“Pandemic affected Latin America unevenly”, said Ibero-American Secretary-General

The name of the most recent seminar of the Fiocruz Global Health Center (CRIS in the Portuguese acronym), last Wednesday (May 12th), came from a question: Ibero-America - A New Space for Health Diplomacy? And it ended with an answer. For most of the event’s attendees, diplomats and experts on both sides of the Atlantic, the pandemic accelerated a process of cooperation that had already been taking place in the region, put health under the spotlight, and showed that a common response is needed for a common problem. “It is not the diplomacy of the disease or the vaccine. It is the diplomacy of health. It is about having health as an asset and fundamental human right”, explained Paulo Buss, coordinator of CRIS/Fiocruz and moderator of the event.

Latin America has been disproportionately affected by the COVID-19 pandemic, said Rebeca Grynspan, economist and former Vice President of Costa Rica, now at the head of the Ibero-American General Secretariat (Segib). Although it has just over 8% of the world’s population, the region concentrates 25% of deaths from the disease. She credited this impact to structural problems that the 20th century failed to solve and that were aggravated by Sars-CoV-2.

“When it comes to recovery, we need to look for a model that overcomes these gaps”, Grynspan said, advocating for a more inclusive and sustainable path. “The first task is to complete the universalization of health. It hurts to lose two decades’ progress in social indicators in a year.”

The Secretary-General of Segib recalled that health was the central theme of the 27th Ibero-American Summit, held in April in Andorra, and that it ended up permeating the other discussions. She divided the results of the meeting into three major interconnected areas: health and vaccination; international financing and foreign debt; environment and climate change. Grynspan stressed that countries in the region will not be able to recover on their own, needing international support.

Epidemiological observatory

At the summit, the creation of an Ibero-American Epidemiological Observatory was approved, a mechanism for coordinating and strengthening the existing epidemiological networks for a more effective response. And the Ibero-American Health Networks, which are now eight, have been recognized in Andorra as an essential part of the cooperation. “They emerged from the dialogue we had with Fiocruz using the existing networks, such as the Latin American ones, and being able to advance in the Ibero-American space”, Grynspan said, with the entrance of institutions from Portugal and Spain. “The exchange of knowledge saves lives.”

The National Visions panel was attended by ambassadors Ruy Carlos Pereira, director of the Brazilian Cooperation Agency (ABC); Carlos Alfonso Abella y de Arístegui, representative of Spain’s Special Mission for the Ibero-American Summit and Region; Rubén Silié Valdez, Deputy Minister of Multilateral Foreign Policy of the Dominican Republic; in addition to the Deputy Director-General of Foreign Policy of the Ministry of Foreign Affairs of Portugal, Ana Filomena Rocha.

For Ruy Pereira, Segip is indeed “a new space for Health Diplomacy”, as a strengthening to the multilateralism and as an action that is analogous to the United Nations 2030 Agenda. He recalled that, recently, the Foreign Ministry created the Health Diplomacy working group. "Brazil's diplomatic offices abroad have been working on mapping vaccines and medical supplies for the treatment of patients with COVID-19”, he said. One of the results of the diplomacy of health, he said, was the donation of medicine and intubation kits by Portugal and Spain.

The field for the action of the diplomacy of health goes further, the ambassador highlighted, recalling discussions at the World Trade Organization (WTO) and the Organization for Economic Cooperation and Development (OECD) on the production of vaccines and technology transfer contracts.

A more inclusive model

Ambassador Carlos Alfonso Abella y de Arístegui highlighted the flexibility of the discussion space, which adapted to the needs generated by the pandemic. “There is, indeed, a diplomacy of health in the Ibero-American space, but maybe we need to work on strengthening it and redirecting recovery projects”, he said. He emphasized access to vaccines and creation of new financing mechanisms as priorities. “In the 30 years of the Ibero-American conferences, this is perhaps the moment of closer collaboration”, he commented.

From Portugal, Ana Filomena Rocha said Andorra has proven that the diplomacy of health is already a reality. Although not a new issue, its prominence increased with the need for coordination of the States and a greater exchange of knowledge and practices in the pandemic. “The more information we have, the more effective the response will be”, she said. “I believe that the diplomacy of health will be felt more and more intensely”, she stated.

From the Dominican Republic, which will host the next Ibero-American Summit, Rubén Valdez drew attention to the need to share experiences and to think of a system model that is more egalitarian, inclusive and respectful to nature. “In the face of thousands of deaths, I draw attention to the enrichment of pharmaceutical companies”, he stated.

Also from the Dominican Republic, the director of Diplomacy of Health at the Ministry of Foreign Affairs, Amado Alejandro Baez, stressed that the pandemic is a global health crisis and, therefore, needs a global response. “We see the importance of a sector in the diplomacy of health that is the diplomacy of vaccine. The importance of not being a race to know which country will have the most power to achieve collective immunity. Those who bet on this will lose, because they may come across the emergence of mutations and variants that are more resistant to the vaccines”, he pointed out.

Action in Networks

The Ibero-American Health Networks, cited by Grynspan and which began to emerge in 2005, have had a panel focused on them. According to Sebastián Tobar, CRIS/Fiocruz, it is necessary to take advantage of the capacity of these institutions of each country and to coordinate the cooperation.

From Portugal, Carla Nunes presented the Ibero-American Network of Schools and Training in Public Health. Formed three months ago, the network was born including schools and institutions in 13 countries, both in Latin America and Portugal, aiming at encouraging scientific research, disseminating information and cooperation, promoting the training of professionals and proposing public health policies. The next step is to find new partners.

One of the projects already shared is the COVID-19 Barometer, launched by Portugal in 2020 and which monitors the development of the pandemic, measuring response capacity, well-being and inequalities. It was first extended to Brazil, represented by Fiocruz, through the Sergio Arouca National School of Public Health (ENSP), and the University of São Paulo (USP), with the Social Thermometer.

Upon speaking about the Networks of National Institutes of Health, veterinarian and sanitarian Felix Rosenberg described that the main goal is to help to structure these institutions. Being the Executive Secretary of the Network of National Institutes of Public Health of Portuguese-speaking Countries (Rinsp/CPLP), he recalled that the new network takes advantage of the experience gained in the South-South partnership, but that the entrance of Portugal and Spain “should bring a fantastic contribution to knowledge sharing”.

Argentinian sanitarian Gabriel Muntaabsky highlighted the importance of the Ibero-American Network of Technical Health Education - a sub-network of the International Network for Education of Health Technicians, which executive secretariat is based at the Joaquim Venâncio Polytechnic School of Health (EPSJV/Fiocruz). “It is essential to strengthen health systems with the qualification of workers to provide better care to people”, he said.

João Aprigio brought the experience of the Ibero-American Network of Human Milk Banks, one of the oldest, which emerged in 2008, in a relationship with Segip that was initiated due to the recognition of the work and its impact on the reduction of infant and neonatal mortality in the 90s by the World Health Organization (WHO).

The Fiocruz’s researcher recalled that, with the pandemic, the challenges increased. “Children continue to be born, the number of premature infants is increasing, the number of newborns in need of care is increasing as well. We need a truly effective strategy to increase human milk collection”, he said.

The event was part of the Cris Advanced Seminars on Global Health and Diplomacy of Health, organized by Fiocruz Global Health Center and co-sponsored by the Latin American Global Health Alliance (Alasag).