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.

Zika Challenges Mount

By Rachel Nadelman* and Fulton Armstrong

Scientists and Zika

Photo Credit: Pan American Health Organization / Creative Commons / Flickr

While scientists struggle to confirm their theories over the link between the Zika virus and the dread health conditions it apparently causes, national and regional leaders face the monumental task of addressing popular anxiety that’s spreading faster than the virus itself.  The Health Minister in Brazil – site of the largest outbreak of microcephaly – has said he is “absolutely sure” that the virus is causing women to give birth to babies with the condition, characterized by abnormally small heads and serious developmental deficits.  The head of the World Health Organization’s emergency response team said last week (2/19) that the “virus is considered guilty until proven innocent,” but that it will take four to six months to even potentially be sure.  In the meantime, other questions are emerging:

  • Argentine scientists calling themselves “Physicians in the Crop-Sprayed Villages” suspect that the outbreak has been caused by pesticides. They note that thousands of Zika-infected pregnant women in Colombia – where the larvicide pyriproxyfen has not been added to drinking water as in Brazil – have delivered normal babies.  El Salvador, also hard hit by Zika, has not reported Zika-related microcephaly cases.  Other scientific authorities, including the U.S. National Academy of Sciences, question the evidence for this theory, and the later arrival of the disease in these countries means the consequences for infected expectant mothers cannot be fully determined.  Research is ongoing.
  • In lowland Colombia, along the Caribbean Coast, the virus is being blamed for an outbreak of Guillain-Barre syndrome, when victims’ immune systems damage nerve cells and cause pain, weakness, sometimes paralysis, and even death. Scientists are investigating.
  • Mental health experts say the Zika virus closely resembles some infectious agents that have been linked to autism, bipolar disorder, and schizophrenia. They can’t confirm their suspicions.
  • Entomologists and climatologists are warning that global warming will accelerate the spread of Zika and other diseases transmitted by the mosquito Aedes aegypti, which thrives in warmer, more humid environments. They caution that the number of people currently exposed to the mosquito, roughly 4 billion, will grow steadily.  Evidence is inconclusive.
  • Other theories include that the birth defects are caused by genetically modified mosquitoes released by a British company in Brazil to combat dengue; and by vaccinations given to pregnant women to prevent rubella and pertussis. But doctors and scientists have so far rejected each one.

Regional organizations and governments are taking whatever actions they can while awaiting more conclusive science.  Briefing the OAS, the Assistant Director of the Pan American Health Organization called on countries to “to mobilize to eliminate mosquito breeding sites in every corner where they may be” and pledged PAHO’s support to do so.  Brazil has formed special teams to travel around the country to rigorously quantify cases of Zika and possible links with microcephaly.  U.S. President Obama has asked Congress for US$1.9 billion and approval to reprogram funds left over from Ebola eradication efforts to deal with Zika in Latin America and the United States.  Cuban President Raúl Castro has mobilized 9,000 troops and police to spray neighborhoods and eliminate standing water in which the mosquitoes breed.

The “epidemic,” as some leaders are calling it, will be difficult to respond to even after scientists certify the mosquito-virus link.  Solving the mystery of the higher concentration of microcephaly cases in Brazil, or linked to Brazil, will also be essential to developing an effective public health response.  Eradicating all mosquitos would be a monumental undertaking – further complicated by the fact that the history of pesticides shows equal or even greater risks to citizen health when used widely.  The Aedes mosquito sucks the blood of both rich and poor, but population density and weak infrastructure — allowing for stagnant water – makes lower-income communities much more vulnerable.  Focusing on the mosquito may not be enough, moreover, because there are early indications that Zika can be sexually transmitted.  Traces of Zika have been found in breast milk, but the implications remain unclear.  Such questions fuel popular panic, increasing the risk that governments will make rash decisions that could have  profound costs.

February 26, 2016

* Rachel Nadelman is a PhD candidate in International Relations at the School of International Service.  Her dissertation research focuses on El Salvador’s decision to leave its gold resources unmined.

The Zika Virus and a New Debate on Reproductive Rights

By Rachel Nadelman*

Zika Women

Photo Credit: Day Donaldson and PresidenciaRD / Flickr / Creative Commons

The call by half a dozen Latin American and Caribbean governments for women to put off pregnancies – as the World Health Organization warns the feared Zika virus is “spreading explosively” – is stimulating a new debate on reproductive rights in the region.  El Salvador’s Health Ministry has urged women to “avoid becoming pregnant this year and next,” and Brazil, Jamaica, Colombia, and others are issuing similar advisories.  A mosquito-borne disease spreading rapidly in the Western Hemisphere for the first time, Zika is blamed for causing devastating neurological birth defects in newborns whose mothers contract the virus during pregnancy.  The U.S. Center on Disease Control has advised pregnant women to avoid travel to the more than 20 Latin American and Caribbean countries now hosting the disease.

Named for the Uganda forest where it was discovered in the late 1940s, Zika is carried and transmitted by the Aedes Aegypti mosquito, best known as the vector for life-threatening viruses like yellow fever and dengue.  Within the Western Hemisphere, the Aedes population has increased drastically in recent years, linked by scientists to changes in climate.  Yet Zika’s arrival in Latin America last year, first documented in Brazil, and subsequent expansion did not attract major attention until the pattern of birth defects emerged.  Zika’s symptoms are sometimes imperceptible or typically mild, including fever, joint aches, and conjunctivitis, so health officials did not consider it a major threat to the general population.  Although definitive clinical proof is still lacking, Zika is now linked to microcephaly, a rare neurological condition that causes children to be born with small heads because of abnormal brain development in the womb or immediately after birth.  The emergence of Zika in Latin America has coincided with a more than 20-fold increase in the incidence of microcephaly.  (Brazil has reported 4,000 cases in the past year, a drastic increase from just 150 in 2014).  The babies suffer from poor brain function and reduced life expectancy.  Doctors are finding traces of the virus in the brains of microcephaly-inflicted babies who were stillborn or died soon after birth.

Warnings and advisories offer no help to the millions of women who live in afflicted countries.  Governments are launching fumigation programs to reduce the Aedes mosquito population and thereby limit disease transmission.  Asking populations to refrain from having children appears a bit facile, if not cynical, in a region with low levels of access to birth control for reasons that range from religious dictates to economic obstacles.  Severely restrictive abortion laws also complicate potential parents’ options.  Five Latin American countries (including Honduras and El Salvador, hard hit by Zika) ban abortion without exception, even to save the mother’s life.  Others criminalize abortion with few allowances.  According to the Guttmacher institute, 95 percent of abortions in Latin America are unsafe, contributing to high maternal mortality rates. It’s not surprising, therefore, that Zika’s link to these devastating birth defects has generated unprecedented public discussion throughout Latin America about women’s and families’ rights and responsibilities for taking control of reproduction.  It is far too early to know if the health advisories will have practical impact on the incidence of microcephaly – or on attitudes toward reproductive rights over the longer term.   

February 1, 2016

* Rachel Nadelman is a PhD candidate in International Relations at the School of International Service.  Her dissertation research focuses on El Salvador’s decision to leave its gold resources unmined.