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Study: Brazil govt undercounts Indigenous deaths from COVID-19 by half

  • A new study shows that official records underreported COVID-19 deaths among Indigenous people in Brazil by half, and also substantially underreported total numbers of infections.
  • A key factor in the problem is that the official records only consider Indigenous people living within officially recognized Indigenous territories, effectively effacing the 36% of Brazil’s Indigenous who live in urban areas.
  • The study authors say that by failing to acknowledge the full extent of the impact of COVID-19 on Indigenous populations, the government can’t allocate adequately funding and other resources to address it.
  • stTo date, COVID-19 has killed more than 1,000 Indigenous people across Brazil, with more than 52,000 confirmed infections across people from 163 ethnic groups.

Indigenous people in the Brazilian Amazon are dying at twice the officially recorded rate from COVID-19, according to an independent study that also found a higher rate of infections than that reported by the government.

The data, from an independent survey by the Coordination of Indigenous Organizations in the Brazilian Amazon (COIAB), show a 103% higher number of fatalities than reported by the Ministry of Health’s Special Secretariat for Indigenous Health (Sesai). They also show a 14% higher number of infections, covering the period Feb. 23 to Oct. 3, 2020. The study, conducted in partnership with other institutions such as the Amazon Environmental Research Institute (IPAM) and the Oswaldo Cruz Foundation (Fiocruz), was published April in the journal Frontiers in Psychiatry.

According to study co-author Valéria Paye from COIAB, this underreporting is intentional. “It’s an attempt to deny Indigenous identity itself as a result of structural prejudice. And that ends up being used to deny their right of access to vaccines and health care.”

She says the reason for the gap between the official data and what the survey found — 330 deaths compared to 670, and 22,127 confirmed infections versus 25,356 — is that the Ministry of Health doesn’t record cases of Indigenous people living outside official Indigenous territories. Effectively, Brazil’s public health authority has effaced the Indigenous people who live in cities, who accounted for about 36% of the country’s entire Indigenous population in 2010, according to the latest available census data. Such a policy also ends up excluding Indigenous people living in urban areas from priority vaccination lists.

The study shows that the COVID-19 incidence rate in Brazil’s Amazonian states (known as the Legal Amazon) is 136% higher than the national average for Indigenous people and 70% higher than in the region’s general population. The Indigenous mortality rate per 100,000 is 110% higher than the Brazilian average and exceeds the region’s average by 89%.

Fiocruz researcher and study co-author Paulo César Basta says such underreporting is extremely harmful. If the government recognizes only half of the problem, he says, it will allocate only half of the funding and resources needed to solve it.

“Then you’ll allocate less qualified professionals to deal with the issue, you’ll invest less, allocate fewer tests, and you’ll have a distorted view of reality, seeing the problem as smaller than it actually is,” Basta says.

The study paints this as a classic case of the government’s deliberate inability to obtain, screen and disseminate reliable and detailed data to inform a public policy. It attributes this deficiency to the federal government’s open persecution of Indigenous people and its funding for them, which has been slashed as a result of Brazil’s Spending Cap Act.

Even with the pandemic, the Indigenous health budget is the lowest it’s been in eight years. Partial data on spending in 2020 show a 14% drop compared to 2018, just before Jair Bolsonaro took office as president, according to a survey conducted by the Institute for Socioeconomic Studies (INESC). And the current budget of the federal Indigenous affairs agency, or Funai, which accounts for just 0.02% of the federal government’s budget, is the lowest in the last 10 years.

In response to the government’s failure to adequately respond to the impact of the pandemic on Indigenous people, the Articulation of Indigenous Peoples of Brazil (APIB) took the issue to court. In August 2020, the Supreme Federal Court unanimously ordered the Bolsonaro administration to take emergency measures to combat the pandemic among Indigenous peoples.

The ruling, which the government has still not fully complied with, calls for measures such as creating sanitary barriers, guaranteeing health care within the Sesai network, and expanding health services to Indigenous people living in cities and in lands undergoing the demarcation process.

“After more than a year into the pandemic, it seems that the federal government has learned nothing from the situation and is implementing a plan specially orchestrated to harm Indigenous people,” Fiocruz’s Basta says.

Ronoré Gavião, 105 years old, who lives in the Mãe Maria Indigenous Territory, was the first Indigenous person to be vaccinated in the state of Pará. Image by Bruno Cecim/Agência Pará.

Incomplete data and indigenous people infected by health professionals themselves

COIAB’s data on COVID-19 cases in the Amazon come directly from the affected communities, which isn’t the case with the data reported by the Ministry of Health. The group has recorded more than 38,000 COVID-19 cases and 918 deaths as of May 4 in the Amazon among 151 Indigenous communities of different ethnic groups.

In addition to data from Sesai, COIAB also takes into account information provided by Indigenous leaders, health staff working on the ground, and organizations that operate within the COIAB network. Across Brazil as a whole, according to APIB, 1,038 Indigenous people have died and more than 52,000 cases have been reported identified among 163 Indigenous communities. A national committee periodically updates the information.

These numbers are higher than those reported by the Ministry of Health on April 16, which lists 46,500 confirmed cases and 639 deaths from COVID-19 among Indigenous people.

The differences between the Ministry of Health’s simplified data and COIAB’s survey are underscored by Martha Fellows, a researcher at IPAM and lead authors of the recent study.

“If you want to think about health care policy, you have to know what is going on in detail. And for that, it’s important to have the most accurate data possible. That’d be crucial,” she says.

Another aggravating factor is that COVID-19 was introduced into Indigenous villages by health care workers who failed to take the necessary precautions, such as getting tested and quarantining for at least 14 days before entering the isolated areas in the Amazon.

“In many cases, Sesai’s own staff were the entrance door for the disease,” COIAB’s Paye says. “That’s what happened in my land, Tucumaque [between Pará and Amapá states]. We saw several cases like that.”

This also happened, for example, with Indigenous people living in the Vale do Javari Indigenous Territory, in the far west of Amazonas state, a region with the largest number of isolated groups, some of them with recent contact with the outside world.

Difficulty in accessing the health system is another crucial factor contributing to the pandemic’s impact on Indigenous populations: the average distance between Indigenous lands in the Amazon and the nearest towns with ICU beds is 271 kilometers (168 miles); for some villages in the Upper Negro River area, in the state of Amazonas, it’s more than 700 km (435 mi).

Asked to comment on the study, the problems and the cases reported, the Ministry of Health did not respond.

 
Citation:

Fellows, M., Paye, V., Alencar, A., Nicácio, M., Castro, I., Coelho, M. E., … Basta, P. C. (2021). Under-reporting of COVID-19 cases among Indigenous peoples in Brazil: A new expression of old inequalities. Frontiers in Psychiatry12. doi:10.3389/fpsyt.2021.638359

 
Banner image of Matsi Waura Txucarramãe, from the Kayapó people, in the village of Piaraçu in Mato Grosso state. Image by André Oliveira Cebola/InfoAmazonia.

This story was reported by Mongabay’s Brazil team and first published here on our Brazil site on April 19, 2021.