Central American Youth Migrants Show Signs of PTSD and Stress

By Daniel Jenks and Ernesto Castañeda*

Central American migrants/ Peter Haden/ Flickr/ Creative Commons License

The trauma experienced by Central American minors before, during, and after their unaccompanied journeys to the United States puts them at high risk of post-traumatic stress disorder (PTSD) and other mental health problems, creating further obstacles to their success in school and broader integration into U.S. society. New research into results from the CLALS Pilot Project Household Contexts and School Integration of Resettled Migrant Youth, which included interviews and qualitative surveys (including a validated PHQ-9 Modified for Teens and the Child PTSD Symptom Scale, CPSS), revealed that about one-third of unaccompanied minors from El Salvador, Honduras, and Guatemala show symptoms of moderate to severe PTSD — significantly higher than the general population.

  • The study team interviewed or administered surveys to more than 100 subjects, including youths who arrived in Maryland before 2017, their parents, and social service providers, teachers, and local officials. At least 20 percent of the youth respondents exhibited symptoms of mild or moderate depression, and 38 percent said that they felt sad or depressed most days during the last year.

Many of the youths suffered deeply from separation from parents who preceded them in traveling to the United States, sometimes blaming them for problems and abuses they suffered back home, but they generally fared better than those whose parents had not emigrated. Those most deeply harmed were forced from their homes by gang violence, police corruption, and other symptoms of low state capacity, and suffered trauma along the journey to the United States. They were able to come to the U.S. and escape those problems because they had family in the United States.

  • Carlos, who migrated when he was 15 years old, left El Salvador because he was facing death threats from local gangs because he refused to join. He was scared to go to home and school. Other youths experienced pre-migration trauma that included natural disasters, war, gang violence, victimization, witnessing a crime, physical and sexual abuse, or attacks based on their sexual orientation or gender identity. (Other studies document the particular abuses faced by girls and young women.)
  • Migrating from Honduras at 13 years old, Samantha was on a bus near the Guatemala-Mexico border when gangs barricaded its door and threatened to set it on fire if they were not given a hefty fee. For the rest of the trip through Mexico, the coyotes gave her and others enough to eat only once a day. Indeed, the increased risk of undernutrition, dehydration, assault, kidnapping, and other forms of violence was common for unaccompanied youths.

Inside the United States, many face the stresses of family reunification and issues of acculturation, although our research indicates that the resulting anxiety is less severe than from the in-country and en-route traumas they experience. One mitigating factor is having access and feeling welcome to use supportive social services, education, healthcare, and employment opportunities.

  • Resentment toward parents who “abandoned” them in Central America — even those parents who were loving, reliable providers — is often deep. School challenges, language struggles, and stress related to their own legal status or that of their family further tax mental health. Complex, intimidating legal proceedings, threats of deportation, and prolonged forced separation from family get many youths off to a stressful start. Many also experience discrimination and hate crimes, becoming more aware of them as they learn English. Real or perceived lack of access to social services exacerbates stresses, and fear of dealing with authorities means that many problems go unreported.
  • Some learn to prosper. Diana, a 16-year-old from El Salvador, was scared and apprehensive when she started school in Maryland, but she found friends whom she could trust and could help her in school, and her mood improved drastically for the better.

We found that the psychological distress and disorders experienced by Central American youths in a troubling number of cases can exacerbate existing obstacles to integration, family reunification, and success in school. These obstacles, in turn, can create new stressors that exacerbate PTSD, depression, and anxiety.

  • Dealing with the traumas that plague youths in Central America is a massive undertaking that, rhetorically at least, the United States and Central American governments are addressing. Inside the United States, successful cases show that the cycle of further trauma exposure, depression, and PTSD can be overcome by making migrant processing more humane, increasing access to mental health services and education, and providing guarantees of protection to those who seek help – reforms that will be very challenging. The underlying problems are deep-rooted, and even when the Executive or Legislative branch pushes particular elements of reform, change will be hard to implement because of institutional and cultural barriers.

August 26, 2021

* Ernesto Castañeda directs the Immigration Lab and teaches sociology at American University, and Daniel Jenks is the Lab’s deputy director. This article is adapted from their full study published in Trauma Care journal.

Mexico: Setting a “New Social Ethic” of Sustainability?

By Veronica Limeberry*

Maize plot using agro-ecological options in Mexico/ International Maize and Wheat Improvement Center/ Flickr/ Creative Commons License

Mexican President Andrés Manuel López Obrador’s decree phasing out the use of the herbicide glyphosate and genetically modified (GMO) corn has strong support in Mexico – for now – and could conceivably show a way ahead on sustainable development for other countries. Announcing the decree on New Year’s Eve, AMLO framed it as creating a “new social ethic” in food production that puts the wellbeing of the Mexican people before the interests of private companies and profits. The government is moving ahead with implementation of the decree this month despite rapid and harsh pushback from Mexican and U.S. agribusiness. The U.S. Farm Bureau Federation, whose members sell GMO corn to Mexico, appealed to U.S. Agriculture Secretary Vilsack to oppose Mexico’s move.

