professionals and scientists, conflicts with federal government decisions and approaches, population testing policies and lockdown discussions. News articles that did not cover these central topics were not considered in the selection. It is worthy to note that this was not an exhaustive collection of news items. Using a common Excel file stored on Google drive, members of the research team fed items into the database (which is available upon request) as they came across them. Over 2 years, the research team met roughly twice a month, collectively reviewing the news archive and arriving at a consensus on the key events, actors and points of controversy/debate over the period. In order to check that our analysis was robust, we presented our results to two interdisciplinary research groups who investigate the response to Covid-19: CompCoRe project, a comparative study of national responses to Covid-19 from Science and Technology Studies perspective (Jasanoff et al., 2021), and CIRIS (Governança, Risco e Comunicaçao) research group, focusing on governance and communication of risks and crises (Monteiro et al., in press).

(2) Scientific publications and public documents provided the means to investigate government’ structures, institutional processes, actions/omissions, outputs, as well as the complex interactions between different levels of government and between government and other societal actors. Besides the review of scientific publications regarding the pandemic in Brazil, we followed all the sessions of the Covid-19 PCI session (by TV Senado), identifying the topics covered, controversies and the reactions of parliamentarians to the testimonies and documents that were presented. We also had a careful reading of the final report of the Covid-19 PCI (Senado Federal, 2021) and the document ‘The timeline of the federal strategy for the spread of Covid-19’ (Ventura et al., 2021). The latter is the final result of a study that collected Brazilian federal and state regulations on Covid-19 in order to investigate and assess their impact on human rights.

Content analysis of the set of documents sources included: (1) floating reading, (2) identifying themes related to the five parameters of risk governance and (3) reviewing themes so as to ensure consistency of findings. The collection and the content analysis were undertaken over a period of 2 years. Ongoing discussion among our research team and an iterative process of reflective analysis of textual reading were important aspects of our study. By triangulating sources, we identified the most contentious aspects of Covid-19 debates and policies in Brazil.

Findings

In this section, we consider (1) the strategies adopted by the federal government concerning the five risk governance parameters; (2) the main actions from a range of actors for each risk parameter and (3) the observed effects regarding the institutional performance during the pandemic. A systematization of our findings is provided in supplementary material1.

Performance of the federal government

Transparency and data accessibility

The documentary evidence reveals that one of the main strategies adopted by the federal government was to prioritize information about recovered cases rather than reported cases and deaths (Senado Federal, 2021, p. 184–195; Ventura et al., 2021). Moreover, financial and structural constraints undermined the updating of data on the evolution of the pandemic. Frequent shutdowns of the Ministry of Health webpages were attributed by officials to faulty system updates, hacker attacks and layout modifications (UOL, 20 May 2021, 11 August 2021).

Aiming to suggest that the pandemic was being overestimated and that there was a ‘hysteria’ around the coronavirus, created by the press (Folha de S. Paulo, 17 May 2020), the government undermined the information provided by other sources. The credibility of data on cases, hospitalizations and deaths released by state governors, mayors and the media was routinely questioned (Senado Federal, 2021, p. 184–194, 619–832; Ventura et al., 2021, p. 4, 19). One example of this is Bolsonaro incentivizing his social media following to invade hospitals and ascertain how many emergency beds were actually used by Covid-19 patients (Folha de S. Paulo, 11 June 2020; Senado Federal, 2021, p. 176, 1009).

Risk communication

We observed the absence of a unified risk communication campaign on the part of the federal government and specifically of the Ministry of Health. A sustained effort was carried out to disseminate disinformation with a clear purpose of minimizing the severity of the disease, while creating and spreading confusion and controversies (Calil, 2021; Massarani et al., 2021; Menengoti and Santano, 2021; Senado Federal, 2021, p. 619–832; Campos, 2020). For example, Bolsonaro publicly defended the use of hydroxychloroquine against Covid-19, arguing that it would be easier and cheaper to invest in a cure than in a vaccine (O Globo, 26 October 2020). He also questioned the efficacy of the vaccines: ‘If you become an alligator [after taking the vaccine], it’s your problem’ (News El Pais, 20 December 2020).

Negotiation between actors

As Bolsonaro claimed that his strategies were under attack from the opposition and the media, the federal government excluded state governors, mayors, professional societies, scientists and the civil society from strategic discussions, negotiations and decisions concerning the pandemic (Senado Federal, 2021, p. 20, 34–45, 133, 159, 164, 662, 763; Ventura et al., 2021, p. 18, 43, 77, 140, 146–147, 155, 173). The federal government’s decisions were supported by a ‘parallel cabinet’, formed by a select group of parliamentarians, Ministry of Health officials, private actors, entrepreneurs, doctors, military personnel and online influencers. The adoption of this strategy empowered non-elected people, many without qualifications to deal with the pandemic (UOL, 31 May 2021). The use of a ‘parallel cabinet’ obstructed transparency in decision-making and undermined the participatory process (Senado Federal, 2021, p. 34–46).

