How Trump and Bolsonaro Broke Latin America’s Covid-19 Defenses


The 2 presidents drove out 10,000 Cuban medical doctors and nurses. They defunded the area’s main well being company. They wrongly pushed hydroxychloroquine as a remedy.


The coronavirus was gathering deadly velocity when President Trump met his Brazilian counterpart, Jair Bolsonaro, on March 7 for dinner at Mar-a-Lago. Mr. Bolsonaro had canceled journeys that week to Italy, Poland and Hungary, and Brazil’s well being minister had urged him to steer clear of Florida, too.

However Mr. Bolsonaro insisted, wanting to burnish his picture because the “Trump of the Tropics.” His grinning aides posed on the president’s resort in inexperienced “Make Brazil Nice Once more” hats. Mr. Trump declared he was “not involved in any respect” earlier than strolling Mr. Bolsonaro across the membership shaking fingers.

Twenty-two people in Mr. Bolsonaro’s delegation examined optimistic for the virus after returning to Brazil, but he was not alarmed. Mr. Trump had shared a remedy, Mr. Bolsonaro instructed advisers: a field of the anti-malaria drug hydroxychloroquine, the unproven remedy that Mr. Trump was then selling as a treatment for Covid-19.

“He mentioned the journey was fantastic, that that they had a good time, that life was regular at Mar-a-Lago, every little thing was cured, and that hydroxychloroquine was the medication that was supposed for use,” recalled the well being minister, Luiz Henrique Mandetta, who was fired by Mr. Bolsonaro the following month for opposing reliance on the drug.

“From that point on, it was very laborious to get him to take the science significantly.”

The Mar-a-Lago dinner, which might become infamous for spreading an infection, cemented a partnership between Mr. Trump and Mr. Bolsonaro rooted in a shared disregard for the virus. However even earlier than the dinner, the 2 presidents had waged an ideological marketing campaign that will undermine Latin America’s capability to reply to Covid-19.

Collectively, the 2 males, fierce opponents of Latin America’s leftists, took goal at Cuba’s nice satisfaction: the medical doctors it sends all over the world. Mr. Trump and Mr. Bolsonaro drove 10,000 Cuban doctors and nurses out of impoverished areas of Brazil, Ecuador, Bolivia and El Salvador. Many left without being replaced solely months earlier than the pandemic arrived.

Then, the 2 leaders attacked the worldwide company most able to preventing the virus — the Pan-American Well being Group, or PAHO — citing its involvement with the Cuban medical program. With assist from Mr. Bolsonaro, Mr. Trump almost bankrupted the company by withholding promised funding on the top of the outbreak, to an extent not beforehand disclosed.

And with assist from Mr. Trump, Mr. Bolsonaro has made hydroxychloroquine the centerpiece of Brazil’s pandemic response, regardless of a medical consensus that the drug is ineffective and even harmful. The Meals and Drug Administration warned final April towards most makes use of of the drug to deal with Covid-19. A month later, Mr. Trump introduced after a telephone name with Mr. Bolsonaro that the USA would ship Brazil two million doses.

Weak well being programs and overcrowded cities made Latin America inherently weak. However by driving out medical doctors, blocking help, and pushing false cures, Mr. Trump and Mr. Bolsonaro made a nasty state of affairs worse, dismantling defenses.

Now Latin America, with a 3rd of the world’s deaths, has suffered more acutely from Covid-19 than some other area.

The 2 strongest leaders within the Americas, Mr. Trump and Mr. Bolsonaro are each ardent nationalists defiant of mainstream science. Each have put financial development and short-term politics forward of public well being warnings. Each are deeply hostile to the area’s leftist governments — particularly in Cuba, a trigger that helps Mr. Trump with Cuban-American voters within the swing state of Florida.

“Of their zeal to eliminate the Cuban medical doctors, the Trump administration has punished each nation within the hemisphere, and with out query that has meant extra Covid instances, and extra Covid deaths,” mentioned Mark L. Schneider, a former head of strategic planning for the Pan-American Well being Group who was a State Division official within the Clinton administration. “It’s outrageous.”

