Amid pandemic, Brazil's health ministry still has an interim boss with no medical experience

Brazil's interim Health Minister Eduardo Pazuello has been in office since May 16.

Sao Paulo (CNN)Brazil is in the grips of a deadly virus, with the world's second highest number of Covid-19 cases and deaths in the world -- and yet the health ministry continues to be run on an interim basis by an army general with no medical experience.

Three months after Army General Eduardo Pazuello was named interim health minister on May 16, there is still no indication that Brazilian President Jair Bolsonaro wants to confirm him in that role or swap him out.
Both the Ministry of Health and the Office of the President have declined to comment about any plans to replace or officially appoint Pazuello as Health Minister. No other ministry has had an interim minister for such a length of time in the Bolsonaro administration.
Prior to running the health ministry, Pazuello was best known for coordinating the Army troops in the Olympic Games in Rio de Janeiro, in 2016, and heading the "Venezuelan Migration Operation" in the State of Roraima, designed to handle migrants fleeing the economic collapse in Venezuela in 2018.
    "Not even during the military dictatorship [did] we have a military man in the Health Ministry," said Eduardo Svartman, a political scientist from the Federal University of Rio Grande do Sul, referring to the period from the mid-60s to mid-80s when the country was run by a military regime.
    "However skilled Pazuello may be in military logistics, this is very different from managing a complex system like the Brazilian healthcare system, especially in the middle of a crisis like that," said Svartman.
    But Bolsonaro has not seemed concerned about Pazuello's lack of experience. In mid-July, the President described him as "born for the role," and "always in the right place to better serve his homeland." And his embrace of a military man isn't unusual -- Bolsonaro has tapped on a pro-military and populist movement in Brazil as his base of support.
    In the early days of coronavirus, Bolsonaro derided the warning of experts and described Covid-19 as a "little flu." He flouted social distancing guidelines and after contracting the virus himself, claimed his recovery was helped by taking hydroxychloroquine, which studies show is not effective and can be harmful.
    Pazuello published guidelines for the use of chloroquine and hydroxychloroquine in the early stages of Covid-19 only 4 days after taking office, despite the lack of endorsement by medical and scientific institutions.
    Pazuello has now lasted longer than his predecessor, physician Nelson Teich, who resigned as Health Minister earlier this year after less than a month in the role. Teich was the replacement for Luiz Henrique Mandetta, also a physician and who openly advocated for social distance measures before he was fired by Bolsonaro.
    "Bolsonaro no longer has the apparatus of a political party, doesn't have staff with administrative experience, doesn't have allies to recommend his staff," said Svartman of the Federal University of Rio Grande do Sul. "So where does he turn to? To the Armed Forces. The problem is that the Armed Forces accepted it," he said.

    The rising death toll

    When Pazuello took on the role of interim minister, Brazil had a little over 230,000 cases of Covid-19 and 15,633 registered deaths. Three months later, the number of cases has surpassed 3.3 million and the number of deaths has topped 107,000.
    Luiz Henrique Mandetta, the former health minister, said the number of deaths should not surprise the Bolsonaro government. He told CNN on July 30 that he showed the President data that predicted more than 100,000 people dying.
    "I think that he didn't want to believe it," Mandetta said. "He just wants people to say what he wants to hear. So he did what he just wanted, and he decided to take this very dangerous path, putting the whole country into it."
    Yet a poll conducted by Datafolha reported that 47% of Brazilians interviewed on August 11 and 12 don't think Bolsonaro is to blame over the number of deaths. Forty-one say he's partly to blame and only 11% believe he's the main culprit. The poll also revealed that 88% didn't know the name of the interim Health Minister.
    Addressing the World Health Organization on Friday, Pazuello ignored the death toll and focused instead on the number of recovering cases. "We are among the world-leading countries in recovered patients," he said, adding that 2 million Brazilians had survived Covid-19.
    Since in the office, Pazuello has been unable to solve shortages of medications such as anesthetics, neuromuscular blockers and sedatives for intubating Covid-19 patients, which have affected 23 of Brazil's 27 states, according to a report released last week by CONASS, a Brazilian state health secretariat council.
    At last week's National Congress for Covid-19, Pazuello said his ministry was not responsible for purchasing the drugs and that the shortage could be chalked up to "market instability" generated by scarcity in some states.
    According to Sergio Cimerman, Technical Director of the Brazilian Society of Infectious Diseases, an interim minister during a pandemic creates uncertainty. "So much that the federal government is transferring the problem to governors and mayors, so they will decide what to do in each place. It should be the other way round, the federal government should point the direction for the local authorities to follow."
    The only positive story for the government, he said, has been hosting three vaccine trials in Brazil. They involve Swiss pharmaceutical company AstraZeneca working with UK's Oxford University, Chinese biotech company Sinovac in collaboration with Brazil's Butantan Institute, and US pharmaceutical giant Pfizer working with Germany's BioNTech.
      "I can attest to you that AstraZeneca-Oxford is still our best option, the most promising (vaccine), but we are still paying attention to all the others, and we [can] quickly enter in another purchase (agreement)," Pazuello said on Thursday.
      Cimerman believes Pazuello will remain in the office until the end of the outbreak. "There are so many political implications, mainly in regard to medical treatments that the President stands for. No doctor, whose conduct is based on scientific criteria, would accept this post."