Public health institutions are under threat by populist governments .
From to , public health agencies are being stripped of funding and independence. Meanwhile, disinformation has sown distrust in scientific experts. The results are already visible through the return of diseases once thought and .
The United States is no exception to this trend. Since Robert F. Kennedy, Jr. was confirmed as secretary of Health and Human Services in February 2025, he has , cut budgets and . Though medical and public health groups have , key government health institutions , and national public health policy has fractured into “” formed by groups of states.
Doctors and scientists across the country to the country’s health system.
As a researcher , I believe it’s helpful to look to countries that have successfully managed similar threats. As , Brazil’s experience offers insights into how public health institutions can preserve power and authority in the face of assault.
Much like the U.S., Brazil has a , it has , and it has a federal system of government. And much like in the U.S., .
But when a populist president ,
A health system under attack
, established in its current form in 1990, provides free universal health care to all its citizens. Despite , including , its focus on preventive care is
Prior to the administration of right-wing populist Jair Bolsonaro, from 2019 to 2022, Brazilians had trust in vaccines. They had what public health experts call a vaccine culture, thanks to the hard work of health workers who had spent years and . Vaccines even had a in Zé Gotinha (Joe Droplet), a cartoon vaccine droplet with a Pillsbury Doughboy-like visage.
When COVID-19 hit Brazil in March 2020, Bolsonaro – dubbed by many as the “” – launched . Among other measures, he fired the senior leadership of the health ministry and appointed as minister an .
Bolsonaro’s – a backbone of Brazil’s preventive health efforts – were especially strong. He . He , and he spread misinformation, notoriously suggesting the vaccine could .
After Bolsonaro’s initial attacks on Brazil’s COVID-19 response efforts, the entire health system . However, Brazil’s public health workers then marshaled broad support to defend their vaccine program.
Opposition governors offered by producing their own vaccine guidance and procuring their own vaccines. But political support, on its own, couldn’t overcome Bolsonaro’s attacks.
That’s because Brazil’s vaccine program depended not just on independence, but also on resources to operate. And governments with an anti-science bent have many ways to deprive even well-established agencies of resources without broad congressional approval.
Brazil’s vaccine program ultimately survived because allies outside government stepped in to defend it not only with political advocacy, but by donating money and resources and with social activism.
Business leaders to the rescue
Businesses filled gaps in government resources with donations of private-sector funding. Two business coalitions gave a total of over 270 million real (US$54 million) to help two public laboratories, , known as BioManguinhos, and .
One of the largest foundations in Brazil, the Lemann Foundation, in Brazil. Ambev, one of the largest firms in South America, to help BioManguinhos acquire supplies and equipment.
, a nonpartisan network of female business leaders, even built a campaign called to help towns and cities acquire the vaccine distribution equipment they needed. They provided local health officials with cheap supplies, like coolers and refrigerators, as well as costlier investments, such as boats and even planes for carrying vaccines to the isolated communities of the Amazon.
As pulmonologist , who consulted for United for the Vaccine, emphasized to me in an interview: “All their requests were met, without one cent of government money being used.”
From the ground up
Another hugely important component of defending Brazil’s vaccine program was support from trusted local grassroots groups.
When vaccines became available, community-based groups across the country jumped in to combat disinformation with their own locally produced information campaigns – especially in underserved communities.
One group I spoke to distributed 5,000 informational posters across their neighborhood. Another, , or We’re in it Together Rocinha, published a book with lessons for kids to do with their parents while school was canceled – all with vaccination information embedded. Voz das Comunidades, or Voice of the Communities, a neighborhood news service, even created to combat misinformation while also notifying community members of daily death tallies.
So many grassroots groups organized to counter Bolsonaro’s attacks on COVID-19 vaccines that researchers began to map the campaigns bubbling up across the country. By early 2021, one map had and over 800 organized by universities.
By August 2022, despite Bolsonaro’s disinformation campaigns, 81% of Brazil’s adult population was fully vaccinated against COVID-19. These equaled those of New Zealand and the Netherlands and were well above that of the United States, where only 67% were fully vaccinated at the time.
This is not to say that Brazil was immune to disinformation campaigns. , as .
But in many ways, the attacks on Brazil’s vaccine program paradoxically strengthened it. By the end of 2022, thanks to donor support, BioManguinhos had already built a new testing laboratory, and Butantan was constructing a new vaccine production facility. Brazil even had a . By 2024, once Bolsonaro was voted out, overall spending on the health system had .
Playing the long game with public health
In my view, these emergency countermeasures in Brazil worked effectively because the country had already spent years building a foundation of trust in – and ownership of – the shared goals of its public health system.
Decades ago, in the 1980s, Brazilians successfully to all – driving the genesis of the country’s universal public health system, known by the acronym SUS.
Brazil’s health ministry continues to invest heavily in making sure citizens take ownership of it. Cities and towns are postered with signs declaring “SUS is ours!” or “Health care is your right!”
As I found in my recent research in Brazil, this kind of advertising makes people feel their institutions are an earned right and reduces the power of partisan messaging.
Brazil also invests in integrating health workers into the communities they serve and cultivating public trust in their expertise. Government health care workers routinely set up shop in public plazas to advertise cancer screenings or give vaccinations. They regularly visit schools, where doctors or nurses talk to young people in accessible language about what the nation’s public health system offers its citizens. As one health care worker told me: “It’s like they are constantly saying, ‘Look, the doors are open. You can come. You’ll be seen and supported.’”
These long-term relationships between communities and the public health system helped lay the groundwork in Brazil for mounting a unified defense when political turbulence threatened public health agencies. Worldwide, a long-term view toward building or strengthening these relationships may help the public embrace the idea that public health institutions are worth defending.
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