Smaller, much less highly effective international locations like Ecuador felt the ache. Ecuador acceded to American strain and despatched dwelling almost 400 Cuban well being care employees shortly earlier than the pandemic. Then the nation additionally suffered from the Trump administration’s freeze on funding for the well being group, which hampered its capability to supply emergency provides and technical help.

“Nobody from the Pan-American Well being Group was right here, and we felt their absence,” mentioned Dr. Washington Alemán, a senior infectious illness specialist and a former deputy well being minister in Ecuador, who recognized the nation’s first confirmed case of Covid-19. “The help was not prefer it was in earlier years, in earlier epidemics.”

Earlier Republican and Democratic administrations have virtually all regarded the general public well being of Latin America as of pressing nationwide curiosity, as a result of infectious illnesses can unfold simply between South and North America.

White Home officers say the administration withheld funds from the well being group to demand transparency. They be aware that the USA helped the area in different methods, by donating tens of tens of millions of {dollars} by organizations just like the World Meals Program, UNICEF and the Purple Cross. Over the summer time, Washington despatched a whole bunch of extra ventilators on to authorities well being programs.

However public well being consultants say the Pan-American Well being Group — with places of work inside each well being ministry and almost 120 years of expertise tackling epidemics — was uniquely positioned to confront Covid-19. Even some critics of the Cuban program say that punishing the well being company sabotaged that effort.

“PAHO didn’t have the instruments they usually didn’t have the cash,” mentioned Dr. Mandetta, the previous Brazilian well being minister who labored with Mr. Bolsonaro to expel the Cubans. “PAHO couldn’t broaden the way in which that they wanted to, and in Ecuador, in Bolivia, you had folks dying of their properties and our bodies left exterior within the streets due to the dearth of help.”

How that occurred is the story of a political battle that shifted amongst many fronts, from Brasília to Miami to Washington. It left scars from villages within the Amazon basin to the slums of the Ecuadorean metropolis of Guayaquil.

Jair Bolsonaro roared into energy in Brazil in October 2018, styling himself as a Trumpian populist, talking favorably of “dictatorship,” and accusing his nation’s left-leaning institution of taking classes from communist Cuba. He promised to expel greater than 8,000 Cuban medical employees.

A predecessor had invited the Cubans 5 years earlier to assist look after greater than 60 million folks, largely in small communities within the Amazon basin, a lot of whom had by no means earlier than seen a health care provider. Tutorial research reported excessive ranges of affected person satisfaction and diminished toddler mortality charges. The Pan-American Well being Group oversaw the Cuban medical doctors in Brazil and promoted their work as a mannequin; the Obama administration raised no objection.

For many years, Cuba has despatched medical employees to fill holes in well being programs in Latin America and past. Cuba paid the doctors as a lot as $900 a month in contrast with the $50 a month they may earn at dwelling. However Havana charged their host governments far more — about $4,300 a month for every physician in Brazil — and pocketed the distinction. Cuba referred to as this system humanitarian; critics, noting that Cuba restricted the liberty of the medical doctors, referred to as it compelled labor and human trafficking.

Throughout Mr. Bolsonaro’s fiery election marketing campaign, a newspaper disclosed six-year-old diplomatic cables suggesting that Brazilian officers had routed funds for this system by the well being group partially to keep away from a debate within the Brazilian Congress over coping with Cuba.

Mr. Bolsonaro accused the well being group of abetting “modern-day slavery” and vowed to get rid of the doctors. Cuba recalled them even earlier than he was sworn in.

Roughly 6,500 miles away, in Miami, Tony Costa noticed a uncommon alternative.

An 80-year-old veteran of the aborted Bay of Pigs invasion, Mr. Costa has spent a long time working to topple the communist management in Havana. When he linked the allegations of Cuban compelled labor with the Washington-based Pan-American Well being Group, he knew he had one thing that will captivate Congress and the White Home.

“That is like bread from heaven!” he recalled considering.

Mr. Costa quickly found Ramona Matos Rodríguez, a Cuban physician who had defected to Miami from a mission to Brazil, and helped her change into the lead plaintiff in a lawsuit accusing the Pan-American Well being Group of compelled labor and human trafficking.

