The relationship between the medical entities and Bolsonarism during the Bolsonaro administration (2019 to 2022)

Medeiros, Henrique Gonçalves Dantas de

doi:10.1590/2358-2898202614911375P

01/01/2019	Jair Bolsonaro’s inauguration as President of the Republic. Appointment of Luiz Henrique Mandetta as Minister of Health.
08/29/2019	Election of new advisors and the new board of directors of the CFM and rapprochement with the AMB and its Bolsonaro-aligned stance.
02/26/2020	First confirmed case of COVID-19 in Brazil.
03/24/2020	Statement by the President of the Republic inaugurating the denialist approach to handling the pandemic.
04/16/2020	Dismissal of Luiz Henrique Mandetta from the Ministry of Health. Appointment of Nelson Teich as Minister of Health. CFM publishes opinion no. 4/2020.
04/24/2020	Sergio Moro’s resignation from the Ministry of Justice and Public Security: the first major schism in the neo-fascist movement.
05/15/2020	Nelson Teich’s resignation from the Ministry of Health.
06/03/2020	General Eduardo Pazuello is appointed interim Minister of Health.
07/25/2020	Peak of the first pandemic wave in Brazil.
08/24/2020	Ceremony at the Planalto Palace with the President of the Republic and the ‘Brazil Overcoming Covid Movement’, in defense of early treatment.
09/16/2020	General Eduardo Pazuello officially takes over the Ministry of Health.
11/08/2020	Beginning of the second pandemic wave in Brazil.
12/09/2020	The Brazilian Society of Infectious Diseases publishes the document ‘Update and Recommendations on COVID-19’, contrasting with the positions of the CFM and the AMB.
01/08/2021	Inauguration of the new AMB board, criticism of Bolsonaro’s denialism.
01/14/2021	Oxygen crisis in Manaus. Public letter criticizing the CFM signed by six former presidents and 14 former council members.
01/17/2021	The first dose of the ‘CoronaVac’ vaccine (Butantan) is administered at an event with the governor of São Paulo.
03/23/2021	Dismissal of General Pazuello and appointment of Marcelo Queiroga to the Ministry of Health.
04/10/2021	Peak of the second pandemic wave in Brazil.
04/27/2021	The Senate’s CPI on the pandemic begins its work.
08/03/2021	Launch of the ‘Alliance for Health in Brazil’: the search for a ‘third way’, with the participation of the AMB.
09/07/2021	Jair Bolsonaro delivers a coup-like speech on Paulista Avenue, threatening to no longer abide by the decisions of the higher courts and delegitimizing the electoral process.
09/10/2021	Publication of the manifesto ‘The Square Belongs to the Three Powers’ by Fiesp and 247 other entities: big capital does not endorse coup attempts.
10/26/2021	Approval of the final report from the CPI of the pandemic.
12/07/2021	Approval of the Conitec report advising against the ‘COVID kit’. AMB votes in favor of the report; CFM votes against, in defense of the kit.
12/26/2021	Beginning of the third pandemic wave in Brazil.
01/04/2022	Data leak involving doctors who participated in a public hearing defending children’s right to be immunized against COVID-19.
04/01/2022	Inauguration of the new CFM board: Bolsonarist alignment maintained.
05/21/2022	Peak of the third pandemic wave in Brazil.
06/18/2022	Jair Bolsonaro’s meeting with ambassadors in Brasília, discrediting the electronic voting system in a coup-like tone.
10/30/2022	Second round of the presidential elections. Lula da Silva wins.
12/12/2022	Luiz Inácio Lula da Silva’s victory is certified by the TSE. Violent protests in Brasília promoted by Bolsonaro supporters.
12/24/2022	Attempted tanker truck explosion at Brasília airport by Bolsonaro supporters.
01/01/2023	Luiz Inácio Lula da Silva’s inauguration.
01/08/2023	Bolsonaro’s attempted coup in the Praça dos Três Poderes (Three Powers Square).

