On May 4 of this year, the Brazilian composer Aldir Blanc died due to complications caused by COVID-19. His most famous composition, “O bêbado e aequilibrista” (The drunk and the tightrope walker), created in partnership with João Bosco, speaks of a Brazil emerging from the military dictatorship (1964-1985) and entering the period of amnesty. At that time, political exiles could return to the country, and among these would be Herbert de Souza, known by his nickname Betinho,1 brother of the well-known Brazilian cartoonist Henfil. One line of the song refers to Betinho”[…] my Brazil, which dreams of the return of Henfil’s brother”.
Betinho and Henfil died of AIDS-related complications in the 1990s and 1980s, respectively. Decades later, a new virus has taken the life of Aldir Blanc, symbolically reuniting the three; the Brazilian cartoonist Nando Motta imagined it as follows: Aldir, balancing on a rope (as in his famous song) reaches the sky and is greeted by Betinho, who calls Henfil to see who arrived.
We learned a lot from HIV, and Betinho was one of the most outstanding figures in Brazil making that possible. Looking back to the early years of the HIV epidemic to inform our response to COVID-19 can be constructive.
In this short text on COVID-19, I highlight the lessons gained from facing other epidemics, such as HIV, and I examine themes such as the importance of solidarity and the need for vigilanceto avoid or mitigate situations that restrict rights.
A pandemic beyond imagination
Identified in the final months of 2019, a disease caused by a new coronavirus took the world by surprise. Initially, it was not alarming. However, in a short time, COVID-19, as it came to be called, became a major global health problem. More than that, it seemed a terrifying materialization of cinematographic fictions, such as Outbreak (1995) and Contagion (2011). Before long, on March 11, 2020, the Director-General of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus, qualified the new disease as a pandemic. At that time, there were 118,000 reported cases and 4,291 deaths. Less than two months later (May 1), there were more than 3 million confirmed cases of COVID-19, and it had caused more than 200,000 deaths.2
Without a vaccine and/or medicine to prevent or treat COVID-19, many countries implemented measures recommended by WHO “to detect, interrupt and contain human-to-human transmission”. The most well-known measure is social distancing, and the isolation adopted in many countries has led to various degrees of confinement. Despite the recognized success of such measures, analyses indicate that new infections will continue to occur.
Maintaining and defending individual and collective rights during a pandemic
Many actions have been taken to support people affected by the pandemic, but it is important to be attentive to the lack of protections for individual and collective rights, which already are being noted. Acts of xenophobia multiply, including by government leaders who refer to the new coronavirus as the “Chinese virus”.
Especially regardingwomen, the scenario is worrying, as highlighted by United Nations (UN) agencies and civil society organizations: there is an increase in domestic violence, made worse by confinement, and restriction of sexual and reproductive rights. Several agenciesare calling attention to marginalized populations who may be particularly vulnerable, such as lesbians, gays, bisexuals, trans and intersex (LGBTI) and also people living with HIV, sex workers, people who use drugs, and people who are in prison. The United Nations High Commissioner for Human Rights highlights that persons with disabilities can be disproportionately impacted by COVID-19.
There is also a possibility, according to UN agencies, that public health measures currently adopted to curb the transmission of the virus could be used to restrict human rights. For the Director-General of the UN, António Guterres, COVID-19 represents a threat to global stability. In Guterres’ view, the UN Security Council should adopt a resolution, yet this has not yet occurred. Guterres warns: “[…] the pandemic also poses a significant threat to the maintenance of international peace and security potentially leading to an increase in social unrest and violence that would greatly undermine our ability to fight the disease.”
What can be learned from other diseases that impacted public health
Epidemics and outbreaks such as Ebola have offered lessons — such as the importance of community involvement, especially in local actions — that can be useful forconfronting COVID-19. Numerous analyses have highlighted how the knowledge acquired with the HIV epidemic can be applied to the COVID-19 pandemic, from various angles, for example intesting. The HIV epidemic has taught, for example, that viruses neitherrecognize nor respect borders. However, HIV also taught that lack of political leadership, lack of information, insufficient financial and human resources, stigma, and discrimination affect populations in different ways, eventually giving the virus different trajectories in affected countries. COVID-19 has been marked with inequalities, as in the United States where a disproportionate number of cases are among African-Americans and Latinos.
As in the HIV epidemic, there was a phase of denying the lethality of the new coronavirus. Now, when it is impossible to deny its devastating impact, we witness a false dichotomy putting public health and economics on opposite sides. Similar argumentsalso circulated during the early days of the HIV epidemic: a 1997 World Bank publication exemplifies this question. But, little by little, this dichotomy was disqualified, as it did fail to consider the benefits and economic gains obtained when people with HIV have access to treatment.