  • Advocates of sustainable development have long opposed the use of glyphosate, the world’s most commonly used herbicide. The chemical was declared a probable carcinogen in a 2015 World Health Organization (WHO) report. Concern about glyphosate has surged in Mexico since a 2019 study by the University of Guadalajara found that all 148 children in the study had glyphosate in their urine, and all had chronic health conditions. The herbicide’s producer, Bayer-Monsanto, is in the midst of one of the largest settlements in history ($10.9 billion) involving tens of thousands of suits claiming that it causes cancer and death. Despite these growing concerns, glyphosate sales grew from $3 billion in 2015 to $8.5 billion last year, and industry watchers forecast them to be over $13 billion by 2027.

AMLO’s decree on GMO corn also reflects growing interest in Mexico to reclaim the country’s agricultural biodiversity. Mexico is the center of origin of over 59 food varieties, including corn, beans, squash, and cocoa. Mexican corn has long been part of the country’s national identity. The campaign Sin Maíz No Hay País (Without corn there is no country), launched more than a decade ago, embraces the grain as “the basis of our culture, our identity, adaptability and diversity.” Nonetheless, Mexico imported 18 million tons of GMO corn from the United States in 2020, comprising 40 percent of corn consumption. Seeking to reverse this, progressive deputy agriculture minister Víctor Suárez led the push for the decree and emphasizes “achieving self-sufficiency and food sovereignty.”

The decree includes radical terminology and establishes agroecology as national policy informed by Mexican food identity and traditions. AMLO and Suárez have defended its emphasis on sustainable, ethical, and increased food production “through the use of agroecological practices and inputs that are safe for human health, the country’s biocultural diversity, and the environment, as well as congruent with the agricultural traditions of Mexico.” The measure has the support of rural communities and both houses of Congress.

  • Some of the AMLO Administration’s rhetoric seems intended to provide leadership to other countries seeking alternatives to herbicides like glyphosate as well as GMO foods while trying to decenter the needs of industry. Numerous studies point to agrarian crises in many countries – such as the farmers’ movement in India – for which AMLO’s move conceivably offers a model. The Mexican decree offers language of community, sovereignty, and wellbeing attractive to advocates of agricultural sustainable development for the future. It will take some time, however, to see if Mexico’s approach persuades others that it can be implemented and retain popular support over the long term.

March 31, 2021

* Veronica Limeberry is a doctoral student at American University focusing on agroecology, food sovereignty, and indigenous territorial rights.

Argentina: Legalized Abortion Demonstrates Feminists’ Hard-Won Clout

By Cora Fernández Anderson*

March for Safe Abortion in Argentina/ International Women’s Health Coalition/ Flickr/ Creative Commons License

Argentine approval of legal abortion – signed into law by President Alberto Fernández on January 14 – validates activists’ claim that women’s rights are never simply granted; they must be fought for. Fifteen years after the launch of the Campaign for Safe, Free and Legal Abortion in Argentina, the Senate voted 38-29 to legalize abortion until 14 weeks. The Lower Chamber approved the measure on December 11 by a vote of 131-117. On December 30, after Senate approval, the streets of Buenos Aires filled with green – symbol of the movement – and demonstrators’ tears and joy, hugs and chants overwhelmed the scene. Feminist leaders proclaimed, “It is a day that we imagined and dreamed of many times.”

  • A strong abortion rights movement was essential to placing the issue on the national agenda and raising awareness about it. The influence of the Catholic Church, coupled with the stigma around abortion nestled in the identification of womanhood with motherhood, had created a strong barrier to any policy change. (Argentina is the home country of Pope Francis.)
  • Until very recently, most politicians, whether from the right or the left, perceived abortion reform as politically costly – a risky issue commonly referred in Argentine slang as pianta-votos – something that makes votes “escape.” Through decades of intense work, the movement showed politicians that society has changed, that new generations have different priorities, and that it is possible to win elections advocating for legal abortion. President Fernández promised to support the initiative in his campaign and he delivered.

Abortion in Argentina used to be ruled by the 1921 Criminal Code, which said it was legal only when the life or health of the woman was at risk and in cases of rape. For most of the 20th century, this regulation was not challenged, and – because the wealthy could afford the necessary certifications and medically safe abortions – class divides had deadly implications: Those with limited resources risked their lives and health in attempts to interrupt their pregnancies.

  • Only after the transition to democracy in 1983 were feminists able to promote debate on the need to legalize abortion. Led by mostly middle-class professional women, early initiatives were very small and did not have much political impact at the time. In 2001, however, protests over political and economic crises toppled the government and sparked a wave of activism that included creation of the Assembly for the Right to Abortion. This built a cross-class alliance that gave the movement a strong foothold – leading, on May 28, 2005, to launch of the Campaign credited with driving last month’s historic bill. The movement’s iconic green pañuelo – emblazoned with the main slogan, “Sexual education to decide; contraception so as not to have an abortion; legal abortion so as not to die” – became ubiquitous.

The campaign’s success can be attributed to the growth of a broader feminist movement, which shifted some public focus onto women’s realities. For example, the increase in the number of femicides inspired the movement ‘Ni una menos’ (Not one less), a grassroots collective fighting to put an end to violence against women. Recent efforts framed criminalization of abortion as another example of violence against women, making the state responsible for their inaction in the face of preventable deaths.

