PAHO and ECLAC call for accelerating vaccination processes, transforming health systems and building welfare states to control the pandemic and further the region’s recovery

Washington, DC, 15 October, 2021 (PAHO/ECLAC) – In a new joint report released today, the Pan American Health Organization (PAHO) and the Economic Commission for Latin America and the Caribbean (ECLAC) urge the governments of the region to accelerate vaccination processes, transform health systems, strengthen public investment and consolidate their welfare states, among other measures, to control the health crisis in the short term and move towards a transformative recovery with equality and environmental sustainability, in line with the Sustainable Development Goals (SDGs). 

“The pandemic has highlighted the need to formulate a public health agenda with a comprehensive and integrated approach in Latin America and the Caribbean, which recognizes the interdependence of the health, social, economic and environmental dimensions,” states the document – The prolongation of the health crisis and its impact on health, the economy and social development – released at a press conference today by Carissa F. Etienne, Director of PAHO, and Alicia Bárcena, Executive Secretary of ECLAC.

The COVID-19 pandemic has claimed just over 1.5 million lives in Latin America and the Caribbean, with more than 45.7 million cases confirmed since its outbreak in the region in February 2020. The region accounts for nearly one-fifth of all confirmed cases of COVID-19 worldwide and about 30% of all related deaths, despite having only 8.4% of the world’s population.

In 2020, the health crisis sparked the most severe economic contraction of the past 120 years in Latin America and the Caribbean, which also saw the worst economic performance of all the developing regions. The region’s near-zero growth in the five years prior to the crisis, coupled with the sharp contraction in 2020 (-6.8%), resulted in a record drop in employment and an unprecedented rise in unemployment, along with sharp increases in poverty, extreme poverty and inequality, all of which has further exacerbated the region’s structural problems. Growth is expected to average 5.9% in 2021, and 2.9% in 2022. However, this expansion will not be enough for the region as a whole to regain its pre-crisis GDP levels.

“Together with the structural weaknesses of the region’s health systems that hinder their ability to deal with the pandemic, the prolongation of the health crisis is closely related to the slow and uneven progress of vaccination campaigns in the region and the difficulties that countries have had to maintain social and public health measures at adequate levels,” the report says. On average, 39% of the population of Latin America and the Caribbean is fully vaccinated. Although countries such as Chile and Uruguay are close to achieving a 70% vaccination rate, 25 out of the region’s 49 countries and territories have less than 40% of their total population fully vaccinated. 

PAHO and ECLAC emphasize that global asymmetry and the institutional fragmentation seen in Latin America and the Caribbean in terms of access to COVID-19 vaccines demonstrate the urgent need to strengthen regional coordination and integration mechanisms, as well as international cooperation. There is an opportunity to deploy production and technological capacities, and to reformulate strategies and policies to strengthen local systems for the production of vaccines and essential medicines for consumption within the region itself. Prominent initiatives in this regard are the Plan for self-sufficiency in health matters in Latin America and the Caribbean — prepared by ECLAC and approved by the countries of the Community of Latin American and Caribbean States (CELAC) in September — as well as the PAHO Regional Platform to Advance the Manufacturing of COVID-19 Vaccines and other Health Technologies in the Americas, launched in September of this year to facilitate technology transfer, innovation and the development of health technologies against COVID-19, including for moving ahead on developing a mRNA vaccine in the region.

The document stresses that the persistence of the crisis has laid bare the need to transform health systems in Latin America and the Caribbean, which even before the pandemic were characterized by the weakness of health services’ response capacity, their fragmentation, segmentation and underfunding – with spending levels far below the regionally agreed threshold of 6% of GDP. ECLAC and PAHO warn that these conditions are the structural causes of inequalities in access to health services and the persistence of high out-of-pocket spending. In fact, the two agencies report that “socioeconomic vulnerability is highly correlated with the severity of COVID-19 infection and mortality.”

Similarly, the shortfalls in public investment in the region’s health systems translate into weakness in the stewardship of health authorities, a relative shortage of human resources in the health professions – with 20 physicians available for every 10,000 inhabitants in the region on average, far below the parameters recommended by the World Health Organization (WHO) – and limitations in the capacity of health service networks to resolve problems, particularly at a primary care level.

“The prolongation of the COVID-19 pandemic in the world’s most inequitable region has demonstrated the centrality that health has for welfare, the economy and development. It is time to transform Latin America and the Caribbean’s health systems based on a primary health care approach, to accelerate the post-pandemic recovery, recoup and maintain achievements in public health and resume the path towards universal health, ensuring access to health and to vaccination for all those who need it,” stated Carissa F. Etienne, Director of PAHO.

“We have moved from an emergency in 2020 to a protracted health crisis in 2021. Last year we argued that without health there could be no economy and today we say again that without health there can be no sustainable economic recovery. The priority is still the need to control the health crisis, taking a comprehensive approach and speeding up the process of vaccinating the population. The importance of strengthening the region’s capacity to produce vaccines and medicines and overcoming the external dependence faced during this pandemic has become clear,” said Alicia Bárcena, Executive Secretary of ECLAC.

The document also expresses concern that the saturation of health services during the pandemic deprived part of the population of access to these services. According to official data, 35% of the countries experienced some disruption in the provision of comprehensive health services in 2021, rising to 55% in the case of countries that reported disruptions in primary health care services.

In the report, PAHO and ECLAC emphasize that “the State has played a crucial role in responding to the challenges of the pandemic; and it must continue to do so in forging a new direction for public policy, to build more egalitarian, inclusive and resilient societies.” 

In their specific recommendations, both institutions point out the need to: build an intersectoral approach into health policies; transform health systems, taking into account the centrality of primary health care, the need to strengthen the execution of essential public health functions, equity in health care, financial sustainability and the role of the State; accelerate mass vaccination processes and maintain social and public health measures at adequate levels to control the health crisis; achieve regionwide technological advances for health and sustainable development; expedite digital transformation of the health sector; maintain expansionary fiscal policies and boost public investment to move towards a transformative recovery; and consolidate welfare states with universal, redistributive and solidarity-based policies under a rights approach.

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