COVID-19 in Latin America

Robert Yates

Well, welcome to Chatham House, which is absolutely wonderful to be talking to a live audience. My first time in, I think, over two years to speak to a live audience here at Chatham House. So thank you for coming out on a cold, February evening and we’re delighted to have this event today to talk about COVID-19, the impact of COVID-19 on health and the economy and societies in Latin America. Of course, every region, every country in the world has been hit hard by COVID, particularly here in the UK where we have one of the highest death rates in Europe.

Tomorrow we’re going to be having the end of our, sort of, COVID restrictions here in the UK, but all across the world the virus is still ravishing populations and particularly, it has been very, very severe in Latin America. Latin America, I think, accounts for about 5% of the world’s population, but 25% of the world’s deaths from COVID-19 have been on the continent. So, we’re here today to discuss what have been the lessons learnt from Latin America, and we have a fabulous panel to discuss this, the ideal panel to discuss this.

First of all, I’m delighted to have with us in the room today, the Honourable Minister of Health from Argentina, Dr Carla Vizzotti. Thank you so much for coming to see us today. I hear you have a packed itinerary in the UK, so we’re delighted that you could spare some time to be with us today. And online, we have Dr Julio Frenk who is the President of the University of Miami, and the Architect of the Mexican health reforms. He was the Secretary of Health in Mexico for six years, from 2000 to 2006, and has an encyclopaedic knowledge about health systems, reforms not only in Latin America, but all around the world.

I should say that today’s event is on the record, we’re not following the famous Chatham House Rule, in fact the event is being recorded and we actively encourage you to tweet about it. If you use the #@Chatham – @CHEvents, then you’ll be able to spread the word about what’s being said today. I might ask the audience here, if you have mobile phones if you can switch your mobile phones off or have them on buzz, that would be very helpful, so it won’t distract us today. I think that’s the housekeeping, unless my colleagues are, sort of, waving at me frantically that I’ve forgotten anything. I think the exits are there and you’ll have seen the toilets at the bottom of the stairs. But otherwise, I think we can get cracking to talk about, you know, this very, very important topic.

We will be opening it up to question and answers as well, both from in the room and online as well. We have a big online audience and for the online audience, very much encourage people to put your questions in the Q&A function. The ‘chat’ function on Zoom has been disabled, but I’ll see the questions come up in Q&A, and we’d very much like you online, if you’d like to ask your question live, we’ll unmute you and so everyone here will be able to hear your questions.

Anyway, without any further ado, I’ll hand over to the Honourable Minister. We’re going to hear about the impact of COVID-19 in Argentina. So, Honourable Minister, how is the situation in Argentina and what lessons would you say that you’ve learnt from the COVID pandemic?

Dr Carla Vizzotti

What a question. First of all, thank you very much for the invitation, for the introduction, it’s very nice and it’s an honour for me to be in Chatham House and to share Argentina’s experience with Julio and with all of you that are present after a very hard couple of years. So it’s a double honour being the first presential meeting and being here to share our experience in Argentina and also, as you said there, a huge impact that had there, pandemic – COVID-19 pandemic in Latin America.

You know that Latin America it’s a very particular region. We have very important gaps. We have a lot of differences between countries and even in each of our country, we have gaps between the provinces, and Argentina, in particular, is the eighth country, regarding an extension and it’s one of the country that is over three million people population. We were in the South of the South hemisphere. We are a 45 million people, most of us living in urban areas and we have the first urban conglomerate, which is – we call the metropolitan area of Buenos Aires, it’s habited by – for more than 15 million people and it was the main – the centre of the pandemic. It was the – amber has the major impact of the pandemic. It’s where it starts and it’s also where it has the higher mortality, and of course, number of cases.

We are a middle-income country. We started the Government in Argentina, President Alberto Fernandez started the government the 10th of December of 2019, just some days before SARS-CoV-2 has been detected and less than three months before the first case in Argentina was detected, and we were going through an important economical and social crisis and the healthcare system was not in the best situation.

So, we can divide the pandemic in three periods, I think. The, first of all, the first period was the preparedness period, we had a lockdown, and we had a huge challenge to strength the healthcare system. We work on that. We build 12 modular hospital in the more density – more densi – with the more density of population just to provide tools to answer if their cases increases. We strength the ICU with – by 60%. We strength the ventilators stock also by 60%, and we work with the 24 province. We are a federal country who have 24 provinces that has the responsibility of the health system of each province, so we work with the 24 Minister, with the social security system, with the private system, with the university system also, and we really integrate, which is a huge problem, and for sure, it will be part of the discussion. We integrate the healthcare system as we never have done, and it was important, during the pandemic, and we really strength the healthcare system and after the cases started to increase in Argentina, every citizen, every Argentinian has the medical attention, the sanitary attention.

