COVID-19 magnifies the vulnerabilities: The Brazilian case

Introduction

Globalization, driven largely by the development of information technology, has made the cheap and accurate movement of ideas across borders possible. Globalization has also increased the possibility of moving labour-intensive work abroad to where human resources are cheaper, regulations are weaker and public policies more daunting for employers. Businesses have become structured in global value chains and propelled by the rapid industrialization process of a handful of developing nations in an era denominated by what has been termed the ‘Great Convergence’ (Baldwin, 2016, p. 12). The interdependence that globalization promotes has made the world less predictable and harder to control. Other ‘shaper nations’ (Hitchcock et al., 2016) came to the position of influencing global politics and many national governments became weak or unwilling to exert their regulatory power afraid to scare away investments, no matter the size or level of development: as a result ‘sovereignties are continuously penetrated’ (Núñez, 2017, p. 36). Nonetheless, the economic power of companies can surpass the national GDP of many States. And three basic developments were made possible by the actual integration of global supply chains, necessary for a global production: revolutionary information technology innovations occurred in all spheres of society, capital mobility increased, and risky financial instruments became more prevalent (Baldwin, 2016, p. 12). As a consequence, countries increased interdependence and the need for coordination relativized their sovereignty.

In this globalized context, the highly heterogeneous set of rules which then apply to businesses has led to a ‘polyarchic’ distribution of power where no single actor, nor even the most powerful nation, has the capacity to impose its own solution without taking into account the views of the others (Sabel and Zeitlin, 2010, p. 15). This reality call for a different legal structure – one less rooted in sovereignty and articulated through international regimes that are ‘sets of principles, norms, rules and decision-making procedures, explicit or implicit, around which the expectations of the actors are constructed in a given area’ (Krasner, 2012, p. 93). International regimes correspond, therefore, to permanent institutional arrangements created to facilitate dialogue, the study of problems and to foster cooperation around common goals. And they are types of global governance (Gonçalves and Costa, 2011, p. 43): the pragmatic cooperation of multiple international actors in pursuit of goals through the most varied forms of legal, technical, and administrative structures (Biermann, 2014, p. 54).

Advances in complex issues that need to be managed in a cooperative manner demand increasing levels of commitment and a certain transfer of sovereignty from individual states (Young, 2010, p. 25; 2014, p. 83). Consequently, impasses, punctual advances, and unstable balances dominate the international system (Pauwelyn et al., 2014). The true implications of this lack of international cooperation has become particularly evident and problematic in the context of a pandemic where ‘everyone is a Westphalian’ (Paparinskis, 2020), trying to maximize their own internal interests on the short term.

Bearing this background in mind, in this paper we present some of the inequalities relating to the health system in Brazil – which have been magnified by the COVID-19 pandemic. We suggest that this demonstrates the negative repercussions of a global economy that has failed to cooperate meaningfully and we argue that now, more than ever, we need to put in place a more collaborative and egalitarian way of financing the health systems of the world (Pogge, 2009) and research and investments in a global public health system. The problem is particularly challenging in developing countries, like Brazil, where there are high levels of poverty and inequalities. The effects of the virus will increase the harm experienced by the poorest people, especially in less developed regions. Brazil has a robust and universal national health system, which is a great triumph in an international crisis such as this (Costa et al., 2020). Unfortunately, however its budget has never been sufficient to guarantee everybody’s access to medicines, quality health materials or adequate services during ‘normal’ situations, let alone the current pandemic.

This paper begins by presenting empirical evidence on just how fragile the Brazilian social-economic network is despite economic growth propelled by the liberal agenda set by the government. In addition, we demonstrate how regional initiatives have presented a more viable and quicker path to deal with the pandemic when there has been a lack of response by the Federal government. Aspects of the paper are necessarily descriptive as it presents evidence that Covid-19 has intensified hardships that already existed in Brazil. The paper is also prescriptive, as it commends best practices and reforms that would make a difference and help the country to ‘build back better’ (Noy et al., 2019). Therefore we aim to respond to and comment upon the new clarity brought about by the pandemic: ‘the things it allows us to see and the way in which they are interpreted and assessed will determine the future of the civilization in which we live’ (Santos, 2020, p. 3).

