Risk governance in the response to global health emergencies:Understanding the governance of chaos in Brazil’s handling of the Covid-19 pandemic

Covid-19 has shown how inadequate institutional strategies interact with, and exacerbate, social inequalities, thus impacting upon the intensity of the harm produced and amplifying negative consequences. One of the lessons from this pandemic, which happens against the background of other, interconnected systemic crises, is the urgency of adopting a “whole-of-society” approach to determining what works and what does not work in the context of a health emergency response. But how can institutional performance in health emergency response be assessed? How to make sense of success or failure? We argue that the adoption of a risk governance approach sheds light on institutional performance in the response to health emergencies. Risk governance is particularly pertinent in situations where the potential for extreme consequences is considered high, where there are enormous uncertainties regarding the consequences, and where different values are present and in dispute. Based on a documentary evidence review, we analyse the Brazilian response to Covid-19 by considering: 1) how the Brazilian federal government performed on its central role of managing the national response, 2) the reactions from other actors prompted by this performance, and 3) the main observed effects emerging from this scenario. We argue that the Brazilian federal government response was weak in five risk governance parameters that are essential in a health crisis response: risk communication; transparency and accessibility of data; negotiation between actors; social cohesion and public participation; decisions based on technical and scientific evidence, resources and contexts. The neglect of risk governance parameters, combined with an attempt to spread doubt, confusion, and disinformation – which could be termed a ‘governance by chaos’ – is an important element for making sense of the effects and controversies surrounding Covid-19 in Brazil.