Elize Massard da Fonseca

Escola de Administração de Empresas de São Paulo | FGV-EAESP · Department of Public Administration

The local manufacture of advanced pharmaceutical products has been a long-standing objective of health and industry policy in many developing countries, including in Latin America. This strategy has been applied to fight epidemics such as HIV/AIDS, malaria, and the COVID-19 pandemic. However, we still know little about the politics and governance t...

Factors outside of healthcare services determine our health and this involves many different sectors. Health for All Policies changes the argument about inter-sectoral action, from one focusing on health and the health sector to one based on co-benefits – a 'Health for All Policies' approach. It uses the Sustainable Development Goals as the framewo...

This article sheds new light on the drivers of bureaucratic resilience in the face of presidential attacks, an understudied but politically salient topic. Scholars have long shown how political advocacy can protect bureaucracies from presidential attacks on policy regulation. We argue, however, that advocacy is insufficient to defend bureaucracies...

Differential access to life-saving COVID-19 vaccines reveals the inequitable distribution of wealth and power in the global system. While several countries have developed homegrown vaccines to avoid being priced out of markets dominated by transnational drug companies, Brazil—a country with a significant research and pharmaceutical base—lagged behi...

Across multiple pandemics, global health governance institutions have struggled to secure the compliance of states with international legal and political commitments, ranging from data sharing to observing WHO guidance to sharing vaccines. In response, governments are negotiating a new pandemic treaty and revising the International Health Regulatio...

This chapter reflects on the COVID-19 health emergency and inequalities in Brazil. It relies on secondary sources to describe disparities in health, education, and social assistance. Studies in health and education inequalities suggest great variation in the impact of the pandemic among different jurisdictions and socioeconomic groups. Brazil’s str...

The COVID-19 pandemic, which featured international pharmaceutical firms seeking to build global manufacturing networks to scale-up the supply of vaccines, has generated heightened interest in understanding the role of firm-to-firm technology transfer. While considerable attention has been given to tracking the extent of international vaccine techn...

The COVID-19 pandemic of 2020 was one of the rare events that shocked almost every world government simultaneously, thus creating an unusual opportunity to understand how political institutions shape policy decisions. There have been many analyses of what governments did. We focus instead on what they could do, focusing on the institutional politic...

Executive bureaucracies can be used by presidents in multi-party systems to leverage legislative support. What are the identity and capabilities of these political appointees? Why are some executive departments able to cultivate autonomy to innovate in a fragmented political regime, while others are not? We analyzed the Ministry of Health in Brazil...

Resumo A discussão de captura regulatória não é uma agenda recente em estudos do Estado, mas o estabelecimento de critérios para identificação de captura, bem como a definição de protocolos para demonstração e mensuração do fenômeno estão longe de um consenso. O presente artigo tem por objetivo, por meio de uma revisão sistematizada não exaustiva d...

The COVID-19 pandemic posed challenges for healthcare systems and political leaders across the globe. In this case study of Brazil, we argue that leadership failings at the highest level contributed to Brazil’s relatively high and escalating death rates during 2020. Drawing on an analysis of a large amount of textual documentation drawn from media...

During the pandemic, Brazil has provided its citizens with support in the areas of long-term care and disability, the labor market, social assistance, education, and pensions. This report focuses on two social policy areas, healthcare and family benefits (including labor policies), as these were the most crucial social policies implemented in Brazi...

As the world struggles to meet the challenges of vaccination against COVID-19, more attention needs to be paid to issues faced by countries at different income levels. Middle-income countries (MICs) typically lack the resources and regulatory capacities to pursue strategies that wealthier countries do, but they also face different sets of challenge...

Vaccines against SARS‐CoV‐2 continue to be developed at an astonishingly quick speed and the early ones, like Pfizer and Moderna, have been shown to be more effective than many public health scientists had dared to hope. As COVID‐19 vaccine research continues to progress, the world's eyes are turning toward medicine regulators. COVID‐19 vaccines ne...

In this chapter, we explore the evolution of public health initiatives during the COVID-19 pandemic in Brazil, the social policies adopted to allow people to quarantine, and the political and institutional factors shaping Brazil’s response. We analyze the negative role played by President Bolsonaro’s denialism and misinformation while emphasizing t...