We even have, in any moment, in any place of the country, in any city, in any town, a problem with the response of the healthcare system. We had attention, we had long attention, but the people had their sanitary attention. So, we – the first – I told the first period was the preparedness. We really made it have a huge inversion, not only for the healthcare system, but also social and economical. The government support the private sector and the people more rural level with a huge budget to sustain their minimal possibility not to go to work or to stay at home. We really support also the private sector for paying their employees’ salary. Half of the salary has been paid by the national government and it was a huge challenge also to identify them and to reach them with this economical support.

And when the cases started to increase, their response was the challenge, the effort, and the commitment of the healthcare working was huge, as all around the world. Argentina has not been the exception, their commitment, their – I think the love, you know, that the healthcare worker took care of all the people in Argentina during long months. We had the first wave, but the second wave last year was really worse. It was more than the double of cases and it lasted more than two month, and by that time, we increased three times the offer of vaccination, for example, and it was at the limit for really a long time and we work really hard, but at that time, the healthcare system also have the strength to take care all our people.

And after that when we were decreasing the second wave we – our main objective was not to have a huge impact with Delta variant. So we had some measures regarding the borders, regarding quarantine from people who came from another country and we were very success – we succeed in that strategy because Argentina had time to improve the vaccination campaign and then, when we had 100% of circulation of Delta variant and 100% of the activities open of all the economical and social activities open, we didn’t have any increase of cases or death. And then Omicron variant arrive, and it was just before the summer and before – near Christmas and we have a very important impact in much more communication and emotional because we went from 800,000 – 800 cases to 105,000 cases in two weeks, without impacting in the mortality. But it was very, very difficult for people and for media to understand the difference between Delta, between Omicron and their recommendations.

But meanwhile, the milestone of the recovery was the vaccination campaign Argentina. I told you it’s a very extent country and we have 45 million people, and we are not a rich country, so from the very beginning of the pandemic, we had the main objective to access the vaccine. We knew it could be difficult, but we work with all the countries, with all the vaccines, with all the pharmaceutical industry to reach as soon as possible as many vaccine as we were able. So, we would travel – we work with Pfizer, with Moderna, with Russia, with China, with Astra of course, Argentina, with Mexico.

Together with Mexico, are the producer of the AstraZeneca vaccines in Latin America in map science and in Learmonth we produced the antigen, the active principle, and in Mexico in Learmonth, finished with the full and finish and it was a strategic partnership, because of what South America could – America, not South America, Latin America couldn’t reach the AstraZeneca vaccine. Argentina is also part of the production of a Sputnik V vaccine with another lab, which makes the full and finish of Sputnik vaccine is Richmond Laboratory and we started from the very beginning with this view. With being part of the clinical trials, being part of the manufacture process, not only for improving the access to Argentina, but also to improve the access to all Latin America. We knew Latin America was going to have difficulties on the access.

So, we start our vaccination campaign in 29 December of 2020 and we kept vaccinating people ‘til now. We are now 40 million people with one dose, received one dose, it’s a huge percentage, more than 82% of the population and the 36 million people, it’s 79% of the population has two doses, and we have already provide and applicated 16 million of booster. So, we started in November with booster, and we are also one of the few countries that are vaccinated from the three years all with Sinopharm, three to 11, with Sinopharm, 12 to 17 with Moderna and Pfizer, and over 18 with the other vaccines. And we also work with Russia and with AstraZeneca, with Sinopharm in order to build evidence, regarding [inaudible – 15:15] schemes. We combine vaccines and we also have strong evidence, regarding safety and regarding immune-efficacy and it was very important for our immunisation campaign. So, I think that the milestone of recovery has been the vaccine.

Now, in Argentina, with a curve which is very, very similar to UK, we are in the sharp decrease of cases, we are with all the activities working and ongoing. We are entering the winter in difference with you, that’s why we still have some concerns and restrictions and measures to take care because we are starting next week, classes. The summer holidays are ending and then the classes are starting again, and we are entering the autumn and facing the winter, so we have some – a couple of months to see the evolution of the virus. But Argentina has recovered ten points of its economy, 10% of the productive activities has – and the number is 10% we compare before the pandemic. It has 10% of increase of the industry and production. And we are in the way to recover the new normality with, of course, a lot of lesson learnt, but knowing that low and middle-income country in South America has been the more impact – not only with the pandemic, with the COVID, but also in the access of the vaccines. And if you see the map of the world, South America is the region of the world that has the highest vaccine coverage and Argentina is over the middle of South America, so we are very, very proud of our vaccination campaign.

The vaccine confidence in Argentina, people really trust vaccines in Argentina and they really support the campaign. They really demand the vaccine and we have a very, very high vaccine coverage and that has been also the main reason that because of – despite the increase of cases, we had really, really low hospitalisation and really, really low deaths, and we didn’t have tension in our healthcare system in the last wave and we could be able, also, to take care of all the other pathologies and the other diseases that extract COVID during the third wave. And of course, facing the questions that everybody’s facing, regarding mental health, regarding cancer, chronical diseases, vaccine coverage from national immunisation programme. And, of course, asking if it’s not a huge opportunity to do all the changes and reforms that are needed in Latin America, regarding the healthcare system, and also knowing that we hope that nobody doubts that health is the milestone to produce, to study, to work and, of course, for all the economies. So, we knew that, but we hope that all the decision-makers doesn’t doubt that and we can keep going with more health strategies and prioritising the health and, of course, working on keeping improving.