Social cohesion and public participation

Social cohesion and public participation were also undermined by the federal government. As the insufficient and erratic emergency aid policies for vulnerable populations jeopardized the public adherence to sanitary restrictive measures (Senado Federal, 2021, p. 146–184), attempts to promote ‘herd immunity’ through contagion (Senado Federal, 2021, p. 46–51; Ventura et al., 2021, p. 3) and delays in the purchase of vaccines (Senado Federal, 2021, p. 87, 146, 195–247) undermined solidarity and trust between different groups. Breaches of the established order of priorities in vaccination were investigated by prosecutors in different states (Folha de S. Paulo, 21 January 2021; R7, 28 January 2021). While the number of registered cases and deaths increased, protests by supporters of the President claimed for the end of social isolation and for the reopening of businesses (Folha de S. Paulo, 27 march 2020). Studies demonstrated a ‘Bolsonaro effect’ on the rise in coronavirus cases, indicating that Covid-19 caused more damage in municipalities more favourable to the President due to the lower rate of effective social isolation (Fernandes et al., 2020; Folha de S. Paulo, 13 October 2020).

Decisions based on scientific evidence, context and resources

Our document review indicates that the federal government, in addition to adopting strategies and making decisions that eschewed scientific evidence, did not make adequate use of resources. For example, the government promoted people’s exposure to the virus, by refusing to issue a federal mandate to restrict the circulation of people or large gatherings and failing to incentivize the use of masks (Senado Federal, 2021, p. 146–183; Ventura et al., 2021, p. 3, 18, 68). The ‘parallel cabinet’ provided advice that went against the scientific consensus and spread disinformation, supporting, for example, the unproven hydroxychloroquine treatment (Senado Federal, 2021, p. 52–144, 243, 523, 524, 976, 977; Ventura et al., 2021, p. 45). The federal government sought to institute a protocol encouraging the use of hydroxychloroquine in the public health system (Ventura et al., 2021, p. 57, 85, 87, 117; R7, 21 January 2021). Public resources were used to produce and disseminate this drug, which had no proven effectiveness (Folha de S. Paulo, 6 February 2021). The PCI also revealed governmental foot-dragging and attempts to undermine vaccine negotiations with pharmaceutical companies, as well as a delay in joining the WHO COVAX facility (the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator) (Senado Federal, 2021, p. 87, 146, 241–247). The government also neglected mass testing (Senado Federal, 2021, p. 177, 178), while the President was making anti-vaccination pronouncements. Finally, frequent changes in the command of the Ministry of Health, with the appointment of unqualified personnel for critical positions, also show the extent to which the government failed to heed to scientific and technical considerations. For example, Eduardo Pazuello, a military officer without training or experience in the health area, took over the position of Minister of Health. He had already declared that, before taking on the role, he ‘didn’t even know what the SUS was’ (Ventura et al., 2021, p. 54).

Throughout the pandemic, the WHO made a series of recommendations based on the most up-to-date scientific evidence available. The disjuncture between the WHO recommendations and Brazilian government actions is shown in Table 2 and underscores the extent to which the latter performed weakly in this risk governance parameter.

Table 2.

World Health Organization recommendations and measures vs Brazilian federal government’s actions and policies

	WHO recommendations and measures	Brazilian federal government’s public actions and policies
Collective immunity	Pursuit of herd immunity through large-scale vaccinationa,b	Encouraging herd immunity via disease transmission and questioning the effectiveness of vaccinesc,d
Testing	Large-scale laboratory testinge	Omission of the Ministry of Health in providing, distributing and encouraging large-scale testingf
Vaccine	Everyone, everywhere, should have access to COVID-19 vaccines. Creation of alliances and cooperation mechanisms for vaccine purchase and distribution (e.g. COVAX facility)g	Obstruction and delay in the purchase and distribution of vaccines: e.g. the President disallowed the purchase of 46 million available doses of CoronaVac (Chinese vaccine) by the Ministry of Health, rejected and ignored several proposals sent by the pharmaceutical Pfizer being the first proposal on 20 December 2020, rejected part of the vaccines offered by the COVAX facility and questioned the effectiveness of the vaccinesh
Early treatment with drugs of no proven effectiveness	Hydroxychloroquine, chloroquine and ivermectin do not reduce mortality for hospitalized COVID-19 patientsi,j	Defence of early treatment with drugs with no proven effectiveness: e.g. incentive and investment in the production and distribution of drugs (hydroxychloroquine, chloroquine and ivermectin); the Ministry of Health sought inputs for the production of chloroquine in other countries; production of chloroquine by the Army Chemical Laboratory The ‘TrateCov’ app, launched by the Ministry of Health, sought to assist health professionals and the population in collecting symptoms from patients in order to improve and speed up diagnosis and treatment of Covid-19, while recommending drugs of unproven effectiveness. A ‘Covid Kit’ was disseminated by the federal government on social networks, encouraging early treatment and the use of chloroquine. It was cited in a publication of 20 October 2020, entitled ‘Early treatment to save lives’k,l
Non-pharmacological measures	Wear a mask, hand hygiene and social distancingm	The government opposed the adoption of non-pharmacological measures that would help to avoid contamination, especially social distancing and the use of masks: e.g. the President vetoed several provisions that dealt with the use of masks and hand asepsis, namely Law No. 14.019n,o
Transparency of epidemiological data	Monitor and disseminate epidemiological datap	Ministry of Health changed the way it published data on the pandemic, alleging overestimationq,r
Emergency aid	Each country should assess its risk and rapidly implement the necessary measures at the appropriate scale to reduce both Covid-19 transmission and its economic, public and social impactss	Delays and obstructions by the federal government in the definition and payment of emergency aidt

a

https://www.paho.org/en/covid19.

b

https://www.who.int/newsroom/commentaries/detail/immunity-passports-in-the-context-of-covid-19.

c

Senado Federal (2021), p. 46–51.

d

Ventura et al. (2021), p. 3.

e

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline#!.

