By Julio Frenk, Felicia Marie Knaul and Michael Touchton
Latin America is now in the exponential growth phase of the Covid-19 pandemic. The region arrived at this stage well after East Asia, Europe, Canada and the United States, and this should have provided Latin America’s leaders and health systems with precious extra weeks to prepare. Yet, in several countries, severely delayed policy measures, poor leadership and weak and depleted health systems will compound the problem. Latin America needs a policy framework that prioritizes health while mitigating economic hardship, and accounts for the heavy burden that will be felt by the poor, those with unstable employment and women who bear the brunt of caregiving.
In Latin America, as elsewhere in the world, we are witnessing the perils of delayed action by populist regimes that devalue science and evidence, putting tens of millions of people at risk until they are proven wrong and must desperately back-peddle to implement policies to contain the virus. By contrast, leaders informed by science are able to implement health policies to flatten the curve, as well as economic and social policies to mitigate the consequences of containment.
As we have seen, the timing of mitigation efforts can shape the trajectory and severity of national outbreaks and the ability to apply scarce health system resources to save lives. Public information campaigns, cancellation of events, restrictions on movement, travel controls, fiscal and monetary measures, caregiver and family support, and emergency health investment all address different elements of the Covid-19 challenge and are all governments’ responsibilities.
In Latin America, the implementation of Covid-19 containment measures varies dramatically both across and within countries. Some governments, for example in Chile, imposed early preventive measures and mobilized health systems to meet the threat. In contrast, others with populist national leaders have done very little to prepare for or otherwise mitigate the epidemic, such as Brazil and Mexico.
Brazil confirmed its first case on Feb. 26–long after the outbreak began in Wuhan, China, and after the United States had implemented travel restrictions. Yet, throughout March, federal policy was best described as absent and, in some cases, blatantly countermanded local efforts to quarantine, with national advice against any isolation or business closures as recently as March 27. The populist Bolsonaro administration finally outlined the possibility of a national quarantine plan on March 30. Even late actions represent positive steps, but they are small consolation considering the almost absent public health response at the federal level that might have prevented community spread of the disease in late February and early March.
Similar to Brazil, Mexico’s President Andrés Manuel López Obrador consistently denied and downplayed the Covid-19 threat, encouraging the population to continue to maintain daily activities and interactions. He traveled extensively, promoting the idea that he was immune to the disease and that there was no need to be concerned until he said so.
As in Brazil, Mexican state and city governments led the public policy response in the absence of federal leadership. Mexico confirmed its first case on Feb. 27, with almost no national policy response until the third week of March, when schools closed for extended Easter vacations. On March 24, the president banned public gatherings of more than 100 people and recommended physical distancing.
The Chilean public policy response was by contrast rapid, thorough and evidence-based. Chile confirmed its first case on March 3. On March 13, President Piñera banned large public gatherings, closed schools and announced the creation of a national fund for medical supplies, to perform tests and to expand hospitals. All of this went into effect on March 15, and the country began widespread testing. These federal actions were implemented within three weeks of the first case, and roughly three weeks before similar policies in Brazil and Mexico. Chile has recorded more than 20,000 cases, but only 270 deaths, one of the lowest rates in the world.
The difference in public policy responses to Covid-19 across Latin America will ultimately combine with variation in access to medical care to determine how many citizens suffer and die from the disease. A cohesive national strategy sets a standard for universal policies, programs and initiatives that protect citizens from poor-performing local governments with low capacity to deliver services. National governments can and should also work with and support state and local governments to implement policy, as Chile did with Santiago’s communes.
Symbolic or rhetorical excesses by top political figures can have serious negative effects, sending signals to the public to ignore state and local health authorities. Put simply, this response is irresponsible, and the consequences are huge.
The Covid-19 pandemic reveals persistent inequities in health, economic and social systems. An isolated focus on disease mitigation is unsustainable for addressing the current pandemic and for preventing future health threats. National governments in Latin America must apply lessons being learned around the world and implement evidence-based policy that will reduce loss of life, build out resilience that mitigates the Covid-19 pandemic in the present and sustains health and equitable economic development in the future.
Public health professionals as well as scientists are collaborating to tackle the pandemic together. For example, the Institute for Advanced Studies for the Americas at the University of Miami, the National Autonomous University of Mexico (UNAM) and the Center for Research and Teaching in Economics (CIDE), among other collaborators, have launched the Observatory for the Advancement of Public Policies Against the Covid-19 Pandemic.
Science tells us that physical distancing flattens the curve, allowing health systems to respond to the needs of patients. Physical distancing is definitive in the outcomes for health systems that are weak to begin with. Yet, many Latin American countries are ill-prepared and have not yet effectively implemented physical-distancing policies. In its first countrywide, state-by-state analysis, the Observatory finds that physical distancing in Mexico was implemented late compared to many countries and scientific advisories. Data for Brazil will be available soon as the Observatory continues its examination of other countries in Latin America.
The Observatory, online at http://www.obscontencovid.info:
- Systematically collects information on multiple commonly observed physical-distancing public policy responses by national and state governments.
- Measures effectiveness of policies in terms of population mobility, which plays an important role in health outcomes for individuals and the greater community.
- Compiles these scores into a common thoroughness index.
- Monitors the epidemiological situation (incidence, distribution, mortality and control of Covid-19) and compares it to the specific public policy and population response.
- Will provide a live stream of information on its website.
Both the public and decision makers will be able to review not only what has been done so far, but also what is being done right now, at this critical moment, to contain the epidemic. In short, the necessary tools for governments to make decisions based on scientific evidence are at their fingertips.
Julio Frenk, a member of the Inter-American Dialogue, is president of the University of Miami, interim CEO of UHealth and former minister of health of Mexico.
Felicia Marie Knaul is director of the University of Miami Institute for Advanced Study of the Americas, professor at the Miller School of Medicine and president of Tómatelo a Pecho.
Michael Touchton is assistant professor of political science at the University of Miami and faculty lead for global health at the Institute for Advanced Study of the Americas.
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