Robert Yates

Fantastic, thank you very much indeed, and I think what you were describing there, I think very much resonates with a British audience as well. I think the trajectory that you were describing and also, you were talking about the vaccines being the milestone in the recovery. And, you know, at the end of the day, that’s been the story here as well, and I’ll perhaps come on – come back to discuss some of these issues about vaccines in a moment because it’s obviously been so crucial for your country and our country, and I think for the whole world as well.

If I can turn to Julio now to talk about, I think, you’re going to give us a regional perspective, Julio, and I think there’s some lessons that perhaps you’re beginning to glean from right across the Latin American region. Oh, I think you just need to unmute there, Julio. Is that something that we can do or that you need to do there? Oh, there you go.

Dr Julio Frenk

Thank you. Thank you, Robert, and I wish – so much wish I could be there in person, but, you know, I guess we’re – it’s part of the new normal will be this hybrid format. But I’m delighted to participate with Chatham House on this important conversation, ‘cause as you clearly indicated in the opening, there’s this completely disproportion or lack of proportion between the share of the world population living in Latin America and the share of both cases and deaths. And there’s no question that Latin America has been the hardest hit region around the world and the question is why. I have, you know, data on Mexico, but maybe we can leave most of that for the Q&A. I have been, you know, even though I’m no longer in the government, but a citizen, I’ve been pretty active in, you know, pretty much trying to document the deficiencies with a constructive purpose, which is how to improve that response.

The fact is that the numbers are pretty eloquent and Latin America, as a region and within that region, particularly Mexico and Brazil have done really – have been among the worst performers, in terms of number of deaths, deaths per capita. Excess mortality, which is one of the indicators of how well the health system performed, because that accounts not just for deaths from COVID that were not properly recorded, but also deaths indirectly attributed to the pandemic because the hospital system was unable to respond to other health needs. And Mexico, you know, just to give a sense of the proportions, the officially recorded deaths is about 320,000 at this point, but the excess mortality is about 600,000, about twice as many, which is the largest differential between recorded and estimated excess mortality in any of the OECD countries, and one of the largest in the world.

That speaks about both the failure to properly record deaths from COVID, but also, these other failures of the health system to take care of other issues. For those who are interested, there is a – actually in – you know, since this is happening in London, The Economist, in the January 22nd issue of The Economist, there’s a couple of stories on Mexico and some of these numbers are there. And again, in the Q&A, if anyone wants more information, I’m glad to give that.

So, you know, even though we’re not yet out of the pandemic because we still have the risk of variants, there’s still, you know, billions of people who need to be immunised in the world and have not done so, even though Latin America, as the Minister was just saying, has actually, for the vaccine part, responded much better than to the pandemic itself, but there’s still many people who are lacking access. So, we’re not yet out of the pandemic, although we are at a point now, although we’re still in the emergency, we can now see that the pandemic phase will be coming, most likely, to an end in the course of this year. And this is a good moment while we still have the attention of policymakers on the pandemic itself, to start talking about the future, and I know this is one of the focuses of this session from Chatham House.

Does this open an opportunity to actually think about how to improve our health systems, ‘cause I do think that we have the – almost, I would say, the moral obligation to all the people who have suffered so much to not just think about a new normal, but a better normal, and this is an opportunity to do so. But to do that we need to learn the lessons from the pandemic so far, and, you know, I would say that there are five big lessons, which if we truly apply those lessons, I think we can improve both our capacity to respond to future pandemics, but more broadly to address our mental health needs in a more – in a broader sense.

So, let me just mention them, because this is meant to be a very short introduction and then I’m looking forward to the interaction with the audience. The first lesson is that pandemics are not naturally meant. We tend to think because there’s a microbe attacking humans that this is sort of natural, they are not natural. They are as anthropogenic as climate change, and I think COVID-19 should be a wake-up call about the fact that our current modes of engaging with the rest of our planet are simply unstainable, the way we abuse the planet. So, one key outcome of this pandemic has to be a renewed commitment to sustainable development to prevent future pandemics and other consequences of this unsustainable way of relating to the planet like climate change.

Second big lesson is the importance of social inequality. I think part of the reason why the response in Latin America has been the worst in the world is that Latin America is also the most unequal region of the world. And what we have seen is that those social inequalities were magnified by the pandemic, but also account for a big part of why the performance of countries was so poor. It’s both the lack of equitable access to healthcare broadly, but it’s also been the large proportion of people without stable employment, so-called informal population. I don’t like the word ‘informal’, the word ‘informal’ it’s a little bit stigmatising, but it’s people who live day-to-day and therefore, who couldn’t afford the luxury of broad confinement and had to go out and, you know, provide for themselves and their families.

