Brazil has one of the best surveillance systems in the world, but updates are always necessary, says new director of DEVIT

Publicação: 11 de March de 2019

Communicable disease surveillance should be more proactive in order to anticipate major epidemics and propose damage reduction strategies

Federative pacing and working along with municipalities and states can help understand the reason for in vaccine coverage decrease

Member of the Brazilian Society of Tropical Medicine (SBMT) and former president of the Brazilian Tuberculosis Research Network – REDE-TB, Dr. Julio Croda has recently been appointed Director of the Emergency Department of Communicable Diseases (DEVIT) of the Health Surveillance Secretariat (SVS) of the Ministry of Health. The appointment was published in the Brazilian Federal Official Journal (DOU) [Diário Oficial da União] on February 5th.

During the interview, the new director reminded that Brazil has the largest unified free health system in the world and, within Latin America, the country hosts the greatest technical capacity to deal with the emerging and reemerging diseases that are frequently reported in Brazil. Dr. Julio Croda believes that, as happened with the Zika virus epidemic, Brazil is able to create an adequate response to the new public health issues that may arise. To know more about his expectations and management challenges, find the full interview below:

BSTM: What are your expectations for your term in office?

Dr. Julio Croda: The expectation is to develop a shared management model alongside municipalities and states in order to support the strengthening of surveillance actions in the territory, and to expand joint actions with Primary Health Care.

BSTM: Brazil has been facing major epidemics in recent years and diseases that had already been eradicated are again a reason of concern among health authorities and health professionals.  Which challenges can be identified regarding Epidemiological Surveillance?

Dr. Julio Croda: The challenge is enormous. Surveillance of communicable diseases must play a more proactive role in anticipating these major epidemics and proposing damage reduction strategies. As vaccine coverage decreased throughout the country over the years, immunopreventable diseases such as measles and yellow fever have again become important public health problems in Brazil. Now, it is necessary to ensure a new federative agreement and work alongside municipalities and states, so we can first understand the reasons for this vaccination coverage decrease and, this way, propose effective strategies to increase this coverage in the entire population.

BSTM: Why is it so difficult to deal with disease prevention?

Dr. Julio Croda: The cultural changes over time in our society create new challenges and therefore, new approaches must be proposed for confrontation. The knowledge, attitudes and practices of our health professionals should try to understand this new era in order to propose innovations able to cope with this new scenario.

BSTM: With the decrease in vaccination rates, Brazil has seen the risk of a resurgence of communicable diseases previously thought to have been eliminated. Is it correct to say that we live in a complex scenario in epidemiological terms and with a strong risk of regression, also regarding other diseases, if control policies are neglected? What should be done to prevent this from happening?

Dr. Julio Croda: Absolutely. We must bring the current strategies back to the discussion, propose new access models and renegotiate with municipalities and states to increase vaccination coverage.

BSMT: Is Brazil ready to deal with epidemic outbreaks and the emergence of new diseases, as the Oropouche Fever, Rift Valley Fever, Chikungunya and others? How to avoid and minimize the progressive spread of diseases?

Dr. Julio Croda: Brazil has the largest unified free health system in the world, the SUS [Unified Health System, “Sistema Único de Saúde”, in Portuguese], and, within Latin America, we have the greatest technical capacity for this confrontation. For this reason, as it happened with the Zika epidemic, I believe that we can create an adequate response to the new public health problems that may arise.

BSTM: Emerging and reemerging diseases are frequently reported in Brazil and in different countries, causing great economic losses and constituting a highly relevant factor for epidemiological surveillance actions. Do you think that coping with these diseases requires more investment in epidemiological surveillance, especially regarding their abilities for early detection?  If so, do you understand that health professionals are able to identify suspected cases and assist in the process of investigation and triggering of control measures? What can be done?

Dr. Julio Croda: Yes. We have already monitored the great public health events, however, with a certain delay after the occurrence of the diseases. It is necessary to upgrade our systems so that we can monitor the diseases in real time and, this way, generate an appropriate response. It is important to note that we have one of the best surveillance systems in the world, but upgrades are always necessary.

BSTM: How can SBMT help with the challenges of communicable diseases? Do you see the possibility of increasing the partnership? How to stimulate the emergence of new leaders?

Dr. Julio Croda: The relation of the Emergency Department of Communicable Diseases (DEVIT), the Secretariat of Health Surveillance (SVS), the Ministry of Health, with the SBMT is long-lasting and there is great technical cooperation regarding the recommendations in our manuals, funding of research projects and events. In addition, we intend to work together with the SBMT media to stimulate guidelines related to major public health problems and the fight against fake news.

BSTM: The lack of investment in research is a reality in Brazil. How and in which way your Office can or intends to work/act to change this scenario?

Dr. Julio Croda: Although DEVIT is a department with an end to surveillance, we intend to work with the Department of Science and Technology (DECIT), to define a research agenda and propose new research funding that actually has an impact on our health system and is innovative not only for Brazil, but to the world.