WASHINGTON (NYTIMES) – The coronavirus was gathering lethal speed when President Donald Trump met his Brazilian counterpart, Mr Jair Bolsonaro, on March 7 for dinner at Mar-a-Lago.
Mr Bolsonaro had cancelled trips that week to Italy, Poland and Hungary, and Brazil’s Health Minister had urged him to stay away from Florida, too.
But Mr Bolsonaro insisted, eager to burnish his image as the “Trump of the Tropics”.
His grinning aides posed at the President’s resort in green “Make Brazil Great Again” hats. Mr Trump declared he was “not concerned at all” before walking Mr Bolsonaro around the club shaking hands.
Twenty-two people in Mr Bolsonaro’s delegation tested positive for the virus after returning to Brazil, yet he was not alarmed.
Mr Trump had shared a cure, Mr Bolsonaro told advisers: a box of the anti-malaria drug hydroxychloroquine, the unproven treatment that Mr Trump was then promoting as a remedy for Covid-19.
“He said the trip was wonderful, that they had a great time, that life was normal at Mar-a-Lago, everything was cured, and that hydroxychloroquine was the medicine that was supposed to be used,” recalled the Health Minister, Dr Luiz Henrique Mandetta, who was fired by Mr Bolsonaro the next month for opposing reliance on the drug.
“From that time on, it was very hard to get him to take the science seriously.”
The Mar-a-Lago dinner, which would become infamous for spreading infection, cemented a partnership between Mr Trump and Mr Bolsonaro rooted in a shared disregard for the virus.
But even before the dinner, the two presidents had waged an ideological campaign that would undermine Latin America’s ability to respond to Covid-19.
Together, the two men, fierce opponents of Latin America’s leftists, took aim at Cuba’s great pride: the doctors it sends around the world.
Mr Trump and Mr Bolsonaro drove 10,000 Cuban doctors and nurses out of impoverished areas of Brazil, Ecuador, Bolivia and El Salvador. Many left without being replaced only months before the pandemic arrived.
Then, the two leaders attacked the international agency most capable of fighting the virus – the Pan-American Health Organisation, or PAHO – citing its involvement with the Cuban medical programme.
With help from Mr Bolsonaro, Mr Trump nearly bankrupted the agency by withholding promised funding at the height of the outbreak, to an extent not previously disclosed.
And with help from Mr Trump, Mr Bolsonaro has made hydroxychloroquine the centrepiece of Brazil’s pandemic response, despite a medical consensus that the drug is ineffective and even dangerous.
The Food and Drug Administration warned last April against most uses of the drug to treat Covid-19.
A month later, Mr Trump announced after a phone call with Mr Bolsonaro that the United States would send Brazil two million doses.
Weak health systems and overcrowded cities made Latin America inherently vulnerable.
But by driving out doctors, blocking assistance, and pushing false cures, Mr Trump and Mr Bolsonaro made a bad situation worse, dismantling defences.
Now Latin America, with a third of the world’s deaths, has suffered more acutely from Covid-19 than any other region.
The two most powerful leaders in the Americas, Mr Trump and Mr Bolsonaro are both ardent nationalists defiant of mainstream science.
Both have put economic growth and short-term politics ahead of public health warnings. Both are deeply hostile to the region’s leftist governments – especially in Cuba, a cause that helps Mr Trump with Cuban American voters in the swing state of Florida.
“In their zeal to get rid of the Cuban doctors, the Trump administration has punished every country in the hemisphere, and without question that has meant more Covid cases, and more Covid deaths,” said Mr Mark L. Schneider, a former head of strategic planning for PAHO who was a State Department official in the Clinton administration.
“It is outrageous.”
Smaller, less powerful countries like Ecuador felt the pain. Ecuador acceded to US pressure and sent home nearly 400 Cuban healthcare workers shortly before the pandemic.
Then the country also suffered from the Trump administration’s freeze on funding for the health organisation, which hampered its ability to provide emergency supplies and technical support.
“No one from the Pan-American Health Organisation was here, and we felt their absence,” said Dr Washington Alemán, a senior infectious disease specialist and a former deputy health minister in Ecuador, who diagnosed the country’s first confirmed case of Covid-19.
“The support was not like it used to be in previous years, in previous epidemics.”
Previous Republican and Democratic administrations have almost all regarded the public health of Latin America as of urgent national interest, because infectious diseases can spread easily between South and North America.
‘Bread from heaven’
Mr Jair Bolsonaro roared into power in Brazil in October 2018, styling himself as a Trumpian populist, speaking favourably of “dictatorship” and accusing his country’s left-leaning establishment of taking lessons from communist Cuba.
He promised to expel more than 8,000 Cuban medical workers.
A predecessor had invited the Cubans five years earlier to help care for more than 60 million people, mostly in small communities in the Amazon basin, many of whom had never before seen a doctor.
Academic studies reported high levels of patient satisfaction and reduced infant mortality rates.
PAHO oversaw the Cuban doctors in Brazil and promoted their work as a model; the Obama administration raised no objection.
For decades, Cuba has sent medical workers to fill holes in health systems in Latin America and beyond.