Health inequality data from Brazil

The numbers of people experiencing Covid-19 in Brazil are grim nationwide. The number of people who have died in Brazil as a result of Covid-19 at the time of writing is 423.229 (Brasil, 2021). It is noteworthy that in Brazil there is massive underreporting (Ribeiro and Bernardes, 2020) which suggests that the numbers do not reflect the reality as many deaths are not identified as Covid-19 related. Some analyses use the high percentages of excess deaths, deaths not explained directly by the pandemic but at extremely higher rates that from the previous years associated with respiratory symptoms (Orellana et al., 2021).

There was also a dispute about the public data that was being opened to the public. Websites were taken down, like the Portal COVID-19 (SVS/MS, 2020) where the Health Ministry, through its 27 Health Secretaries daily uploaded consolidated data on the epidemiological situation of COVID-19 in Brazil. In addition a widespread fake news campaign, disseminating malicious content related to the virus, contributed to the discrediting of science and global health institutions in the country (Galhardi et al., 2020).

In addition, regional inequalities impact the resilience of the local services, for example deficiencies about critical healthcare infrastructure for coping with the pandemic (De Sousa Júnior et al., 2020) are aggravated in the poorer regions. States in the North of the country tend to be more affected, as it is the case of Amazonas, in relation to the other states with more economic competitiveness in the Southeast of Brazil (Veiga e Silva et al., 2020). So the pandemic is not experienced equally across Brazil.

Also at the municipal level, the numbers show aggravated risks according to lower income. For example, the Municipality of São Paulo, despite being the wealthiest Brazilian city has the highest recorded numbers in the national pandemic situation, and showcase the unequal consequences of the Covid-19 pandemic. The Epidemiological Bulletins released by the Municipal Health Secretariat of the Municipality show the number of infected and killed by district is directly proportional to the poverty data. ¹ Comparing the demographic and socioeconomic data of the locations indicated in the weekly bulletin of the municipality, allows us to affirm that although the number of cases in the poorest districts is not the greatest, maybe because of underreporting due to the lack of mass testing, the number of deaths is directly proportional to the level of poverty. This may be related to access to food, implementation of primary and specialized health strategies, educational level, unemployment, poor housing, lack of basic sanitation, among other factors that accompany poverty in Brazil.

The data above suggests that the idea of coronavirus democratization, that it infects everyone equally despite race and social status, is an ideological statement. Although many people believe the virus does not know class or other social inequalities the national and global health systems experience suggests a clear differentiation based on race, ethnicity and gender. This produces socially referenced impacts on poverty, whether due to the lack of access to the formal labour market or access to the health system (Alfers et al., 2020). The Economic Commission for Latin America and the Caribbean – ECLAC indicates, as a result of the pandemic, an increase in poverty for the region on four variables: ‘(i) in all scenarios, poverty and extreme poverty will increase in all countries; (ii) in the high scenario, the largest increases in extreme poverty are likely to occur in Mexico, Nicaragua and Ecuador; (iii) also in the high scenario, poverty in general will increase especially in Argentina, Mexico, Ecuador and Brazil; and (iv) this exercise exposes the particular vulnerability of the region’s three largest economies’ (ECLAC, 2020). According to Coelho et al., ‘social distancing was one of the main strategies put in place to delay transmission. This was expected to be difficult to achieve in areas with high social vulnerability where poor living conditions make it difficult to adhere to hygiene and isolation protocols’ (2020). The response of the state to the pandemic therefore had different, negative, consequences for those who were already living in poverty. Indeed, empirical studies prove this point. In exploratory research conducted by Bolaño-Ortiz et al. (2020, p. 10) in Latin American and Caribbean cities strongly affected by the pandemic, it is clear that quality of life, social inequality, access to public health services and the environment, air pollution, which imply a greater or lesser degree of poverty, are directly related to the degree of mortality from COVID-19:

The results show that average temperature, minimum temperature, and air quality were significantly associated with the spread of COVID-19 in LAC. Additionally, humidity, wind speed and rainfall showed a significant relationship with daily cases, total cases and mortality for various cities. Income inequality and poverty levels were also considered as a variable for qualitative analysis. Our findings suggest that and income inequality and poverty levels in the cities analysed were related to the spread of COVID-19 positive and negative, respectively. These results might help decision-makers to design future strategies to tackle the spread of COVID-19 in LAC and around the world. (Bolaño-Ortiz et al., 2020, p. 10)

Health inequality: An old systemic problem

While the data discussed above could be read as particular to Brazil, evidence suggests that this is global characteristic of the pandemic: the Brazilian figures above reflect the global situation as the poorest in societies are the most negatively affected by the pandemic (Simler, 2020). The implications and the reasoning therefore necessitate a broader critique. At a broad level one of the main structural causes of the crisis is the dominance of capitalism across the globe – which historically takes advantage of the heterogeneity of the countries and reinforcing inequalities. The transition from Fordism to post-Fordism led, in political terms, to neoliberal choices that removed the State from socially directed regulation, placing it as a guarantor of the economic structure of competition (Hirsch and Kannankulam, 2011).