Natural units	Meaning Attributed
“President Bolsonaro receives CFM - [...] In a meeting at the Planalto Palace, the board of the Federal Council of Medicine (CFM) presented to the President of the Republic, Jair Bolsonaro, and the Minister of Health, Luiz Henrique Mandetta, the new Code of Medical Ethics (CEM), detailed in Resolution No. 2.217/18 and already in force. The representatives of the doctors also presented an agenda with four items of demands from the category” n. 290¹¹( 4).	Free movement of medical entities within the Bolsonaro government.
“The Chaos is Over - The year 2019 could have gone down in history as the beginning of the end for medicine in the country, but President Jair Bolsonaro’s vetoes of sections of the Doctors for Brazil law and the Revalida exam prevented what would have been a major mess in the process of validating medical diplomas from abroad [...] ‘The President of the Republic acted responsibly and courageously. The medical profession is very grateful to him. The health of the Brazilian population cannot be used for electoral purposes, as was being done again, in a manner identical to what occurred in the More Doctors program. The ‘Revalida Light’ would generate fake doctors, and those who use the SUS (Brazilian public healthcare system) would pay the price with their own health,’ explains Diogo Sampaio, vice-president of the AMB. [...]: ‘This episode made very clear the weight of electoral interests and the power of persuasion that the medical education industry has with legislators, to the point of getting the Bill voted on in the way it was: hastily, in an improvised manner’” n. 1411¹²(26-29).	The construction of the identification of the category with the messianic, salvationist, and supposedly ‘anti-system’ image of the President by the AMB, including through the discursive repertoire of its vocabulary.
“To date, all signs point to abstinence as the best approach to treating these users. In this sense, the Federal Council of Medicine (CFM) pledges its support to the new national drug policy, in effect since the beginning of April, following the publication of a decree signed by President Jair Bolsonaro [...]. This includes adopting measures such as expanding psychiatric inpatient beds, increasing financial support for therapeutic communities, conducting campaigns to discourage drug use, and adopting effective plans to combat drug trafficking. The CFM helped build the new intervention model adopted by the Government, which was widely discussed in the National Council on Drug Policies (Conad)” n. 290¹¹(3).	The CFM ‘borrowing’ scientific rigor for the new national drug policy, legitimizing prohibitionism and the ideology of the ‘war on drugs’.
“The federal career path for doctors, launched by the Ministry of Health, is not yet the state career path intended for the category, as proposed by the Federal Council of Medicine (CFM) and other professional associations. However, it is undeniable that it represents a significant advance by providing more attractive remuneration and the possibility of formal employment contracts” n. 293¹¹(2).	The announcement of the PMpB as a minor commitment to the medical profession, reinforcing its status as a ‘support class’.
“Mauro Ribeiro assumes the presidency - ‘This administration intends to work with the Brazilian Medical Association (AMB), the National Federation of Physicians (Fenam), and the Brazilian Medical Federation (FMB), which are our great partners. Our relationship is often hampered by political reasons, but the crisis in Brazilian medicine is so great, so serious, that at this moment we must set aside our vanities, sit down, and do something that truly makes a difference in Brazilian medicine.’ [...] ‘Many of the criticisms leveled at the Federal Council of Medicine - regarding the arrival of Cuban doctors in Brazil, the Revalida exam, and the opening of medical schools in the country, as if the institution were negligent in relation to these points - concern precisely the set of major causes for which we fight, at all levels, together with other medical entities. The criticisms did not leave any kind of lasting effect, any kind of negative feeling. On the contrary, they made us reflect on the fact that we communicate poorly with Brazilian doctors’” n. 297¹¹(3-4).	The election of the new CFM council members and board of directors (Aug. 2019) and its alignment with the AMB’s political line, which is more radicalized and identified with Bolsonaro’s ideology.