Cuba paid the doctors as much as US$900 (S$1,223.40) a month compared with the US$50 a month they might earn at home.
But Havana charged their host governments much more – about US$4,300 a month for each doctor in Brazil – and pocketed the difference.
Cuba called the program humanitarian; critics, noting that Cuba limited the freedom of the doctors, called it forced labour and human trafficking.
During Mr Bolsonaro’s fiery election campaign, a newspaper disclosed six-year-old diplomatic cables suggesting that Brazilian officials had routed payments for the programme through the health organisation in part to avoid a debate in the Brazilian Congress over dealing with Cuba.
Mr Bolsonaro accused the health organisation of abetting “modern-day slavery” and vowed to get rid of the doctors. Cuba recalled them even before he was sworn in.
Roughly 10,460km away, in Miami, Mr Tony Costa saw a rare opportunity.
An 80-year-old veteran of the aborted Bay of Pigs invasion, Mr Costa has spent decades working to topple the communist leadership in Havana.
When he connected the allegations of Cuban forced labour with the Washington-based PAHO, he knew he had something that would captivate Congress and the White House.
“This is like bread from heaven!” he recalled thinking.
Mr Costa soon discovered Dr Ramona Matos Rodríguez, a Cuban doctor who had defected to Miami from a mission to Brazil, and helped her become the lead plaintiff in a lawsuit accusing PAHO of forced labour and human trafficking.
In a court filing, lawyers for the organisation said the allegations were “grossly inaccurate” and “bear almost no resemblance to reality”.
Experts say the lawsuit is at best a long shot, but, in politics, it made an impact.
Citing the accusations, the State Department pressured Ecuador, Bolivia and El Salvador until they expelled more than 1,000 Cuban medical workers last year.
But the bigger blows hit the Pan-American Health Organisation.
The Trump administration focused intensely on the organisation’s ties to Cuba, even though its involvement with the Cuban doctors had ended about a year earlier, when they left Brazil.
The US stopped paying its annual dues of US$110 million, more than half the agency’s core budget. Mr Bolsonaro’s government also froze payment of its US$24 million in dues.
By the end of 2019, the agency faced a funding crisis. It had sharply reduced international travel, frozen hiring and cut contracts for the medical consultants who do most of its hands-on work.
Within six weeks, Covid-19 began seeping into Latin America.
Bodies on the streets
Perched on Ecuador’s southern coast, Guayaquil is a busy port city surrounded by hillsides covered in slums.
Ms Bella Lamilla, 70, arrived from Spain on Feb 15, to visit her nearby birthplace. But while there, she developed pneumonia.
Ecuador had no labs with the supplies or capacity to test for the coronavirus, but Ms Lamilla’s family happened to take her to a private clinic that employs Dr Alemán, the former deputy health minister.
He used his contacts to get a sample sent to the Centres for Disease Control and Prevention in Atlanta.
She became Ecuador’s first confirmed case on the night of Feb 29. Within two weeks, every intensive care unit in the city was overwhelmed.
Doctors in Guayaquil say that more hands-on advice from PAHO might have helped detect the virus much sooner, before it had penetrated the city so deeply.
More direct support from PAHO consultants “could have prevented not only that mistake but many others”, Dr Alemán said.
During past disease outbreaks, local doctors credit PAHO with procuring supplies or rushing in skilled consultants to provide face-to-face technical help to laboratories and hospitals.
The agency’s officials say that this time they faced special challenges. Testing materials and protective equipment became scarce globally. By late March, shutdowns of commercial air travel made it difficult to deploy experts.
But the funding crisis caused by Mr Trump’s freeze also loomed large, even as leaders tried to compensate by shifting resources to prioritise Covid-19 response.
The forced departure of 400 Cuban medical workers from the country did not help, either.
At the Martha de Roldós Health Centre on the outskirts of Guayaquil, the director, Mr Hugo Duarte, said two Cubans had to leave months before the pandemic.
Ecuadorean doctors would have been just as good, he said, if the Health Ministry had paid enough to fill the vacancies. But the loss had strained the clinic, especially when he was sickened for weeks.
“People were falling dead on the sidewalk, just outside the health centre,” Mr Duarte said.
Dubious medical advice
As the epidemic was exploding in Ecuador, Mr Bolsonaro returned to Brazil from Mar-a-Lago.
He quickly summoned Dr Nise Yamaguchi, a São Paulo oncologist who had become a prominent champion of hydroxychloroquine.
Dr Yamaguchi told the President that the outbreak left no time for the kind of clinical trials other doctors were waiting for.
Brazil had been known for one of the strongest public health systems in Latin America for fighting infectious diseases.
But when two health ministers refused to support the drug, Mr Bolsonaro replaced them with a loyal military officer, while Dr Yamaguchi became his most trusted adviser.
Ignoring a medical consensus, Brazil’s Health Ministry still provides free hydroxychloroquine to anyone with Covid-19.
And critics say Mr Bolsonaro’s promotion of the drug, coupled with his refusal to wear a mask or socially distance, has undermined public health.
Brazil has suffered more than 157,000 deaths from Covid-19, a total second only to the United States.