So, the pandemic both reflects, magnifies, exacerbates the inequalities and again, I think this is a call to address those inequalities head-on and to build into the preparedness plans for future pandemics and emergencies this factor which, I think, has not been taken explicitly into account. The fact that people from the poorest sectors of the economy are over-represented in the so-called essential workers that had to go out. The fact that so many people didn’t have the infrastructure to continue working from home or children learning from home. The disaster of education that we’ve seen in Latin America, with the lack of access from children and a generation that risks losing a lot of the gains that have been achieved in the past, all of those, I think force us to pay attention to inequalities.

The third big lesson, and again, I’m just closing very briefly, is about the importance of leadership. Yuval Harari, the great thinker, in The Financial Times, in a recent essay in The Financial Times, I think summarised the pandemic, what I think is the best summary of the pandemic. He said, “The pandemic is a triumph of science and a failure of leadership,” and he was talking about political leadership. “A triumph of science, the failure of leadership,” and this is what we have seen.

When we look across the world, we see that particularly in the early response to the pandemic that was so critical to determine the future pathway of countries, you see that among the poor – well, you see two things. The striking variance in the effectiveness of national response among countries with very similar income per capita, very similar levels of investment in health and yet, vastly different effectiveness in tackling the pandemic. And one parallel that’s notable is that in the group of worst performers you have an overrepresentation of populist regimes, and Latin America doesn’t have a monopoly on population, but does have a high concentration of populist leaders. And dare I say, populist syndrome that includes distrust of experts, distrust of science, and very often, like in the case of Mexico, active confrontation with the scientific community. A tendency in the populist mind to divide people among, you know, the corrupted elites, among them, the experts, and the good people that the leader purports to represent.

That divisiveness is exactly what you don’t need in an emergency, you need unity. But furthermore, what that has led is to the politicization of many of the actions. It first led to a minimisation of the threat of the pandemic, and you see that everywhere that there were – with populist leaders. At the beginning, in the Americas, starting with the United States, Mexico, Brazil very similar responses contradicting the opinion of experts, contradicting the science, spreading misinformation, minimising the impact of the pandemic, therefore delaying the effort and broadly confusing the population about what had to be done. So, I think one of the big lessons is that leadership does matter, and national leadership does matter. And I mean, I’m hopeful that like happened in the US, there will be some, you know, accountability for populist regimes.

The three largest countries in the Americas, the US at the beginning of the pandemic, Mexico, Brazil, all of them federal governments, all of them led by populist leaders, I frankly think it’s secondary, whether it’s right-wing or left-wing populism, it’s the populism that shares this attribute and that, I think, accounts for a lot of the disastrous response. Other parts of the world, with populist leaders, similarly had very poor response, like India, like Turkey, like other such countries, but in Latin America, we do happen to have a concentration. I’m not saying that populism causes bad responses to pandemics, I am saying that there is a cluster and a lot of the political mindset of populism was particularly poorly suited to articulate a good response.

And then the fourth lesson is an obvious one, but I think we need to reiterate it because it’s in danger. This is a global crisis and global crises need global solutions. And there is the risk that part of the populist mindset, which is to blame others, to goat-scape, or create scapegoats for events brings those countries to a retrenchment from global engagement, a rise of again xenophobic, anti-global discourse, exactly when we need to have the opposite.

The reason that we are doing so well with vaccines is because that was the exemplary effort, global effort in this pandemic. It involved people from all over the world, in the public sector, in the private sector, in academia, working together. That’s what gave us highly effective vaccines in record time. So, right now what we need to do is focus our efforts in enhancing even more that scientific operation to create permanent technological platforms that will allow us to better resist future pandemics. And in focussing on the improving the global governance for this kind of event, which obviously was found lacking and there’s a very big discussion about that reform of the global health system to be better prepared and the global security system to be better prepared for future pandemics.

And then, the last lesson is that obviously alongside, it’s not – the global and the national are not alternative approaches. Every national reality occurs in a global reality, so while we emphasise global engagement, we also need to realise that national health systems, by and large, failed in their response of the pandemic, and to different degrees. Clearly, Argentina did much better than Brazil or Mexico, but this is a chance to launch a new generation of reforms, and I hope we will talk more about that. As Robert was saying, many, many largescale reforms, including in the UK with the Beveridge Report, have been in the midst of a crisis like a war, a world war or a pandemic. This is an opportunity, while people have realised how important health is for the economy, how important it is for social cohesion, that this is an opportunity to launch a new generation of reforms.

Let me just finish by saying, there’s a number of resources. I was – there’s a think tank based in Washington called The Inter-American Dialogue and we – I coached, along with my colleague, Helene Gayle, a task force looking at lessons from the pandemic in the Americas. The technical team was led by Beatriz Londoño, the former Minister of Health of Columbia and we put out a document called, “Deepening Co-operation and Co-ordination on Health Policy in the Americas.” So, some of these lessons are further explained and expanded on for the entire region of – for the entire continent of the Americas in that report for anyone who would like more information.