f

Senado Federal (2021), p. 177, 178.

g

https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-vaccine-access-and-allocation.

h

Senado Federal (2021), p. 87, 146, 195–247.

i

https://www.medicina.ufmg.br/kit-covid-o-que-diz-a-ciencia/.

j

https://www.sanarmed.com/oms-reforca-que-ivermectina-nao-funciona-contra-covid-19-nem-deve-ser-usada-em-pacientes.

k

Senado Federal (2021), pp. 52–144, 243, 523, 524, 976, 977.

l

Ventura et al. (2021), p. 45.

m

https://www.who.int/en/emergencies/diseases/novel-coronavirus-2019/advice-for-public.

n

Senado Federal (2021), pp. 146–183.

o

Ventura et al. (2021), p. 68.

p

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline#!.

q

Senado Federal (2021), p. 184–194.

r

Ventura et al. (2021), p. 63, 90, 101.

s

https://www.who.int/publications/i/item/critical-preparedness-readiness-and-response-actions-for-covid-19.

t

Senado Federal (2021), p. 441–461.

Reactions of other actors

Transparency and data accessibility

Understanding that transparency and accessibility of the data were critical to deal with the pandemic, and faced with data blackouts on the part of the federal government, six Brazilian communication companies (O Estado de S. Paulo, G1, O Globo, Extra, Folha de S. Paulo and UOL) created a media consortium on 8 June 2020. The main goal was to compensate for the lack of official data on the evolution of the pandemic, with up-to-date daily information collected directly from the states.

As the Brazilian mass media sought to expand the time on air of scientists, health authorities and practitioners (Massarani et al., 2021; Caleffi and Pereira, 2021), we observed numerous instances of public communication by individual professionals, which increased their participation and visibility in social networks. This helped to bridge the gap between science and society. For example, ∼97% of Brazilian science influencers on Twitter talked about vaccination and helped to spread information about the importance of immunizations, in a collaborative effort of knowledge dissemination and sharing (Meirelles, 2020).

Risk communication

While the government opted for communication strategies that minimized the severity of the pandemic, the press and part of state and municipal governments developed risk communication campaigns to inform the population (Araújo, 2021; Felten, n/d). Some national regulatory agencies [e.g. Federal Supreme Court (STF), Federal Audit Court, Brazilian Bar Association and National Health Surveillance Agency (ANVISA)] sought to combat government disinformation. Some social media companies also took actions in this direction, excluding or marking posts about specific issues or even deleting profiles. For example, in March 2020, the justice system banned a federal government campaign—‘Brazil cannot stop’—which openly contradicted science. Prosecutors claimed a communication plan on the pandemic, stating that the information provided by the government to the population was scarce and unconstitutional (CONJUR, 2021).

Negotiation between actors

The government’s failings led other actors to step in to fill the risk governance vacuum and to compensate for the lack of transparency and accountability in the decision-making process—made visible by the existence of the presidential advisory group (the ‘parallel cabinet’). One important reaction came from the STF, which, faced with ongoing conflicts between the federal, state and municipal governments regarding restrictive measures and actions to deal with the pandemic, decided that states and municipalities had the autonomy to adopt measures at the local level (G1, 15 April 2020). Two other critical examples of negotiations came from the governors and mayors. While governors of the Northeast states created the ‘Northeast Consortium’ to purchase Sputnik vaccine (G1, 12 March 2021), mayors from different Brazilian cities sought to negotiate the purchase of the CoronaVac vaccine directly from the Butantan Institute (UOL, 10 December 2020).

Social cohesion and public participation

The government’s pandemic response created deep cleavages among Brazilian authorities, politicians and civil society (Campos, 2020). In response, the STF moved to allow states, municipalities, local authorities, the scientific community, medical authorities and civil society organizations to engage the population in the decision-making processes—the goal being to foster social cohesion and public participation (Vieira and Notícias, 2020). Non government organizations, social movements and institutions engaged in local solutions to deal with the pandemic and minimize its negative effects. For example, the project ‘Conexão Saúde: de olho na covid!’ (Health Connection: Keeping an Eye on Covid) engaged professionals from Fiocruz and other institutions to offer tests, disseminate information and provide medical support to the residents of Complexo da Maré in Rio de Janeiro (UOL, 13 October 2020). In São Paulo, the social project Fazendinhando Institute organized crowdfunding campaigns and donations of food for residents of Jardim Colombo (Nunes, 2021).

Decisions based on scientific evidence, context and resources

Mayors and state governors opposed the federal government’s herd immunity strategy, proven to be ineffective (OPAS, 2021a), and sought to promote non-pharmacological measures and vaccines, which had been shown to be the best strategy (OPAS, 2021b). For example, in São Paulo, Brazil’s most populated and industrialized state and most affected state by Covid-19, governor João Doria instituted fines for failing to wear a face mask in public from 1 July 2020. By March 2022, this measure was mandatory for outdoor and closed spaces. In Araraquara, a small city in the state of São Paulo, the mayor implemented two strict lockdowns in 2021: from 23 February to 2 March and 20 to 27 June. Later results confirmed that the social distancing interventions were effective tools for flattening epidemic curves (Figueiredo Filho and Silva, 2021).

