DEEPENING COOPERATION AND COORDINATION ON
JULY 2021DEEPENINGCOOPERATION ANDCOORDINATION ONHEALTH POLICY IN THEAMERICASA New Approach to Health EmergenciesInter-American Health Task ForceWhite PaperDeepening Cooperation and Coordination on Health Policy in the AmericasJULY 20211
TABLE OF CONTENTSAcronyms and Abbreviations. 3Executive Summary. 4Figure 1. Summary of specific recommendations for health emergencies cooperation and coordination in the Western Hemisphere . 6Introduction and Background. 7The Guiding Principle: "Health is the Greatest Wealth". 9Purpose of the Task Force. 9Chapter 1: Setbacks in Regional Cooperation and Coordination in the Time of Covid-19. 101.1. Inadequate Political Leadership, Coordination and Planning. 101.1.1. Weak Global Solidarity Undermines Regional Cooperation . 101.2. Challenges to Intragovernmental Coordination at All Levels . 121.2.1. Management Challenges. 12Chapter 2: Understanding the Crisis Along Four Axes. 132.1. Data Accuracy, Timeliness, Availability, Transparency, Consistency, Completeness . 132.1.1 Surveillance: The Foundation for Prevention. 132.1.2. Integrating Artificial Intelligence, Privacy, and Transparency in Pandemic Management . 142.1.3. Timely Data Sharing and Open Access in the Era of Global Pandemics. 152.1.4. The Importance of Genomic Sequencing to Covid-19 Response. 162.1.5. Regional Efforts to Gather and Share Data. 172.2. Noncompliance with the IHR. 172.2.1. WHO's Work in Covid-19: Findings and Opportunities. 172.2.2. Lack of Investment in IHR in Americas Region. 202.2.3. A New Potential Framework Convention for Pandemic Preparedness and Response. 202.3. Lack of Equitable Access to Health Products and Services in the Time of Covid-19. 212.3.1. Shortages of Medical Supplies. 212.3.2. Access to Health Products in the Time of Covid-19: Business as Usual. 222.3.3. Access Gaps Threaten the Regional Fight Against Covid-19. 252.2.4. Collateral Effects of Covid-19 in Access to Health Care and Social Care. 262.4 Misinformation, Disinformation, Conspiracy Theories: A War Against Multiple Forces. 272.4.1. Coordination and Cooperation are Essential to Deal with Disinformation. 282.4.2. Vaccine Opponents. 29Chapter 3: Why Focus on Enhancing Post-Covid-19 Cooperation and Coordination in the Western Hemisphere?. 303.1 Boosting Hemispheric Cooperation on Health Emergencies . 303.1.1 Shaping More Resilient Health Systems to Covid-19 and Other Health Crises . 313.1.2. The Underlying Principles for Sustainable and Lasting Cooperation in the Region . 32Chapter 4: The Way Forward For Improving Regional Cooperation in Pandemic Preparedness and Response. 344.1 Specific Recommendations. 34Table 1. A new take on cooperation and coordination on health emergencies in the Western Hemisphere: Specific recommendations . 35Glossary. 42References. 462Deepening Cooperation and Coordination on Health Policy in the Americas
DIÁLOGO INTERAMERICANO FEBRERO2018JULY 2021ACRONYMS AND Oartificial intelligenceCenters for Disease Control and PreventionEconomic Commission for Latin America and the Caribbeanemerging infectious diseasesFoundation for Innovative New Diagnosticsgender-based violenceintensive care unitinternational financial institutionsInternational Health RegulationsIndependent Panel on Pandemic Preparedness and Responsemisinformation and disinformationmachine learningnoncommunicable diseasesOrganization of American StatesOrganization for Economic Cooperation and DevelopmentPan American Health Organizationpersonal protective equipmentresearch and developmentreproductive, maternal, neonatal, and child health servicesSustainable Development GoalsTrade Facilitation Agreement(Agreement on) Trade-Related Aspects of Intellectual Property RightsUnited Nations Development Programvariant of concernWorld Health Organization 2021, Inter-American DialogueFirst EditionPrinted in Washington, DCCover photo: Tim Evanson / Flickr / CC BY-SA 2.0 / Edits: Made black and white,added blue tint, cropped / Original: bit.ly/3ld3sJ5Layout: Kaitlyn Blansett / Inter-American DialogueIndustrias extractivas y regulaciones ambientales en el posconflicto: Preguntas clave para el nuevo gobierno Colombiano3
EXECUTIVE SUMMARYThe Covid-19 pandemic has laid bare fundamental flawsin political leadership, coordination, and health policyintegration in the Western Hemisphere. Moreover, thecurrent geopolitical divides among governments in theregion have undermined the few mechanisms in place forcooperation on health governance. The post-pandemicrecovery would benefit from coordination and cooperation,both between and within countries.Although national health systems, including those withuniversal health care, were not well equipped to cope withan epidemic of the magnitude of Covid-19, communitiesacross the Americas expected their governments to maketimely decisions; balance scientific, economic, and socialfactors; and protect their citizens from the virus and fromthe negative impact of the pandemic on livelihoods andwell-being.Understanding the CrisisAlong Four AxesThe Covid-19 pandemic has underscored long-standingchallenges in meeting all the capacities required by theInternational Health Regulations (IHR). Strengthening andinvesting in health systems is both a national and globalpriority for economic stability and security. Likewise, thepandemic has deepened the existing vulnerability of themedical product supply chain. The spread of the noveldisease has been accompanied by global shortages ofcritical medical products, high prices, unfair competition,nationalism, and export bans. Moreover, the region is anexample of inequalities in access to Covid-19 vaccines.The vaccines have arrived in Latin America and theCaribbean (LAC), but at a slow pace compared to NorthAmerica, threatening, and prolonging their social andeconomic recovery.Furthermore, the need for trustworthy information hasnever been greater and more urgent than during thispandemic. One of the key pillars needed to slow the spreadof Covid-19, mitigate its effects, and underpin collectivesocial responses is reliable sources of information.4Deepening Cooperation and Coordination on Health Policy in the AmericasMisinformation, disinformation, and conspiracy theories,which have spread widely, have contradicted, or dismissedthe warnings and advice of the scientific community.On the other hand, other factors have been used as anopportunity for health systems to be updated, includingthe use of big data, artificial intelligence, and telemedicine.Nevertheless, despite efforts by the Pan American HealthOrganization, health ministries, national statistics offices,multilateral organizations, agencies, and academicinstitutions, among others, the challenge of harmonizingand combining such diverse data systems remains anarduous task, particularly in some countries that lacksufficient resources, adequate infrastructure, and technicalcapacity. For these reasons, it becomes rather difficultto meet basic standards in areas such as accuracy,consistency, timeliness, transparency, completeness, andusability of data.A New Take on HealthEmergencies Cooperationand Coordination in theWestern HemisphereThe ability to respond regionally to the acute phaseof the Covid-19 pandemic and recovery depends oncoherent health governance that relies on the principlesof solidarity, transparency, trust, and sustainability ofcooperation across the region. Furthermore, there is anopportunity to address deficits in public health governanceand enhance preparedness for future pandemics.Advantage should be taken of regional or subregionalintegration mechanisms to join forces and shareexperiences in epidemic prevention and control of futureor existing diseases that could threaten people's security,particularly the most economically marginalized.
JULY 2021KEY MESSAGES - EXECUTIVE SUMMARY Leadership, governance, political will, and trust among countries in the Western Hemisphere area necessary condition for success in fighting this pandemic and preparing for the next one. Thismay seem to be a major challenge in today's geopolitical environment. However, the devastatingimpact of Covid-19 on all communities and countries and the universal commitment to never letthis happen again offer a common purpose and agenda for transformative change in global andregional collective action. The current Covid-19 pandemic raises important questions about the quality, transparency,sharing, and use of data, and it highlights the challenges associated with data use. High-qualitydata, transparency, and continued investment to ensure data protection are prerequisites for theanalysis and use of big data and for the guarantee of value and exchange of open data and dataprotection and privacy. The world needs a new era of cooperation and collaboration for IHR implementation. It isimperative to enable transparent, independent, and regular assessments of the core capacitiesand preparedness of countries for future pandemics; understand gaps in performance ofcountries’ responses to public health outbreaks; and support countries in prioritizing investmentsin health security and the strengthening of health systems. Ensuring equal access to Covid-19 health services and products – in particular, vaccines –would maximize social and economic recovery and bring the pandemic under control in theregion. Therefore, all stakeholders should act to protect the populations with the greatest unmetneed, provide further financial and in-kind support to COVAX, and ensure availability of Covid-19vaccines, including by expanding production and manufacturing capacity, sharing intellectualproperty, and facilitating technology transfer. Controlling and managing the spread of misinformation, disinformation, and conspiracytheories. The best way to deal with the spread of misinformation is to put science at the forefrontof all discussions. Misinformation, disinformation, and conspiracy theories are a growingthreat that will ultimately require global and regional cooperative efforts among researchers,governments, and social media platforms.PURPOSES AND RECOMMENDATIONSThe purpose of this white paper is to understand thelessons and challenges of the regional response toCovid-19 and appraise, in retrospect, how they wereaddressed and how they could have been addressed.The paper also makes specific recommendations. Theserecommendations are grouped into five areas gearedtoward improving cooperation and coordination inhealth policy to support regional Covid-19 response andrecovery, as well as future health emergencies:1.Promoting leadership and better governance inregional health emergencies;2.Increasing access and sharing of high-quality data;3.Strengthening regional health security by investingin national preparedness;4.Ensuring equitable access to Covid-19 healthservices and products, in particular vaccines, and;5.Controlling and managing the spread ofmisinformation, disinformation, and conspiracytheories.Deepening Cooperation and Coordination on Health Policy in the Americas5
