Brazilian sanitarian Oswaldo Cruz faced three simultaneous epidemics

The Vaccine Uprising is a subject that is part of the school curriculum, but a detail that is not always remembered is that the sanitary transformations that took place in Rio de Janeiro at the beginning of the 20th century were led by a young Oswaldo Cruz, just over 30 years old. This Friday (5), the day that marks 150 years since his birth, Agência Brasil recalls how this audacious sanitarian took over the country's main public health agency in 1903, with the promise of defeating three simultaneous epidemics that ravaged the federal capital: bubonic plague, smallpox, and yellow fever.

Recently emerged from the Empire, Brazil wanted to show the world a modern and promising image, but bringing visitors and immigrants to Rio de Janeiro, its capital, was a difficult task, since the city had a reputation of being a "foreigners' tomb". The reason was the infectious diseases that devastated the carioca population, which lived in terrible conditions of hygiene and sanitation, with slums and alleys that grew in an accelerated and disorderly urbanization.

The President of the Republic at the time, Rodrigues Alves, appointed the engineer Pereira Passos as Rio de Janeiro's mayor in order to carry out a broad urban reform that would open wide avenues and improve basic sanitation and ventilation. On a complementary front, it fell to Oswaldo Cruz to devise strategies to tackle infectious diseases, and the young doctor was appointed director-general of public health, a position that, at the time, could be compared to what is today the minister of health.

Historian Bruno Mussa, from the Life Museum of the Oswaldo Cruz Foundation (Fiocruz), explains that, despite being young, Oswaldo Cruz had a solid background, and was the first Brazilian to study at the Pasteur Institute, a research center in Paris that was the greatest reference at the time in the West on microbiology and health. Upon his return to Brazil, in 1899, he participated in a scientific mission that identified an outbreak of bubonic plague in the port of Santos. This work earned him the notoriety to become the technical director and then the head of the Instituto Soroterápico Federal, the embryo of what would become Fiocruz. The next step was to accumulate the position with the directorate in which he became famous for the policies implemented in the country.

"From then on, the Directorate General of Public Health will assume a larger and more significant space, and public health will become an increasingly relevant point in Brazil," evaluates the historian. "In everything he planned, he thought about the implementation of a lasting work project. If the Oswaldo Cruz Foundation today is a strategic institution, it is a consequence of this character's vision of the future."

Yellow Fever

A major public health problem in the city, yellow fever was Oswaldo Cruz's first focus as director of public health. Under the suspicion of the medical class of the time, the sanitarian brought to Rio de Janeiro the idea that the disease was transmitted by mosquitoes, while the most accepted thesis in Brazil was that the infection would come from people who were already sick.

Oswaldo Cruz created sanitary brigades that went around the city with insecticides, looking for places where mosquito larvae were present, including houses, whose owners could be ordered to carry out renovations or even demolish them if they were considered unhealthy.

The strategy was successful, and the disease that killed about a thousand people a year in 1902 was no longer an epidemic in 1907, which earned the sanitarian the main prize at the 14th Berlin Congress of Hygiene and Demography, held in Germany that year.

"This international recognition was extremely important to produce the seal of approval that Oswaldo Cruz has had since then," says Mussa. "It starts to be recognized in Brazil after the recognition that it had abroad.

One of the greatest proofs of this recognition was the change of name of the institute he directed to Instituto Oswaldo Cruz (IOC), which still exists today as part of Fundação Oswaldo Cruz. The researcher also became an immortal of the Brazilian Academy of Letters, in 1913.

Bubonic Plague

Once the fight against yellow fever was organized, Oswaldo Cruz and his public health directorate turned their attention, in 1903, to bubonic plague, a disease transmitted by the fleas of contaminated rats.

Mussa explains that, besides being present in the collective memory for the tragic epidemic that killed millions in Europe, the disease also has a strong economic impact, since its dissemination is often through rats on ships, from port to port, which can even force a contaminated city to close down.

"The bubonic plague did not become a huge problem in Rio de Janeiro, but the diagnosis generates a series of actions so that it did not prosper". he says. "It was a disease that came from outside and could generate a very big impact on the economy."

Once again, Oswaldo Cruz adopted the strategy of fighting vectors, with a hunt for rats in Rio de Janeiro. Employees of the public health directorate were given the goal of turning up at least 150 rats a month, under threat of dismissal, and the government began to buy rats from anyone who killed them.

Besides rat extermination, the sanitarian promoted the vaccination of the population in the most affected areas of the city, and the Federal Serum Therapy Institute produced the serum for the treatment of the sick, whose cases became compulsorily notifiable. This set of actions had a strong impact on mortality from bubonic plague in the city, which fell more than 20 times between 1903 and 1909, according to Fiocruz.

Smallpox

The removals of the poor population forced by urban reform, the truculence of the sanitary brigades, and the political tensions of the newly proclaimed republic created a climate of growing tension in the federal capital during the Rodrigues Alves government. Amidst this scenario, smallpox had a peak of cases in 1904, and about 3,500 people died in Rio de Janeiro.

The tragedy led Oswaldo Cruz to the drastic proposal of enforcing compulsory vaccination, with proof required even for marriages. In addition, the law approved in Congress, nicknamed the "Torture Code" by opponents, provided that health services could enter residences to vaccinate residentes.

The historian explains that this was the trigger for the cauldron of dissatisfaction to explode, and the Vaccine Uprising lasted 10 days, during which there were protests in the streets and military insurrection. The result was 30 dead, 110 wounded and 945 arrested, almost half of whom were exiled to Acre, where they were subjected to forced labor.

Despite having regained control of the capital, the government decided to suspend compulsory vaccination, which represented a defeat for smallpox prevention and made possible an even more deadly epidemic in 1906, with more than 6,000 victims.

Mussa points out that even though the smallpox vaccine was already used worldwide and was proven effective, the climate of tension was taken advantage of by the opposition to the government while widespread illiteracy and the scarcity of communication channels hindered an awareness campaign.

"This whole process presents in the history of Brazil the moment when the relevance of having a good public communication of science and a good development of scientific debates with society is demonstrated, because it was the absence of this and a lot of application of determinations by decree and by force that contributed a lot to the animosity and to the revolt that happened."

Legacy

Just like his great achievements, death came early for Oswaldo Cruz, who died at the age of 44, in 1917. The sanitarist was a victim of kidney failure, caused by nephritis, the same disease that victimized his father.

For the director of the Oswaldo Cruz Institute, Tania Araújo-Jorge, the greatest legacy of the sanitarist was to include research as a fundamental element in public health policy. She recalls that, years after taking over the Federal Serotherapy Institute, the doctor transformed it into an experimental pathology institute, dedicated to medical research focused on collective health.

"Public health has a before and an after Oswaldo Cruz. Without research, you can't do a good job of addressing any health challenge," she says. "Not only the people from the Oswaldo Cruz Institute, but every Brazilian researcher feels inspired by his vision that you have to do training, you have to do research, and that this has to be committed to improving the health of the Brazilian people.

Tania assesses that, faced with the challenges in the General Directorate of Public Health, the young Oswaldo Cruz had the energy to face the challenges of the time, and at the head of the research institute, he collaborated to the transmission of knowledge that occurs until today in the foundation.

"The fact that he implemented research and the training of new researchers was very important. They all died very young, and you had to pass on the legacy. Who had to face the Spanish flu epidemic in Brazil? It wasn't Oswaldo, he died in 1917, and the epidemic started in 1918. It was Carlos Chagas, who had learned everything from him. Carlos Chagas was a student of Oswaldo Cruz, and he went on to form a generation of scientists, and we have 122 years of training scientists".