Observed effects

The weak performance of the Brazilian federal government in relation to the five risk governance parameters plausibly intensified and amplified the effects of the pandemic. Conflicting and disorganized information jeopardized prevention strategies, and by fostering confusion and misunderstandings, it hindered public adherence to sanitary measures and fostered denialist stances among the population (Lencucha and Bandara, 2021). This impacted unequally upon vulnerable populations, with studies confirming higher rates of mortality among the black population and indigenous communities (Bambra et al., 2020; Baqui et al., 2020; Santos and Vargas, 2020; Santos and Pereira, 2021; Rodrigues De Sá, 2021). While the federal government used vast public resources to purchase medicines without proven effectiveness, people refused to wear masks and the use of non-effective medicines escalated. For example, in January 2021, the Brazilian media reported that the sale of ivermectin, ineffective against Covid, had grown by 466% in 2020 (Folha de S. Paulo, 8 January 2021).

Different, and at times conflicting, pandemic response strategies in different spheres of government, in addition to hindering social cohesion, led to mismatched public policies and to the waste of human and financial resources. For example, to produce and distribute hydroxychloroquine, Bolsonaro mobilized five ministries, states, the Army and the Air Force. In June 2021, a public prosecutor demanded that the federal government returns R$23 million spent on hydroxychloroquine treatment kits (Senado Federal, 2021, p. 142–144; UOL, 21 June 2021; 24 June 2021).

Another effect was the collapse of the health system (public and private) (Taylor, 2021). This was starkly illustrated by the case of Manaus, the capital of the Amazonas State in the north region, which registered 2195 deaths from Covid-19 in January 2021 (Lavor, 2021). The combination of weak isolation policies, ineffective medicines, the emergence of the Delta variant and the lack of vaccines resulted in widespread contagion and rising hospitalizations. The federal government’s sluggishness in aiding the municipality contributed to the collapse (Barreto et al., 2021). While the tragedy revealed the lack of coordination and the resistance of the federal government to make decisions based on scientific evidence, it also prompted representatives of regulatory agencies, journalists, communication companies and civil society organizations to push for the creation of the PCI (Senado Federal, 2021; Ventura et al., 2021, p. 167). After 6 months of inquiries and investigations, the PCI identified a set of crimes committed by the President, including crimes against humanity (Senado Federal, 2021).

Yet another effect of the weak performance in relation to risk governance was the delay in mass vaccination (Table 3). In May 2021—4 months into the vaccination campaign—only 15% of the Brazilian population had received at least one vaccine dosage in Brazil, a small proportion considering the substantial impact on the virus’ spread at the time. However, in October 2022, 90.84% of the population aged ≥3 years (i.e. the vaccinable population) are partially immunized and 85.42% are fully immunized (G1, 14 October 2022). The case of vaccination shows how the use of risk governance parameters holds potential for making sense of how different actors interacted during the Brazilian Covid-19 response and the effects produced. In this case, the trajectory of the vaccination campaign happened despite repeated attempts by the federal government to undermine the process.

Table 3.

Risk governance and Covid-19 vaccination in Brazil

Selected parameters—risk governance	Performance of federal government	Reactions from other actors	Observed effects
Data transparency and accessibility	Delays in the presentation of a vaccination schedulea Minister of Health Eduardo Pozuelo made vague and ironic statements about the timing of vaccinationb,c Pazuello abruptly changed the logistical process for distributing vaccines, without consultation and agreement of states and municipalitiesd Bolsonaro distorted and inflated vaccination datae	Media and governors criticized the federal government’s vaccination strategyf,g,h. Media consortium presents data on vaccination, with more transparency than the federal governmenti	Delays and obstructions to the purchase of vaccines (Monari et al., 2021) Deaths due to vaccination delaysj National Immunization Plan, recognized as one of the most efficient vaccination programmes worldwide, was underused and underminedk
Risk communication	Bolsonaro stated that there was no need to rush in vaccination. He encouraged an anti-vaccine rhetoric using incorrect information and distorted vaccination datal,m,n Bolsonaro questioned the effectiveness of vaccines even after the validation of ANVISA, the national drug control agencyo,p,q,r	Dissemination of technical-scientific evidence by professional organizations. For example, ANVISA approves emergency use of vacciness, press widely publicizes the efficacy and safety of vaccinest and regulatory bodies contradict statements by Bolsonarou,v
Negotiation between actors	Delays/refusals in negotiating vaccines with pharmaceutical companies, namely Pfizerw Delays in joining the WHO COVAX facility. Brazil opted for minimum coveragex,y Delays in negotiating the sale of the Pfizer vaccinez The PCI reveals negotiations with intermediaries of questionable standing for the purchase of the Indian vaccine Covaxinaa,bb Amid a dispute between Bolsonaro and João Doria (the Governor of São Paulo), the federal government obstructed negotiations with the Butantan Institute of the State of São Paulo, the producer of CoronaVac in Brazil, hampering its distribution in the public health systemcc,dd,ee Refusal to work with governors of North-eastern states to purchase the Sputnik vaccineff	Discussions between representatives of professional associations, states, municipalities, health authorities and scientists The National Council of Health Secretaries issued a letter proposing urgent measures to avoid chaos in the public and private health networkgg Confederation of municipalities asked for the sacking of the Minister of Health due to failures in vaccinationhh Government of São Paulo started tests and production of CoronaVac with its own resources, without assistance from the federal government, and initiated vaccination independentlyii Butantan Institute sends the federal government a proposal to supply CoronaVacjj Governors of the Northeast created the ‘Northeast Consortium’ to attempt to buy Sputnik vaccinekk. 39 million doses of Sputnik contractedll Governors and mayors attempted to negotiate the purchase of the CoronaVac vaccine directly from the Butantan Institutemm The PCI investigated irregularities and delays in the purchase of vaccinesnn
Social cohesion and public participation	Delay in the purchase and distribution of vaccines contributed to undermining solidarity and trust in society, with breaches of the established order of priorities in vaccinationoo Bolsonaro criticized states emergency aid to people who are prevented from working during the pandemic, arguing that this measure combined with social isolation policies was a way of infringing on citizens’ freedomspp Bolsonaro expressed his satisfaction with protests against social isolation, arguing that they showed the presence of democratic feelingsqq	Local vaccination campaigns. Governors, mayors and health professionals sought to convince the population to vaccinate as soon as possible. For example, Mayors act to speed up vaccinationrr Low population adherence to the anti-vaccine movement (Vaccinable population immunized until 6 February 2022: 82.95%)ss,tt Prosecutors investigated breaches to the established order of priorities in vaccination in different citiesuu
Decisions based on technical and scientific evidence, resources and contexts	Bolsonaro cast doubts about the efficacy of vaccines, attacking governors and vaccine manufacturersvv,ww The Minister of Health opposed health professionals and civil society, declaring that the vaccination of teenagers (12 to 17 years old) was not safe. At that moment, the Pfizer-BioNTech vaccine was already approved by national and international control agenciesxx Bolsonaro stated, with no scientific evidence, that the pandemic would be finished in two months after the vaccinesyy	Dissemination of technical-scientific evidence by professional organizations. For example, ANVISA approved emergency use of vaccineszz, the press widely publicized the efficacy and safety of vaccinesaaa and regulatory bodies contradicted statements by Bolsonarobbb,ccc The contrarian position of the Minister of Health regarding the Pfizer-BioNTech vaccine for teenagers generated protests in various sectors of civil society, including governors of 21 states who kept the 12–17 years of age group in their vaccination planddd ANVISA contradicted Bolsonaro, informing that vaccine was necessary even for those who have been infectedeee Pressure from civil society and control agencies to accelerate vaccine purchasefff and implement recommended measuresggg,hhh Population widely adheres to the mass vaccination campaigniii

