As the COVID-19 pandemic has unfolded, the media, health experts, and academics have explained the split in the United States’ COVID-19 vaccines as partisan, educational, racial, or socioeconomic. As it stands, the overall immunization rate for adults in the United States has been around 65 percent for months. But this division may stem from the founding ideals of democracy in the US: Americans are simply not used to expecting much from their government.
Vaccinating everyone depends on more than vaccine availability; it depends on the health infrastructure woven into the fabric of society. If preventing further pandemics is truly a goal of the US public health system, then instead of investing in private health care and subsidizing private research for vaccine development, the US should invest in the development of public health systems and social inclusion strategies Rights develop the principles of its democracy.
Brazil, our homeland, is a prime example of how this can succeed and how vaccination acceptance can become a matter of course.
In July 2021, a group of drug dealers approached staff at a public vaccination center called Maré in a Rio de Janeiro slum. A friend of ours who works in Maré shared the story: Armed with shotguns, the drug dealers demanded to be vaccinated against COVID-19, even though Rio at the time only vaccinated people over 50 (most drug dealers are in their teens or 20s).
“We know this Delta variant is circulating and we want to be protected,” they told vaccination staff, who had no choice but to vaccinate everyone.
At first glance, drug dealers’ eagerness to get vaccinated may seem surprising, but the truth is that Brazilians from all walks of life embrace vaccination as a public health right. For example, in the 2020 H1N1 pandemic, Brazil vaccinated more people than any other country. Citizens are used to queuing at public health centers for routine vaccinations, despite the anti-vax stance of their President Jair Bolsonaro.
Although COVID-19 vaccines were slow to arrive in Brazil, nearly 100 percent of the adult population in Rio and São Paulo is fully vaccinated as of March 2022. This is a clear difference to the USA. In New York, one of the most vaccinated megacities, 78.2 percent of the adult population has received two doses – although there is no shortage of vaccines. Brazil has about two-thirds the population of the US, but as of November 2021, Brazil surpassed the US in the proportion of its population that is fully vaccinated. And that distance is getting bigger and bigger.
The reason most Brazilians embrace vaccinations and about a quarter of Americans resist them is deeply rooted in the evolution of these two democracies.
Since the 19th century, political analysts such as Alexis de Tocqueville have pointed to the US’s decentralized democratic structure, which has marginalized the role of state and relied heavily on associations within civil society. During the founding of the US, the emphasis was on civil and political rights, with an emphasis on individual liberty and liberty.
While Brazil is also a democracy and a federation with its own grassroots political associations, Brazil’s political history has emphasized the role of the state in ensuring social rights. In short, Brazilians expect health and other services to come from the government. Even before the current 1988 constitution, which enshrines public health as a human right, previous governments secured labor rights and social benefits for everyone in the country.
The development of the Brazilian democratic process created the infrastructure for a free nationwide public health system. This, in turn, has encouraged the acceptance of top-down public health interventions – even among drug traffickers. Even though this system is often precarious and at risk of being dismantled by Bolsonaro’s government, people still expect the government to provide free health care. This is very different from the US, where federally funded health care is primarily geared towards people living below the poverty line and the elderly.
Years ago, when one of us (Araujo) worked as a teacher in Rio’s Vidigal slum, his students told stories of stopping by the public health center on their way to school to greet the doctor. This daily exchange created a relationship of trust. Whenever someone felt ill, he did not hesitate to ask for help; Help was in her community. This trust in the public health system has now translated into public acceptance of COVID-19 vaccines.
These healthcare providers are part of SUS, Brazil’s public health system, created as a human right in 1988 with the intent to serve everyone in the country. The service, which includes a decentralized network of providers including doctors, hospitals and emergency centers, is free. Most of the favela and low-income populations in Brazil depend entirely on SUS for health care, and many middle-class citizens use SUS for routine vaccinations and emergency care.
SUS is not perfect. Public hospitals, for example, are struggling with funding bottlenecks and long queues for treatment. But everyone has access to basic medical care. SUS providers represent a continuously present institution and are often members of the community themselves. SUS providers are more than just an inconvenient step to obtaining a prescription.
The US does not have such a system. For many Americans, regular health care is financially unattainable. Half of Americans have medical debt — and the government plays little role in ensuring access to health care. Health care is expressly a luxury and not a right.
During this pandemic, it has been clear for months that vaccine acceptance is not only a scientific issue, but also a public health and communications issue. What is less clear, however, is how deeply rooted the acceptance of public health measures is in each country’s own historical political process. We cannot change history, but we can learn from it to implement policy changes that improve people’s lives.
This is an opinion and analysis article and the views expressed by the author or authors do not necessarily reflect those of Scientific American.