A report published in May 2020 presented results of surveys conducted in 11 countries (Canada, China, France, Germany, India, Japan, Mexico, Saudi Arabia, South Korea, United Kingdom, and the United States). One question asked whether it was more important to save lives or save jobs and restart the economy. Almost 70% responded that the government must save the largest number of lives, even if as a result the economy suffers damage and recovers more slowly.
Two other lessons from the HIV epidemic are relevant to COVID-19: the importance of community involvement as part of local, regional, and global responses; and the practice of solidarity.
One of the most worthwhile lessons from the crisis inflicted by HIV was certainly the importance of mobilizing civil society, especially people living with HIV, in constructing responses to the epidemic. In this current crisis, the participation of civil society has been identified as something that can improve the way different countries respond to COVID-19. One example is South Africa. Profoundly affected by HIV, the country implemented a program of community health workers to tackle the epidemic, and this experience is now being used to confront COVID-19.
Solidarity was a key word promoted by civil society organizations in the response to the HIV epidemic. Currently, it is a concept being invoked by several organizations, including UN agencies, and it offers diverse prospects for facing COVID-19, such as, for example, the needed support for health professionals and other essential workers. Another example of solidarity is the support received by the WHO after U.S. President Donald Trump announced in April that he was suspending the United States’ contribution to that agency. This same kind of solidarity is evident in the resolution International cooperation to ensure global access to medicines, vaccines and medical equipment to face COVID-19, adopted on April 20, 2020, at the 74thsession of the United Nations General Assembly in New York. A few days later, on April 24, concrete steps were taken in this direction with the launch of an innovative collaboration platform, realized in the Global collaboration to accelerate the development, Production and Equitable Access to New COVID-19 diagnostics, therapeutics and vaccines. The virtual inaugural event for the initiative included, as co-organizers, the WHO, the President of France, the President of the European Commission, and the Bill & Melinda Gates Foundation. A few days later, on May 4, a virtual fundraising event — moderated by the President of the European Union and attended by representatives of 40 countries, as well as by foundations, the UN, experts, and others —succeeded in raising 7.4 billion euros. It is important to highlight thatseveral countries have not yetcommitted to the initiative, including China, the United States and Brazil.
Support for health professionals and essential workers and the importance of maintaining hope
To conclude,I highlight two elements: health professionals and essential workers, and the importance of maintaining hope. When 2020 was designated the year of the nurse and midwife, no one was imagining that health professionals would confront a disease as lethal as COVID-19. Already there a high rate of infection and death among these professionals, as well as among other workers engaged in essential activities.3These professionals, who in many cases lack access to needed personal protective equipment, are deservedly being applauded in various parts of the world, but it is hoped that this admiration during the pandemic will translate into concrete acts of support.4
As for hope, it is not easy to sustain during a pandemic as deadly as that of COVID-19, and the example that I present comes from Brazil. During the past two decades, afterconsiderable struggle by civil society, the country came to beknown for its innovative responses to the HIV epidemic, especially regardingcommunity participation and the provision of medicines for people living with HIV. In recent years, however, the country has faced setbacks. In relation to COVID-19, Brazil has unfortunately offered contradictory messages in facing the pandemic. The country and President Jair Bolsonaro have been criticized for policies undermining the nation’s response to the pandemic. Considering the current scenario, forecasts are not good for the evolution of the pandemic in the country.5
But, as the saying goes, “Brazilian, profession: hope”,6 I highlight Betinho, mentioned at the beginning of this text. Sociologist and activist, he participated intenselyin several struggles, including AIDS — he was the founder and president of the Brazilian Interdisciplinary AIDS Association(AssociaçãoBrasileiraInterdisciplinar de AIDS/ABIA) — land reform, and the fight against hunger. With respect to AIDS, Betinho led several campaigns, including for access to information and medicines. In January 1992, the Brazilian newspaper Jornal do Brasil published an article by Betinho titled O dia da cura(The day of the cure), in which he relates what the day announcing the cure for AIDS would be like. He imagined:
It was an ordinary morning like any other, when I opened the newspaper and read the headline: The Cure for AIDS is Found! At first, I shifted in bed as if the floor had been moved and my room was in a different place. I stood still for some time without knowing what the first act of a person should be sentenced to live again. The first thing was to be certain. I called my doctor. It was really President Bush himself giving statements on American TV announcing the truth: 10 patients with advanced AIDS had taken the CD2 medication and shown no signs or symptoms of the virus in their systems. An efficient virucidal had been discovered.The other news followed the same course. The CD2 laboratory’s shares on the New York Stock Exchange jumped to a new high. In France, the Pasteur Institute said they observed a similar occurrence of the vagaries of science and that there was also CD2 in the pipeline to be announced. I called my psychiatrist and relayed the news about the cure for AIDS and decided I would only confront my happiness in our future sessions. After all, I had prepared myself so thoroughly for death that life was now a problem.
