An outbreak of underdevelopment

The recent outbreak of yellow fever in urban areas of some of Brazil’s richest states exposes the still precarious health and sanitation conditions of the country.
Photo by stvcr / resized / (CC BY-SA 2.0) / Source: Flickr

Brazil’s states of Minas Gerais, São Paulo and Rio de Janeiro, three of the most developed, have recently gone through an outbreak of yellow fever, a disease transmitted by mosquitoes, which can have deadly consequences.

More than a health issue inherent to any tropical place like Brazil, it has also exposed the still fragile conditions of the country’s health and sanitation systems.  

What is yellow fever?

According to the US Center for Disease Control and Prevention, the yellow fever virus is transmitted to human beings by mosquitos that have previously bitten a contaminated person or monkey.

The symptoms vary from simple head and muscle aches to dangerously high fever, heart rate disorders and bleeding from the nose, mouth and eyes – after which the mortality rate reaches about 50%.

According to the World Health Organization (WHO), 47 countries are considered high-risk places for endemic yellow fever cases – all of which are in Africa and Latin America.

The treatment consists only in hydration to deal with the liver and kidney failures, since there is no specific anti-viral drug for yellow fever. Vaccination is the main instrument to prevent the disease, particularly when outbreaks are recognized in high-risk areas.

The recent outbreak in Brazil

Officially, the recent outbreak of yellow fever in Brazil started in July of 2017. As of February 2018, 464 cases have been reported, with 154 deaths. From these cases, 181 were reported in São Paulo, 225 in Minas Gerais and 57 in Rio de Janeiro, summing 153 deaths.

This outbreak has been considered the first urban epidemic in Brazil since 1942.

Appropriately, the response of the public authorities has consisted in the intensification of vaccinations in high-risk areas, from door-to-door actions to mass campaigns. In February of 2018, 4.3 million people had been vaccinated in Brazil since the start of the outbreak.

However, to fight outbreaks like this would require that Brazil’s policies more broadly relate to development than particularly to health. In fact, this outbreak makes explicit the peculiar procrastination of the country to implement some of the most basic government policies.

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Beyond mosquitoes

This recent outbreak of yellow fever in some of Brazil’s richest states mean more than just a health emergency. Actually, it reinforces the still precarious conditions of the health and sanitation systems of the country.

Yellow fever is transmitted by the mosquito aedes aegypti, which procreates in standing water. In urban areas, this condition is closely related to the lack of sanitation, which refers basically to the lack of potable water access and appropriate toilets. According to the Reuters, this is the case for about one-third of Brazilians.

The lack of sanitation has already been responsible for the regular, yearly outbreaks of dengue fever which targets Brazil on a regular basis. Similarly, the outbreak of Zika virus in 2015 and 2016 in the country was equally potentialized by the same issue. Not coincidentally, both dengue fever and Zika virus can be equally transmitted by the same mosquitoaedes aegypti.

Because of this overlap, the rural areas of the Minas Gerais, São Paulo and Rio de Janeiro are still the most vulnerable, since these are the places where a lack of sanitation and the natural presence of the mosquitoes are more common. However, a particular concern of Brazil’s health authorities regarding yellow fever is whether the outbreak reaches these states’ urban agglomerations, such as slums, where the lack of sanitation becomes concentrated and the transmission of the disease may accelerate.

The constraints of the health system

Although Brazilian immunization programs can be considered some of the best in the world – offering vaccines free of charge and reaching 95% of vaccination coverage against a range of diseases – difficulties have been faced regarding the current yellow fever outbreak: in spite of the efforts, only 21% of the targeted population had been vaccinated against this illness by February 2018, and this share had reached only 12.1% in the state of Rio de Janeiro .

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This scenario is aggravated by the current economic crisis in Brazil, which has reduced the government investments in health. In the country, the proportion of the government budget which has been invested in health has decreased since 2010 to only 6.8% in 2016. This proportion is about half of the world average, which is 11.7%.

Vaccines and development

The recent outbreak of yellow fever in Brazil may be intrinsic to the characteristics of a tropical country, but it is also consequence of the country’s problems related to the lack of sanitation and an unsatisfying health system. It is emphasized by the occurrence of the outbreak in some of the Brazilian richest and most urbanized states.

Therefore, the fight against this outbreak requires a strategy which combines both vaccines and development. More specifically, it requires government policies which address health beyond short term targets such as vaccination coverage, but a permanent health infrastructure related mainly to sanitation. Otherwise, Brazilians will continue being easy and regular victims of mosquito bites.

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Diego da Silva Rodrigues

Diego is an applied economist interested in policy evaluation and quantitative methods. His main interests are around family issues, such as marriage, parenting, gender, fertility and children, being member of the International Network of Child Support Scholars (INCSS) and the Parenting Culture Studies Postgraduate Network. Diego has also publications in migration and health economics, and is currently involved with human rights and democracy activism in South America. At present, he is completing his PhD at the University of Kent, UK, and is lecturer in Economics at IESGO, Brazil.
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