The pandemic demonstrates that societies need to be more prepared to face the global risks of our contemporary world, to rethink the role of the nation states in integrating economic growth with social welfare. Notwithstanding that there is a need for more international cooperation among countries, not less as many populists’ governments have been pleading (Ferguson, 2016), acting in this way against the interests of their own people. If the populism may be reactionary, ‘every construction and action on behalf of a people as a political subject is not eo ipso populism’. We must differentiate populist policies, which in general lead to the depoliticization and denaturalization of the political, from ‘the popular without the people’ (Žižek, 2006).

In order to think about the role of the state as a producer of strategies to overcome these inequalities, Martha Fineman (2010) proposes a theory arguing that vulnerability is inherent to the human condition and should therefore be considered central when designing socially referenced policies. As a condition, vulnerability is understood as universal, constant, complex and particular:

As a result, our vulnerabilities range in magnitude and potential at the individual level. Vulnerability, therefore, is both universal and particular; it is experienced uniquely by each of us. Important in regard to this particularity point is the fact that our individual experience of vulnerability varies according to the quality and quantity of resources we possess or can command. (Fineman, 2010, p. 269)

The context of Fineman’s theory is the neoliberal policies of the United States, but Brazil’s recent history with privatization of public services and the colonization of public interest and social responsibility for private interests (McCluskey, 2017), as outlined above, allows an approximation between American institutions and Brazilian based non-interventionist rhetoric. The Brazilian neoliberal state has increased its relevance in political discussions since the 1990s. With it came more privatizations, the state’s lack of responsibility for essential public services and the distrust of affirmative actions. The mediation between society and the vulnerable individual places the inexorability of this condition in social relations and institutions. This condition leads to political and legal implications when the state recognizes its responsive and responsible role in creating social technologies to reduce, improve conditions and compensate for these vulnerabilities, especially when we speak of public health in times of economic crisis as a natural need (Fineman, 2010, 2016). Fineman places vulnerability as the basis of an aggregating legal project, or a multidisciplinary approach within the law. More than that, we understand that the rescue of the irreconcilable individual by state institutions promotes the construction of a new social and political pact.

A new vision of law and public policies in this scenario requires an epistemological change about the meaning and the role played by the vulnerable individual in society. As Fineman (2020) proposes, it means breaking with the logic of legal subjectivity, replacing it with a vulnerable, or non-identical subject (Adorno, 1973), breaking with the logic of personal responsibility and individual freedom. The argument leads us to think directly about the interventionist, responsive state, which takes initiatives for recognizing that every individual is necessarily vulnerable and, therefore, this value must guide public policies and politics. This is especially so in the light of a pandemic where certain people, the poorest in societies, are experiencing acute hardship as a result of the state’s response to the crisis as they lack the resources of other more privileged cohorts: for example essential services workers, women and black people, sex workers, immigrants, and LGBT communities (Brown, 2020; Reid and Ritholtz, 2020).

Alternative subnational articulations

One interesting experience that shows creativity and scientific accuracy to deal with the pandemic is the paradiplomatic (Tavares, 2016) iniciative of the Comitê Científico de Combate ao COVID-19 (Scientific Committee against COVID-19) ² and the Consórcio dos Governadores do Nordeste (Northeast Governor’s Consortium), a platform that intends to create an ‘epidemiologic dialogue with society’ (Projeto Mandacaru, 2020), ³ to collect data and produce knowledge to support emergency public policies of the Brazilian Northeast ⁴ Consortium. This is an institutional structure composed by the 9 governors of the states that form, with the North, the poorest region in Brazil ⁵ with public health provision already stretched long before the pandemic (Gomes et al., 2020).