In a courtroom submitting, attorneys for the group mentioned the allegations had been “grossly inaccurate” and “bear virtually no resemblance to actuality.” Consultants say the lawsuit is at finest an extended shot, however, in politics, it made an impression.

With out ready for a courtroom ruling, Mr. Costa, a founding father of the Miami-based Basis for Human Rights in Cuba, rushed the lawsuit to the eye of highly effective pals in Congress and the White Home. “It’s simply despicable what they’re doing to those poor medical doctors,” Senator Rick Scott, Republican of Florida, mentioned in an interview final month.

Citing the accusations, the State Division pressured Ecuador, Bolivia and El Salvador till they expelled greater than a thousand Cuban medical employees final yr.

However the greater blows hit the Pan-American Well being Group.

It’s typically referred to as the regional arm of the World Well being Group, but it’s a long time older and receives far more funding from member states. Public-health consultants credit score the company with eradicating smallpox, polio and measles from Latin America lengthy earlier than they had been eradicated from Africa and Asia.

The Trump administration centered intensely on the group’s ties to Cuba, despite the fact that its involvement with the Cuban medical doctors had ended a few yr earlier, once they left Brazil. The US stopped paying its annual dues of $110 million, greater than half the company’s core finances. Mr. Bolsonaro’s authorities additionally froze cost of its $24 million in dues. Mr. Bolsonaro and his workers refused to remark for this text. John Ullyot, a Nationwide Safety Council spokesman, defended the American funding cutoff as an vital step “to demand accountability from all worldwide well being organizations that rely upon American taxpayer assets.”

By the tip of 2019, the company confronted a extreme funding disaster. It had sharply diminished worldwide journey, frozen hiring and steeply reduce contracts for the medical consultants who do most of its hands-on work.

Inside six weeks, Covid-19 started seeping into Latin America.

Perched on Ecuador’s southern coast, Guayaquil is a busy port metropolis surrounded by hillsides lined in slums.

Bella Lamilla, 70, arrived from Spain on Feb. 15, to go to her close by birthplace. However whereas there, she developed pneumonia.

Ecuador had no labs with the provides or capability to check for the coronavirus, however Ms. Lamilla’s household occurred to take her to a non-public clinic that employs Dr. Alemán, the previous deputy well being minister. He used his contacts to get a pattern despatched to the Facilities for Illness Management in Atlanta.

She grew to become Ecuador’s first confirmed case on the night time of Feb. 29. Inside two weeks, each intensive care unit within the metropolis was overwhelmed.

Medical doctors in Guayaquil say that extra hands-on recommendation from the Pan-American Well being Group may need helped detect the virus a lot sooner, earlier than it had penetrated the town so deeply.

Then ill-informed well being ministry officers and native medical doctors compounded the disaster with a primary error: The ministry really useful low cost coronavirus antibody assessments quite than harder and costly genetic assessments.

The antibody assessments yielded false negatives on the level when sufferers had been most contagious, main them to unknowingly unfold the virus.

“It was ignorance, completely,” mentioned Juan Carlos Zevallos, an American-trained epidemiologist appointed in late March as well being minister.

Extra direct help from Pan-American Well being Group consultants “may have prevented not solely that mistake however many others,” Dr. Alemán mentioned.

For a lot of households, these errors meant heartbreak. In July, Patricio Carrillo, 70, visited a health care provider at his native well being middle close to Quito, the nationwide capital. He had acquired a damaging antibody check and was given penicillin for pharyngitis, his son recalled.

“I’ve nothing greater than the flu,” Mr. Carrillo reassured his household in a hoarse voice message.

Days later, he was useless from Covid-19.

On the important public hospital in Guayaquil, Paola Vélez Solorzano, 38, an infectious illnesses specialist, had urged directors as early as February to organize a 29-bed coronavirus isolation ward. She commandeered 900 disposable biohazard fits mistakenly ordered for upkeep employees.

However when the pandemic arrived, her preparations had been “like nothing,” she mentioned. So many individuals died that medical doctors needed to step over our bodies piled on the ground of the morgue. “Wherever you stood, it smelled like rotting flesh,” she mentioned.