  • In addition to proving that it was possible to win a presidential election on a platform to legalize abortion, the Argentine campaign has inspired and given renewed hope to activists across Latin America – like those in Colombia awaiting the decision of the Constitutional Court on a case that might lead to the decriminalization. Women in Chile, who in 2017 won a few exceptions to the total ban on abortion, are now pushing harder to remove that legacy of the Pinochet years. This past week, the Chilean Parliament began to discuss a bill that would legalize abortion until 14 weeks in line with the law recently passed in Argentina.
  • The fight is not over even in Argentina, however, because opponents want the law declared unconstitutional and many doctors want to be conscientious objectors. But the movement is aware of the challenges and is ready for the fight. Indeed, feminists are not resting on their laurels. The movement will play an important role in monitoring the implementation of the law and disseminating accurate information about it so as to make abortion access a reality across the country.

January 28, 2021

* Cora Fernández Anderson is Assistant Professor of Comparative Politics at Mount Holyoke College. She is the author of Fighting for Abortion Rights in Latin America. Social Movements, State Allies and Institutions. Portions of this analysis appeared here in Ms. Magazine.

Mexico and Central America: Taking Aim at Corruption in Pharmaceutical Procurement

By Thomas Andrew O’Keefe*

Secretary of Health Headquarters, Mexico City, Mexico / Diego Delso / Wikipedia, Not Modified / Creative Commons License

Under pressure to reduce the cost of medications and medical supplies, the governments of Mexico, Guatemala, and Honduras have resorted to an international facilitator to combat inefficiencies and a lack of transparency in medical procurement while attempting to build their own capacity to manage purchases and reduce related corruption in the future.

  • The Mexican government has been trying to obtain lower prices from manufacturers and distributors of patented or single-sourced medications and medical devices since at least 2008, when it created a Coordinating Commission to Negotiate the Prices of Medications and Other Health Inputs. A pooled procurement mechanism overseen by the country’s Social Security Institute (IMSS) was established in 2013 to purchase pharmaceutical products and medical supplies on behalf of various federal and state agencies. When President Andrés Manuel López Obrador (AMLO) took office at the end of 2018, he labelled the Coordinating Commission as ineffectual and IMSS’ pooled procurement process as hopelessly corrupt – and terminated both. He consolidated purchasing authority for Mexico’s public health sector in the Secretariat of Finance and Public Credit, which also proved incapable of handling the task. To address widespread shortages throughout the country that were putting lives at risk, the Secretariat was signing contracts at exorbitant prices.
  • Last July, the AMLO administration executed an agreement with the United Nations Office for Project Services (UNOPS), a not-for-profit agency based in Copenhagen better known for implementing humanitarian and development projects. For 2021, the Mexican government is expected to spend some $4 billion to procure medications through UNOPS on behalf of federal entities and 26 of Mexico’s 32 states. UNOPS will reportedly net a 1.25 percent commission for what will be its largest single procurement project to date. In 2022, UNOPS will set up an electronic reverse auction system to conduct the bidding process with international suppliers.

Guatemala and Honduras reached out to UNOPS, with good results, years ago.

  • In 2014, UNOPS began assisting the Honduran Social Security Institute (IHSS) and Ministry of Health to establish a more effective and transparent procurement system for purchasing medications and medical supplies. After a year, UNOPS was able to procure medications at costs at 40 percent or more lower than what had previously been paid. Government funding remains a problem, but allegations of corruption in medical purchases have dropped sharply.
  • Following major corruption scandals at Guatemala’s Social Security Institute (IGSS), the Guatemalan government signed a contract with UNOPS in 2016 that involved both procurement and technical assistance to the IGSS to enhance transparency and strengthen its procurement processes. As a result, the Guatemalan government estimates the IGSS achieved an estimated 57 percent reduction in the prices of procured medicines and a 34 percent savings in surgical medical supplies and cochlear implants. The IGSS claims it was able to utilize these savings to, among other things, build new hospitals and extend health insurance coverage to more Guatemalans.
  • These experiences build on Guatemala and Honduras’ participation since 2010 in a mechanism overseen by the Council of Ministers of Health of Central America and the Dominican Republic (COMISCA) to jointly negotiate the prices of medications and medical devices for subsequent purchase by the public health sector in their countries.

Ensuring efficiency and reducing corruption in medical purchases will ultimately depend on the governments’ ability to reform their own systems, not on developing a permanent dependency on UNOPS or other international entities. UNOPS is scheduled to hand the entire procurement system over to the Mexican government in 2024. The recently created Mexican Institute of Health for Well-Being (NSABI) will initially oversee distribution within Mexico, but the AMLO administration has indicated that this function will eventually be taken over by a more specialized agency that will also have warehousing capabilities (including cold storage facilities).

  • AMLO signed an executive decree at the end of October that recognizes the health safety certificates issued by regulatory authorities in other countries as being equivalent to those issued by the Federal Commission for Protection against Health Risks (COFEPRIS) in Mexico. The decree also simplifies the process for COFEPRIS to issue certifications for the sale and consumption of all imported medications in Mexico. These moves are intended to undermine the ability of unscrupulous pharmaceutical firms to “capture” the regulatory approval process and thereby hinder competition.
  • The positive experiences in Guatemala and Honduras with UNOPS may encourage reformers in other Latin American countries, as just happened in Mexico, to look to the self- financing UN agency for assistance in clamping down on corruption, ensuring better management of the public health care sector, and implementing modern procurement systems to address the longstanding challenge of getting essential medical supplies to citizens who need them. The COVID 19 pandemic has made health a global priority and exposed serious deficiencies that no longer can be ignored. Without robust and equitable public health care systems, there is no sustainable economy.

