Investigating the ‘Bolsonaro effect’ on the spread of the Covid-19 pandemic: An empirical analysis of observational data in Brazil

Mireille Razafindrakoto; François Roubaud; Marta Reis Castilho; Valeria Pero; João Saboia

doi:10.1371/journal.pone.0288894

Peer Review History

Original SubmissionJuly 5, 2023
7 Sep 2023 Decision Letter - Ivan Filipe de Almeida Lopes Fernandes, Editor PONE-D-23-20876Investigating the ‘Bolsonaro effect’ on the spread of the Covid-19 pandemic: an empirical analysis of observational data in BrazilPLOS ONE Dear Dr. RAZAFINDRAKOTO, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: The manuscript presents updated results confirming that pro-Bolsonaro municipalities had higher fatality rates than other Brazilian municipalities. The article's theme is relevant, but there are already published articles showing more cases of COVID-19 and higher mortality in Brazilian municipalities where JB had more votes. Thus, for the present article to be considered for publication, the authors need to describe this previous research and be convincing about what the present article can add to the findings of these authors. Without this effort, the present article will be seen as "more of the same." The manuscript should also debate the centrality of STF decisions in combating the pandemic and Bolsonaro's attempts to prevent social distancing measures or mandatory vaccination. The author should also explain their methodological choices and the methods proposed to make causal inferences and be more comprehensive in presenting results. Finally, the conclusion should be refined to the broad literature about populism and democracy. ============================== Please submit your revised manuscript by Oct 22 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ivan Filipe de Almeida Lopes Fernandes, Ph.D. Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include a separate caption for each figure in your manuscript. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: The manuscript presents updated results confirming that pro-Bolsonaro municipalities had higher fatality rates than other Brazilian municipalities. The article's theme is relevant, but there are already published articles showing more cases of COVID-19 and higher mortality in Brazilian municipalities where JB had more votes. Thus, for the present article to be considered for publication, the authors need to describe this previous research and be convincing about what the present article can add to the findings of these authors. Without this effort, the present article will be seen as "more of the same." The manuscript should also debate the centrality of STF decisions in combating the pandemic and Bolsonaro's attempts to prevent social distancing measures or mandatory vaccination. The author should also explain their methodological choices and the methods proposed to make causal inferences and be more comprehensive in presenting results. Finally, the conclusion should also be refined to the broad literature about populism and democracy. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The paper is well written and has a clear and relevant research problem. The data used demonstrates that the main argument is well supported. I am not able to assess the quality of the statistical tests presented, but would like to draw attention to issues that could be improved in the text. First, it is important to emphasize the relevance of the paper not only for what it adds when compared to the existing literature. It failed to present the reader the relevance of the work to a broader discussion, such as the impact of populist and anti-science leaders for the development of evidence-based public policies and, specifically, for facing health crises, such as Covid-19. Regarding the works already published on the subject, I missed one that had repercussions in Brazil, that of Fernandes and Fernandes (2022), "Populism and health. An evaluation of the effects of right-wing populism on the COVID-19 pandemic in Brazil" There is a vast literature on the effects of populist leaders on democracy and its policies, and this debate should be mentioned in the paper's justification. Second, the paper has not mentioned a set of existing works in the national literature that mention the centrality of STF decisions in combating the pandemic and Bolsonaro's attempts to prevent social distancing measures or mandatory vaccination. Studies such as Fernandes and Ouverney (2022) and Oliveira and Madeira (2021), among others, have presented this debate. Finally, the conclusions were very much centered on the empirical findings, but failed to rescue the broader debate in which it is embedded, including the one mentioned above - the impact of populist leaders on the conduct of evidence-based public policy. Reviewer #2: The manuscript titled "Investigating the 'Bolsonaro effect' on the spread of the COVID-19 pandemic: an empirical analysis of observational data in Brazil" presents updated results confirming that pro-Bolsonaro municipalities had higher fatality rates compared to other Brazilian municipalities. In terms of the literature review, I recommend more extensive engagement with the article "Populism and health: An evaluation of the effects of right-wing populism on the COVID-19 pandemic in Brazil," published in PlosOne. To address potential bias associated with unobserved factors related to time and geography, it is advisable to include day and fixed-effects in your analysis. I discourage the