FIGURE 1. SUMMARY OF SPECIFIC RECOMMENDATIONS FOR HEALTH EMERGENCIESCOOPERATION AND COORDINATION IN THE WESTERN HEMISPHERE (SEE TABLE 1.)6Deepening Cooperation and Coordination on Health Policy in the Americas
JULY 2021INTRODUCTION ANDBACKGROUNDAmerica became a global epicenter of infections anddeaths from the SARS-CoV2 virus and its associateddisease, Covid-19, by mid 2020. The pandemic that startedin Wuhan, China, quickly moved to Europe, Canada, andthe United States. In time, it spread to Latin America andthe Caribbean (LAC) with disastrous consequences. WhileCanada and the United States have reported more than26,000 and 610,000 deaths, respectively, Latin Americaand the Caribbean, with only 8 percent of the world’spopulation, have recorded more than one million threethousand deaths, or almost 30 percent of the world’stotal, and more as of July 23, 2021. About 89 percent ofthe deaths in the LAC region occurred in five countries:Brazil (44.3 percent), Mexico (22.1 percent), Colombia (8.3percent), Argentina (7.3 percent), and Peru (6.7 percent).Of the remaining deaths, 3 percent were recorded inCentral America and 1 percent in the Caribbean, accordingto the Pan American Health Organization (PAHO). Dr.Carissa Etienne, the director of PAHO, expressed it clearly:“This is a tragic milestone for everyone in the region.”1Although there is precedent for countries in the region tocollaborate on health policy, Covid-19 has been addressedwith unilateral responses. Countries adopted differentstrategies in their effort to contain the spread of the novelcoronavirus. This led to a perverse competition in theearly phase of the pandemic to procure critical medicalgoods, including personal protective equipment (PPE) andventilators. While the marketplace for most of these andother critical supplies has stabilized, we are still at a riskthat these patterns will prevail and adversely impact theaccess to and exchange of knowledge on critical issuessuch as effective medicines, clinical trials, and equitableaccess to vaccines. The World Health Organization (WHO)has called on countries to administer vaccines usingpriority health criteria. In the words of WHO Director1. Pan American Health Organization and World Health Organization,“Latin America and the Caribbean Surpass 1 Million COVID Deaths,”PAHO, May 21, 2021, eral Dr. Tedros Adhanom Ghebreyesus, “all at-riskpeople in all countries, especially health workers, olderpeople and those with underlying conditions, need access tovaccines – not all people in some countries.”Preexisting structural economic and social problems haveamplified the negative impact of the Covid-19 pandemicin the hemisphere. This, in turn, has exacerbated thosehistoric problems. According to the Economic Commissionfor Latin America and the Caribbean (ECLAC), by the endof 2019, several LAC countries experienced more thanfive years of economic slowdown, rising unemploymentand informal labor rates (up to 54 percent), rising poverty,inequality, including the effects of low commodity prices,fleeing foreign capital, and weakening currencies.2 In2019, the economic growth of the region stood at just 0.2percent, and real gross domestic product (GDP) contractedby 8.1 percent in 2020, the worst among the world’s majorregions. In the case of the United States and Canada, realGDP fell by -4.3 and -7.1, percent, respectively, in 2020.In the same period, the global economy declined by -4.4percent.3This is linked to the fact that the Americas region hasbeen significantly affected by the Covid-19 pandemic,even though it is a global champion of leading vaccinationprograms to eliminate common infectious diseasessuch as smallpox, measles, and rubeola and having awell-placed Pan-American Health Organization (PAHO),in dual identity as a specialized health agency within theinter-American system and the WHO Regional Office for2. Economic Commission for Latin America and the Caribbean,“Reconstruction and Transformation with Equality and Sustainabilityin Latin America and the Caribbean,” October 26, 2020, 8/files/20-00652ses.38 reconstruction-transformation web.pdf.3. International Monetary Fund, “Real GDP Growth Annual PercentChange,” International Monetary Fund, June 11, 2021, https://www.imf.org/external/datamapper/NGDP RPCH@WEO/OEMDC/ADVEC/WEOWORLD/CMQ/WE.Deepening Cooperation and Coordination on Health Policy in the Americas7
