Reckoning with COVID-19 denial: Brazil's exemplary model for global response

Abstract

In the aftermath of the coronavirus disease 2019 (COVID-19) pandemic in Brazil, accountability is crucial for those who denied the severity of the virus, spreading false information and causing harm. Some individuals have already faced legal proceedings against them, revealing economic motivations behind their actions. It is equally important to hold doctors accountable for prescribing ineffective treatments, putting the population at risk. The leaders of the denial movement and the federal government, who mishandled the pandemic, should be held accountable for the high death toll. Seeking justice from the legislative and executive branches is necessary, along with exemplary measures for those who spread misinformation about COVID-19.

Core Tip: Amidst the tumultuous landscape of misinformation during the coronavirus disease 2019 pandemic, a Federal Court in Rio Grande do Sul, Brazil, has set a precedent by holding a group of doctors advocating unproven early treatments accountable for collective moral and health damages. The decision underscores the imperative to address the dissemination of false scientific information, emphasizing the need to prosecute not only medical practitioners but also those who exploit their social respectability to fuel anti-vaccine movements. The unfolding legal actions signal a critical juncture for justice and accountability, prompting reflection on the broader repercussions of scientific denialism on public health.

TO THE EDITOR

It is necessary to settle the score

After everything that has occurred in Brazil during the Coronavirus disease 2019 (COVID-19) pandemic, and continues to occur on a smaller scale, it is time to settle the score with the deniers, those who, through scientific fake news, have caused deaths and suffering. The Federal Court in the state of Rio Grande do Sul has issued a decision against a group of doctors advocating for the so-called early treatment for COVID-19[1], which lacks scientifically proven effectiveness. These professionals have been ordered to pay compensation in the amount of R$ 55 million for collective moral and health damages. This decision was announced by the Federal Public Prosecutor's Office (MPF) on May 25, 2023.

The case of false information about electronic voting machines in the United States, disseminated by Fox News, illustrates that it is possible to hold accountable (even though this TV channel made a multi-million-dollar deal to settle the case) those who believe they can spread misinformation and not face any consequences; it is time to reflect and act on this matter. It is not too late to hold former President Bolsonaro accountable for his actions and speeches that resulted in deaths during the pandemic[2]. An example of his irresponsible practice was when he claimed on a social media platform, followed by millions of people, many of whom were misinformed or uninformed, that the COVID-19 vaccine could cause acquired immunodeficiency syndrome[3]. One can only imagine how many people refrained from getting vaccinated because of this fraudulent news and how many perished because of this and many other "live" events with such an approach, disseminated by the leader.

It is time to bring to trial a group of Brazilian scientists who signed a manifesto in favor of the use of harmless COVID-19 drugs and who opposed the use of vaccines[4]. It is also time to hold accountable journalists and other once respected professionals who used their supposed respectability to support COVID-19’s anti-vaccine movement and in favor of dead-end drugs[5,6]. All those who somehow supported this movement, fomented the use of useless drugs have their share of blame, but one group in particular has a greater responsibility, the doctors, because after all there is a (correct) mantra widely spread in Brazil: "Never take any kind of medicine without a doctor's prescription"[7]. But what should the Brazilian population have done, when a considerable part of the medical community prescribed useless and dangerous drugs in the middle of a pandemic? The population went to the doctors and fell prey to anti-scientific obscurantism.

It is necessary to hold responsible those doctors, both in Brazil and around the world, who even after the proof that these drugs had no effect in combating the disease, continued to prescribe them due to political, ideological or religious affinity, abdicating any scientific basis in their practice[1,8]. Furthermore, it is necessary to criminalize the offenses committed by these doctors, since by prescribing these drugs early in the treatment, they only worsened the condition of patients with COVID-19, and these drugs could have been effective in other situations, later in the evolution of the disease.

But it is crucial to recognize that those who prescribed this dangerous cocktail preemptively committed much more serious crimes against their patients[9]. They poisoned healthy people, who were not sick, with dewormers, antibiotics[6], and antineoplastic drugs, among others. These patients, when they really required severe acute respiratory syndrome coronavirus 2 drugs, ended up more vulnerable and showed higher lethality and morbidity. At the beginning of 2024, new studies suggest that the tragedy caused by the misuse of chloroquine in the treatment of COVID-19 may have caused many more deaths than had been imagined[10].

Moreover, these health professionals not only exposed their own patients, but also put the entire population at risk. We must reflect that by prescribing antibiotics, for example, for a viral disease, or even worse, preventively in healthy individuals[9], the entire population is exposed to the risk of selection of resistant bacteria. The result is that antibiotics are rendered ineffective when really needed[11], with consequences that we cannot yet measure.