use of the Negative Binomial (NB) model with fixed effects (FEs). Instead, it would be preferable to use either Linear Probability Models (LPM) or Poisson regression with fixed effects. A valuable reference for this approach is Wooldridge, J. M.'s 1999 paper, "Distribution-Free Estimation of Some Nonlinear Panel Data Models" in the Journal of Econometrics (Vol. 90, pp. 77–97). Tables should offer comprehensive details regarding variable measurements and technical information, reducing the need for readers to refer back to the article for clarification. Furthermore, I recommend excluding the last columns of Tables 1 and 2 if you do not intend to interpret the controls. This can streamline the presentation of results and emphasize the key findings. For a scientific journal, it is advisable to consider shortening your article to enhance clarity and improve communication with your readers. Lastly, given the causal nature of your research, it is imperative to clarify the causal interpretation of the main coefficient and provide robust justification. Explain why this coefficient can be interpreted causally and offer supporting evidence or reasoning. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Gabriel Cepaluni ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0288894.r001
Revision 1
15 Nov 2023 Author Response Please see the file "Response to the reviewers". Many thanks Attachments Attachment Submitted filename: Response to Reviewers - Investigating Bolsonaro effect.docx https://doi.org/10.1371/journal.pone.0288894.r002
19 Jan 2024 Decision Letter - Ivan Filipe de Almeida Lopes Fernandes, Editor PONE-D-23-20876R1Investigating the ‘Bolsonaro effect’ on the spread of the Covid-19 pandemic: an empirical analysis of observational data in BrazilPLOS ONE Dear Dr. RAZAFINDRAKOTO, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The manuscript presents updated results confirming that pro-Bolsonaro municipalities had higher fatality rates than other Brazilian municipalities. The paper's theme is relevant, and interesting and fundamental changes were made to the manuscript that made the study more suitable for a journal such as Plos One. However, some minor adjustments are still necessary for the manuscript to be published, as indicated by one of the reviewers, such as the issues of ecological fallacy, the choice and reasoning of controls, and omitted variabel bias, which need to be answered in the paper or justified to the reviewer. Please submit your revised manuscript by Mar 04 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Ivan Filipe de Almeida Lopes Fernandes, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: The manuscript presents updated results confirming that pro-Bolsonaro municipalities had higher fatality rates than other Brazilian municipalities. The paper's theme is relevant, and interesting and fundamental changes were made to the manuscript that made the study more suitable for a journal such as Plos One. However, some minor adjustments are still necessary for the manuscript to be published, as indicated by one of the reviewers, such as the issues of ecological fallacy, the choice and reasoning of controls, and omitted variabel bias, which need to be answered in the paper or justified to the reviewer. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The article has been carefully revised, taking into account the comments of the two reviews. The revision has helped improve the article and the result is now suitable for publication. Reviewer #2: Thank you for giving me the opportunity to review the revised version of “Investigating the 'Bolsonaro effect' on the spread of the Covid-19 pandemic.” I find the article promising, but it still requires several improvements before it can be published. Firstly, I noticed that the revised version is missing the figures and the appendix. A letter from the authors explaining the revisions would have been highly beneficial for me. On page 12, the claim that “a significant effect at the municipal level guarantees significance in terms of individual probabilities” is not accurate. This overlooks the ecological fallacy, an important statistical concept. Significant effects at a municipal level do not necessarily translate to similar relationships at an individual level, as aggregate data can mask significant variations. Thus, it's crucial to analyze and interpret data at the appropriate level to avoid incorrect inferences. Still on page 12, the authors’ dismissal of the potential influence of omitted variables correlated with political factors is unconvincing. Many factors could impact the relationship between support for Bolsonaro and the spread of Covid-19. For example, pre-existing characteristics of the municipalities, such as distrust in science or social behavior patterns, might influence this relationship. I believe the authors should focus on acknowledging the limitations of their research design rather than defending it weakly. I suggest that on page 13, instead of using bullet points, a chronological figure would be more effective for clarity. The authors do not disclose the controls in their regressions, which makes the analysis on pages 18 and 23 challenging to interpret. They should spend more time explaining their choice of controls, referencing the work of Carlos Cinelli, Andrew Forney, and Judea Pearl from 2022 on differentiating between “good” and “bad” controls. Since the authors frequently praise Brazil’s immunization system, I believe it is essential for them to present more substantial evidence and cite relevant literature to support these claims. For minor comments: - In the first paragraph, I suggest using an active voice and clearly stating that Brazil had the second-highest absolute number of Covid-19 deaths. - The term 'Covid-19' should be used consistently throughout the text. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Gabriel Cepaluni ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: ReviewPLOSONE2024.odt https://doi.org/10.1371/journal.pone.0288894.r003
