Public health institutions around the world are increasingly under threat from populist governments that strip funding, undermine independence, and fuel disinformation. In countries from Hungary to Indonesia, this erosion of trust in scientific expertise has contributed to the resurgence of preventable diseases like measles and whooping cough. The United States has experienced similar challenges, with sweeping staff cuts, budget reductions, and policy disruptions under the leadership of Robert F. Kennedy, Jr. as Secretary of Health and Human Services. These shifts have created leadership vacuums, fractured national public health policies, and left doctors and scientists concerned about long-term systemic damage.
Brazil offers a compelling case study in protecting public health systems under political assault. Its universal health system, established in 1990, has long focused on preventive care and built strong public trust in vaccines, supported by campaigns and a national mascot, Zé Gotinha. During the COVID-19 pandemic, former President Jair Bolsonaro launched aggressive attacks on Brazil’s vaccine program, firing senior officials, blocking vaccine procurement, and spreading misinformation. Despite these threats, Brazil’s public health system survived largely due to the intervention of allies outside government, including businesses, foundations, and grassroots organizations.
Private-sector support played a critical role in sustaining Brazil’s vaccine infrastructure. Business coalitions contributed over US$54 million to public laboratories, while companies like Ambev provided logistical assistance for vaccine distribution. Initiatives such as United for the Vaccine, led by women business leaders, supplied local health authorities with essential equipment, including coolers, boats, and planes to reach remote communities. These contributions allowed vaccination efforts to continue without reliance on government funding.
Community-driven initiatives further strengthened public health resilience. Grassroots groups produced educational campaigns, distributed posters, developed children’s books, and launched mobile apps to counter misinformation and inform citizens about vaccines. By early 2021, over 1,300 grassroots campaigns were active, ensuring broad outreach even in underserved neighborhoods. By August 2022, 81% of Brazil’s adults were fully vaccinated against COVID-19, surpassing rates in countries like the United States and demonstrating the power of local engagement.
The effectiveness of Brazil’s response was rooted in decades of public trust and community ownership of the health system. The universal health system, SUS, is promoted as a collective right, with health workers embedded in communities, engaging citizens in schools and public spaces, and fostering long-term relationships that encourage confidence in public health services. These sustained efforts created a foundation that enabled Brazil to mobilize rapidly, defend its institutions, and even expand health infrastructure despite political attacks.
Brazil’s experience underscores the importance of building public trust, fostering community engagement, and cultivating partnerships across government, private sector, and civil society. By investing in these long-term relationships, countries can better safeguard their public health institutions, maintain vaccine coverage, and ensure that public health policies survive political turbulence while protecting citizens’ well-being.