the Americas. This can partially be understood in light ofthe fact that the region has the world’s highest incomeinequality.While the estimates predict a financial and economicrecovery in the Americas from 2021 onward, the socialeffects of Covid-19 could be more dramatic for LatinAmerica and the Caribbean in the long term. In addition toCovid-19, the region is grappling with the challenges posedby migration in Central America, as well as the Venezuelansituation, as many people struggle to survive in extremelyprecarious situations. These crises are taking placewithin a surge of populism, nationalism, xenophobia, andauthoritarianism, a combination that threatens democracy,political stability, and human rights.Central America and the Caribbean bear the additionalrisk posed by natural disasters, shown by the recentdevastation of Hurricanes Eta and Iota in November 2020.Hazards such as meteorological and natural disasterswill continue to coexist and interact with the effects ofCovid-19. These interactions challenge the resilienceand recovery of the social, economic, and environmentalstructures in the region after Covid-19. Resolving politicalpriorities in response to the Covid-19 pandemic and theeffects of natural hazards requires a complex decisionmaking process that must inevitably be guided by scientificevidence.4Progress in poverty reduction has been reversed, as havethe gains in gender equity in the region. The World Bankestimates that between 119 and 124 million people fell intopoverty in 2020 globally because of the pandemic. In 2021,this figure is set to increase from 24 million to 27.6 millionin Latin America and the Caribbean.5 According to WorldBank surveys, female workers were 44 percent more likelythan male workers men to lose their jobs at the start of thecrisis.6 The biggest concern was the significant increasein cases of gender-based violence (GBV) and the greater4. Mark C. Quigley et al., “A Multi-Hazards Earth Science Perspectiveon the COVID-19 Pandemic: The Potential for Concurrent andCascading Crises,” Environment Systems & Decisions 40, no. 2 (May16, 2020): 199–215, https://doi.org/10.1007/s10669-020-09772-1.5. Christoph Lakner et al., “Updated Estimates of the Impact ofCOVID-19 on Global Poverty: The Effect of New Data,” WORLD BANKBLOGS, August 7, 2020, a.6. The World Bank, “COVID-19: The Costly Setback in Latin AmericanWomen’s Progress,” World Bank, March 4, 2021, a-mujer-latinoamericana.8Deepening Cooperation and Coordination on Health Policy in the AmericasWe need to capitalize onwhat is undoubtedly a globalpublic health moment andintroduce not only short-term,marginal improvements,but fundamental structuralchanges into the globalhealth system so it can betterprotect everyone in our deeplyinterdependent planet.Julio Frenk, Co-chair, Inter-American Health Task Force,First Virtual Meeting, March 2, 2021difficulties in accessing assistance during the pandemic.Throughout the region, international organizations haveworked with authorities, police, the private sector, civilsociety, and local communities to develop innovative waysto tackle the rising GBV rates.It is in the interest of the region that the social andeconomic needs of the most vulnerable and marginalizedare met to overcome the Covid-19 crisis. The regionneeds to be equipped with new financial instruments fora sustainable recovery that facilitates access to criticalmedical goods and a regional accelerated approachto ensure equal access to Covid-19 vaccines withoutexcluding migrants.The region needs to rebuild health, social, and economicsystems in ways that follow international guidelinesand are supported by research and science. Healthemergencies will continue to challenge the region due tothe global climate crisis and the unsustainability of current
JULY 2021economic patterns. Likewise, governments and expertsneed to focus on reliable information and measuresthat promote target-specific interventions to developaccurate risk perception, and therefore, a more significantcommitment to community protective behavior. It is crucialto stimulate group identity and the sense of belongingof citizens to achieve more successful results. Thesignificant impact and relatively successful response inAsia-Pacific countries can be attributed to their experiencewith infections, such as the Severe Acute RespiratorySyndrome in 2003, where the population experiencedpreemptive containment measures and strong centralgovernment.capital is the most valuable source of economic mobility.But human capital needs to be understood as part of ahealthy planet. Human health protection is linked to theeffects of human economic activities that disrupt thebalance between ecosystems and habitats.Why focus on enhancing post-Covid-19 cooperation andcoordination in the Western Hemispheric? While Covid-19 isan unfolding event, and there is uncertainty about howthe world will look when the pandemic ends, high-qualityinternational and regional cooperation must be put in placeto successfully address current and emerging challenges.