Revision 2
27 Jan 2024 Author Response see the file "Response to reviewers" Detailed answers to Reviewers We would like to thank the editor and reviewers for their positive assessment of our article and their valuable comments. The suggestions helped us to improve the quality of the document. We have taken them all into consideration in our revision. We believe that the manuscript has been significantly improved and we hope that this revised version meets the journal's requirements for publication. In any case, we remain at your disposal if you have any further questions. Please find below our responses (in black) regarding the points you raised (in blue). To facilitate the iden-tification of our modifications, they appear in the revised manuscript (revision 2) as ‘track changes’. Reviewer #1: The article has been carefully revised, taking into account the comments of the two reviews. The revision has helped improve the article and the result is now suitable for publication. We would like to thank reviewer #1 for this comment in recognition of the efforts made to carefully revise and improve the manuscript (responding to and considering all the comments made in the previous review). Reviewer #2: Thank you for giving me the opportunity to review the revised version of “Investigating the 'Bolsonaro effect' on the spread of the Covid-19 pandemic.” Thank you for giving me the opportunity to review the revised version of “Investigating the 'Bolsonaro effect' on the spread of the Covid-19 pandemic.” I find the article promising, but it still requires several improvements before it can be published. Firstly, I noticed that the revised version is missing the figures and the appendix. A letter from the authors explaining the revisions would have been highly beneficial for me. First, we must stress that we have prepared and sent an extensive Answer to the Reviewers, with special attention to Reviewer#2 comments, who carefully reviewed our paper in the previous round (revision 1). We deeply regret the fact that reviewer 2 did not receive our detailed responses which consider all the comments (as pointed out by reviewer#1; see above). The figures and the appendix were also sent with the revised manuscript and the response to the reviewers. In his new review by Reviewer#2, some comments were already addressed in our first “Answer to the Reviewers”, while other are new comments, not stressed earlier. Thus, we will send our initial (and augmented) answers to the old comments (taking advantage to re-send the full Answer) and elaborate on the new queries. Reviewer #2: On page 12, the claim that “a significant effect at the municipal level guarantees significance in terms of individual probabilities” is not accurate. This overlooks the ecological fallacy, an important statistical concept. Significant effects at a municipal level do not necessarily translate to similar relationships at an individual level, as aggregate data can mask significant variations. Thus, it's crucial to analyze and interpret data at the appropriate level to avoid incorrect inferences. First, we make it clear in the paper that we do not interpret our results in terms of individual probabilities. Our approach and the analysis is carried out at the municipal level. Regarding the comment on the inaccuracy of this specific sentence “a significant effect at the municipal level guarantees significance in terms of individual probabilities”, we disagree with this point. Let us suppose there is no individual effect (correlation, conditional or unconditional) at the individual level (take for instance by gender). Necessarily, there should not be any effect at the aggregate (here municipal) level (P => Q). In consequence, as (No Q => No P), an effect at the aggregate (municipal) level implies necessarily the existence of an effect at the individual level. What is not known is the sign of the effect, although the probability the correlation changes its sign is limited, but it is still possible. This argument is explicitly developed in: McLaren, J. (2021). Racial disparity in COVID-19 death: Seeking economic roots with Census data. The B.E. Journal of Economic Analysis & Policy, 21(3), Doi: 10.1515/bejeap-2020-0371, p.899: ‘The data used are US county aggregates of COVID-19 mortality over time, matched with socioeconomic and demographic data by country. The mortality data are not broken down by race, but in principle one can still test for and measure racial disparity by looking for correlation between the size of a county’s minority population share and the county’s mortality rate. If there were no difference in mortality between a minority group and the rest of the population, the size of the minority share would have no effect on the county’s mortality rate, so this correlation provides indirect evidence of a disparity in mortality rates. The exercise follows two steps: first, confirm the existence of a racial disparity by using a regression to show that minority population shares