The Consortium is an instrument of subnational cooperation that was strengthened during the pandemic due to the absence of a single command and the failure of the federal government to provide an action plan for the whole country. The consortium is a voluntary association between government entities for the production and sharing of public values, requiring cooperation between stakeholders in achieving common goals. The Scientific Committee against COVID-19, pointed to different critical areas regarding the fight against the pandemic, creating nine subgroups and focusing on data collection and analysis, application development and support in the information technology area, in addition to simulations, estimates, scenarios, logistics organization and public communication (Consórcio Nordeste, 2020). Its objective was to monitor the situation in the region, aiming to consider data and other important scientific evidence in the political decision process. This committee is an example of how technology can be used to provide reliable and differentiated information to public agents and to the population in general. The Committee created a digital platform to face what its coordinators considered to be one of the biggest challenges of the pandemic: the fight against fake news and bad quality information (Projeto Mandacaru, 2020).

Among the committee’s recommendations, and of particular relevance to this paper, were the improvement of information and health surveillance systems and the dissemination of data that can serve to improve understanding of the pandemic, with a focus on sex, age, race, education, occupation and place of residence. Another concern of the committee is related to the improvement and integration of the SRAG case reporting systems (Severe Acute Respiratory Syndrome, COVID-19 case reporting and the results of exams registered (Projeto Mandacaru, 2020, p. 26).

Significantly, the committee brought together different research groups and autonomous researchers when there was an absence of nationwide molecular testing for all people with characteristic symptoms of COVID-19. It instituted the clinical-epidemiological criterion for the notification of cases. The use of clinical data in real time allowed for a kind of data collection and sorting, separating the mildest from the most serious cases, scheduling, when necessary, consultation at health services. To deal with mild and moderate cases, the use of Telemedicine could be recommended, with video consultation for monitoring and home treatment (Consórcio Nordeste, 2020, p. 26). From this mapping, the committee could identify, isolate, test and track contacts to establish quarantine and could define areas with different levels of vulnerability, based on the number of cases, deaths, availability of ICU beds, testing capacity, in addition to the social and economic conditions of the affected population (Consórcio Nordeste, 2020, pp. 25–26). It was also able to propose directing the distribution of medical supplies, refer patients to appropriate hospitals and recommend the use of homemade masks with appropriate materials. In the case of making masks, based on the committee’s recommendations, contracts were signed with small artisans, in an effort to coordinate between a scientific policy, aimed at the use of masks, and an economic and social initiative, aimed at the equation of its distribution or sale at very low cost.

Another important initiative of Scientific Committee against COVID-19 was the identification of the virus’s entrance doors in the Northeast region, which resulted in the recommendation to ANAC – National Civil Aviation Agency – to close airports with a greater flow of people coming from abroad or the Southeast of the country, who were taking the virus to the region (Nicolelis et al., 2020). This measure aimed at containing the pandemic, as well as the placement of health professionals to measure temperatures at airports, were both prohibited by the federal government. In general, the committee sought to gather subsidies to support the decisions of government officials (instead of executing the measures itself), causing some controversial decisions, such as the decree or not of unpopular measures, such as the lockdown, or the flexibility of measures of social distance are taken based on the analysis of different indicators, obeying the parameters established by the World Health Organization.

In addition to the committee, the Consortium of Governors of the Northeast, acting in an intersectoral manner, created Thematic Chambers in different areas, among them family farming and health, with the assumption of optional membership and the opening to the participation of representatives of the governors of each state. Through a Board of Directors, with direct contact with the Health Departments, the objective was to form an institutional arrangement to obtain financing for different policies, regardless of the endorsement or resources of the Union. Although the Northeast is commonly treated as a homogeneous region, ‘the differences between states and, in each state, between the capital and other municipalities and regions must be taken into account in the implementation, maintenance or flexibility of control measures, according to the evolution of the epidemic and characteristics of each location’ (Consórcio Nordeste, 2020, p. 25).

The experience of the North-eastern Consortium of Governors and its Scientific Committee to Combat Coronavirus demonstrate that responsibility for preventing contamination and death in the 2020 pandemic may involve new legal strategies. Agreements between public agencies; state agreements with the private sector; international cooperation etc. Art. 2, 1, of the International Covenant on Economic, Social and Cultural Rights, places the obligation to promote these strategies at the economic, technical and legal level. As Fineman points out (2010), it is not a question of whether the state model is more active or silent, whether it is liberal or social. The question is whether it will fulfil the institutional responsibility arising from the human condition, regardless of the model designed in the Federal Constitution.