It is easy but mistaken to think that public health emergency measures and social policy can be separated. This paper compares the experiences of Brazil, Germany, India and the United States during their 2020 responses to the COVID-19 pandemic to show that social policies such as unemployment insurance, flat payments and short-time work are crucial...

COVID-19 is the most significant global crisis of any of our lifetimes. The numbers have been stupefying, whether of infection and mortality, the scale of public health measures, or the economic consequences of shutdown. Coronavirus Politics identifies key threads in the global comparative discussion that continue to shed light on COVID-19 and shap...

Resumo O artigo discute o Índice de Capital Humano (ICH) proposto pelo Banco Mundial em 2018 para avaliar o desempenho das áreas de saúde e educação de 157 países. A situação do Brasil é comparada com sociedades com sistemas de proteção social institucionalizados. Demonstra-se que a condição do Brasil no ICH é sofrível em função do baixo desempenho...

In this chapter, we explore the evolution of public health initiatives during the COVID-19 pandemic in Brazil, the social policies adopted to allow people to quarantine, and the political and institutional factors shaping Brazil’s response. We analyze the negative role played by president Bolsonaro’s denialism and misinformation whilst emphasizing...

COVID-19 has created a ramifying public health, economic, and political crisis throughout many countries in the world. While globally the pandemic is at different stages and far from under control in some countries, now is the time for public health researchers and political scientists to start understanding how and why governments responded the wa...

Despite the relevance of qualitative methods in political science, the process of teaching qualitative research has received relatively little attention in the literature. What is it like to teach qualitative research in political science? This article focuses on the teaching of qualitative research by exploring examples from Brazil. The country is...

This viewpoint reflects on the challenges of promoting affordable and innovative medicines while fostering a competitive environment for research and development in developing countries. We explore the life sciences industrial policies of Brazil and the United Kingdom in order to identify mechanisms and conditions that could serve as lessons to pra...

Brazil’s strategy for addressing hepatitis C, which combines evidence-based treatment protocols and innovative initiatives for local production of generic direct-acting antiviral drugs, needs to be considered in light of ongoing conflicts over pharmaceutical patents.

Drug users (DU) are a marginalized group and at risk for viral hepatitis, who seldom access health services. A cross-sectional survey was conducted with 111 DU with chronic HBV/HCV and 15 in-depth interviews with health professionals/policymakers in Rio de Janeiro, Brazil. Most interviewees were male, non-white, with a low educational background, u...

Brazil has encouraged an ambitious set of policies toward the pharmaceutical industry, aiming to foster technological development while meeting health requirements. We characterize these efforts, labeled the “Health-Industry Complex” (Complexo Industrial da Saúde, CIS), as an outcome of incremental policy change backed by the sustained efforts of p...

The global health community is increasingly advocating for the local production of pharmaceuticals in developing countries as a way to promote technology transfer, capacity building and improve access to medicines. However, efforts to advance drug manufacturing in these countries revive an old dilemma of fostering technological development versus g...

Brazil was the first low- and middle-income country to provide universal treatment access to people living with the acquired immunodeficiency syndrome (AIDS), becoming a widely acclaimed model for best practice to managing this epidemic. However, we know little about important challenges to the key pillars of Brazil's response. This article discuss...

Promoting the use of generic drugs can constitute a core instrument for countries' national pharmaceutical policies, one that reduces drug expenditure while expanding health care access. Despite the potential importance of such policy measures and the differences among national practices, scholars embarking on comparative analysis lack a roadmap fo...

Promoting the use of generic drugs can constitute a core instrument for countries’ national pharmaceutical policies, one that reduces drug expenditure while expanding health care access. Despite the potential importance of such policy measures and the differences among national practices, scholars embarking on comparative analysis lack a roadmap fo...

Although there has been a renaissance of qualitative methods in political science and a relative increase of courses offered in American universities, the teaching of qualitative research has received relatively little attention in the literature. What is it like to teach qualitative research in political science? What are the cultural, structural,...

The protection of pharmaceutical intellectual property (IP) rights is one of the most controversial debates in contemporary public health as countries have to balance incentives for drug development with the necessity of providing life-saving drugs. Compliance with IP protections is mandatory for members of the World Trade Organization (WTO). Howev...

