[In the press] Rio de Janeiro’s temple to health sciences!

In line with the history and spirit of Dr Oswaldo Cruz, the foundation that carries his name and celebrates its 120th anniversary continues to provide Brazil and the world with innovative and high-quality health services thus fulfilling the bold vision of its creator.

In the pantheon of Brazilian national heroes in the field of science, Dr Oswaldo Cruz stands out as the most prominent figure. He was an ambitious man and knew exactly what he wanted. Born to a middle-class family in the inland of São Paulo in 1872, he made it to the prestigious medical college of the Federal University of Rio de Janeiro already at the age of 15 and concluded his studies with an outstanding thesis on “Microbial transmission through water”. An insatiable enthusiast for microbiology, he later left a high-rank position in a national laboratory in order to spend two years in the renowned Pasteur Institute in Paris, where he got to deepen his knowledge on serotherapy and immunology, in addition to interacting with famous scientists such as the French bacteriologistÉmile Roux and Nobel laureate Ilya Mechnikov.

From a tiny lab in the forgotten mangrove swamps of northern Rio, Fiocruz evolved into Latin America’s largest and most prominent health research institution. (Photo: Cristiano Mascaro)

Dr Cruz rose to prominence- both for good and bad – when he returned to Rio, Brazil’s capital by then. After co-founding the Federal Serotherapic Institute on 25 May 1900 and becoming its Director-General a year later, he was appointed Director-General of Public Health of Brazil, a post equivalent to today’s Health Minister. In these roles, he literally created and implemented the concept of “public health service” in the country. In order to successfully fight the bubonic plague and yellow fever, he introduced innovative procedures such as the isolation of patients, compulsory notification of positive cases, raids against mosquitoes and rats, and disinfection of homes in risky areas.

Yet, during an outbreak of smallpox in 1904, he had to face his greatest enemy: unfounded opinion. Citizens, the press and politicians protested against Oswaldo Cruz’s universal immunization program by arguing that it would cause more harm than the disease itself. The rebellion escalated and turned into public mayhem, an episode that became known as the “Vaccine Revolt”. The government finally stepped back, but during a second outbreak of the disease years later, people would voluntarily show up at government offices to get vaccinated. At the end of the day, Dr Oswaldo Cruz was right, and this was duly recognized: he became known as “microbe crusader”, won the Gold Medal of the 14th International Congress of Hygiene and Demography in Berlin in 1907 and was repeatedly sought after to fight outbreaks all over the country. Thanks to him, malaria was brought under control in the Amazon region and yellow fever in other hotspots in Brazil. Due to a chronic kidney condition, Dr Oswaldo Cruz died prematurely at the age of 44, while serving as mayor of the city of Petrópolis, in the highlands of the state of Rio de Janeiro.

Dr Oswaldo Cruz has shaped Brazil’s overall research and public health landscape. Yet nowhere can his legacy be more significantly seen than in the institution he helped establish exactly 120 years ago. The former serotherapy institute became today’s “Oswaldo Cruz Foundation”, short “Fiocruz”.

From a tiny lab in the forgotten mangrove swamps of northern Rio, Fiocruz evolved into Latin America’s largest and most prominent health research institution. The foundation is better understood as a full-fledged “health complex”, as it carries out not only R&D, but also large-scale production of drugs and vaccines, medical services, health campaigns, vocational training, graduate programs and public policy advisory. Formally under the Brazilian Ministry of Health, Fiocruz encompasses 11 supporting institutes at its headquarters, 10 regional offices throughout Brazil and an international office in Mozambique.

The Pharmaceuticals Technology Institute (Farmanguinhos) is one of Fiocruz’s main institutions and currently develops drugs for tropic and endemic diseases such as malaria, viral hepatitis, Aids and cardiovascular dysfunctions, among many others. Its production line is capable of manufacturing 2,5 billion drug units a year. In 2017, it started a partnership with Indian pharma major Lupin in order to co-produce combined medicaments against tuberculosis, a disease that still haunts both Brazil and India.

Another top-notch facility is the Institute of Technology in Immunobiologicals (Bio-Manguinhos), which is Latin America’s largest development and production centre for vaccines and lab reagents of infectious and parasitic diseases. It is an international reference for yellow fever vaccines, accounting for 80% of worldwide production. A vaccine against AC meningococcal meningitis is also among the institute’s expertise. In 2018 alone, it produced 119 million vaccine units (about one-third of Brazil’s total demand) and 6,6 million diagnostic kits.

Fiocruz has been at the forefront of the fight against new diseases. In 2015, its scientists spearheaded research on Zika and chikungunya, building on previous understanding from dengue-related studies. The first testing kit to differentiate these three was developed by the foundation. In previous years, it had made similar strides in developing rapid diagnosis for HIV.

Most recently, in response to the COVID-19 pandemic, the foundation has taken the lead in treating patients as well as conducting research on the disease. This month, the National Institute of Infectologyunder Fiocruzwas partially converted into an advanced hospital unit, equipped with state-of-the-art devices in order to treat complex and advanced cases. Fiocruz has also set up the “Covid-19 Observatory”, which aims at integrating results from various research fronts within the Foundation, such as those dealing with epidemiological scenarios, social impacts of the pandemic, control measures and patient`s safety. Pioneering research projects — such as the effect of the novel coronavirus disease on rare diseases and the vulnerability of indigenous people to COVID-19 — have also been jumpstarted by its scientists.

The Foundation’s decisive contribution to fighting the pandemic has been recognized by the international community: the World Health Organization (WHO) designated Fiocruz’s laboratory on respiratory viruses as a Reference Laboratory for Covid-19 in the Americas. (The only other such reference lab in the Americas is at the Center for Disease Control, in the United States.)

In line with the history and spirit of Dr Oswaldo Cruz, the foundation that carries his name and celebrates its 120th anniversary continues to provide Brazil and the world with innovative and high-quality health services thus fulfilling the bold vision of its creator. The building that houses Fiocruz is one of the architectural icons of Rio de Janeiro and a triumph of eclectic architecture in Brazil. It would have been a perfect fit to Mumbai’s and Kolkata’s late 19th-century Indo-Saracenic scene. Rumour has it that once asked by an unadvised passer-by at the construction site whether the towering building was supposed to be a church, Dr Cruz answered without hesitation: “Yes, it is going to be a temple…to Science!”

Authors: André Aranha Corrêa do Lago, Ambassador of Brazil to India and Pedro Ivo Ferraz da Silva, Embassy of Brazil in New Delhi.