Her colleague Galo Martínez, 34, recalled gazing out the window of the intensive care unit. “All I may see was crowds of individuals crying out for assist,” he mentioned, shaking his head.

With out sufficient protecting tools, half the well being ministry staff in Guayaquil fell sick, medical doctors mentioned. Greater than 130 medical doctors died.

“We didn’t even have masks,” Dr. Zevallos, the well being minister, mentioned.

Throughout previous outbreaks, native medical doctors credit score the Pan-American Well being Group with procuring provides or speeding in expert consultants to supply face-to-face technical assist to laboratories and hospitals.

The company’s officers say that this time they confronted particular challenges. Testing supplies and protecting tools grew to become scarce globally. By late March, shutdowns of economic air journey made it tough to deploy consultants.

However the funding disaster attributable to Mr. Trump’s freeze additionally loomed massive, at the same time as leaders tried to compensate by shifting assets to prioritize Covid-19 response.

Jarbas Barbosa da Silva Jr., the company’s assistant director, acknowledged that the impression of the American funding freeze was “extreme” however argued that its penalties had been laborious to evaluate exactly. By spring, he mentioned, the freeze was not but “a life-or-death state of affairs” for the group, and even with fuller funding the journey shutdown would have restricted it to providing digital coaching classes.

However talking on situation of anonymity to keep away from angering the Trump administration, different senior officers mentioned more cash would have enabled the company to supply extra hands-on assist, sooner. Regional conferences which may have mentioned efforts to sort out the virus had been as an alternative consumed by the funding disaster.

“Will it shut its headquarters? All these discussions took up the agenda,” mentioned Felipe Carvalho, who follows the group on the nonprofit Medical doctors With out Borders.

On the bottom in Ecuador, Carmina Pinargote felt the distinction. A veteran well being ministry official on the northern coast, Ms. Pinargote recalled how the Pan-American Well being Group instantly despatched 15 epidemiologists and technical consultants after an earthquake in 2016. This yr, she mentioned, just one company marketing consultant arrived in her area.

“We have now not seen the identical depth,” she mentioned.

The compelled departure of 400 Cuban medical employees from the nation didn’t assist, both. On the Martha de Roldós Well being Heart on the outskirts of Guayaquil, the director, Hugo Duarte, mentioned two Cubans needed to depart months earlier than the pandemic.

Ecuadorean medical doctors would have been simply pretty much as good, he mentioned, if the well being ministry had paid sufficient to fill the vacancies. However the loss had strained the clinic, particularly when he was sickened for weeks.

“Individuals had been falling useless on the sidewalk, simply exterior the well being middle,” Dr. Duarte mentioned.

Because the epidemic was exploding in Ecuador, Mr. Bolsonaro returned to Brazil from Mar-a-Lago. He shortly summoned Nise Yamaguchi, a São Paulo oncologist who had change into a outstanding champion of hydroxychloroquine.

Dr. Yamaguchi instructed the president that the outbreak left no time for the sort of medical trials different medical doctors had been ready for.

Brazil had been recognized for one of many strongest public well being programs in Latin America for preventing infectious illnesses. However when two well being ministers refused to help the drug, Mr. Bolsonaro changed them with a loyal navy officer, whereas Dr. Yamaguchi grew to become his most trusted adviser.

In an interview, she mentioned Mr. Trump’s donation of two million doses had made Brazil’s reliance on the medication attainable.

“It was essential as a result of we had a worldwide scarcity of hydroxychloroquine on the time,” Dr. Yamaguchi mentioned.

“God is Brazilian, the remedy is correct right here!” Mr. Bolsonaro exclaimed to supporters in late March.

Ignoring a medical consensus, Brazil’s well being ministry nonetheless supplies free hydroxychloroquine to anybody with Covid-19. And critics say Mr. Bolsonaro’s promotion of the drug, coupled along with his refusal to put on a masks or socially distance, has undermined public well being.

“Individuals say, ‘If I change into sick I can exit and get hydroxychloroquine just like the president,’” mentioned Julio Croda, an infectious illness specialist and former well being ministry official. “Individuals suppose they will dwell regular lives they usually don’t have to do any prevention.”