The World Health Organization estimates that approximately 60% of the world’s new annual cancer cases occur in Asia, Africa, and Central and South America, and that 70% of cancer deaths occur in these regions. Although oral chemotherapy is a promising intervention for cancer treatment, given its high cost, it is usually unavailable in middle-income...

This chapter aims to provide a critical analysis of the literature on policy studies on generic drug regulation and contextualise the Brazilian case. Very few studies of the political process to implement generic drug regulation were identified. This type of study is particularly important in clarifying how the drug policy is discussed, approved an...

This chapter explores the development of the generic drug policy. We know that generic drug regulation persisted even after Serra left the government, but we know less about how this happened. In what ways has the generic drug regulation influenced the governance of the pharmaceutical sector in Brazil? The first part presents the economic outcomes...

This chapter turns now to assess the stakeholders that question the current architecture of the pharmaceutical regulation in Brazil. There is an increasing apprehension among AIDS activists about the stringency of Brazil’s regulation for generic medicines, citing that these rules might limit competition and undermine access to medicines. Similarly,...

Brazil has a relevant, although relatively unknown, special medicines programme that distributes high-cost products, such as drugs needed for cancer treatments. In 2009, the purchase of these medicines became the responsibility of the Brazilian Federal Government. Until then, there were no clear norms regarding the responsibilities, in terms of the...

The World Health Organization (WHO) promotes the use of generic drug policies to foster competition in the pharmaceutical sector, reduce drug prices, and increase access to therapeutic drugs. However, little is known about how countries implement these policies. This article describes different terminology adopted by national regulatory authorities...

Reviews: “Brazil, in public health as in so many other things, is much discussed but frequently misunderstood. For all the ink spilt discussing access to medicines, astonishingly little work has investigated the actual politics and effects of Brazil's famously innovative access to medicines policy. Fonseca's pathbreaking book solves this problem,...

The contribution of health policy research to both the theory and the practice of decentralization has been voluminous but often disappointing. This chapter argues that the challenge for health systems analysts is to adopt and use cat- egories from other social sciences, especially economics, political science, and comparative social policy, in a t...

This chapter traces the period of the generic drug reform in Brazil and its institutional antecedents. The first part provides background information about the local production of medicines to contextualise the pharmaceutical sector in Brazil. The second part assesses the three antecedent events to the Generic Drug Act that happened together in the...

Brazil is renowned worldwide for its remarkable reforms in pharmaceutical regulation, which have enhanced access to essential medicines while lowering drug costs. This book innovates by analysing the generic drug reform in Brazil, demonstrating that pharmaceutical regulation is only partially influenced by non-state actors. Little is known about th...

Brazil is well-known for its vigorous AIDS advocacy. During the 1990s, AIDS activists in Brazil centred their agenda on demanding the provision of medicines by pressuring the government through the media and courts to gain legal recognition of their rights to health as guaranteed by the 1988 Constitution. After this period of initial confrontation,...

O Brasil possui um relevante, porém pouco conhecido, programa de medicamentos especializado, com distribuição de produtos de alto custo, como no caso do tratamento do câncer. Em 2009 a compra destes medicamentos passou a ser de responsabilidade federal. Até então não existiam normas claras sobre as responsabilidades da União e estados na gestão e f...

Brazil is renowned worldwide for its remarkable reforms in pharmaceutical regulation, as the Generic Drug Act that have enhanced access to essential medicines while lowering drug costs. In contrast with analysis of pharmaceutical regulation that invokes international guidelines as inspiration for countries to reformulate their norms or argues that...

Brazil is renowned worldwide for its remarkable reforms in pharmaceutical regulation, as the Generic Drug Act that have enhanced access to essential medicines while lowering drug costs. In contrast with analysis of pharmaceutical regulation that invokes international guidelines as inspiration for countries to reformulate their norms or argues that...

In contrast to analyses that regard health policy and industrial policy as anathema to each other, either because an emphasis on health implies neglect of industry or because gains in industrialization come at the expense of health, we show positive synergies between the two realms. Government intervention into the health sector can catalyze interv...

