During the historic Free, Democratic and Popular Health Conference, the health movement presented Lula with a letter of commitment, urging him to persist in “strengthening the role of the state in fostering and sustaining the Health Economic-Industrial Complex (CEIS)” in his government program. Upon being elected, Lula honored his commitment to health in his first year in office by initiating the reconstruction of an institutional framework that could make the CEIS even more relevant and useful for the population.
However, the task is far from complete with the President’s series of decrees, ordinances, and announcements. In the years ahead, Brazil still needs to build up critical mass and thoroughly plan the directions that the boost to the CEIS will take, particularly when considering it as one of the central axes of Brazil’s new industrialization, as proposed by the government.
A debate organized on February 22 by the Maurício Grabois Foundation brought together José Gomes Temporão, former Minister of Health, Carlos Gadelha, Secretary of Science, Technology, Innovation and Health Economic-Industrial Complex at the Ministry of Health, and Julieta Palmeira, advisor to the Ministry of Science, Technology, and Innovation (MCTI).
The three covered various topics, including the history of the struggle for health sovereignty in Brazil, the conceptual framework underlying the current government’s strategy for the CEIS, and the importance of inter-ministerial collaboration in this endeavor. Their insights provided a comprehensive understanding of the origins and future trajectory of the CEIS, which Gadelha characterized as “a policy of national reconstruction with Health as its critical vector.”
Struggle for Brazilian health sovereignty has a rich history
In an overview of government actions that either supported or hindered the consolidation of a national pharmaceutical industry, José Gomes Temporão emphasized that, despite having “surfaced with intensity in the pandemic,” this “is a debate that spans decades of Brazil’s history, crossing tensions between different models of development, autonomy and sovereignty.”
The historical framework outlined by Temporão spans from the creation of institutes such as Butantan, the main producer of immunobiologicals in Brazil, the Oswaldo Cruz Foundation, and the Adolfo Lutz Institute at the beginning of the 20th century, to more recent initiatives such as Farmácia Popular and the breaking of the efavirenz patent. This includes actions taken during the Goulart government and the period of redemocratization.
This cumulative effort spanning a century has been crucial in ensuring that, today, Brazil is not starting from scratch in its pursuit of the consolidation of autonomous production of medicines, vaccines, and other essential supplies for the Unified Health System (SUS).
Read more: The people are the builders of the Brazil’s Unified Health System
However, Temporão also pointed out instances when foreign pharmaceutical companies exerted significant influence over Brazil. Among them, he highlighted the repeal of the Goulart government-era Profit Remittance Law by the military dictatorship, as well as the enactment of the 1996 Patent Law by the Cardoso government. According to Temporão, these actions led to the “dismantling of the national pharmaceutical industry” at the time, in contrast to India’s approach to dealing with TRIPS, he told Outra Saúde.
He also emphasized that even today, we need to remain vigilant against the dissemination of ideas aimed at obstructing the “autonomy of Brazilian production capacity,” often funded by foreign stakeholders.
Actions to enhance the complex
Carlos Gadelha recalled that Jair Bolsonaro’s government marked a significant setback in this area. He noted that the departments of the Ministry of Health and the executive group responsible for coordinating the CEIS were shattered by the government’s actions.
“There was no inter-ministerial institutionalization to deal with the vulnerability in the production of vaccines, medicines and ventilators” during the pandemic, with tragic results, he said. However, according to Gadelha, resuming pro-CEIS actions “does not mean reverting to the past, but rather, ushering in the future.”
In this regard, he emphasized that “developing for health” represents the novelty in the current approach. He highlighted that the new National Strategy for the Development of the Health Economic-Industrial Complex, launched in September by the government, “is not merely another technological and innovation policy, but rather, a national reconstruction policy with health as its critical vector.”
Today, he said, “there is nothing more industrial than a large hospital,” and “nothing can be achieved in the field of health without economic, technological, and productive sovereignty.” For this reason, Gadelha believes that the government is taking a significant step by “interlinking sovereignty with the right to life” and establishing a “new national development project that sees life as its starting and finishing point.”
According to Gadelha, it is no small achievement that Health is one of only six priority missions of the Nova Indústria Brasil strategy. Equally groundbreaking, he considers the decision to entrust the “coordination of an economic policy” to a ministry typically associated with “social” policy, such as the Ministry of Health.
Gadelha argues that the correct approach is to “break down the barrier between economic and social policy.” He asked: “Is producing vaccines economic or social policy? Both.”
The ‘inter-ministeriality’ of CEIS
Julieta Palmeira highlighted that the collaborative effort between various areas of management is one of the main characteristics of CEIS.
Among the evidence of this, she said, was the expansion of the Health Economic-Industrial Complex Executive Group (GECEIS), a platform for formulating actions that promote the strengthening of the complex, which now involves the participation of twenty-one ministries—previously, there were fifteen.
Particularly noteworthy has been the dedication of the Ministry of Science, Technology, and Innovation to this task, as demonstrated by a series of actions over the last year.
One such action was the incorporation of CEIS into the decision that outlined the guidelines for the new National Science, Technology, and Innovation Strategy. The text of Ordinance No. 6,998/2023 specifies efforts to “structure and expand industrial-technological complexes in strategic areas for national development, such as health.”
In turn, Finep, an MCTI public company focused on financing technological innovation projects, is also supposed to contribute by allocating resources to CEIS-related initiatives. Palmeira pointed out that Finep is “a significant provider of non-repayable funds” in this area and intends to allocate BRL 250 million (around USD 50.7 million) to such projects.
Future prospects
Commenting on other guidelines that the CEIS plans should incorporate, Palmeira emphasized the importance of “capillarizing local development.” For her, the inauguration of the Hemobrás plant in Pernambuco was a first step in this direction. However, for the future, there has to be even deeper integration.
“I want to see Butantan together with Bahiafarma and Fiocruz working with the scientific and technological institutes in Pernambuco,” she said.
Temporão also expressed optimism for the future of CEIS. “We have the SUS and the largest production base in Latin America. The state has significant purchasing power: 40% of the pharmaceutical market, 95% of the vaccine market, and 50% of the diagnostic and treatment equipment market comprised of public purchases. We have all the necessary conditions to develop our own project,” he said.
Carlos Gadelha, meanwhile, commented that the work to develop CEIS should focus in the long term to addressing two major challenges: preparing for future health emergencies and public health crises, and addressing the primary issues and diseases that affect the people in Brazil.
The implementation of plans to expand the Health Economic-Industrial Complex, merging economic development with the promotion of social justice and the strengthening of the public SUS, will signify “Celso Furtado and Sérgio Arouca joining hands,” he concluded.
The report was written by Guilherme Arruda and published in Portuguese on Outra Saúde.
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