Unprecedented research by FGV’s Department of Public Policy Analysis (DAPP) analyzed the recent yellow fever outbreak, indicating a gap between the public spending dynamic and the structure needed to handle epidemiological crises in several municipalities. To that end, “Yellow Fever – a case study” cross-referenced data from registered cases, vaccinations applied and the available budget for epidemiological monitoring, allowing for specific recommendations regarding the Brazilian public health policy.
Between the end of 2016 and the first few months of 2017, Brazil experienced an extensive yellow fever outbreak in the country’s southeastern states, registered in areas previously deemed infection-free and therefore outside the scope of epidemiological monitoring. Minas Gerais was the most affected state and received a significant number of vaccination doses. Nevertheless, northwestern municipalities maintain insufficient numbers of applied doses, with less than 80% of the population immunized.
The DAPP survey showed that the Minister of Health was late in releasing funds for epidemiological monitoring at the beginning of 2017. Spending in January, a crucial month for controlling the disease, was R$ 3 million, compared to R$ 74 million in 2016. Minas Gerais was the state that allocated the most resources to “epidemiological monitoring” in 2015. However, only R$ 11.7 million was transferred to the municipalities, complementary to the federal funds, which is an average of R$ 13,678 per city.
The research further shows that the performance of northwestern municipalities of Minas Gerais in allocating resources was poor, even when compared to cities with similar social-economic profiles. Senador José Porfírio (PA), with 11,000 residents and a Municipal Human Development Index (MHDI) of 0.514, spent R$ 48 per capita on epidemiological monitoring. Itambacuri (MG), with 26,000 residents and MHDI of 0.634, allocated R$ 22.8 per inhabitant. In addition, none of the northwestern municipalities in Minas Gerais had infectologists on their medical staff, a fundamental issue for agility in diagnosing and treating hospitalized patients.
As a general conclusion, the study indicated the need to reinforce the preventive and permanent character required for investments in epidemiological monitoring. Due to the high uncertainty and possible irreversible impacts of these situations (in the case of identifying avoidable deaths), epidemiological crises such as the case studied must be handled early, employing strategies that avoid the worst possible risks.