December 21, 2020

* Thomas Andrew O’Keefe is president of Mercosur Consulting Group, Ltd. and lecturer with the International Relations Program at Stanford University.

Brazil: Presidential Lockdown?

By João Jarochinski Silva*

Bolsonaro Questioned

Bolsonaro addresses the press, May 2019/Palácio do Planalto/ Flickr/ Creative Commons License

Brazilian President Jair Bolsonaro faces mounting crises that could cut short his term in office and prolong Brazil’s multi-year political turmoil. The departure last month of two of his most widely respected cabinet members – Health Minister Luiz Henrique Mandetta and Justice Minister Sérgio Moro – came on the heels of other bad news as Bolsonaro completed his 16th month in office.

  • Brazil’s GDP grew only 1.1 percent in 2019 despite the government’s promise that pension reform and other measures would make it almost double that. Most of the growth, moreover, came from the informal sector, not the entrepreneurial class that was expected to back Bolsonaro. Moreover, all predictions are that economic performance will decline significantly because of COVID-19.
  • A number of disputes have significantly eroded his political base. In his first year as president, he left the Liberal Social Party (PSL), which gave him a home and crucial help in his campaign and early days of government. Since November, he has been trying to create a new party, Aliança pelo Brasil, but it is unlikely that he will have it ready to participate in this year’s municipal elections (Brazil has 5,000 municipalities) or able to attract politicians, mainly deputies and senators, to form a consistent base in Congress. These likely failings will affect the party budget and its TV time in the national elections of 2022. Social media was central to Bolsonaro’s successful formula last year, but observers wonder if the magic will remain.

In this context, his decision to fire Mandetta and Moro’s decision to resign are particularly severe blows.

  • Bolsonaro and Mandetta had clashed over how to deal with the COVID‑19 crisis. Bolsonaro wanted to reopen some sectors of the economy, but the minister – with apparently strong public support – sought to follow the international protocols established for “flattening the curve” to protect the health system from collapse.
  • Moro disagreed with the President’s decision to fire the commander of the Federal Police when investigations appeared to be closing in on some activities of his sons. As lead ex-judge of the Lava Jato investigations, when Moro joined the administration, he brought credibility among some sectors to the Bolsonaro government’s stated commitment to anti-corruption. Moro’s speech on leaving the ministry suggested that he felt betrayed.

Bolsonaro’s strategy at this point appears to focus on reaching out to two constituencies that he considers reliable: Evangelical Christians and the military.

  • Two of his sons, while managing to keep their government positions, shifted to the Partido Republicano, which has strong links with the Universal Church of the Kingdom of God and the second most-watched TV channel in Brazil, and other Evangelical groups. These groups are historically linked with the Centrão, a group of parties that do not have long-term political allegiances but support anyone who promotes their most immediate interests on issues such as federal administration and control over some areas with great budgetary power in the government.
  • Bolsonaro has also given the military a central political role in his government. Several government posts are held by retired and active-duty military officers, some of whom, like Moro, brought good levels of public approval to the administration. Some were seen as agents capable of taming Bolsonaro’s impulsiveness, even if evidence of success has been lacking. By lashing himself to military officers, however, Bolsonaro has tied the armed forces to his own fate and essentially coopted the officer corps into supporting him. In the event of an impeachment or other trauma, Vice President Hamilton Mourão, a retired general, and others would be held responsible for the government’s failure.

At this point, there is no good scenario for the Bolsonaro government – and COVID and other factors raise the specter of very bad scenarios in which courting the Centrão will be costly politically and financially. His alliances with the Centrão and the military also put at risk what little credibility he may have had remaining on anti-corruption after Moro’s defection. The military may not always want to be the guarantors of the government for public opinion.

  • The military will assume a technical role in dealing with the consequences of the coronavirus, including managing the impact of the economic decline such as a worsening of social tensions, but the results in terms of governance are unpredictable.
  • As Bolsonaro gropes for a way ahead, Vice President Mourão seems unlikely to willfully trip him up. Despite investing in a more thoughtful and responsible image than the president, he has not projected himself as an alternative. But the pressures for impeachment could mount steadily. Former Justice Minister Moro will be an important factor in any future scenario, but he will have to face angry supporters of Bolsonaro, mainly on social networks. A deep sense in the ranks of the other parties that he had a political agenda and lacked impartiality in the trials related to former President Lula by the Brazilian Supreme Court promises to continue the fireworks.

May 5, 2020

* João Jarochinski Silva is a CLALS fellow and professor at the Universidade Federal de Roraima (UFRR).

Regionalism in the Time of Coronavirus: The Only Way Forward?

