Lessons from Brazil's Public Health System Amid Global Challenges

Public health institutions worldwide are facing significant challenges, particularly from populist governments that undermine their funding and independence. This trend is evident in various countries, including the United States, where Robert F. Kennedy, Jr. was appointed as Secretary of Health and Human Services in February 2025. His tenure has seen the dismissal of over 10,000 staff members, budget cuts, and attempts to weaken childhood vaccine recommendations. As a result, national public health policy has fragmented, leading to the formation of “health alliances” among states, raising concerns among medical professionals about the long-term implications for the health system.

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Brazil's public health system, established in 1990, provides free universal health care and is recognized for its focus on preventive care. However, during the COVID-19 pandemic, President Jair Bolsonaro launched aggressive attacks on the vaccine program, which is a cornerstone of Brazil's public health efforts. He pressured the drug regulatory agency to ban pediatric vaccines and spread misinformation about vaccine safety. Despite these challenges, Brazil's public health workers mobilized support to defend the vaccine program, demonstrating resilience in the face of political adversity.

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The survival of Brazil's vaccine program relied not only on political advocacy but also on substantial support from the private sector and grassroots organizations. Business coalitions contributed over 270 million real (approximately US$54 million) to public laboratories, while the Lemann Foundation financed clinical trials for AstraZeneca's vaccine. Additionally, initiatives like "United for the Vaccine," led by female business leaders, provided essential resources for vaccine distribution, particularly in remote areas.

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Grassroots organizations played a crucial role in combating misinformation and promoting vaccination. By early 2021, over 1,300 grassroots campaigns had been identified, significantly contributing to Brazil achieving a vaccination rate of 81% among adults by August 2022, surpassing that of the United States.

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Brazil's public health system has successfully cultivated trust through long-term community engagement. Health workers frequently interact with citizens in public spaces, promoting health services and fostering a sense of ownership over the public health system. This proactive approach has helped mitigate the impact of disinformation and political attacks, allowing for a unified defense of public health initiatives.

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The Brazilian experience underscores the importance of building trust and community involvement in public health systems. As countries grapple with similar challenges, investing in long-term relationships between health institutions and the communities they serve may prove essential in safeguarding public health against political and social upheaval.

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• “All their requests were met, without one cent of government money being used.” — Margareth Dalcolmo, Pulmonologist

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• “It’s like they are constantly saying, ‘Look, the doors are open. You can come. You’ll be seen and supported.’” — Health Care Worker

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Brazil's public health system offers valuable lessons for other nations facing threats to their health institutions. By fostering community trust and resilience, countries can better navigate political challenges and ensure the continued effectiveness of their public health initiatives.

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