I’m keen to engage in the discussion period to maybe deepen some of these ideas. Thank you, Robert.

Robert Yates

Fantastic, thank you so much, Julio, and again, I think a lot of what you’re describing, I think, very much resonates with our experiences here in the UK as well. I think some of the things that you were referring about, sort of, people ignoring the science and maybe sort of populist leaders, I think, I can see people, sort of, nodding and very much resonating with what’s been happening here.

The five lessons, I think, a lot of the issues that you’re referring to, one can say are highly political rather than technical. I mean, I think things like inequalities and reducing inequalities and replacing populist leaders, I’m just, sort of, wondering, are you seeing, both in Argentina, but through Latin America, electorates beginning to recognise what’s been going on here? You know, that we have seen, for example, President Trump voted out of power in the United States, I think there was an expectation that he would have won that election with the economy doing quite well in the US, and I think a general view that his COVID performance, you know, was one of the reasons for his downfall.

There was a New York Times article, about a month ago, really sort of charting a swing in the pendulum perhaps more to, sort of, the left in Latin America, thinking about countries like Chile and I think Honduras and potentially in Colombia. Are you, sort of, seeing this change now in electorates? I mean, do you – are you foreseeing that there is going to be this switch to perhaps new parties being elected that are going to push for universal health coverage and move things in the direction that we’d like to see, reducing inequalities and, you know, sort of, tackling these problems head on? Maybe, Minister, if I can start with you on that. In Argentina are you seeing more of a, perhaps, a, sort of, swing of the pendulum to the left and more, sort of, pro-health issues rising up the agenda?

Dr Carla Vizzotti

I think I am not sure if I would say the word ‘populism’. I am more comfortable with negationism, you know, because I have some reflections. Being a leader in a pandemic is not easy, I can assure you. Saying what to do, it’s more easy than do it. This is a very important situation because it was a huge uncertainty, it was a new virus, and nobody knew what to do. So, this is, I think, the main issue that maybe we forgot because we have gone through two years that have been very intense and I think that negationism was one of the main problems because some governments didn’t prioritise health, and I think that that cannot be called populism.

I believe that, so I will call it negationism and I will talk about what happened in Argentina. We started our government before the pandemic going from a right government, which left a huge economical crisis and social crisis, and Alberto Fernandez, it really prioritised health and the economical support was not enough for sure. But it was, Julio said that nobody – not everybody had the luxury or the possibility to quarantine or to stay at home. We have, in Argentina, a lot of people that just could stay at home at the beginning of the lockdown and then they had to go to work and that was the main problem, and of course, that they – after one year of this extremely unexpected and extraordinary situation, not only people, but also Politician, but also media and, of course, the economical and social prices has a huge impact and people start being angry, being emotionally – with the emotional difficulties from their emotions and it’s impossible to follow the rules or to know exactly what to do and when to do that.

So, I – another thing that we saw in Argentina, we have 24 provinces and normally they are not of the same political colour. Always they are position of the officialism is against what they stand, so that’s another situation, at least in Argentina and I think in most of the country, it doesn’t matter if they are from the left or from the right or from the centre, the opposition has some – always critics, of course, of the management of the pandemic. And even high-income countries and very evolutionate societies have some management of the pandemic that didn’t work. But I think that the elections now, their middle term of the President elections all around the world has been interfered by the pandemic. So, I think that that’s not easy to evaluate and to have strong conclusion. But yes, we are in a huge crisis, or we have a huge opportunity to turn former threat and into a real opportunity to build a – from now on, a stronger healthcare system. As I said, in Argentina we could integrate the different healthcare system and we could have a very federal work with the 21 – 24 provinces, and I think that this is a great opportunity to think about a new milestone about that. To have an important rhetoric from the press and from the government to work on that way and to integrate the healthcare system for sure, learning the lessons, you know, and learning what happened and try to think very technically.

Robert Yates

Great, thank you very much indeed, and Julio, what do you think? They say “Never waste a good crisis,” so what do you think is the potential for, you know, this crisis to catalyse a new, sort of, generation of universal health reforms?

Dr Julio Frenk

Yeah, I think it’s a huge opportunity and what I would say, you know, to the first part of your question, whether there might be a switch towards the left, I think at this point in Latin America the key differentiator, I don’t think is so much left and right on the ideological spectrum. It’s whether there is a commitment to democracy or an inclination towards autocracy. If I had to make a distinction, that to me is the most relevant and the most urgent. There is very little that resembling regimes that are all supposedly left-wing.