a

Senado Federal (2021), p. 195–197.

b

https://politica.estadao.com.br/noticias/geral,dia-d-e-hora-h,70003578178.

c

Ventura et al. (2021). p. 111.

d

https://noticias.r7.com/brasil/pazuello-muda-logistica-e-vacina-chega-com-atraso-a-estados-18012021.

e

https://noticias.uol.com.br/confere/ultimas-noticias/2021/08/26/bolsonaro-distorce-dados-de-vacinas-marco-temporal-e-inflacao.htm.

f

https://brasil.elpais.com/brasil/2020-12-01/brasil-fica-para-tras-na-estrategia-de-vacinacao-contra-a-covid-19-e-acende-alerta.html.

g

https://noticias.r7.com/prisma/r7-planalto/e-grave-que-brasil-nao-defina-plano-de-vacinacao-diz-maia-07122020.

h

https://g1.globo.com/politica/noticia/2020/12/12/grupo-de-pesquisadores-diz-nao-ter-sido-consultado-sobre-plano-de-vacinacao-enviado-ao-stf.ghtml.

i

Gomes, M. Santos, C. The role of the Consortium of Press Vehicles in the COVID-19 pandemic in Brazil. Intercom—Sociedade Brasileira de Estudos Interdisciplinares da Comunicação 44º Congresso Brasileiro de Ciências da Comunicação.

j

https://oglobo.globo.com/rio/noticia/2022/06/atraso-na-vacinacao-contra-a-covid-19-no-rio-custou-a-vida-de-31-mil-pessoas-segundo-estudo.ghtml?utm_source=globo.com&utm_medium=oglobo.

k

Senado Federal (2021). CPI da Pandemia, p. 245.

l

https://noticias.uol.com.br/ultimas-noticias/reuters/2021/10/14/bolsonaro-volta-a-adotar-retorica-contra-vacina-e-usa-informacao-incorreta.htm.

m

https://noticias.uol.com.br/saude/ultimas-noticias/redacao/2021/01/22/bolsonaro-diz-que-pode-distribuir-vacinas-amanha-mas-mente-sobre-eficacia.htm.

n

Ventura et al. (2021), p. 111.

o

https://g1.globo.com/politica/noticia/2021/01/22/vacina-nao-esta-comprovada-cientificamente-diz-bolsonaro-contrariando-o-que-disse-a-anvisa-e-as-provas-obtidas-por-cientistas.ghtml?utm_source=facebook&utm_medium=social&utm_campaign=g1&fbclid=IwAR0jptdCNnKRb_05lUkoCkRsvkkZ1lYN3n9WJiDxDfUC0Ovy4UKtV-QFGsY.

p

https://g1.globo.com/politica/noticia/2021/01/22/vacina-nao-esta-comprovada-cientificamente-diz-bolsonaro-contrariando-o-que-disse-a-anvisa-e-as-provas-obtidas-por-cientistas.ghtml?utm_source=facebook&utm_medium=social&utm_campaign=g1&fbclid=IwAR0jptdCNnKRb_05lUkoCkRsvkkZ1lYN3n9WJiDxDfUC0Ovy4UKtV-QFGsY.

q

https://noticias.uol.com.br/amp-stories/as-trapalhadas-do-governo-nas-vacinas-contra-covid/.

r

Ventura et al. (2021), p. 113, 118.

s

https://noticias.r7.com/saude/diretoria-da-anvisa-aprova-uso-emergencial-de-vacinas-contra-covid-10122020.