By Leslie Elliott Armijo*

Coronavirus Latin America

Map of the COVID-19 outbreak in Latin America as of 30 April 2020/ Pharexia/ Wikimedia Commons (modified)

To overcome the multiple challenges of the COVID‑19 crisis, Latin America’s leaders will need to build regional cooperation around pragmatic solutions – an elusive goal for countries with a legacy of disunity and weak collaboration. The coronavirus has hit at a moment of economic vulnerability. Regional growth averaged only 1.9 percent in 2010-19, worse than in the “lost decade” of the debt-crisis 1980s (2.2 percent). Labor productivity, which in 1960 was almost 250 percent of the world average, has fallen steadily in every subsequent decade, and in 2019 sat at a mere 90 percent of the global mean. Persistent squabbling among Latin countries has meant that major global trading states, including the United States and more recently China, could dictate the terms of bilateral trade and investment agreements in ways that favored these larger powers.

  • In negotiating global trade, Latin America and the Caribbean have shown little shared identity or cohesion, whether as a region or as sub-regions. As of late 2018, as global value chains coalesced around three regional hubs – China/East Asia, U.S./North America, and Germany/European Union – Mexico, Central America, and the Caribbean were linked to the U.S. but lacked bargaining power to seize more advantageous positions vis-à-vis the United States. South America has deindustrialized since the turn of the century, returning to its historic role of commodity exporter to all three hubs. Intra-regional trade as of 2017 was only 22 percent of all Latin American trade and had fallen since 2013.
  • This is a shaky foundation from which to face the health and economic challenges of COVID‑19. The IMF’s scenario, which assumes an optimistic return to business mostly-as-usual in the third quarter, predicts a contraction of GDP in 2020 of 5.2 percent in the region, driven by brutal collapses in the two largest economies, Brazil and Mexico, of -5.5 and -6.6 percent respectively. The extra-regional markets for Latin America’s exports certainly will shrink due to both short-term reasons of global depression and longer-term ones of enhanced economic nationalism abroad. Remittances and tourists from the U.S. and elsewhere will not return to their previous numbers for a long time.

A coronavirus-solidarity virtual summit last month showed that some regional leaders realize the need for joint action. Nine of 12 South American presidents participated, although Brazilian President Jair Bolsonaro – who has made intemperate and dismissive remarks about his fellow leaders – gave his seat at the video conference to his foreign minister, Ernesto Araújo.

  • Argentine President Alberto Fernández participated despite Bolsonaro’s snub (including on previous occasions) and his previously chilly relations with the sponsoring body, PROSUR, founded in 2019 by center-right Presidents Iván Duque of Colombia and Sebastián Piñera of Chile as an explicit counter to the pre-existing regional body, UNASUR, which leaned left during the presidency of Bolivia’s Evo Morales (now in exile in Argentina). In so doing, Fernández demonstrated the pragmatism and understanding that Latin American and Caribbean leaders often eschew: if you want to solve policy challenges, you must maintain dialogue with people with whom you disagree.

If there is any light at the end of this tunnel, it could be psychological, as crises tend to focus minds. The disruption in international relations beyond Latin America probably will accelerate the move away from the post-Cold War “unipolar moment” and fuel domestic economic nationalism that will shake up the three major global trading hubs – a reorganization in which the region could redefine its place. In this scenario the best defense for Latin America is a strong offense. As Alicia Bárcena, Executive Secretary of the UN’s Economic Commission on Latin America and the Caribbean (CEPAL), said recently, the region’s resilience likely depends on “investment in strengthening regional production chains” to create “complementarities in production structures and regional integration.”

  • Diplomacy enables states to share knowledge and engage in collective action to meet real cross-border challenges, including those of the current crisis. Regional solidarity does not require headquarters buildings, formal treaties, and summit pageantry, nor even similar domestic political systems. The considerable achievements of the loose, informal clubs known as the G7, the G20, and the BRICS prove the value of cooperative models that need not boast costly institutional scaffolding. The Association of Southeast Asian Nations (ASEAN), formed in 1967 by 10 countries that were at least as mutually suspicious of one another as they were of China, provides another lesson about somewhat effective regional cooperation that Latin America would do well to note.

April 30, 2020

* Leslie Elliott Armijo is an associate professor at the School for International Studies, Simon Fraser University, Vancouver. Her most recent book, coauthored with C. Roberts and S.A. Katada, is The BRICS and Collective Financial Statecraft (Oxford University Press, 2018).

Cuba: Dealing with the Global Pandemic

By Ricardo Torres*

Cuban nurses carrying the Cuban flag

COVID-19 Response: Over 100 Cuban Nurses Arrive Barbados / Flickr / Public Domain

Cuba faces a “perfect storm” – a global health crisis – that poses the latest in a long list of challenges to its government, but a systematic destabilization of the country is highly unlikely, if not remote, for now. The COVID‑19 pandemic has caused an unprecedented disruption to the world economy, the devastating effects of which no country has escaped. The Cuban economy is critically dependent on tourism and remittances, two areas that have been deeply affected. Those countries from which visitors and cash flow to Cuba are greatest – the United States, Canada, Western Europe, and China – have been hit hard.

  • The shock is compounded by a drop in Cuba’s average annual growth from 2.7 percent in 2010‑15 to 1.4 percent in 2016‑19. The causes of that decline include the economic crisis in Venezuela; the cancellation of medical services agreements in Bolivia, Brazil, and Ecuador; the end of the international tourism bonanza; and the effect of new U.S. sanctions. Washington’s actions have complicated trade, foreign investment, and travel. The measures have limited remittances, reduced Cuba’s ability to import fuel, and clamped down on foreign firms operating in Cuba, such as through the first application of Title III of the “Helms-Burton Act.”
  • Another factor has been the disappointing results of Cuba’s internal economic reform, which has been wrapped up in political contradictions and a lack of clarity of its objectives. One costly flaw in these circumstances has been the government’s inability to stimulate industries that provide essential products, particularly food. Combined with the international challenges, including fresh, tough sanctions by the United States, this problem has contributed to a situation in which the Cuban people face growing shortages of all kinds of products, including food, medicines, and fuel.

