Over the past decade, there has been increasing recognition of the importance of regional perspectives in contextualizing global norms and enhancing cross-border collaboration. Yet regional bodies with health and non-health mandates have been relatively untapped as agents of political and technical solidarity in this pandemic, and levels of cooperation and coordination have differed significantly between regions. There is great heterogeneity within regions that might account for some of this diversity in approaches, but while some regions have been able to unite as a bloc against the pandemic, others have struggled to find common ground or have not been so inclined.
The regions highlighted below exemplify the spectrum of regional, or subregional, solidarity. While the insights offered here are based primarily on interviews with key stakeholders based in the region, this introduces a limitation in that certain regions (notably the Eastern Mediterranean) were not as well covered.
Latin America and the Caribbean
Response efforts in the Latin America region were characterized by political and technical dissonance, and interviewees agreed that the factors separating and dividing countries in the region played a greater role in shaping the response than those they had in common. One said, ‘We are more divided than together.’ (RI-018) The level of institutional and organizational fragmentation in the region challenged its ability to function as a unit and mount a well-coordinated, unified response. Lines of communication and distribution between regional and subregional bodies were confused, and some countries took advantage of this – for example by requesting the same resources from different organizations. The political proximity of the Pan-American Health Organization (PAHO) to North America was singled out by interviewees as a barrier to effective and harmonious regional coordination and cooperation, and hence to solidarity. Interviewees reflected on the level of political interference and lack of actionable commitment from state and non-state actors, calling for constructive dialogue and stronger efforts to broker relationships between organizations and states. The region imports the majority of its healthcare products, and is thus heavily reliant on China, which has not imposed export restrictions (which some interviewees interpreted as a strong sign of interregional solidarity).
States in the Caribbean are used to relying on one another, sharing resources and supporting the weakest among them.
Uniquely within the Latin America region, the Caribbean emerged as an exemplar of solidarity. One interviewee suggested that smaller blocs, such as the Caribbean, tend to be better coordinated and more resilient because of their political inclinations, economic similarities and cultural proximities, which all play a role in fostering a community-oriented culture and approach to cooperation. States are used to relying on one another, sharing resources and supporting the weakest among them. Key institutions in the subregion framed solidarity in more concrete and actionable terms than institutions with a wider regional remit. For example, as one interviewee stated, it requires ‘listening to all the partners and seeing really what you can do, and not to be stepping over each other and duplicating, trying to fill the same gaps’ (RL-015), with a recognition that resources are limited and therefore need to be allocated efficiently. Importantly, as one interviewee pointed out, this practice of solidarity existed prior to the pandemic. For instance, when Caribbean countries have requested extensions from WHO for implementation of International Health Regulations (IHR), countries did not ask individually but as a bloc, demonstrating a culture of solidarity with less well-prepared countries in the subregion.
Africa
Leaders and public health policymakers at a regional level in Africa – namely the Africa Centres for Disease Control and Prevention (ACDC), a technical agency of the African Union (AU), the WHO Regional Office for Africa (AFRO), the African Development Bank (AfDB), and the West African Health Organization (WAHO) – called for solidarity very early on in the pandemic response. The first case was reported on the continent on 14 February 2020, and an emergency meeting of all health ministers was convened on 22 February to establish a Joint Continental Strategy and a task force to coordinate activities across the continent. The AU and ACDC have played a major role in mobilizing resources and organizing supplies of needed inputs for the whole of Africa. To date, among other key initiatives launched in response to the pandemic, they have collectively established the AU COVID-19 Response Fund; the Africa Medical Supplies Platform (AMSP) to pool and execute orders for needed medical supplies; the Partnership to Accelerate COVID-19 Testing (PACT) in Africa; the African Vaccine Acquisition Task Team (AVATT); and the Africa Pathogen Genomics Initiative. These efforts have been instrumental in securing vaccines for Africa over and above what is likely to be available through COVAX, including 270 million doses on behalf of the AU’s 55 member states.
The success story of the AU/ACDC was recognized across the pool of interviewees, particularly by those in Latin America and Southeast Asia who thought solidarity could be enhanced in their own regions if similar governance structures and political will existed. Determined and decisive leadership, aligned with public health goals, paved the way for countries within the region to unite and engage in processes of mutual support and reinforcement. Both the Africa and Caribbean regions, led by their respective regional and subregional health bodies, understood where there were capacity gaps and acted quickly to identify and allocate resources appropriately. Additionally, the ACDC engaged in interregional collaboration and cooperation, with the Caribbean countries gaining access to the AMSP, including 1.5 million vaccine doses.
Asia-Pacific
In the Asia-Pacific region, while several regional and subregional bodies exist, most notably the Association of Southeast Asian Nations (ASEAN) and WHO regional offices, interviewees did not see them as playing a significant role in fostering regional or subregional solidarity. Countries did not appear to be dependent on supranational governance structures to galvanize cooperative and coordinated action, nor did the relative absence of regional solidarity mechanisms appear to hinder or handicap response efforts (at either a regional or a national level).
What solidarity existed was the result of the shared experience of the previous outbreaks of SARS and Middle East respiratory syndrome (MERS). This was similarly the case across Africa and in the Caribbean region, where interviewees attributed the high levels of solidarity to prior experience in coordinating response efforts to such major outbreaks and the increased investment in public health preparedness capacities. Indeed, since SARS, all Asia-Pacific countries are convened annually by the two WHO regional offices to report on the Asia Pacific Strategy for Emerging Diseases (APSED). One interviewee suggested that the pandemic has restored a sense of purpose to these initiatives, to ‘put every action beneath this promotion of the solidarity’ (RL-002). In this regard, the pandemic may catalyse greater awareness of regional solidarity, and conscious efforts towards fostering and strengthening those pre-existing relationships and mechanisms for regional cooperation and collaboration. Indeed, in November 2020 ASEAN announced the launch of a Centre for Public Health Emergencies and Emerging Diseases.
Solidarity was facilitated to some extent by the mechanisms established by ASEAN. As one interviewee explained, when China shared COVID-19 reports with WHO, they were likewise shared through the ASEAN Secretariat and Health Sector for dissemination to all ASEAN Health focal points. The interviewee attributed this cooperation to efforts to build a trusting and transparent relationship between ASEAN and China over the past decade.
