Strong public health governance and leadership driven by scientific evidence, community participation, and attention to social and structural determinants of health are key to effective covid-19 containment. Given the failure of the federal government in Brazil to adopt effective public health measures, state and municipal governments, as well as community activists, have stepped in to fill the void. This essay examines the synergistic role that local governments, public universities, public health institutions and mutual aid initiatives have played in Brazil to advance pandemic control and mitigate the damaging effects of central government policies and neglect. Drawing on literature, media reports, and insights from journalists and activists based in Rio's favelas, we show how grass roots groups take actions that bear complex and vital relationships with local governments, NGOs, universities, and public health institutions. Effective local public health governance goes beyond technical public health responses and involves strategies for countering chronic marginalisation and disempowerment of local communities which open new pathways for creative intermunicipal collaboration, social change, power redistribution. It remains to be seen if actions and emerging networks at the local level can exert pressure on national government while not further exacerbating the polarising politicisation of the pandemic.