Populist Pharmakons

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On March 22, Venezuelan President Nicolás Maduro delivered a long cadena– an impromptu speech carried live by public and regime-controlled TV stations – dedicated exclusively to COVID-19. Wearing, somewhat incongruously, a FC Barcelona tracksuit, Maduro gave a grim report on the spread of the virus around the world and justified his decision to impose a “voluntary and radical national quarantine” across the country. People should stay at home, he exhorted, and everybody walking around will need to wear a face mask at all times. He made clear that the full power of the state would be used to enforce these and any other additional measures the crisis might demand. The military immediately joined the effort by announcing that, at 10am the following morning, fighter jets of the Bolivarian Air Force would start flying over Caracas in a show of support.

So far so good, or at least (minus the air parade) in line with what many other countries around the world are doing at the moment. But then Maduro’s speech took an unexpected turn. Displaying a folder of charts and printouts, he disclosed a recent conversation with Sirio Quintero, a Venezuelan “nanotechnologist” who claims to have found a cure for COVID-19. Derived from “ancestral” Venezuelan medical knowledge, the improbable remedy consists of a brew of malojillo (lemongrass), ginger, black peppercorns and lemon zest, to be drunk at regular intervals seven times a week. The SARS-CoV-2 virus itself – Dr. Quintero argued and Maduro repeated – is an intracellular parasite engineered by unnamed “centres of imperial power” as a weapon of bioterrorism (not a particularly lethal one, we can surmise, if it can be defeated with a herbal infusion). In the last few days regime-affiliated outlets – including Maduros’s own Twitter account – have energetically promoted Mr. Quintero’s “very Venezuelan” COVID-19 remedy. 

A “revolutionary” quarantine, parades of low-flying fighter jets, and a home brew of malojillo make for an odd policy mix to combat a clear and present public health danger. The combination of the coercive and the ludicrous is typical of the current situation in Venezuela, but slightly less virulent forms of the same strain of heavy-handed crackpottery have been in evidence among other self-styled ‘strong men’ in the region. 

In Brazil, President Bolsonaro has consistently downplayed the seriousness of COVID-19 (“It’s just a little flu or the sniffles”), tried to sabotage stay-at-home orders issued by state governors, and declared large religious gatherings “essential services” to prevent their closure by local authorities. The only concrete measure he has adopted – or at least the only one he appears to have adopted willingly – was an order to the Ministry of Defence to increase production of the chloroquine, followed by a decision to ban exports of the drug. He did this, of course, the day after Donald Trump had touted in a press conference the promise of the anti-malarial drug despite the lack of hard evidence about its therapeutic effect against the new coronavirus (“I feel good about it”). Bolsonaro continues to extoll the merits of chloroquine in virtually all his public appearances. Videos posted by him on social media declaring that chloroquine “works everywhere” were recently removed by Facebook and Twitter for spreading misinformation. 

Obviously chloroquine is not malojillo– it is far more toxic – but the logic that drives Bolsonaro (and Trump for that matter) to hype the prospects of an unproven treatment is not too dissimilar from Maduro’s eagerness to publicize Dr. Quintero’s pseudo-treatment: a desperate hope that a ready-made cure will absolve them from the obligation to mount a proper public health response.  

The proliferation of these populist pharmakoi raises important questions about the political impact of the new coronavirus in the Americas. One would expect authoritarian rulers to use the COVID-19 emergency to consolidate their grip on power. This is at least how epidemics have often played out in history. A sudden and acute biological threat increases the vulnerability of the population and enhances the role of the state as the only effective lever of power. “Social distancing” measures disorganise civil society and limit the capacity of citizens to coordinate collective acts of protest, particularly in countries where rulers are able to control the flow of information. The result is an opportunity for non-democratic leaders to concentrate power in their own hands with the excuse of serving as “protectors” of the people in times of critical need. China’s experience with COVID-19 offers a good example of this dynamic. In Hungary, Orbán is trying to follow the same playbook.