Conclusion: The magnifying lens of the pandemic and the way ahead

COVID-19 is not an unpredictable phenomenon in the international health system, which is increasingly affected by the emergence and re-emergence of a virus or other diseases propagated by human contact with infected people or animals (Morens and Fauci, 2013). According to Woodward et al. there is ‘[…] an increasing tension between the new rules, actors and markets that characterize the modern phase of globalization and the ability of countries to protect and promote health’ (2001). Yet, the neoliberalism is pushed to the limit by the pandemic. For decades this model has proven to produce a huge developmental gap between countries, highlighting a North-South division. The outbreak of COVID-19 makes this gap clearer as the heavy burden over Global South countries increases in terms of protectionism, predatory market practices over medical supplies, and violations of human rights (Reventlow, 2020; Struthers, 2020) and governments are supressing liberties and adopting digital surveillance tools, justifying that such decisions are made for the ‘greater good’, to contain the virus. The pandemic exposes several existing weaknesses of the economic structure of capitalism. For example, the capitalist economy has produced much inequality and this is particularly true in countries like Brazil. Furthermore, ‘poor populations lacking access to health services in normal circumstances are left most vulnerable during times of crisis’ (Stiglitz et al., 2020). The inequitable response to the pandemic so far only reinstates that healthy life expectancy and mortality rates are markedly disproportionate between the richest and poorest populations.

In addition, disinformation and miscommunication disproportionally affect individuals with less access to information channels, who are thus more likely to ignore scientific recommendations such as physical distancing measures. In Brazil a significant number of people access online information mostly through WhatsApp (Cesarino, 2020), due to the zero rating policy implemented by the mobile phone carriers. The characteristics of this private message app compromises the fact checking ability of the users and the reach of public policies to curtail the spread of fake news. Moreover, Brazilians are particularly prone to believe on the information they receive through any communication media; e.g. the country ranks fifth in the confidence in the media index (Reuters Institute, 2020). Unfortunately fake news spreads 70% faster than real news (Vosoughi et al., 2018) even in traditional media (ComProp, 2019).

The challenge of coping with a global pandemic brings the opportunity to comprehensively address the serious human vulnerabilities it has revealed; and presents a rare opportunity for instituting bold structural reforms that can revive and sustain prosperity in the post-Covid-19 world. Certainly, as we argue above, the most effective reforms will come about through concerted intergovernmental cooperation, not isolationist measures: a view of the state as responsive and aware of its responsibilities accordingly to the theory of vulnerability. Heikkilä et al. (2020) argue that this is the main consequence when assuming natural vulnerability: an active state that builds resilience, an attitude that will provide the means to face the social damage caused by inherent and constant condition of human vulnerability. Hence, in shaping an institutional order we should bare the universality of vulnerability in mind and be more concerned that it not substantially contributes to the production of disease pools specially among disadvantaged groups and in poor countries. To do that we need to be able to challenge our tendencies to protect only the ones that are closest (Pogge, 2001): only compatriots or only people from a region, city or company for instance.

In this sense, an effective global initiative is needed and it could focus on several important functions. First it could strengthen multisectoral approaches such as the COVAX global collaboration in order to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines, under the auspices of the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Alliance for Vaccines and Immunization (GAVI), the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) as the delivery partner. This would made possible rapid availability of the vaccine worldwide, in an equitable and efficient manner, not prioritizing only the rich countries that can afford the price and the technology (freezers, energy etc) needed to complete the distribution. The ideal would be to offer the jabs at or below marginal cost (Pogge, 2020).

Second, an effective global initiative could support the creation and funding of a Global Intellectual Property Repository, to accelerate the assemble and deployment of existing and newly established intellectual property in relevant pharmaceutical molecules, diagnostics, health data, software, 3D printing codes etc. This repository would have to receive donations from national governments as well as public, and private sectors, relating to health to the amount it should be prepared to pay competitive prices so as to encourage a stream of useful innovations continuously (Pogge, 2020).