Brazil has suffered greater than 157,000 deaths from Covid-19, a complete second solely to the USA.

Indigenous communities within the distant Amazon basin, which misplaced 8,000 Cuban medical employees, have been hardest hit. In contrast with different Brazilians within the Amazon basin, Indigenous folks have been 10 occasions as more likely to contract the virus, based on the Pan-American Well being Group.

The Cubans had been a essential supply of well being recommendation and remedy, typically offering the one major look after a whole bunch of miles, mentioned Luiza Garnelo, a health care provider and anthropologist based mostly in Manaus for the Flocruz basis.

With out the Cubans, she mentioned, “there are not any professionals to diagnose.”

When the pandemic hit, the Pan-American Well being Group started elevating $92 million to ship out infectious illness consultants and significant provides. The purpose was later raised to $200 million.

Washington would ordinarily be one of many largest contributors. However the primary donor company, the USA Company for Worldwide Improvement, or USAID, is now headed by Ambassador John Barsa, a Cuban-American critic of Havana who participated in a 2019 information convention to publicize the lawsuit towards the Pan-American Well being Group.

This time, the USA provided virtually no new cash.

By Might, the Pan-American company’s board warned in an inner report of a looming disaster.

Referring to the group by its alternate title — the Pan-American Sanitary Bureau, or P.A.S.B. — the report mentioned that the Trump administration’s withholding of funds was “significantly reducing the capacity of the P.A.S.B. to supply technical cooperation to its member states and entailing the discharge of many essential short-term workers members and contingent employees.”

On the finish of the month, Mr. Trump introduced that the USA was withdrawing from the World Well being Group and the administration briefly froze other grants to the Pan-American company.

USAID made one exception: It added $3.9 million in grants associated to Venezuela, based on officers. That spending is a part of the administration’s efforts to overturn the nation’s leftist authorities. (The Facilities for Illness Management and Prevention additionally despatched $900,000.)

In any other case, the marketing campaign towards the company solely escalated. “PAHO must explain the way it got here to be the intermediary in a scheme to use Cuban medical employees,” Secretary of State Mike Pompeo declared on June 10.

It took funding from Canada for the well being group to ship some protecting tools to Ecuador, the primary time it had finished so for any nation. President Lenín Moreno greeted the June 25 cargo on the airport.

Lastly, underneath congressional strain, the Trump administration on July 15 unblocked $65 million, staving off insolvency for the group. Mr. Pompeo mentioned it had agreed to an outside investigation of the Cuban medical doctors program, and different funds had been unfrozen a short while later, after a roughly three-month suspension.

“PAHO is uniquely positioned to carry out Covid-19 response in sure international locations the place there is no such thing as a viable various,” a State Division official wrote on July 15 in an e-mail informing Congressional workers of the cost.

Catching the virus did nothing to vary both president’s outlook. Mr. Bolsonaro, 65, was contaminated in July and suffered solely gentle signs. He celebrated his restoration with a motorbike experience and stands by his embrace of hydroxychloroquine.

Mr. Trump, 74, quietly stopped selling that drug. When he was briefly hospitalized with Covid-19 earlier this month, he acquired different medicines. He started describing a few of these as miracle cures and returned to dismissing the virus.

“Individuals are tired of Covid,” he mentioned this week on a marketing campaign convention name. “Individuals are saying: ‘No matter. Simply depart us alone.’”

Pan-American Well being Group officers say they’ve raised solely $46.5 million from member states towards their $200 million purpose to fight the virus.

The Trump administration continues to strain different international locations to expel Cuban medical doctors. A company of Caribbean states this summer time condemned the White Home for threatening to “blacklist” people who refuse.

Different international locations recognized for his or her refined well being programs have welcomed Cuban assist. A gaggle of 40 Cuban medical employees went to Turin in Italy final spring to assist battle the pandemic, mentioned Carlo Picco, who leads well being providers within the metropolis.

“The Cubans had been successful story for us,” he mentioned.

Letícia Casado contributed reporting from Brazil, and Gaia Pianigiani from Italy.



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