Saúde digital e Covid-19 nos BRICS: a liderança da China e a perspectiva do Brasil na pandemia

Abstract

Pandemics have accompanied human history. Recently, the response to COVID-19, one of the greatest challenges of the 21st century, highlighted the importance of digitalization in healthcare and of international cooperation mechanisms, such as BRICS, in addressing global health threats. This study aims to analyze the use of digital health in addressing COVID-19 in BRICS member countries, with a focus on Brazil and China. Initially, a scoping review was conducted on digital health solutions for surveillance, prevention/control, and clinical management of COVID-19 in BRICS countries. Five steps were followed: 1) defining the research question, 2) identifying relevant documents, 3) selecting documents, 4) extracting data, and 5) summarizing and presenting the results. Next, a multiple case study on Brazil and China compared the countries and the development of digital health, with COVID-19 as a turning point. The selection of countries was driven by a particular interest in the Brazilian context, by China's leading role in the use of digital solutions to tackle the pandemic, and by their contrasting performances in overcoming the crisis - Brazil recorded the highest and China the lowest COVID-19 mortality rates among the BRICS countries. Three steps were followed: 1) defining and planning, 2) preparation, data collection, and analysis, and 3) analysis and conclusion. Through the scoping review, involving databases and gray literature, 481 out of 8,551 initial records were included, from which 900 mentions of digital health solutions were extracted. China's leadership in the number of solutions was identified, followed by India, with Brazil in third place. Most solutions were subnational in scope and publicly funded. Regarding technological types, in addition to eHealth, emerging technologies such as and big data were highlighted. The public-private partnership in China and the international reach of solutions in India were distinguishing factors. Intra-BRICS cooperation was weak. Emphasis was placed on the use of digital solutions by data services for surveillance and by healthcare professionals for clinical management of COVID-19. The multiple case study confirmed the initial theory that pre-existing national capacities influenced how countries developed and implemented digital health solutions to address COVID-19. China started from a position of advantage, the result of its longstanding prioritization of health and digitalization in the sector - a process accelerated after the 2002 SARS epidemic, which became a turning point for digital health transformation. Since then, the country has invested in strengthening its autonomous technological and infrastructural capacity, launching national projects focused on emerging technologies such as artificial intelligence and big data, supported by the private sector and encouraged by regional cooperation. During the pandemic, strict containment measures were implemented to control the spread of COVID-19 in China, combining traditional approaches with digital solutions to support public health efforts such as case identification, contact tracing, and monitoring the disease’s transmission chain. In the post-COVID-19 context, China’s priorities include reducing inequalities in access to digital health, continuing to develop the national industry, standardizing and integrating data, and improving data privacy and security policies. In Brazil, digital health advanced at a slower pace. Before the pandemic, the country was working toward national integration, but basic issues - such as the digitalization of health facilities - remained unresolved. During the pandemic, the Brazilian federal government’s denialism resulted in a more moderate mitigation response, downplaying the severity of the health crisis and leading to unsatisfactory outcomes. In 2020, the launch of the Digital Health Strategy for Brazil 2020-2028 aimed to implement the National Health Data Network. However, the difficulty in meeting the targets within the established timeframe highlights the challenges of advancing digital health implementation in the country. Telemedicine gained prominence with the pioneering regulation of teleconsultations, but infrastructure deficiencies, difficulties in executing strategic plans, and the lack of national coordination limited progress. In the post-COVID-19 period, digital health in Brazil gained renewed momentum with the creation of the Secretariat for Information and Digital Health (2023) and the launch of the SUS Digital program (2024), aimed at digitally transforming the Brazilian health system. Brazil and China hold strong potential for strategic collaboration: Brazil could benefit from China’s experience in technological infrastructure and health innovation, while China may find inspiration in elements of Brazil’s primary health care model. Together, they can collaborate to promote interoperability, reduce regional inequalities, and strengthen their health industries. This study emphasized the importance of cooperation between countries, not only to share experiences but also to strengthen their strategic positions in the international context, contributing to the health agenda in the Global South.