The government’s response to COVID‑19 has evolved from caution to the gradual imposition of increasingly radical measures.

  • In mounting a medical response, the centralization and verticality of the Cuban model allows authorities to adapt plans and resources in the face of new priorities. The Cuban health system, for example, is known for its national coverage and access to resources (including 848 doctors and 5.5 beds per 100,000 inhabitants), and it has experience dealing with epidemics. Decisions have been taken around the concept of epidemiological vigilance, including closing the borders on April 2 and bolstering research, although the inability to carry out massive testing has been a weakness. The government has also guaranteed workers’ income and employment, except for parts of the private sector and informal economy, and expanded food-rationing to a broader list of products.

The economic impact in the medium term should not be underestimated. GDP growth will enter negative territory. Financial problems will surely deepen. Shortages of an array of basic necessities are going to worsen. Restructuring of foreign debt is necessary.

  • Internally, Cuban policymakers are going to have to take into consideration the new socioeconomic structure of the country and the need to focus support where it’s needed most. The crisis provides a good opportunity to give substance to longstanding rhetoric about improving agricultural production. Greater flexibility in regulating private businesses is also an obvious policy option. Accelerating and broadening digital access throughout society should also be a priority under the wisdom of “not putting off till tomorrow what can be done today.”

The Cuban Government is not presiding over a terminal crisis, however. Even considering the system’s weaknesses before the pandemic, this perfect storm is not its responsibility. For the medical challenge, Cuba is prepared and probably will overcome some of the criticisms made abroad about its medical missions, as brigades of Cuban doctors deploy to 19 countries. The country’s biotechnology industry also stands to make advances. It’s too early to say whether Cuba will be able to profit from these opportunities, but Havana may benefit from its willingness and ability to be a responsible international partner.

  • Washington’s policies also put it in sharp contrast with China, which continues to provide help during these difficult times. If the pandemic has made anything clear in Cubans’ minds, it’s that the United States is disqualifying itself as a positive force for change on the island.

April 17, 2020

*Ricardo Torres is a professor at the Centro de Estudios de la Economía Cubana at the University of Havana and a former CLALS Research Fellow.

 

Nicaragua in the Time of COVID-19

By Kenneth M. Coleman*

Presidente de El Salvador participa en Cumbre SICA-Nicaragua.

President of Nicaragua Daniel Ortega /Flickr / Creative Commons

Nicaraguan President Daniel Ortega and his wife, Vice President Rosario Murillo, have not appeared in public for 28 days, but their response to the threat of COVID‑19 has consistently been the equivalent of “Don’t worry, no problem, we got this!” Government policies suggest it is going out of its way to pretend the virus poses no threat to Nicaraguans.

  • On April 4, the pro-Ortega city council of Altagracia on the tourist island of Omotepe promoted a motorcyclist gathering by offering free fuel and free transport on very crowded ferries. Press photos of the event show no masks and no social distancing.
  • Several days earlier, the government orchestrated the arrival of hundreds of supporters to celebrate the opening of a bridge in Granada, with a similar absence of anti-viral measures.
  • In late March, “health brigades” were mobilized to visit households and provide information on how to avoid COVID‑19, but some citizens refused the visitors because of the lack of social distancing.
  • Private schools have closed, but public schools and universities have not. Media reports are that primary and secondary teachers are being pressured to schedule exams to compel attendance. Some parents are keeping their children at home anyway.
  • On March 13, Murillo convoked a march (but did not personally participate) entitled “Love in the Time of COVID-19,” with thousands of party supporters and public employees and their children marching in close contact.

Citizens say the government’s posture has not been reassuring and are taking action themselves. The government has not revealed the number of tests conducted, but has reported only six cases of coronavirus, all people who had been abroad, with one confirmed death. It reports no community transmission inside Nicaragua, although three Cuban women have tested positive for the virus after visiting Nicaragua. Dora María Téllez, who was a Health Minister in the 1980s, says the government is not seriously pursuing contact tracing. Costa Rica’s admission of 502 confirmed cases makes people doubt Managua’s figures. Local leaders, most affiliated with the government, have shown little willingness to taking independent action on the virus.

  • In a mid-March survey, CID-Gallup found that 65 percent of Nicaraguans were “not at all satisfied” with the government’s handling of the virus, while 11 percent were “dissatisfied.” In the same survey, 57 percent said they felt there was “much risk of contagion” in their neighborhood, and another 25 percent felt there was “some risk.”
  • Taking matters into their own hands, family-owned market stalls in public markets started closing weeks ago. Two major companies in maquila zones last week furloughed 19,000 workers to protect their health. Citizens have created an Observatorio Ciudadano COVID‑19 to collect data on cases and exposures to the virus. The Superior Council of Private Enterprise (COSEP) has pleaded with the government to close schools and allow private hospitals to test for the virus, and it joined the Central American Institute for Business Administration (INCAE) and other private-sector organizations to encourage social distancing, urge debt relief for the poor, and create a Humanitarian Assistance Fund. The government has not responded to their offers to cooperate.