t

https://oglobo.globo.com/sociedade/vacinas-contra-covid-19-saiba-tudo-sobre-os-efeitos-colaterais-eficacia-plano-de-vacinacao-24792472?utm_source=globo.com&utm_medium=oglobo.

u

https://noticias.uol.com.br/confere/ultimas-noticias/2021/10/14/nota-da-anvisa-desmente-tese-de-bolsonaro-para-nao-se-vacinar-contra-covid.htm.

v

https://g1.globo.com/bemestar/coronavirus/noticia/2021/01/17/diretores-da-anvisa-dizem-que-vacina-e-necessaria-porque-nao-ha-tratamento-precoce-contra-a-covid.ghtml.

w

Senado Federal (2021). CPI da Pandemia, p. 195–247.

x

https://noticias.uol.com.br/colunas/jamil-chade/2020/12/08/brasil-optou-por-cobertura-minima-em-alianca-mundial-de-vacinas.htm.

y

https://noticias.uol.com.br/colunas/jamil-chade/2020/12/08/brasil-optou-por-cobertura-minima-em-alianca-mundial-de-vacinas.htm.

z

Senado Federal (2021). CPI da Pandemia, p. 213–225.

aa

https://noticias.uol.com.br/politica/ultimas-noticias/2021/08/26/cpi-revela-mensagens-e-aponta-tentativa-de-favorecer-precisa-em-licitacao.htm.

bb

Senado Federal (2021). CPI da Pandemia, p. 238–241.

cc

https://g1.globo.com/bemestar/vacina/noticia/2020/12/12/veja-a-cronologia-da-disputa-entre-bolsonaro-e-doria-em-torno-da-vacina-contra-a-covid-19.ghtml.

dd

Senado Federal (2021). CPI da Pandemia, p. 229.

ee

https://g1.globo.com/bemestar/vacina/noticia/2020/12/12/veja-a-cronologia-da-disputa-entre-bolsonaro-e-doria-em-torno-da-vacina-contra-a-covid-19.ghtml.

ff

https://g1.globo.com/pi/piaui/noticia/2021/03/12/consorcio-nordeste-assina-contrato-de-compra-de-39-milhoes-de-doses-da-vacina-sputnik-diz-governador-do-pi.ghtml.

gg

https://g1.globo.com/bemestar/coronavirus/noticia/2021/03/01/conselho-de-secretarios-divulga-carta-com-sugestoes-de-medidas-urgentes-contra-iminente-colapso-das-redes-publica-e-privada-por-causa-da-covid.ghtml.

hh

https://noticias.uol.com.br/politica/ultimas-noticias/2021/02/16/confederacao-dos-municipios-pede-saida-de-pazuello-por-falhas-na-vacinacao.htm.

ii

https://g1.globo.com/sp/sao-carlos-regiao/noticia/2021/01/21/com-vacinacao-de-tecnica-de-enfermagem-e-presenca-de-doria-araraquara-inicia-imunizacao-contra-a-covid-19.ghtml.

jj

Senado Federal (2021). CPI da Pandemia, p. 229.

kk

https://g1.globo.com/pi/piaui/noticia/2021/03/12/consorcio-nordeste-assina-contrato-de-compra-de-39-milhoes-de-doses-da-vacina-sputnik-diz-governador-do-pi.ghtml.

ll

https://g1.globo.com/pi/piaui/noticia/2021/03/12/consorcio-nordeste-assina-contrato-de-compra-de-39-milhoes-de-doses-da-vacina-sputnik-diz-governador-do-pi.ghtml.

mm

https://noticias.uol.com.br/saude/ultimas-noticias/redacao/2020/12/10/coronavac-governo-de-sp-anuncia-acordo-com-com-municipios-de-sc.htm.

nn

Senado Federal (2021). CPI da Pandemia, p. 195–197.

oo

https://www1.folha.uol.com.br/equilibrioesaude/2021/01/promotorias-investigam-casos-de-fura-fila-da-vacina-em-seis-estados.shtml.

pp

https://economia.uol.com.br/noticias/redacao/2021/03/12/bolsonaro-critica-auxilio-estadual-contra-a-pandemia-povo-dominado.htm.

qq

https://noticias.uol.com.br/saude/ultimas-noticias/reuters/2021/03/17/na-contramao-de-queiroga-bolsonaro-se-diz-feliz-por-protestos-contra-isolamento.htm.

rr

https://noticias.r7.com/cidades/novos-prefeitos-entram-na-corrida-pela-vacina-contra-covid-19-01012021.

ss

https://g1.globo.com/bemestar/vacina/noticia/2020/12/12/datafolha-73percent-dizem-que-pretendem-se-vacinar-contra-a-covid-19-22percent-afirmam-que-nao.ghtml.

tt

https://noticias.uol.com.br/colunas/coluna-entendendo-bolsonaro/2021/06/03/contra-bolsonaro-ruas-gritam-por-vacina-e-auxilio.htm.

uu

https://www1.folha.uol.com.br/equilibrioesaude/2021/01/promotorias-investigam-casos-de-fura-fila-da-vacina-em-seis-estados.shtml.

vv

https://noticias.uol.com.br/confere/ultimas-noticias/2021/08/26/bolsonaro-distorce-dados-de-vacinas-marco-temporal-e-inflacao.htm.

ww

https://noticias.uol.com.br/ultimas-noticias/agencia-estado/2021/07/30/bolsonaro-se-vacina-for-efetiva-para-cepas-mais-2-meses-voltamos-a-normalidade.htm.

