Contested Epidemics: Policy Response in Brazil and the U.S. and What the BRICS Can Learn

By Vaitsman, Jeni | Brazilian Political Science Review, September 1, 2016 | Go to article overview

Contested Epidemics: Policy Response in Brazil and the U.S. and What the BRICS Can Learn


Vaitsman, Jeni, Brazilian Political Science Review


Contested Epidemics: Policy Response in Brazil and the U.S. and what the BRICS Can Learn * (Gómez, Eduardo J.. Contested Epidemics: Policy Response in Brazil and the U.S. and what the BRICS Can Learn. London: Imperial College Press, 2015)

No country responds to epidemics in the same way. What makes some countries to be more successful than others in coping with epidemics? It is this question which Eduardo Gómez (2015) tries to answer in his research. He compares the responses that have been given by the United States and Brazil, since the early twentieth century, to the emergence of what he calls contested epidemics, such as syphilis, polio, AIDS, tuberculosis, malnutrition and, currently, obesity.

Contested epidemics usually imply political views, proposals and conflicting interests between leaders, bureaucrats and civil society, and governments usually do not quickly react before their emergence. When they are associated with behaviors such as AIDS, syphilis and alcoholism or have an incidence over poor and marginalized groups, moral beliefs often guide the perceptions of decision makers and other stakeholders on their potentiality to become a threat to society.

Walking away from analyses that suggest that mature democracies with stable democratic institutions and with health systems with more financial and technological resources respond in a better way to epidemics, Gómez (2015) argues that not all the responses depend on the type of political regime or on the resources invested in health. Non-democratic or less developed countries, with more limited resources and infrastructure, often respond to epidemics in a way as effective as -or more effective than- richer countries.

It is a thorough work that seeks to answer, through a comparative analysis, to two central questions related to what different theories and models from the field of public policy say about the policymaking process: What makes a problem eligible for being included into the political agenda and becoming an object of governmental decision? Which are the conditions for the success of the implemented policies?

Methodologically, the author relies on the Most Similar Systems Design (MSSD), a tool that compares, in the cases that studies, similar contextual variables, indicating causal relationships and different results. The purpose of the comparison is to point out the historical, political and social singularities that produced institutional and political responses to the epidemics. Both countries underwent significant social, political, economic and scientific-technological changes in the long period analyzed, both on the domestic and international level. Even so, Gómez (2015) manages to identify certain patterns of responses, whose explanation is sought in the historical trajectories of both countries.

As preconditions for the governments to respond to an epidemic -the problem of the agenda and the decision-making-, he emphasizes: the interest of the presidents, their personal beliefs and ambitions, especially at the global level; and threats to national security. As for the success of the responses, he shows that they depend on conditions that are not related to the personal interest of the presidents: the existence of a centralized bureaucracy able to coordinate the interventions; and the role of civil society in the institutional political context of the countries. These variables are considered as crucial for the implementation of policies conducting to the response.

In the US, the government's responses to epidemics and diseases only became priority and were centralized when presidents got personally interested in the problem or when the problem became a threat to national security, affecting military recruitment or economy. Since the beginning of the twentieth century, the American civil society played an important role on various health problems, such as syphilis, malnutrition, polio; its role did not, nonetheless, involved a centralized government response. …

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