Nicaraguan experts, such as epidemiologist Leonel Argüello, fear the country could eventually have as many as 500,000 COVID‑19 infections, implying thousands of deaths. The consequences for Nicaragua’s years-long political standoff are unclear. While the business community is extending an open hand to deal with the crisis, the government seems disinclined to cooperate. The one situation that would alter this dynamic is if Daniel Ortega himself – who has not appeared in public for four weeks now – were to be incapacitated. On COVID‑19, Rosario appears to be calling the shots, but if Daniel is seriously ill, internal dynamics, over time, might prove unpredictable. Were he to die, it would put in jeopardy the dynastic succession that he and Murillo (and her two sons) have worked hard to put in place. Rosario and the sons are already under sanctions by the U.S. Department of the Treasury. Even members of their party might see some disadvantages to having a president unable to conduct most international banking transactions.

April 9, 2020

* Kenneth M. Coleman is Director for Partner Programs at the Association of American Universities. The views expressed herein are his own.

 

Latin America: The Massive Challenge of COVID-19

By Carlos Malamud and Rogelio Núñez*

Bolsonaro & AMLO

Presidents Bolsonaro of Brazil and López Obrador of Mexico have been criticized for downplaying coronavirus concerns// Left: Palacio del Planalto/ Flickr/ Creative Commons (modified)// Right: PresidenciaMX/ Wikimedia Commons (modified)

Latin America has had several advantages as the COVID-19 virus has moved in – including the chance to learn the lessons of Asia and Europe – but it faces it with fundamentally weaker tools: under-resourced health infrastructures, slowing economies dependent on declining commodity prices, comparatively little ability to increase public spending, and politically weakened governments. The WHO numbers are rising and will grow steadily owing both to accelerating infection rates and more widespread testing.

Most governments have taken strong actions, including closing borders, imposing quarantines, and closing schools, but leaders face huge challenges. In many countries, their inability for years to respond to the growing social demands of the emerging middle classes, especially regarding health care, education, and other social services, have already led to major social unrest and incumbent weakness.

  • They’re going to confront the virus with grave institutional problems, including corruption and lack of financing, and a lack of popular goodwill. The worst are Venezuela, Nicaragua, and Haiti (a failed state), but Brazil and Mexico will be most deeply affected. Brazil already has a high infection rate, and Mexico’s will grow as well.
  • In Latin America’s presidential systems, most presidents have put their personal imprint on national policies. Their measures to slow the spread of the virus have faced little backlash. Brazilian President Jair Bolsonaro and Mexican President Andrés Manuel López Obrador have gone out of their way to appear oblivious to the scientific indicators that their countries could face catastrophe. Especially for politically vulnerable presidents – Chilean President Sebastian Piñera has a 10 percent approval rating – the virus entails great personal political risk.
  • Making things worse, regional organizations such as the South America Defense Council (part of UNASUR), the Pan-American Health Organization (PAHO), and the OAS have not yet provided effective international coordination. PAHO is sending “support teams” with unspecified mandates and no new resources. The Central American presidents have met digitally to coordinate strategies.

Failure of the early control measures could have dire health consequences. Health services are vulnerable and easily overwhelmed. The delayed arrival of the virus has given health officials time to prepare, and the best hospitals are in urban centers with greatest need. But the region has several Achilles’ heels, especially the shortage of facilities and resources.

  • “Universal coverage” is actually only “partial” in all but Costa Rica and Uruguay, according to a London School of Economics study. Some countries improved their preparedness in the wake of outbreaks of chikungunya, zika, dengue, and other contagious diseases, but most still lack the laboratories and field facilities to slow a virus of COVID-19’s scope.
  • Most seriously, many of the health systems lack the infrastructure to identify, treat, and isolate patients enough to slow the spread of such a highly contagious disease. The lack of efficient isolation facilities, coupled with shortages of trained personnel and essential supplies and equipment, leave the region – despite its short-term preparations – vulnerable to an outbreak much larger than in Asia, Europe and the United States.

Market crashes and likely recession in Asia, Europe, and the United States are causing collapse of the prices of Latin American exports and a series of profound pressures on economic growth in the region. Our colleague Federico Steinberg notes that the difference between a “soft-impact” scenario and a catastrophic one will depend on whether the virus is brought under control in the second quarter of the year.

  • Many observers believe the impact will be less severe in Latin America than Asia, but that assumes reasonable success keeping the crisis relatively short. Some decline is inevitable, however, because China, Europe, and the United States’ recovery will take time. Among the sobering predictions is that of the EU’s Director for Economic and Financial Affairs, who on March 13 said the EU and Eurozone will enter a recession this year with growth “considerably below zero,” but his reference to a good chance of a “normal” bounce back next year may be optimistic.
  • Experts expect food exports to suffer more and longer than energy and mineral exports, although the drop in oil prices to 1980s levels will squeeze Venezuela, Ecuador, Mexico, Colombia, Brazil and Argentina hard. New oil exploration in Brazil and fracking in Argentina has halted.