are correlated with mortality rates. Second, control for a range of county-level socio-economic factors to see if the racial disparity weakens or disappears. If it does, then that stands as evidence that the socioeconomic factor is part of the reason for the racial mortality discrepancy” In our paper, we have specified that : “However, this type of approach has its limitations and the results should be interpreted with due caution. First, analysis by municipalities cannot be interpreted in terms of individual risks. However, we know that a significant effect at municipal level also guarantees significance in terms of individual probabilities. We can assume, then, that the individual and municipal approaches generally converge in terms of signs (McLaren, 2021). Otherwise, inverse mechanisms would need to be explained. ” Reviewer #2: Still on page 12, the authors’ dismissal of the potential influence of omitted variables correlated with political factors is unconvincing. Many factors could impact the relationship between support for Bolsonaro and the spread of Covid-19. For example, pre-existing characteristics of the municipalities, such as distrust in science or social behavior patterns, might influence this relationship. I believe the authors should focus on acknowledging the limitations of their research design rather than defending it weakly. New comment. The reviewer is right: the omitted variable bias cannot be excluded. But this is the case of all analysis on observational data (unless credible empirical strategies – like IV or RDD – can be implemented; which is not our case). However, in the specific example of political factors mentioned by the reviewer (distrust in science, social behaviour patterns), we do test this potential bias, at least for vaccination. As the “Bolsonaro effect” is not significant on other vaccines in 2019 (Bolsonaro was not in charge; placebo test), but only since 2020 on Covid-19 vaccination (and other vaccines), we can plausibly induce that we are capturing a real “Bolsonaro effect”, based on his specific attitudes and behaviours regarding the pandemic. Furthermore, logistic regressions based on an individual survey sponsored by Sou Ciência in 2022 show the “Bolsonaro effect” holds controlling for religion (evangelic, correlated with Bolsonaro support and anti-science attitudes) and other sociodemographic variables on vaccination, Covid-19 testing and masks (results available upon request to the authors). In all case, we explicitly highlight the potential issue of omitted variables (see our first Answer to the Reviewers). In our paper, we have specified that : “the econometric models tested here can be used to estimate the correlations between the mortality rate and different factors, corrected for structural effects. However, as in most analyses of observational data, we identify correlations that do not necessarily imply causality. For example, it is quite plausible that restrictions were applied more strictly in municipalities where mortality rates were already higher. It is therefore hard to disentangle the actual impact of the restrictive measures. Finally, there is the issue of potentially omitted variables correlated with political factors. In this case, the correlation observed in our model might be influenced by these omitted variables. Yet it is hard to find convincing arguments to support this reservation. Considering the data on comorbidities most often cited as examples of omitted variables, it is not clear to what extent they might be correlated with political factors” (Section 3.1, Empirical approach); and “Although the nature of the phenomenon analysed, with observational data, does not allow a causal relationship to be clearly identified, our specifications, which consider a large number of characteristics of municipalities, highlight significant and informative conditional correlations between political factors and the Covid-19 mortality rate.” (Conclusion) Reviewer #2: I suggest that on page 13, instead of using bullet points, a chronological figure would be more effective for clarity. We thank the reviewer for this suggestion, which makes the presentation clearer. A figure presents the timeline of the Covid-19 pandemic instead of bullet points. Reviewer #2: The authors do not disclose the controls in their regressions, which makes the analysis on pages 18 and 23 challenging to interpret. They should spend more time explaining their choice of controls, referencing the work of Carlos Cinelli, Andrew Forney, and Judea Pearl from 2022 on differentiating between “good” and “bad” controls. First, we would like to point out that the complete tables with the controls are available in the appendix provided with the manuscript (table S2, S3, S4, etc.). We have been advised to simplify the presentation of the tables in the body of the text, bearing in mind that our main objective is to better identify the 'Bolsonaro effect' rather than to interpret all the controls per se. But, we would like also to thank the reviewer for this suggestion to provide more explanation on the choice of control variables. We agree, and we think that quoting this reference (Cinelli et al., 2022) is highly relevant for identifying bad and good controls. We have therefore taken into consideration this suggestion. However, as we have already been asked to shorten the manuscript, we have essentially added explanations in cases where the choice of introducing controls was debatable and potentially problematic. In reference