In contrast to analyses that regard health policy and industrial policy as anathema to each other, either because an emphasis on health implies neglect of industry or because gains in industrialization come at the expense of health, we show positive synergies between the two realms. Government intervention into the health sector can catalyze interv...

Civil society action in national policies in response to the AIDS epidemic since the 1980s, one of the prime examples of successful policy combining government capability and societal activism in Brazil, is examined by Elize Massard Fonseca and Francisco Inácio P. Bastos. As the basis for analysing the overall policy, they focus on government polic...

Introduction Brazil's response to the HIV/AIDS epidemic has been viewed worldwide as one of its most successful policies. This chapter discusses the crucial and evolving role of civil society organisations (CSOs) in the Brazilian response to the AIDS epidemic. Specifically, we explore the responsibility of civil society in shaping AIDS public polic...

Policy analysis in Brazil is part of the International Library of Policy Analysis and is the first book to paint a comprehensive panorama of policy analysis activities in Brazil. Highlighting the unique features of the Brazilian example, it brings together 18 studies by leading Brazilian social scientists on policy analysis as a widespread activity...

Governing decentralized health policy in Brazil (e-letter) Elize M. Fonseca, Postdoctoral Research Fellow, Center for Metropolitan Studies, Sao Paulo, Brazil Diogo Ferrari Comments and Response to Rich, Jessica A., & Eduardo Gómez. 2012. Centralizing decentralized governance in Brazil. Publius: The Journal of Federalism, 42(4), 636-661. We read Je...

Although many study the effects of different allocations of health policy authority, few ask why countries assign responsibility over different policies as they do. We test two broad theories: fiscal federalism, which predicts rational governments will concentrate information-intensive operations at lower levels, and redistributive and regulatory f...

Psicólogos, enfermeiros, assistentes sociais, médicos, terapeutas ocupacionais, nutricionistas: ao todo, 28 autores com variados perfis e experiências produziram os 16 capítulos deste livro, cujas análises, muitas vezes, põem em xeque o senso comum. “Senso comum que insiste em tingir com alarmismo apocalíptico as drogas, investindo-as de um caráter...

Drug users (DU) are a marginalized group and at risk for viral hepatitis, who seldom access health services. A cross-sectional survey was conducted with 111 DU with chronic HBV/HCV and 15 in-depth interviews with health professionals/policymakers in Rio de Janeiro, Brazil. Most interviewees were male, non-white, with a low educational background, u...

Brazil has one of the developing world's largest, and arguably most successful, AIDS treatment programs. In this paper we review the treatment program, including controversial policies that Brazil has used to promote widespread local and global access to AIDS treatment. We also examine the lessons learned from this program and highlight the challen...

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trad...

What effects do interest groups have on the democratization and legitimacy of the European Union (EU)? Interest groups can democratize the EU only to the extent that they do not replicate inequalities. We use a newly constructed database to look for inequalities: Are the big organizations in Brussels the same as the ones in the EU member states? Ar...

Background: Little is known about the long-term drug costs associated with treating AIDS in developing countries. Brazil's AIDS treatment program has been cited widely as the developing world's largest and most successful AIDS treatment program. The program guarantees free access to highly active antiretroviral therapy (HAART) for all people livin...

Translation of the Abstract into Portuguese by Francisco Bastos, Amalia Bastos, and Amy Nunn (30 KB DOC)

Translation of the Abstract into Spanish by Germán Velasco and Amy Nunn (41 KB DOC)

This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are ass...

This paper assesses how decentralization of re- sources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Pro- grams (SEPs) are...

This exploratory study examined patient-provider communication dynamics regarding adherence to highly active antiretroviral therapy (HAART) and protective sexual behavior among people living with HIV/AIDS (PLWHA). We conducted 20 direct observations of routine consultations between PLWHA and care providers in two large public health clinics providi...

The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP). After consulting national and regional networks of people working in projects/programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempt...

O uso de drogas injetáveis acarreta, com freqüência, danos ao próprio usuário de drogas, à comunidade em que ele está inserido e, em dadas circunstâncias, à sociedade de uma forma geral. Esses danos envolvem o risco de overdose; de transmissão do HIV (vírus da Aids) e dos vírus das hepatites, no compartilhamento de agulhas e seringas potencialmente...