But this principle assumes that rulers have an interest in promoting public health to begin with – whether as a substantive end in itself, a means of concentrating political power, or a combination of both. When rulers display instead a general indifference towards the wellbeing of their population and lack the wherewithal to take effective measures, public health crises accentuate the shortcomings of authoritarian regimes and reveal their deepest contradictions.

In this regard, Bolsonaro’s blasé response to COVID-19 (“Some will die. I’m sorry. That’s life”) is not simply a reflection of his limited understanding of the lethality of the virus, or an attempt to ape his hero in the White House, but above all a sign of his chronic disregard for the health of the nation in general, and of large (read: poor) sections of the population in particular. His obsession with chloroquine at the expense of other actions that might reduce the spread of infection or alleviate the suffering already unfolding in the country reflects the absence, within his impoverished ideological worldview (“Brazil above everything, God above everyone”), of any principle that might be translated into actual and effective assistance to his people in this hour of need. His pandemic strategy consists entirely in gambling on the efficacy of an old antimalarial drug. 

It is telling that, in the absence of a coherent government policy, initial efforts to contain the virus in deprived urban areas have relied on the mobilization of a myriad community organisations and grassroots initiatives. Even criminal syndicates are displaying a keener sense of the public health threat. In some favelas in Rio de Janeiro, drug-trafficking gangs and militias are reportedly enforcing lockdowns and limiting large public gatherings. As gang members in Cidade de Deus angrily noted: “We’re imposing a curfew because nobody is taking this seriously.”

The situation in Venezuela is even more dramatic. The hollowing of state institutions leaves the country with very few options against the virus. With a shattered health system the country will be unable to manage a growing outbreak (some of the hospitals designated by the government to lead the COVID-19 response do not even have running water, and the country has probably fewer than 200 active Intensive Care Units for a population of more than 30 million). The situation is likely to escalate quickly when the general lockdown starts to be ignored by impoverished Venezuelans who can’t work remotely and rely on daily commercial activity to survive. 

The social distancing strategies imposed by Maduro also represent a severe blow to the extremely fragile Venezuelan economy, which had just experienced a small revival following the lifting of some economic controls. Travel restrictions and lockdowns across the region threaten to close the country’s only escape valve: large-scale migration and the remittances sent by Venezuelans living and working abroad. Furthermore, the arrival of COVID-19 coincides with the global collapse of oil prices and a steady decline in national oil production and revenue. The prospects are so dire that Venezuela has recently requested financial help from the International Monetary Fund (IMF) to purchase medical equipment. The IMF has so far refused any assistance, and is unlikely to change course now that the U.S. Department of Justice has brought charges of drug-trafficking against Maduro and other leading regime figures.

In the meantime, the virus has become another excuse to crack down on internal opponents or anybody perceived to represent a threat to the regime. Darvinson Rojas, a Caracas-based journalist, was detained by security officers on March 21 under the allegation that someone in his house had denounced a COVID-19 case. Other journalists have been forced by the military to surrender their mobiles after visiting hospitals in Caracas. Citizens who denounce the shortcomings of the government’s response are forced into hiding. In poor areas of Caracas, colectivos armed groups of pro-regime civilians) have been imposing curfews, using in some cases indiscriminate force. On March 21 three people were shot dead, allegedly by members of one of these groups, when they were found playing board games in the street in defiance of the order to remain indoors. 

Civil society groups, which are playing a crucial role in tackling other ongoing public health emergencies such as the limited supply of antiretroviral HIV drugs, are no substitute for concerted public health action in the face of a pandemic. Palliative community activism of the sort in evidence in Brazil is hampered by the regime’s suspicion of any social organisation it does not directly control. In the meantime, Dr. Quintero’s bogus cure remains, tragically, the least harmful of the government’s policies. 

Juan Carlos Gabaldón is a Venezuelan medical doctor interested in tropical medicine, malaria and public health. Currently a MSc candidate in Medical Parasitology at the London School of Hygiene and Tropical Medicine.

Javier Lezaun is Associate Professor in the School of Anthropology and Museum Ethnography at the University of Oxford, where he directs the Institute for Science, Innovation and Society (InSIS).