to Cinelli et al. (2022), we consider in our models a broad spectrum of controls: 1/variables with a potential direct or indirect effect on the mortality rate (neutral control, possibly good for precision) and above all, 2/ confounding variables which potentially might have influence on the mortality rate and the political factor (good controls aiming at blocking back-door paths). We specified in the manuscript that “Among the control variables, the vaccination rate and mobility indicator are two transmission factors that could be considered. However, their inclusion in the model would potentially absorb at least part of the effect of our variable of interest (the political factor). This could lead to overcontrol, as our interest is in the total effect (Cinelli et al., 2022). In addition, it should be noted that the introduction of these two variables could engender a reverse causality problem in model 1. … In the case of the vaccination rate, when considering the 2nd dose of the vaccine, controlling for the 1st dose is a way to purge the reverse causality effect from the ratio of mortality to the number of vaccines. So, the vaccination rate remains in one of our specifications, but since it could be classified as a ‘bad control’ or a collider, our preferred specification also excludes the vaccination rate.” In the discussion, we acknowledge that the introduction of the vaccination rates as control variables could be questioned [Cinelli et al., 2022], but, we have decided to keep this step as a sensitivity test. Reviewer #2: Since the authors frequently praise Brazil’s immunization system, I believe it is essential for them to present more substantial evidence and cite relevant literature to support these claims. We thank the reviewer for this recommendation. Even though we have already cited references highlighting the success of the vaccination pro-gramme in Brazil: 46. Bernardeau-Serra, L., Nguyen-Huynh, A., Sponagel, L., Sernizon Guimarães, N., Teixeira de Aguiar, R.A., Soriano Marcolino, M. (2021), “The COVID-19 Vaccination Strategy in Brazil – A Case Study”, Epidemiolo-gy 202 (2): 338-359. 60. Larson, H.J., de Figueiredo, A., Xiahong, Z., Schulz, W.S., Verger, P., Johnston, I.G., Cook, A.R., Jones N.S. (2016), “The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey”, EbioMedi-cine, 12: 295-301. doi: 10.1016/j.ebiom.2016.08.042. We provide here additional references which support the assertion that the National Immunization Program (NIP) is considered as one of the most successful immunization programs. We have in-cluded two of them in our revised manuscript. Homma, A., Martins, R. d. M., Leal, M. d. L. F., Freire, M. d. S. & Couto, A. R. (2011), ‘Atualização em vacinas, imunizações e inovação tecnológica’, Ciência e Saúde Coletiva 16(2), 445–458. In this study, researchers from Fiocruz claim that: “The NIP is the most effective programme among emerging countries and is comparable to that of developed countries. Its enormous growth can be demonstrated with the following figures: in 2000, the budget was R$200 million; it rose to R$825 million in 2009, offering 26 different types of vac-cines....” Domingues, C. M. A. S., Maranhão, A. G. K., Teixeira, A. M., Fantinato, F. F. S., & Domingues, R. A. S. (2020). 46 anos do Programa Nacional de Imunizações: uma história repleta de conquistas e desafios a serem superados. Cadernos De Saúde Pública, 36, e00222919. https://doi.org/10.1590/0102-311X00222919 Sato, A. P. S.. (2018). What is the importance of vaccine hesitancy in the drop of vaccination cov-erage in Brazil?. Revista De Saúde Pública, 52, 96. https://doi.org/10.11606/S1518-8787.2018052001199 Pércio J, Fernandes EG, Maciel EL, Lima NVT. 50 years of the Brazilian National Immunization Program and the Immunization Agenda 2030. Epidemiol Serv Saude. 2023 Dec 4;32(3):e20231009. doi: 10.1590/S2237-96222023000300001. For minor comments: Reviewer #2: - In the first paragraph, I suggest using an active voice and clearly stating that Brazil had the second-highest absolute number of Covid-19 deaths. Many thanks, we took into consideration this suggestion and made the changes in the manuscript. Reviewer #2: - The term 'Covid-19' should be used consistently throughout the text. We are sorry but we do not understand this comment. We had our paper proofread by a native English speaker. On checking, we used the term Covid-19 consistently to refer to the Coronavirus disease 2019. In the text, we use the expression "the Covid-19 pandemic" on a few rare occasions when we consider it necessary to emphasise the fact that this is a pandemic. Attachments Attachment Submitted filename: Response to Reviewers -Investigating Bolsonaro effect-Rev2.docx https://doi.org/10.1371/journal.pone.0288894.r004
2 Feb 2024 Decision Letter - Ivan Filipe de Almeida Lopes Fernandes, Editor Investigating the ‘Bolsonaro effect’ on the spread of the Covid-19 pandemic: an empirical analysis of observational data in Brazil PONE-D-23-20876R2 Dear Dr. Razafindrakoto, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Ivan Filipe de Almeida Lopes Fernandes, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0288894.r005
Formally Accepted
16 Feb 2024 Acceptance Letter - Ivan Filipe de Almeida Lopes Fernandes, Editor PONE-D-23-20876R2 PLOS ONE Dear Dr. Razafindrakoto, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Ivan Filipe de Almeida Lopes Fernandes Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0288894.r006

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