Natural Units	Meaning Attributed
“The CFM (Federal Council of Medicine) addressed early treatment for COVID-19 in Opinion No. 4/20 out of respect for the frontline physician, who has no political or ideological position and practices the profession out of a vocation to serve and do good [...] The fundamental point that underpins the CFM’s position is absolute respect for the autonomy of the frontline physician to treat their patient as they deem most appropriate, as well as the patient’s autonomy to want or not to be treated in the manner proposed by the attending physician. [...] Opinion No. 4/20 does not support or condemn early treatment or any other pharmacological treatment or clinical protocols of specialty societies or the Ministry of Health. The Opinion respects the autonomy of the physician and the patient so that both, by mutual agreement, establish which treatment will be carried out. For those who insist on publicly attacking the CFM, pressuring it to change the Opinion, aiming to support or prohibit early treatment, we clarify that these political actions are useless, as they have been until now and will continue to be” n. 310¹¹(3).	Defending medical autonomy based on the supposed political neutrality of the CFM as an indirect mechanism for legitimizing Bolsonaro’s scientific denialism in the handling of the pandemic.
“For the Federal Council of Medicine (CFM), this responsibility must be assumed by public managers, especially governors and their health secretaries, who urgently need to give this group of men and women committed to life access to quality personal protective equipment (PPE)” n. 302¹¹(3). “The Northeast Consortium, formed by a group of governors from the region, argues that these graduates should work without diploma revalidation during the pandemic. [...] The Brazilian Medical Association (AMB) is absolutely opposed to the idea. ‘The Northeast Consortium does not inform with the necessary clarity where a larger contingent of doctors would be needed, which makes it impossible to identify the real need, reaffirming the opportunistic electoral posture’ [...] assesses Diogo Sampaio, vice-president of the AMB” n. 1.413¹²(6).	Support for the bolsonarist strategy of attacking governors and opposition figures during the pandemic.
“Unfortunately, politicization has also reached medical specialty societies and ideological groups of doctors, especially regarding so-called early treatment with hydroxychloroquine, ivermectin, and azithromycin” n. 310¹¹(3). “The political derby surrounding hydroxychloroquine will leave a dark legacy for Brazilian medicine if the autonomy of physicians is restricted, as those who advocate for the prohibition of hydroxychloroquine prescriptions want. [...] The AMB [...] is committed to defending the preservation of physician autonomy. It will also defend Opinion 4/2020 of the Federal Council of Medicine, which regulates the matter. [...] The AMB clarifies that it does not defend the use of hydroxychloroquine, but rather the autonomy of physicians in situations such as that experienced during the pandemic, with off-label use, enshrined in medicine, whenever the physician deems it necessary. [...] ‘We cannot allow ideologies and vanities, in an untimely manner, fueled by the spotlight, to make us regress in practices that are already so respected. One cannot call for science and adopt positions based on ideology or partisanship, ignoring consolidated practices in medicine. This is a crime against medicine, against patients and, above all, against science itself’, emphasizes Lincoln Ferreira, president of the AMB” n. 1414¹²(16-17).	Reaction from the Bolsonaro faction within the CFM and AMB against medical specialty societies that demanded condemnation of the off-label use of the so-called ‘COVID kit’: division within the medical profession as an expression of the process of disaffection with Bolsonarism.
“We need a minister who recognizes the importance of the preventive measures advocated by all national and international medical entities. It is necessary to clearly instruct, without any subterfuge: ‘Practice social isolation. Wear masks. Avoid crowds. Wash your hands frequently with soap and water and use hand sanitizer. We will trace all contacts’. It is essential to be in line with what the specialty societies, the Brazilian Medical Association, and its federated entities recommend” n. 1416¹²(3).	The AMB is distancing itself from Bolsonaro’s ideology and combating the federal government’s denialist stance, starting with the inauguration of the new board in January 2021.
“The Parliamentary Commission of Inquiry already has elements to point out the responsibilities of the perpetrators of numerous facets of the tragedy, such as the lack of oxygen in the Amazon, among others. [...] The Brazilian Medical Association, as well as good Brazilians, calls for an immediate, swift and thorough investigation. Exemplary punishment of those responsible for any illegalities that may be proven is essential. Including doctors who, according to the testimonies of witnesses, allegedly participated in and led the scheme. The AMB will invariably defend Ethics and dignified assistance to citizens. If the content of the testimonies to the Covid-19 Parliamentary Commission of Inquiry is consistent, we would simply be regressing to barbarism, placing Brazil as the subject of one of the worst atrocities against humanity in all of history” n. 1418¹²(26-27). “One thing is certain: in this equation there are no guilty parties, but victims who must seek, through the union of efforts, a way out of the situation that is approaching” n. 315¹¹(2).	The AMB explicitly supported the Senate’s Parliamentary Inquiry Commission on the pandemic (Apr. - Oct. 2021), contrasting with the complicit silence of the CFM.
Source: Own elaboration.