xx

https://g1.globo.com/bemestar/vacina/noticia/2021/09/16/ministerio-da-saude-volta-atras-e-passa-a-nao-recomendar-vacinacao-de-adolescentes-sem-comorbidades.ghtml.

yy

https://noticias.uol.com.br/ultimas-noticias/agencia-estado/2021/07/30/bolsonaro-se-vacina-for-efetiva-para-cepas-mais-2-meses-voltamos-a-normalidade.htm.

zz

https://noticias.r7.com/saude/diretoria-da-anvisa-aprova-uso-emergencial-de-vacinas-contra-covid-10122020.

aaa

https://oglobo.globo.com/sociedade/vacinas-contra-covid-19-saiba-tudo-sobre-os-efeitos-colaterais-eficacia-plano-de-vacinacao-24792472?utm_source=globo.com&utm_mediu =oglobo.

bbb

https://noticias.uol.com.br/confere/ultimas-noticias/2021/10/14/nota-da-anvisa-desmente-tese-de-bolsonaro-para-nao-se-vacinar-contra-covid.htm.

ccc

https://g1.globo.com/bemestar/coronavirus/noticia/2021/01/17/diretores-da-anvisa-dizem-que-vacina-e-necessaria-porque-nao-ha-tratamento-precoce-contra-a-covid.ghtml.

ddd

https://g1.globo.com/bemestar/vacina/noticia/2021/09/16/ministerio-da-saude-volta-atras-e-passa-a-nao-recomendar-vacinacao-de-adolescentes-sem-comorbidades.ghtml.

eee

https://noticias.uol.com.br/confere/ultimas-noticias/2021/10/14/nota-da-anvisa-des.

fff

https://noticias.r7.com/cidades/novos-prefeitos-entram-na-corrida-pela-vacina-contra-covid-19-.

ggg

https://br.noticias.yahoo.com/brasil-esta-6-meses-atrasado-em-plano-para-vacina-diz-medica-da-fio-cruz-130346265.html.

hhh

https://noticias.uol.com.br/politica/ultimas-noticias/2021/02/16/confederacao-dos-municipios-pede-saida-de-pazuello-por-falhas-na-vacinacao.htm.

iii

https://especiais.g1.globo.com/bemestar/vacina/2021/mapa-brasil-vacina-covid/?_ga=2.236212545.1316818289.1654178587-ee0d366f-7dc1-442e-6c2b-f9830839ecee.

Source: Authors. Elaborated from the content analysis of collected data

Discussion

Risk governance is a participatory decision-making process based on the assumption that a range of stakeholders can make important contributions to govern risks. In emergencies, a strategic commitment on the part of policymakers to better manage national responses is crucial. Leadership and a management of expectations based on trust and transparency are critical to help societies and individuals make decisions (Florin, 2014). As O’Riordan et al. (2020, p. 7) point out, ‘where Covid-19 has been fought successfully, this has been the result of strong government leadership, with people following and reinforcing’. Although national policymakers are not the only actors who can take the lead, effective risk governance during emergencies depends on central coordination of efforts. This is particularly true for countries, like Brazil, structured by a federal political system and where the federal government is constitutionally mandated to coordinate epidemic responses.

The documentary evidence reviewed in this article suggests weaknesses in the Brazilian federal government performance along five key risk governance parameters: transparency and accessibility of data, risk communication, negotiation between actors, social cohesion and public participation and decisions based on technical and scientific evidence, resources and contexts. Looking at the pandemic performance of the federal government through the prism of risk governance sheds light on a series of actions which sidestepped essential components of what a pandemic response should be. It also reveals how different actors interacted in a complex process, thus helping to make sense of how effects were produced during the response.

The analysis of the body of evidence indicates that a governmental strategy was visible in the postponement of decisions, the creation of diversions and distractions and the amplification of confusion. The federal performance was also characterized by efforts to obstruct those who wanted to act. Nunes (2022) points out examples of this obstruction, which are also observed in our analysis of the documentary evidence, including Bolsonaro’s accusations that state governors and mayors who instituted more restrictive measures were infringing on citizens’ freedoms, and laying blame on these officials for the economic consequences of the pandemic.

As Boholm et al. (2012) argue, risk governance takes places in contexts that are historically, spatially and institutionally situated. In Brazil, the failures of risk governance happened against a background of political polarization, a crisis of confidence in political institutions and increased populist tendencies in the public discourse. The pandemic emergency also interacted with, and fed into, anti-science and anti-expertise sentiment, the demise of traditional media and authoritative sources of information and the growth of disinformation. Adopting a risk governance lens allows one to assess the government response to this crisis without losing sight of these other, interlocking crises.

This article identified several controversies created or fostered by the federal government. It provides further evidence of strategy aimed at creating chaos to divert societal attention from the government’s failings. According to Nobre (2020), Bolsonaro has time and again resorted to the ‘method of chaos’, that is, the spread of disinformation and confusion, as one of his main strategies. Lima and Costa (2022) suggest that this method has been used in environmental governance as well. The authors identified a combination of nonfeasance (failure to act in situations where actions are expected or required), misfeasance (related to inappropriate action that cause harm) and malfeasance (improper deliberative action) on the part of the Brazilian federal government, which resulted in what they call ‘environmental misgovernance and malgovernance’ (Lima and Costa, 2022, p. 12). For the authors, ‘[w]hile misgovernance may indicate poor management […] malgovernance denotes intentionality, and thus a political problem that cannot be subsumed to a set of technical deficiencies’ (Lima and Costa, 2022, p. 4).

