Background:
Brazil’s response to the COVID-19 pandemic was one of the worst in the world. However, governors and mayors of the northeast region of the country, among the poorest states in Brazil, joined to organize their technical, economic and political responses to the pandemic to reduce hospitalizations, deaths and the economic impact of the pandemic. However, as the pandemic continued, the response became less effective and appropriate. The aim of this study is to document and review this history and the reasons for the growing ineffectiveness of the planning and the interventions.

Methods:
A timeline of intervention events was established for the nine states. Surveillance data was added to the timeline. A desk review was conducted reviewing published and unpublished accounts of policies and programs as well as pandemic major news and political events that captured public attention. The narrative constructed was then shared with expert public health specialists in the nine states to guarantee accurateness.

Results:
In the first wave of the pandemic, most governors in northeastern Brazil responded actively to mitigate the impact of the pandemic. Physical distancing was promoted, including some lockdowns, the use of masks was made mandatory throughout 2020 and part of 2021, vaccination was carried out as doses were received from the federal government, the number of ICU beds was increased, economic measures were instituted to alleviate the situation of families that were left without permanent or temporary employment. However, over time as economic pressure increased and despite the entry of several more transmissible variants, masks were withdrawn, emphasis on immunization was reduced, communication with the population regarding the increase in cases declined, as well as the need to return to masks, complementing doses or boosters of the vaccine and the impact of repeated reinfections on the body, even among those with frank disease.