The best way to eliminate diseases is to work together, says Health and Environment Surveillance Secretary

For the postdoctoral fellow in Epidemiology at Johns Hopkins University, her appointment represents the recognition of serious and committed work with science, which demonstrates the important role of the female researcher

The former president of the Brazilian Research Network on Tuberculosis REDE-TB, epidemiologist and professor at the Federal University of Espírito Santo (Ufes), Dr. Ethel Maciel was invited by the Minister of Health, Dr. Nísia Trindade, to compose her team in front of the Secretariat of Surveillance in Health and Environment, one of the most important within the board, which was created to reinforce an extremely strategic area of the Ministry, through the strengthening and expansion of Epidemiological Surveillance actions. Among its responsibilities are the national programs to combat dengue, malaria and other vector-borne diseases; prevention and control of immunopreventable diseases such as measles, control of zoonoses; and surveillance of emerging diseases. The Secretariat also aggregates important national programs to combat diseases such as tuberculosis, leprosy, viral hepatitis, STIs and AIDS. The board also has among its actions, the National Immunization Program, responsible for all vaccines that are distributed by the Unified Health System (SUS).

Although Brazil has the largest public and free-of-cost Unified Health System in the world and the greatest technical capacity in Latin America to face emerging and re-emerging diseases that have been frequently reported in the country, we still live with a significant number of cases of these diseases. The challenge of the new Secretary of Surveillance in Health and Environment will be great, but her experience in the Technical Committee of the World Health Organization (WHO), which helps countries with high rates of tuberculosis to combat the disease, along with her participation in the National Tuberculosis Control Program and as a member of the Technical Advisory Group on Tuberculosis at the Ministry of Health, added to her prominence in combating the coronavirus during the pandemic, having participated in the National Vaccination Plan against Covid-19, of the Ministry of Health, should be her greatest differential. The Communication Advisory of the Brazilian Society of Tropical Medicine (SBMT) spoke with the Secretary of State, Dr. Ethel Maciel.

Read the interview in full.

SBMT: What are the expectations for your management in the Secretary of Health Surveillance of the Ministry of Health?

Dr. Ethel Maciel: Our expectations are the best possible, I am very motivated and hopeful to reconstruct several programs that were negatively impacted during the last management. We will also act to combat several diseases that fell far short of what was desired in Brazil; vaccination itself, where there was effective action to damage vaccination coverage in the country, with campaigns that questioned the safety and effectiveness of vaccines; including speeches by authorities who were in charge of the board. So, the expectation is the best possible, mainly because we will have the first woman Minister of Health, a person very prepared for this mission and who I am sure will lead the Ministry very well. Dr.  Nísia is gathering all the experience she has, especially as head of the Oswaldo Cruz Foundation (Fiocruz). I’m very hopeful. I think that’s the best word in this reconstruction and I’m very motivated.

SBMT: What are the prospects for tropical diseases such as dengue, chikungunya, kala azar, Chagas disease, tuberculosis, leprosy, among others?

Dr. Ethel Maciel: The perspective for tropical diseases is that we can improve and innovate in coping actions. We have scientific research that already suggest new forms of control for the vectors of these arboviruses, and that have not been effectively implemented. Ahead of Department of Communicable Diseases, we will have to seek scientific evidence so that new forms of control can be implemented. We will work this together with Primary Care, where effectively these policies are made, and also together with Specialized Care, which are two other secretariats of the Ministry of Health. The Minister’s proposal is that the secretariats work on integrated actions, and that is what we intend to do. Regarding leprosy and Chagas disease, which are among the diseases in elimination, they are within a specific coordination, and will also be the priority of this management. These are diseases that are placed in areas subject to intervention, and with good planning we can get close to the elimination of many of them. Regarding tuberculosis, which is in the Department of STI-AIDS, Hepatitis and Tuberculosis, we thought of a common strategy of joint action. It is a department that we have high expectations because Brazil has assumed several goals with the World Health Organization aimed at control and elimination as a public health problem.  However, in the last four years the government has moved far away from them. We must resume Brazil’s leading role in the control of these diseases.

SBMT: Brazil has faced major epidemics in recent years and diseases already eradicated are again a cause for concern among health authorities and health professionals. Are we prepared to deal with outbreaks, epidemics and the emergence of new diseases? How to prevent and minimize their advance?

Dr. Ethel Maciel: Brazil has faced major epidemics and the Covid-19 pandemic itself, which is still a cause for concern because it continues, even though the Brazilian government has revoked the declaration of a public health emergency; we will assess, with the support of experts, the need for emergency restitution in the country, observing mainly what is happening in China. We have a specific emergency department that will take care of these actions together with the Scientific Committee, which is being resettled. This is an important action of Minister Nísia. We will be aware of this expert assessment.

SBMT: What challenges can be listed regarding Epidemiological Surveillance?

Dr. Ethel Maciel: There are huge challenges for Health Surveillance, but fortunately, we have at the head of the Ministry a person who understands the importance of the Unified Health System (SUS), who understands the importance of science, who works in these fields and who therefore knows the need for investment and planning, using the best evidence so that we have concrete results to deliver to our society.

SBMT: How can the SBMT help in the challenges of communicable diseases? Do you see the possibility of an increase in partnership? How to stimulate the emergence of new leaders?

Dr. Ethel Maciel: The Brazilian Society of Tropical Medicine is fundamental so that we can, stimulate in partnership, in addition to the emergence of new leaders in the scientific committees, count on the support that the SBMT has to assist us in the best decision-making. We must provide Brazilian society with the best in health care, in the control and surveillance of our diseases. So, the SBMT has a fundamental role in this commitment, as well as other scientific societies, but specifically in helping to formulate these policies.

SBMT: The control programs within the Ministry of Health are very well designed and organized, but they have very little impact when distributed between states and municipalities. How and in which way does your Secretariat intend to work/act to change this scenario?

Dr. Ethel Maciel: We need to work, as I said before, in an integrated way. The Secretariat of Health Surveillance, together with the Secretariat of Primary Health Care and the Secretariat of Specialized Care, making joint actions so that we can impact the control of these diseases in Brazil. In addition, many diseases affect more vulnerable populations and intersectoral actions focusing, for example, on the homeless population with ministries of Cities and also Social Development, in the Ministry of Justice, especially communicable diseases in the prison system, in the indigenous population with a new Ministry of Originating Peoples.

SBMT: Would you like to add something?

Dr. Ethel Maciel: I was very honored for being invited by Minister Nísia Trindade to compose this management, because I believe that this represents a new chapter in the history of Brazilian health. In addition, she is also the first woman to occupy this Secretariat of Health Surveillance, which is now called the Secretariat of Health and Environmental Surveillance. I am very motivated and very happy to be part of the reconstruction of our Unified Health System and health policies in Brazil.