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Opinion: Brazil’s Favelas Offer Lessons in Building Trust in Dealing with Pandemics
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Experts often cite mistrust of the government as a key reason certain communities have suffered disproportionately during deadly outbreaks, including Ebola and Covid-19. Mistrust is a serious problem in a pandemic if it prevents people from obeying health recommendations, seeking medical care and accepting vaccines.
In marginalized communities, mistrust is often rooted in a history of discrimination, neglect or abuse at the hands of authorities. The onus to mend those relationships should therefore be on governments that have proved untrustworthy, and that requires political change. But the next pandemic — or another disaster — may strike sooner. In the meantime, health officials and researchers would be wise to learn how to assist the communities that are most in need. That starts with recognizing the grass roots power that has kept them resilient for so long.
Lessons lie in Brazil’s favelas because, in the face of decades of government neglect, many have created internal systems to support one another. When Covid-19 began to spread and people were out of work, community leaders like Mr. Nascimento raised money to provide food and face masks for those in need. In Jacarezinho, Mr. Nascimento co-founded a collective called LabJaca to report Covid-19 data because he and others suspected that official counts had underestimated case loads. Journalists and community leaders in other favelas were attempting something similar, and soon LabJaca was one of several groups feeding data into a dashboard tracking the disease across 450 favelas in Rio de Janeiro.
In the hilltop favela of Morro dos Prazeres, Janice Delfim, a community leader, printed out lesson plans for children when schools closed because their families didn’t have computers at home. And when the kids complained of hunger, she appealed to nongovernmental organizations for donations of food, face masks and hygiene products. In other favelas, community leaders installed faucets in heavily trafficked paths so that people without running water could wash their hands.
Brazil’s president at the time, Jair Bolsonaro, denied the gravity of Covid-19 as hospitals overflowed. He encouraged mass gatherings and unproven treatments. He disputed the worth of face masks and, later, of vaccines. But even when health authorities broadcast recommendations for people to wash their hands and stay home, Ms. Delfim said their words rang hollow for those living without running water or the ability to work from home. “Our reality is different,” she told me.
Fernando Bozza, a doctor and public health researcher at Fiocruz, a research institute in Rio de Janeiro, realized the need to work at a grass roots level as Covid-19 began to spread in favelas. He and other Fiocruz scientists partnered with the nongovernmental organization Redes da Maré, which had long served Rio’s massive Maré favela and residents from the community.
Through this coalition, scientists provided free Covid-19 tests. When someone tested positive, a member of the group would offer to deliver food, cleaning supplies and masks to the person’s home, as well as provide check-ins with a health worker over the phone. Residents in the coalition also relayed circulating rumors for the scientists to correct. And those who were influential in local WhatsApp groups or on Instagram or TikTok created messages to combat the misinformation. “It was a continuous listening process with people from the community leading,” Dr. Bozza says.
Such coalitions emerged around the world. In California’s hard-hit Central Valley, local researchers cooperated with grass roots organizations serving farmworkers to roll out testing and care. In Goa, India, a network of community correspondents that had long been working in rural districts of the country partnered with Lieve Fransen, a doctor and adviser in global public health based in Belgium. Dr. Fransen held daily video calls with the correspondents about how to treat the severely sick when clinics were overwhelmed or too far away. When Covid-19 vaccines rolled out, she says that uptake was high because of the trust that people had in these correspondents, which had been built over nearly 20 years.
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