Brazil’s struggle to reconstruct healthcare post-Bolsonaro

On 14 January 2021, dozens of Brazilians died as authorities scrambled to get oxygen to Manaus, an isolated city in the heart of the Amazon. Over the next few days, the federal government began transporting critical patients to other states, but lines for hospital beds were still long. Without oxygen supplies, many had to be resuscitated in hallways, while others suffocated to death.

The Manaus oxygen crisis is perhaps the best example of how Brazil’s former far right president Jair Bolsonaro handled the pandemic. It is also a reflection of the precariousness to which the country’s public healthcare system—also known as Unified Health System, or SUS—has descended after years of regulatory and institutional setbacks promoted by former administrations.

Its reconstruction should now be one of the main priorities of President Luiz Inácio Lula da Silva, re-elected for his third term in October 2022. Since taking office, however, it is clear he is facing greater challenges than in his previous terms.

In addition to the more than 693 853 covid deaths in Brazil by the end of 2022—corresponding to 10% of the global death toll—the pandemic undermined SUS’s provision of non-covid-19 procedures,1 resulting in the deterioration of several health indicators in Brazil.

According to the Transition Commission’s Health Working Group—a commission created by the Lula government to evaluate the state of public administration—only 71% of the target population was vaccinated against polio in 2021, the lowest coverage since 1995. Between 2019 and 2021 maternal mortality increased from 55 deaths per 100 000 live births to 110.

The restriction of patient access to the healthcare network during the pandemic also resulted in a sharp …