Third, the initiative could foster the creation and funding of a Global Logistics Centre to help monitor and coordinate the worldwide demand and supply of urgently needed goods and services, such as medicines, diagnostics, medical supplies and machinery, personal protective equipment, trained medical personnel and transport capacities. The goal is to overcome poor information, bureaucratic execution and deliveries disruptions due to higher bidders. Such coordination could facilitate the meeting of emergency needs through an effective and cheaper method by negotiating concessionary bulk rates on shipping and travel (Pogge, 2020). Fourth it could lead to the creation and funding of a Global Pre-emption Taskforce that would identify and protect populations that lack resources or pose particular risks to others. Experts would have the function of studying which are the high-risk locations in need to receive prioritized measures to prevent entry of the virus and, should this fail, to plan for rapid containment and suppression of infections or eventually the resilience of the community (Pogge, 2020).

Finally, greater global collaboration could mean that the Health Impact Fund (HIF, 2015) could offer innovators health impact rewards for the health gains achieved. Collaboration with national health systems, international agencies and NGOs would foster a strong public-health strategy around the innovator product and enable the research focus on the diseases more common among the poor. This modified incentive would make a big difference in communicable diseases such as COVID-19. It would create an important profit interest to the innovator to present results: reduce the incidence of the target disease and deploy measure to control proliferation as rapidly and cost-effectively as possible (Pogge, 2020).

Beyond these proposals for greater institutional cooperation at a global level the global health system depends on the resources from taxes. Unfortunately, the global architecture for taxation and the illicit flows of money hinders this funding. The injustice that misplaced taxes plays results in systemic damage to human rights, especially women’s rights and across a whole range of intersectional inequalities (Pogge and Mehta, 2016). Tax abuse by multinational companies, public and private corruption are central to the global economy, but this can be changed. Professor Pogge suggests the following: first, organizing a developing country tax reform and global financial architecture summit to enable the implementation of a global minimum tax on corporate profits, policies curbing the misuse of transfer pricing to shift profits from one jurisdiction to another; and other practices. Balancing governmental revenue are particularly challenging to developing countries which are continuously faced with the need for inbound investment, what often results in a race to the bottom standard, that tends to perpetuate the inequitable distribution of tax revenues even further (Pogge, 2020). Second, the taxation of natural resources that correspond to the wealth of developing countries, particularly the ones derived from the biodiversity, there is an urgent need to stablish a global system to remunerate this type of assets not only the pharmaceuticals that come up with the drugs but also the origin countries and communities that enable the existence and the maintenance of the natural resources. Although the Nagoya Protocol on Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Biological Diversity (UN, 2011) creates an international regime, its implementation faces the challenging of sovereignty as well as manipulation by the powerful through treaty shopping, profit shifting, and use of subsidiaries in tax havens that have no economic substance (Pogge, 2020).

Third, Pogge suggests taxation of the anonymous wealth currently parked in various secret jurisdictions with the resulting revenues directed to global health. Much of this anonymous wealth belongs to the richest 0.1% of world population, and most of it is associated with tax dodging and other crimes. It is estimated that an annual tax of 0.5% on anonymous wealth held in tax havens and secret jurisdictions, estimated at $24–35 trillion, could yield $120–175 billion a year (Pogge, 2020). Fourth, equitable distribution of the earnings from globalized business despite the digitalization of the economy. Profits should be allocated by factors – employees, physical assets, and sales. The maximization of the value of the intangibles in comparation with the production on the real word can be pointed out as the main flaw in the system preventing it to allocate globally earned profits fairly among countries where real activities take place and therefore exacerbating the inequalities continuously (Pogge, 2020). Fifth, all publicly held companies should be required to report their income and taxes paid on a country-by-country basis, and this information should be public rather than available only to tax authorities. Enabling open data analyses by society and automatic exchange of information across all taxing jurisdictions (Pogge, 2020).

The full effects of the pandemic are yet to be seen. As the global economy plunges deeper into an economic crisis and government bailout programmes continue to prioritize industry, scarce resources and funding allocation decisions must aim to reduce inequities rather than exacerbate them. Nevertheless, the inequalities have been made even more blatant. This paper brings data to demonstrate that using the case study of Brazil. But this is not a particular or limited scenario. On the contrary, so far, the virus has mainly magnified the multi-folded structural problems societies around the globe were already struggling with long before the virus outbreak. For this reason, the global disruption must be taken as an opportunity to implement major structural reforms such as the ones this paper outlines, on the expectation to inspire public policies capable of shaping a fairer new normality.