“Health is the greatest wealth” is the guiding principle ofthe Inter-American Health Task Force. In a rich, biodiverseregion, the Covid-19 recovery offers an opportunity toadvance in achieving the Sustainable Development Goals(SDGs) by strengthening the accessibility and resilience ofhealth systems.The Guiding Principle:"Health is the GreatestWealth"Purpose of the Task ForceThe Roman poet Virgil coined the famous phrase, “Thegreatest wealth is health.” As a global health crisis thathas paralyzed the world unfolds, the importance ofplacing health at the center of all investment prioritiesis unquestionable, to address the links between social,economic, and environmental systems.Sustainable economic development is not possible withoutinvestment in health. Covid-19 reminds us that humanThe Covid-19 pandemic has signaled the relevance ofother guiding principles in global governance of infectiousdiseases. One Health, whole-of-government and healthin-all-policies approaches have been on the global healthagenda but mostly unknown and, in some cases, slightlyimplemented by public policy decision-makers andentrepreneurs in setting economic policies and strategies.The Inter-American Health Task Force strives to analyzeand identify specific recommendations to improvecooperation and coordination in health policies to supportregional preparedness, readiness, monitoring, andresponse for future health emergencies in the WesternHemisphere. The work of the Task Force members wascarried out through virtual exchanges, including twomeetings that took place on March 2, and May 4, 2021,and were supported by a Steering Technical Director andTechnical Associate of the Inter-American Dialogue.This white paper has been made possible with thegenerous support of the Inter-American Development Bank,UnitedHealth Group, and the World Bank.The social effects of Covid-19 could bemore dramatic for Latin America andthe Caribbean in the long term.Deepening Cooperation and Coordination on Health Policy in the Americas9
1. SETBACKS INREGIONAL COOPERATIONAND COORDINATION INTHE TIME OF COVID-19Covid-19 could be considered a case study of politicalmissteps. Although national health systems, includingthose with universal health care, were not well equippedto cope with an epidemic of the magnitude of Covid-19,communities across the Americas expected theirgovernments to make timely decisions, balancing scientific,economic, and social factors to protect their citizens fromthe virus and from the negative impact of the pandemic onlivelihoods and well-being.1.1. Inadequate PoliticalLeadership, Coordination &PlanningIn times of crisis, governments and politicians have theprimary responsibility to lead national responses and tocommunicate the information to citizens on the basis ofthe best available scientific evidence. The initial responseof Covid-19 was negligent in some cases, resultingin millions of preventable deaths and high social andeconomic costs.While facing crises is a task that political leaders must beprepared for, it is not an easy or straightforward endeavor,particularly when crises emerge suddenly. When leadersfocus on returning to normalcy, bias in seeing the crisis asa slow-developing event can lead them to underestimateboth the possibility of a crisis and the impact it could have.As a result, Covid-19 has evolved from a health crisis toa global political crisis. The shortcomings of governmentleadership, including its role in multilateral institutions,have impacted the public’s willingness to cooperate incontaining the spread of the virus and opened the door to10Deepening Cooperation and Coordination on Health Policy in the Americasmisinformation and conspiracy theories. In the case of theAmericas, the crisis was exacerbated by shared factors ofnationalism and unilateralism by the leaders of the majoreconomies - mainly Brazil, Mexico, and the United States.1.1.1. WEAK GLOBAL SOLIDARITY UNDERMINESREGIONAL COOPERATIONThe social and economic effects of Covid-19 havesurpassed those of other emerging infectious diseases(EIDs) identified since the 1918-19 Great Influenza (H1N1).Paradoxically, the current pandemic is taking place in theage of big data, global scientific evidence, and establishedmultilateral organizations and agreements to cooperateand coordinate in response to health emergencies resources that were not available in the past.Despite these global assets, the unknown origins ofCovid-19 and the slow dissemination by the Chinesegovernment of information on the virus hampered initialinternational efforts to curb the spread of the disease. Thisexacerbated the existing political confrontation betweenChina and the United States, impacting trust in multilateralmechanisms to put in place a swift global response tothe disease. As a result, some Western Hemisphere andEuropean countries underestimated the initial warningsabout the severity of Covid-19, leading to a dividedresponse that did not prevent the disease from spreadingrapidly and widely, with countless effects in developingcountries.By comparison, the scientific community has provided acle
4 Deepening Cooperation and Coordination on Health Policy in the Americas The Covid-19 pandemic has laid bare fundamental flaws in political leadership, coordination, and health policy . The best way to deal with the spread of misinformation is to put science at the forefront of all discussions. Misinformation, disinformation, and conspiracy .
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