In Nicaragua most recently or Venezuela, not to speak of Cuba, but that’s an old case of undemocratic government, there’s very little in common with that with, you know, the new President in Chile and the kind of regime he’s trying to do. Or the situation in Argentina, which is highly committed to democratic values, or, you know, the Presidency of Lula, who might come back as President, who again, you know, we all call those left-wing and yet, the contrasts couldn’t be more stark. And I think the big story of Latin America in the 1990s was the rise of democratic regimes.

The big story, in this part of the 21st Century, is the decline, the erosion of democracy. Country-after-country you’re seeing an erosion and there’s a very strong set of countries, fortunately, that are resisting that. And some of those are left-wing governments, like the ones I just mentioned, but also, some so-called left-wing governments are very much the ones that are moving towards an autocratic version of that. And I think it’s less become an ideological issue as whether you commit to democracy, which means separation of powers, commitment to the rule of law, committing to a system of checks and balances, where you don’t have power concentrated.

I’m sorry to say that Mexico, even though it’s nominally a left-wing government has failed to, a lot in the pandemic, to implement many of those more signature policies of a left-wing government, contrast to what the Minister said about it in her [inaudible – 43:59]. Mexico started the pandemic with a government that for two years, in its first two years in office, had cut the budget of the Ministry of Health and has not restored the budget, even with the pandemic, contrary to what many other governments left and right did, which was to provide income support, either through the direct cash payments or other forms of economic support.

Mexico is the country, again the story in The Economist in January 22 will attest to that, with one of the lowest proportions of GDP allocated to that direct support to households, as about 0.6% of GDP, compared to 9% in Brazil and other Latin American countries. So, it is – I think the labels are here a little bit misleading. To me, the litmus test, in the next few years, is going to be whether a government is committed to a democracy, which entails the possibility of different parties gaining power or whether they move towards continuing the erosion of democracy and instituting autocratic regimes.

Having said that, I do think this is an opportunity for left and right-wing governments to embark in a serious effort to reform the health systems. I have written, with a, you know, proposal in Mexico, although we didn’t have a stromatic rebuttal, as we had in the United States and looks likely we’ll have in Brazil, to talk about the largest populist regimes, but in the midterm elections and the party of the President lost ground in the Congress. So, we have a much more pluralistic Congress and so – and that was, I think, an important outcome of that election, in addition, the government lost most of Mexico City, lost the elections in – the local elections for Mexico City. But it’s the Congress that I think was important because it denies now the majority that will be required to change the Constitution.

So, in light of a more pluralistic and reaffirmation of the balance of democracy by the electorate, I’ve written and advocated for the creation of a parliamentary commission, a little bit like the Beveridge Commission, and I use that as an example, to actually chart a pathway forward, given the obvious failure of the current healthcare system, to respond effectively to the pandemic, given the enormous amount of suffering that has happened during those 600,000 excess deaths, from what would have been expected without the pandemic. I think it is a time when actually you can find an element of unity in the country at a moment of great distress, great trauma, collective trauma, a way of healing the trauma of the pandemic and millions of people who have lost a loved one or who have lost a livelihood. It’s a way of healing, is to embark in a serious effort to improve the health system, through substantial reforms, both to be better prepared for future pandemics, which there will be. But equally important, to be able to better respond to the regular problems that a very complex epidemiological transition is bringing to Latin America in particular, where you still have a huge unfinished agenda of infectious diseases, and you already have some of the highest burdens in the world of non-communicable diseases.

Robert Yates

Yeah, fascinating, thank you very much, and, of course, you know, you’re talking about the importance of democracy and therefore, you know, a very important, what happens to your northern neighbour as well. I know lots of people are looking very anxiously at the demise of democracy in the United States at the moment and how important that will be for the world. I’d very much like to come to questions from the audience now, please, and I can take questions from the floor here and I think, to be fair, I think I might take one from the audience and then one online. And so, if my colleagues can be, sort of, lining up, I think Eshaka’s got a cracking question here that we’ll be able to – so, I think the first hand I’ve seen up here, being democratic, if you’d like to ask your question, please.

Lisa Merton

Sure, thank you so much for your insightful comments. I’m Lisa Merton. I’m a News Editor for Nature Biotechnology. So, if I may, I would like to move the conversation a little bit towards what is undoubtedly the miracle amongst all this horrible crisis, which are the vaccines. And I think that in your position what I would like to do is perhaps to urge you to take this time, to take this opportunity to come to some arrangement and some negotiation with the big pharmas and biotechs over the manufacture of vaccines. Vaccine manufacture is not something that can happen instantly, it’s something that needs to be built, the expertise needs to be built and there is like an extraordinary arrangement between the African Union and BioNTech that’s just been signed. Are you thinking of perhaps bringing those big companies to the table, so that this manufacturing becomes something more local and something that can be owned by yourselves rather than by the big pharmas?

Dr Carla Vizzotti

That’s an excellent question. Actually, that’s the first question we had online as well, actually, so poor Eshaka, I think we’ve – that’s a very similar question that Eshaka was going to ask. Domestic vaccine manufacturing, it’s one of the hottest topics, so, Minister, what’s your thoughts on that?