Our documentary analysis suggests a similar situation in the case of the Covid-19 response. Despite all the instances of resistance we identified (e.g. media and communication efforts to avoid the spread of disinformation, court decisions guaranteeing municipal and state autonomy, actions from social movements and efforts from the Brazilian scientific community), the weak risk governance performance by the federal government contributed to effects that went well beyond the physical injuries associated with the pandemic. The creation and amplification of confusion and disinformation contributed to undermining the public commitment to necessary health measures. Specifically, and speaking to other works in the literature (e.g. Campos, 2020; Calil, 2021), our analysis provides further evidence of the mechanisms by which the government’s response led to an increase of anti-science beliefs and denialism. We also provided further detail of the process by which the federal government contributed to hindering social cohesion (namely, by obstructing actors in other levels of government and in civil society, by empowering unelected members of a ‘parallel cabinet’ and by casting doubt on health authority advice). The documentary evidence we reviewed also indicates that federal government actions contributed to delays in the vaccination process, while fostering widespread public use of medicines without proven effectiveness.

The Brazilian federal government adopted what could be termed a ‘governance by chaos’, consisting of inadequate efforts to meet risk governance parameters coupled with an attempt to sow doubt and confusion. The concept of ‘governance by chaos’ is aligned with what has been termed ‘Bolsonaro’s federalism’ (Abrucio et al., 2020). Reduced participation of the federal government in the reduction of territorial disparities and inequalities, combined with increased conflict with subnational governments and other levels of the administration—the main strategies of Bolsonaro’s federalism—jeopardized the coordination of policy responses to the pandemic. Moreover, as Monteiro et al. (in press) argue, the choices and actions made by the federal government amplified controversies and associated conflicts that have exposed and fuelled a broader institutional crisis.

This article supplemented these arguments, offering a layered account of institutional failure in Brazil’s response to the pandemic. It is worthy to note that the use of documentary sources is an effective means of gathering data, particularly in situations, like health emergencies, which involve decision makers/government actors; where there are enormous uncertainties; where different values are present and in dispute (Abott et al., 2004) and where there are difficulties of collecting data through interviews (Morgan, 2022). The use of documentary sources is not without its limitations, namely: documents can vary in quality and biased selectivity might be a concern (Abott et al., 2004; Gorsky and Mold, 2019). We sought to cope with such limitations by carefully structuring our data collection and analysis, as described in the Methodology section. We did not set out to conduct an exhaustive account of performance or conduct in-depth analyses of discourses. Instead, our study illustrates the application of the risk governance framework through a case study of institutional failure. In this sense, the Brazil case shows the analytical added value of using a risk governance framework in the analysis of the institutional response to health emergencies. With this framework, effects can be traced back to performance deficiencies in relation to risk governance parameters. Risk governance is a useful resource to understanding complex situations where multiple actors interact in a fast-shifting scenario of competition and uncertainty. Ultimately, by allowing us to identify the effects and ramifications of policies (or the absence thereof), as well as societal reactions, risk governance parameters also shed light on what an integrative and inclusive governance approach, capable of dealing with the impacts of health emergencies, can look like.

Abbreviations

ANVISA = National Health Surveillance Agency

OAB = Brazilian Bar Association

PCI = Parliamentary Commission of Inquiry

STF = Federal Supreme Court

SUS = Sistema Único de Saúde (Unified Health System)

TCU = Federal Audit Court

WHO = World Health Organization

Supplementary data

Supplementary data are available at Health Policy and Planning online.

Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Funding

G.M.D.G. acknowledges funding from the Brazilian Federal Foundation for Support and Evaluation of Graduate Education - CAPES (Process: CAPES-PRINT - 88887.569693/2020-00), and Brazilian National Council for Scientific and Technological Development – CNPq (Process: 311503/2020-9). F.R.C. also acknowledges funding from CAPES (Process 88887.615671/2021-00).

Acknowledgements

G.M.D.G., I.M.M. and F.R.C. acknowledge all insights and comments received from the colleagues from CompCoRe Project and CIRIS research group.

Author contributions

G.M.D.G. was responsible for the following roles and tasks: conception and design of the work, data analysis and interpretation, drafting the article and critical revision of article. I.M.M. was responsible for data collection, data analysis and interpretation and drafting the article. F.D.R.C. was responsible for data collection, data analysis and interpretation and drafting the article. J.N. was responsible for data analysis and interpretation, drafting the article and critical revision of article.

All authors approved the paper prior to submission.

Reflexivity statement

Our paper embraces inclusivity and diversity, mainly considering three critical aspects: the majority of the authors work at a university from Global South (Brazil); there is a gender parity and the authors are in different stages of the academic career (two are in more advanced stage and two are early-career researchers). G.M.D.G. is an associate professor at University of São Paulo (USP, Brazil) and visiting researcher at University of York (UK) from September 2021 to September 2022. J.N. is a senior lecturer at the Department of Politics, University of York. I.M.M. and F.D.R.C. are PhD candidates in Global Health and Sustainability Postgrad Program at USP, under G.M.D.G.’s supervision.

Ethical approval

This research did not include human participants. Ethical approval for this type of study is not required by our institutions.

Conflict of interest statement

The authors do not have any conflict of interest.

Endnotes

1.

Numbers from 12 December 2022, according to the Brazilian media consortium integrated by O Estado de S. Paulo, G1, O Globo, Extra, Folha de S. Paulo and UOL.