Most Latin American leaders are not oblivious to the trials ahead. On March 15, Colombian President Iván Duque said the virus will be “especially difficult for the Latin American countries” and “can overwhelm us.” The crisis requires the region to bring its principal comparative advantages – time and the ability to analyze the successful (and failed) tactics in Asia, Europe, and the U.S. – to bear to compensate for its structural weaknesses.

  • Latin America does not have the resources or mobilizational capacity that South Korea does to carry out a massive campaign to test and treat the population, but the region can avoid total catastrophe if it expands and maintains its drastic measures, adheres to the scientific evidence, and learns from other countries’ efforts to manage the outbreak.

March 26, 2020

* Carlos Malamud is a Senior Analyst for Latin America at the Elcano Royal Institute and Professor of Latin American History at the Universidad Nacional de Educación a Distancia (UNED), Madrid. Rogelio Núñez is a Senior Fellow at the Elcano Royal Institute and Professor at El Instituto Universitario de Investigación en Estudios Latinoamericanos (IELAT), Universidad de Alcalá de Henares. This article is adapted from their recent analysis published here on the Elcano Institute website.

This post has been updated to correctly identify the President of Chile.

New Western Hemisphere Trade Pacts Push Back Against Big Pharma

By Thomas Andrew O’Keefe*

Money_and_pills_in_three_colors

Attempts to limit competition from generics by pharmaceutical giants were called “TRIPS-plus” provisions in USMCA drafts/ Ragesoss/ Wikimedia Commons

Two major trade agreements affecting the Western Hemisphere have recently struck blows against the pharmaceutical industry’s efforts to keep drug prices high by limiting competition from generic medications. Big Pharma tried, but failed, to include provisions in the United States-Mexico-Canada Agreement (USMCA) and the EU-MERCOSUR Association Agreement that would go beyond those expressly permitted by the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS).

  • Those provisions would have made it extremely difficult for generic manufacturers to enter the market and contain costs. Unaffordable medicines are a large and growing global problem. Many people die of diseases today not because there is no cure, but because they cannot afford the medications.

In the version of USMCA approved by the U.S. Congress and to be signed by U.S. President Trump this week, the Democratic majority in the House of Representatives removed “TRIPS-plus” provisions that would have given “data exclusivity” for new uses of existing pharmaceutical products for up to three years and for so-called “biologics” for ten years. (Biologic drugs are produced from a living organism or contain components of a living organism, including a wide variety of products derived from humans, animals, or microorganisms by using biotechnology.)

  • Data exclusivity would have prevented generic manufacturers from utilizing the original trial results and other test data filed with regulatory health agencies concurrently with the patent application, demonstrating the medication’s safety, quality, and efficacy. Also removed from the USMCA was a provision that would have restricted competition from generic pharmaceutical manufacturers by delaying patent expirations to compensate for “unreasonable” bureaucratic delays in approving the patent. Furthermore, the USMCA now expressly allows generic manufacturers, as per Article 30 of the TRIPS Agreement, to utilize compounds used to make a patented drug in order to develop a generic version in anticipation of that drug’s patent expiration.

Similarly, the IPR chapter in last year’s EU-MERCOSUR agreement does not include TRIPS-plus provisions thanks, in part, to resistance from South American governments concerned about bankrupting their national health care systems because of increasing costs for new medications. The IPR chapter specifically supports World Health Assembly Resolutions on pandemic influenza preparedness and on a global strategy and plan of action on public health, innovation and intellectual property – both of which recognize that “intellectual property rights do not and should not prevent Member States from taking measures to protect public health.”

  • The IPR chapter is consistent with the Doha Declaration on the TRIPS Agreement and Public Health of November 2001. Furthermore, all the signatory states are required to implement articles of the TRIPS Agreement providing the legal basis for WTO members to grant compulsory licenses exclusively for the production and export of affordable generic medicines to other members that cannot domestically produce the needed medicines in sufficient quantities. (The only obligation is for the signatory states to make “best efforts” to adhere to the Patent Cooperation Treaty.)
  • The MERCOSUR countries resisted intense lobbying pressure from European pharmaceutical companies to accept provisions on data exclusivity and to compensate for bureaucratic delays by extending the monopoly on a patented medication beyond the 20-year maximum permitted by TRIPS. The fact that the United Kingdom, home to global pharmaceutical giants such as GlaxoSmithKline and AstraZeneca, was distracted by Brexit undoubtedly contributed to this outcome.

The successful pushback against attempts by the major pharmaceutical multinationals to extend their state-sanctioned monopolies to guarantee a steady flow of profits reflects public outrage over multiple scandals that have ensnared the industry in recent years. This includes not only the massive opioid addiction crisis in the U.S., but firms buying up patents that are about to expire and jacking up their prices in excess of 1000 percent. It makes the traditional industry argument of needing extended monopolies to incentivize innovation and the development of new drugs ring hollow as these speculators incur no research and development costs. As a result of the efforts of MERCOSUR and Democrats in the U.S. House of Representatives, the pharmaceutical industry may be facing a paradigm shift in which it will be forced to develop a new business model for pricing new treatments.

January 28, 2020

Thomas Andrew O’Keefe is the president of Mercosur Consulting Group, Ltd. and a lecturer at Stanford University. He is the author of Bush II, Obama and the Decline of U.S. Hegemony in the Western Hemisphere (Routledge, 2018).