Dr Carla Vizzotti

I think that this is the main lesson leant that until all the world accepts the vaccines, we are not going to finish the pandemic and – but I tried to say that in my speak, in our country we thought about that from the very beginning, regarding the clinical trials, and regarding being part of the manufactured process, not only for Argentina’s access, but also for all the region. And that happened with AstraZeneca vaccine and with Sputnik V vaccine. And I think that the AstraZeneca strategy of non-profit and the effort made for having different stakeholders all around the world to scale up the vaccination was an excellent example about the non-profit and the importance of the access.

I think that the pharmaceutical industry weren’t, at that point, they didn’t put their part, regarding the access in COVAX mechanism. I think that we, from 2009 pandemic H1N1 ‘til now we learnt that we had to improve access and COVAX mechanism was – has this aim, and it was important because if it doesn’t – if it didn’t exist or it wouldn’t – if it didn’t exist it wouldn’t be possible for a lot of countries to receive vaccines. But 80% of the vaccines went to 10% of the countries, and then, the countries, when they didn’t need the vaccines, they donated, but it was impossible for low income country to use the vaccines because of the short expiration date. So, Argentina is working on that, Latin America region is working on that, World Health Organization is working on that. Argentina and Brazil has been selected as the Latin America centre to develop capacities for R A – mRNA – I’ve never said that, the vaccine, the technology in the region and there are today the Director announced their support for more county from Asia and South Korea and Vietnam and Serbia in Europe, were in the meeting. Their Minister of Health were in the meeting and for sure, it’s a very complex challenge because you have the aim and you have the reality, the economic reality, the pharmaceutical industry reality, all the patents issue. And Argentina is calling for that in the OMC, since before the pandemic start, but without this step, it’s not going to be a solution, but Argentina and Latin America is working on strengthen the regional capacities and also, supported by the World Health Organization.

Robert Yates

Thank you, and Julio, what do you think about this issue of, sort of, greater vaccine manufacturing capacity in the region, and the potential for things like TRIPS waivers to speed that up?

Dr Julio Frenk

No, absolutely, since – you know, we started having a greater frequency of pandemics or public health emergencies of international concern starting with the influenza, the Avian influenza at the beginning of the 21^st Century, there’s been that discussion of having a more distributed capacity. Surely, Latin America could fill a lot of that, and there is very substantial capabilities in Brazil, in Argentina, as the Minister said, in Mexico, in Cuba, in Guyana there’s quite a bit of capacity. And we have had a great example of co-operation that she mentioned, Lisa mentioned in her comment, in which with AstraZeneca part of the process now two companies, two private companies in – one in Argentina, one in Mexico co-operated with Astra to increase availability of that particular vaccine, throughout Latin America. And it’s just a great example of the kind of relationships which should help. And I do very much think we need to adapt the intellectual property aspects, with all due respect to patents because we don’t want to kill these – the incentive for innovation. But allowing through the proper mechanisms, I think the longest ongoing pandemic, which is the AIDS pandemic, the longest running pandemic has shown us that we can increase access, in that case for antiretrovirals, but the same logic applies to vaccines and to other therapeutics, we can increase access dramatically, without undermining the respectful intellectual property and achieve both goals.

They are not goals in competition. I think the way the world handled the AIDS, and lack of access to – and the inequities associated with that, I think offers very valuable lessons for other crisis, like in the case of vaccines in the future.

Robert Yates

Yeah, yeah, excellent. Now if I could take another – and take a question actually online now, and I do apologise, Eshaka, that your question was basically asked from the audience here. Is it possible to bring in Trisha online, please to ask her question? It’s an excellent question about gender sensitive initiatives in Argentina, so is it possible to bring Trisha on mic?

Trisha de Borchgrave

Can you hear me?

Robert Yates

Beautifully, yeah.

Trisha de Borchgrave

Okay, great.

Robert Yates

Yes, Trisha, fire away.

Trisha de Borchgrave

Thank you very much. Buenas noches, thank you very, very much for this session. I wanted to direct my question actually to the Health Minister, if I may, because Argentina was ranked number one in the world by the United Nations for the highest number of gender sensitive measures, in response to COVID-19. And we know very much so, we’ve, you know, we’ve seen it, we’ve experienced it, that globally women have been particularly hard hit by the pandemic, you know, with increased levels of, as we know, domestic abuse and job losses and then, that childcare responsibility thing. It has been really, really difficult, and having been ranked number one, I’d love to hear from the Health Minister what specific measures did you deploy that actually helped women in particular? Thank you very much.

Dr Carla Vizzotti

Thank you. Yes, Argentina has, first of all, when the government started in 2019, we – the President created the Ministry of Women, Women, Gender and Diversity, that wasn’t – that didn’t exist. The President created again the Ministry of Health who – which was the greatest asset to a Secretary and also created again, the Ministry of Science, Technology and Innovation. And it was a clear sign of these priorities, even before the SARS-CoV does exist, and it was a commitment, during the campaign, and it was very, very important. And we have an important problem, regarding violence, regarding inequities and gender inequities, and also, with the diversity, so we knew that the lockdown and the social impact of the pandemic would be even worse in women and in diversity.