Suddenly I realized that everything had changed because the announcement of a cure. I realized that the idea of inevitable death paralyzes you. I realized that the idea of life motivates you … even if death is eventually inevitable, as we all know. Waking up knowing that you will live allows life to make sense again and changes how you live your life. Waking up knowing that you will die takes away any meaning of life. The idea of death instead of life is death itself instilled. Suddenly I realized that the cure for AIDS had always existed as a possibility, even before it existed as an announced discovery, and that its name was life. It happened suddenly, like how everything happens.
Hemophilic and infected with HIV byblood transfusion, Betinho died in 1997 of AIDS-related complications. The cure has not yet arrived, but more effective drugs for controlling HIV became available — which we hope will happen soon with COVID-19, as indicated by the global effort in this direction. Until that moment comes, we must hope that the cure for COVID-19 (and perhaps for AIDS) will one day emerge.
Betinho’s poetic description for the day of cure for AIDS signals the need that, even in adverse and devastating circumstances — such as the HIV epidemic in the 1980s and 1990s, or as the pandemic in which we now live —, we must continue tohope, fight and believe. As Brazilian singer and songwriter Rita Lee sings, “diasmelhoresvirão!” (better days will come!).
- In 1971, when repression was severe in Brazil, Betinho went into exile. Betinho lived first in Chile, where he taught at the Latin American Faculty of Social Sciences in Santiago and worked as an advisor to President Salvador Allende, who was deposed in 1973. Betinho escaped the coup by seeking asylum in the Panamanian embassy. In 1974 he went to Canada and then to Mexico, where he pursued his doctorate. During his exile, Betinho assumed leadership and advisory positions in organizations such as the International Peace Research Association, and the UN Food and Agriculture Organization of the United Nations. He was also a professor in the doctoral program in Economics in the Division of Advanced Studies at the National Autonomous University of Mexico. In the late 1970s, with intensified pressures for a political opening in Brazil, his name became a symbol in the campaign for the return of exiles. In 1979, following a political amnesty, Betinho was able to return to Brazil. Soon, he was again deeply involved in social and political struggles, always trying to expand democracy and social justice. (see Galvão J. 2009. Betinho: Celebration of a Life in Brazil. In: The Practice of International Health: A Case-based Orientation. Perlman D, & Roy A, Eds. Oxford: Oxford University Press, p.231-243).
- In recognition of the seriousness of the pandemic, the 73rd World Health Assembly (WHA) —scheduled originally to take place from 17 to 21 May 2020 —for the first time in history will be virtual and now shortened to two days (18-19 May), and it will have basically one item on the agenda: the new coronavirus. The WHA is the WHO decision-making body and occurs once a year in Geneva, usually in May. The Assembly includes delegations from the 194 WHO member states, as well as other UN agencies, civil society organizations, public health experts, academics, foundations, donors, and the private sector.
- The definition of what is considered essential is not uniform and may vary from country to country, as, for example, in Brazil.
- On Easter Sunday (April 12, 2020), a medical white coat was projected onto the statue of Christ the Redeemer, in Rio de Janeiro, in honor of the health professionals who are facing COVID-19.
- One example is President Jair Bolsonaro’s opposition to the prevention measures recommended by WHO and nonetheless implemented by the governors of many states in Brazil. Such measures had the support of the then Minister of Health, Luiz Henrique Mandetta, dismissed by Bolsonaro on April 16, 2020, “after weeks of conflicts over the strategy to face the pandemic of the new coronavirus in Brazil“. It is worth noting that, in February 2020, Bolsonaro declared that “a person with HIV is an expense for everyone in Brazil”. The Brazilian Institute of Social and Economic Analyses (Instituto Brasileiro de AnálisesSociais e Econômicas/Ibase) and ABIA, institutions founded by Betinho, prepared a fictional letter in which Betinho responds to President Jair Bolsonaro regarding his controversial speech (“a person with HIV is an expense for everyone in Brazil” ): “I died in August 1997, but I feel obliged to respond to a public statement that places the burden on us, the sick, of being a cost to the country”.
- “Brasileiro, profissãoesperança” (Brazilian, profession: hope), a play written by the Brazilian playwright, Paulo Pontes, in the 1960s, during the military dictatorship.
*Jane Galvão, anthropologist, PhD in Public Health, was general coordinator of ABIA (1993-1999). She is currently a Senior Health Advisor on the UNHR team in Geneva, Switzerland.
A version of this article was originally publishedonline in Portuguese on May 11, 2020 by ABIA.