How does the context effect of denialism reinforce the oppression of the vulnerable people and negatively determine health?

The article by Xavier et al. analyzed data from 5570 municipalities and found that the risk of death from the coronavirus was 44% higher in those that were better developed and aligned with Brazilian president Bolsonaro. Considering cities with similar health structures and HDI, comparisons were made to isolate the effect of political alignment with the far-right wing in the country.

In 2019, Oppenheim et al. developed an Epidemic Preparedness Index (EPI) to measure a country's ability to detect and respond to infectious disease events. The multidimensional approach of the composite index considered contextual effects associated with the economy and social formation. Still, it did not include an essential aspect: the political conjuncture, which emerges as a critical contribution from the text by Xavier et al.

Brazil has a well-documented history of denialism by the federal executive about the severity of the pandemic, delays in decision-making, and the discouragement of physical distancing and vaccination. For this reason, a Parliamentary Commission of Inquiry of the Federal Senate indicted the President on nine crimes.

The authors' choice was correct and timely. We add that his approach overcomes the fundamental problem of ecological studies: the ecological fallacy. It is a methodological issue discussed first in the studies on suicide by the sociologist Émile Durkheim. It occurs when an observed association between aggregates is assigned to the individual level. In the case of the article by Xavier et al., there are no inferences about the personal level deduced from a group to which the individual belongs. On the contrary, the arguments presented by the authors reinforce the idea that the effect of the group - represented by denial of the pandemic - is not restricted to those who defend it or align themselves electorally. They spread throughout society and hit the most socially oppressed and marginalized sectors more intensely. A portion most likely not among Bolsonaro's majority voters, typically middle-aged men who belong to the middle and upper-middle class.

The report confirms the idea that in a pandemic, it is the most vulnerable who suffer the most from all kinds of difficulties, from access to diagnosis, adoption of adequate measures of physical distance, to economic instability. In the end, political alignment with denialism is a way of oppressing and subjugating individuals with greater social vulnerability.

Contributors

RM Guimarães and MR Moreira contributed equally on writing the correspondence and final review of manuscript.

Declaration of interests

Authors declare they do not have any kind of conflict of interest, neither financial, political or institutional.