That’s why, first of all, they started some specific politics about that, but also, it was the classed essential service, there’s social support for violence and the workers from violence and the workers from the – women could – were allowed to go out and look for help. And we created some programmes, regarding to our campaign, women in violent situation with economical support and with also, a scholar companion, and it’s called to go with you and to bring social support. And it was one of the – it was the first ranking in the nation – United Nation, regarding support and it was a very important decision, because from the very beginning, we knew that the problem would be worse, and it would be worse in women and diversity and regarding violence. So, it has been some of the measures that have been taken in Argentina. Thank you for the questions.

Robert Yates

Yeah, and congratulations for topping the world poll. Well done. I can take one more question. We’re on the hard stop at seven, which is just about 30 seconds away, so if I take the gentleman just on the front row here, if I may.

Member

Who me?

Robert Yates

Yes, the mic’s above your head.

Member

Yeah, thanks. A question for, you know, either of you. I think the global health community we can agree that we’ve failed in convincing policymakers and people holding purse strings on the value of investing in health, especially in non-communicable diseases. Moving forward, I mean, are there any, sort of, lessons or any tips, tricks, anything we can take forward to convince the next generation of policymakers on the importance of investing in health?

Robert Yates

Super question, that would have been the question I’d have asked as well.

Dr Carla Vizzotti

Just for the end, simple question.

Robert Yates

Beautiful. So, please.

Dr Carla Vizzotti

And I think it’s now or never. I think it’s now or never really, because we were sure that without health we cannot improve social conditions, economical conditions, production conditions. But now has been shown so, so clearly, so it’s now or never that we have to make the changes in the healthcare system, in the laws, in the frame – in the legal framework, yeah, and if not, we are going to lose the opportunity. Because I think that before the pandemic, very few Minister of Health were known and now, at least in Argentina, some of them has been candidates for being Member of Parliament after the first two year of the pandemic. So, if we don’t do that now, I think that we are going to miss the opportunity.

Robert Yates

And Julio, to finish off, do you think it’s now or never?

Dr Julio Frenk

Yeah, I mean, we’ve been – I mean, those of us in Global Health have been making the point repeatedly for many, many years that health is not just a consequence of economic devolvement, but also a condition for economic development. And there’s a long trajectory, starts with the 1993 World Development Report by the World Bank called Investing in Health. It goes through the commission of macroeconomics and health, and a long, long series of building evidence that health is a major determiner to economic performance.

Well, if we ever, ever needed a demonstration of that, we’re having it right now. Here you have a healthy [inaudible – 61:42], a public health crisis triggering the most important economic crisis, global economic crisis in 100 years. And I think this is the moment, and what we’ve seen with previous pandemics is that we need to seize the moment literally while the crisis is still on because otherwise policymakers, Ministers of Finance, Prime Ministers, Presidents move to the next thing.

I am greatly encouraged by the fact that the Independent Panel on Preparedness, Pandemic Preparedness and Response put together by WHO for the first time has an incredible level of representation of Heads of State and Government, the Former President of Liberia and the Former Prime Minister of New Zealand, the Former President of Mexico is a member of that. They’ve issued the report. They’re proposing, at the level of the UN system, a Health Threat Council that would, you know, be like a little bit of a Security Council for this kind of measures. They’re proposing introducing it to the IMF, a diagnosis of countries economies and as a requirement, prove that countries are better prepared.

There’s a groundswell from the G20, from the EU, from many other actors to do a profound reform of global governance around pandemics, and I’ve seen a lot of energy. I hope the geopolitical tensions between China and the US, the current crisis in Ukraine, do not derail this longer-term agenda, which is one of common security around health. And today, this is the moment to persuade those decision-makers that deal with the allocation of resource that without health, there is no wealth, and that the pandemic was just a very painful demonstration of that principle and of the perils of underinvesting and therefore having weak and vulnerable health systems.

Robert Yates

Fantastic, that’s a lovely way to conclude. And really just to say that we here at the Centre for Universal Health at Chatham House, this is very much the raison d’être for our centre really, to be addressing issues around the politics and the political economy of health and health reforms. And it’s very much our philosophy as well that, you know, now is the time to be promoting universal health coverage to Ministers of Finance and Heads of Government, as well. So we’d be delighted to work with you and your colleagues right across Latin America and across the world on these issues, and let’s hope we have many more productive sessions like this as well.

So, thank you very much indeed for joining us today. It’s been an absolutely fascinating discussion and one I’ve really thoroughly enjoyed, so please do join us again online and come back when we’ll have another session like this soon, I hope. Thank you. Thank you very much indeed [applause].

Dr Carla Vizzotti

Thank you very much.

Dr Julio Frenk

Thank you.