This historical moment, marked by the pandemic and the exponential growth of the spread of fake news[12], should serve as an opportunity for holding accountable those who have directly or indirectly caused the death and suffering of thousands or even millions of people. A pandemic with millions of deaths, occurring simultaneously with the increased influence of social networks and the dissemination of false scientific news, highlights the need to hold accountable those who contributed to this misinformation[13], taking advantage of its relative social respectability and knowledge of new media.

An interview with the Minister of Health of the Lula government, published on June 5, 2023, addresses the urgency of holding accountable denialist doctors who spread false news about vaccines on social networks. According to Minister Nísia Andrade, the misinformation by these doctors regarding vaccination will be investigated, and a working group will be formed composed of the judiciary and the executive to assess who will be held accountable and how this will be done. This speech demonstrates a positive change from the Brazilian federal government, in relation to the fight against Fake News, and points to the hope that this cycle of misinformation through health professionals will be interrupted in the country.

Justice is coming...

The Brazilian justice system has started to partly reach some groups, as mentioned before, but we must wait and see what the results will be. The federal court has judged two actions of the MPF against those responsible for publishing the material entitled "Manifesto Pela Vida". This group, which called itself "doctors of early treatment in Brazil", encouraged the use of drugs that were supposed to be an "early treatment" against COVID-19. This material was disseminated to the general population, including the indication of doctors who prescribed the so-called covid kit[14]. Médicos Pela Vida [Medical Dignity Association of Pernambuco (ADM/PE)], together with the companies Vitamedic Indústria Farmacêutica, Centro Educacional Alves Faria (Unialfa) and the José Alves Group (GJA Participações), were jointly condemned to pay R$ 55 million for collective moral damages and to health, within their responsibilities. In one of the actions, the amount imposed by justice was R$ 45 million, and in the other, the condemnation was R$ 10 million.

The financial relationship between these groups was confirmed, justifying the need for exemplary measures. A medical association in Recife (PE), composed of physicians registered with Cremers (Regional Council of Medicine of Rio Grande do Sul), publicized in an advertisement the supposed benefits of "early treatment" for COVID-19, explicitly mentioning the drugs used. However, this reference omitted the adverse effects of the drugs, potentially encouraging self-medication due to the medical association's recommendation. The collaboration between the pharmaceutical company Vitamedic and the Associação Médicos Pela Vida was proven, with the company irregularly financing this advertisement, investing R$ 717 thousand. This information was admitted by Vitamedic's director in testimony in the Parliamentary Inquiry Commission (CPI) of COVID in the Federal Senate, Vitamedic being the manufacturer of ivermectin. That company had an increase in its revenue from R$ 15.7 million in 2019 to R$ 470 million in 2020 just from the sale of ivermectin, one of the drugs ineffective against COVID-19. This case highlighted that many advocates of the so-called "kit-covid" were being funded to deceive the population, resulting in significant profits for companies like Vitamedic at the expense of the lives of thousands of Brazilians.

The leaders of this directed catastrophe have yet to be held accountable

The numbers show the harmful effects of the erratic handling of the pandemic by the federal government and its followers, mainly due to the dissemination of false news over the internet and social networks[15]. Brazil, with only 2.7% of the world's population, accounts for 10% of global COVID-19 deaths. By mid-February 2023, the death rate in the world was 860 deaths per million inhabitants, while in Brazil it was 3200 deaths per million inhabitants.

In Brazil, intubation proved to be more dangerous, with 80% of patients in this state dying, while the global average was 50%[16]. Why did this happen in this country? Brazil’s healthcare system is not among the worst in the world[17], and its doctors and nurses are competent. However, it was one of the only countries that poisoned its population with dozens of useless drugs, such as the "kit-COVID"[18], that have proven side effects[19] making it absurd to prescribe them even preventively[9]. As evidence of this correlation, the municipalities most aligned with President Bolsonaro's thinking, which earned him the most votes, were those that registered proportionally higher numbers of COVID-19 deaths[20,21].

The consequences could have been even more damaging if all the vaccination efforts carried out within the Unified Health System had not occurred and if civil society and the CPI of the pandemic had not pressed for a reorientation of the Federal Government's actions. In addition, the Federal Supreme Court legally prevented the Bolsonaro government from harming municipalities and states by taking the necessary measures to contain the pandemic[22].

It is necessary that the entire Brazilian society, which has suffered the most from all this erratic science denial movement, demand justice from all the constituted powers, legislative and executive. All doctors and any other professionals who have spread and still spread false news about COVID-19 must be exemplarily disciplined, either financially or professionally (e.g., losing their medical licenses). A country like Brazil, which has an internationally recognized public health system[23] despite its problems, and which has had exemplary vaccination rates, cannot abandon itself to the mercy of inconsistent and unscientific deniers.

Let us hope in the next health emergency that occurs - as it surely will, even if we don't know when - that we will only have to face the disease and its inherent difficulties, and not also problems created by professionals who fail to fight against, or who even fight for, the threat to the public health. May we also have governors who are guided by scientific rigor and who protect their population regardless of their ideology and personal convictions.