Public Health Models for Latin America
By 
Carina Vance Mafla is the former minister of public health in Ecuador. She writes for Al Jazeera on how the global health model failed Latin America and the Global South more broadly during the pandemic and considers alternatives.
When the COVAX initiative was set up by rich countries and international organisations, it promised to purchase and distribute COVID-19 vaccines equitably across the globe, but it didn’t. Some wealthy countries, like the UK, received significant vaccine supplies from COVAX, while poorer countries were left waiting or had to rely on vaccine donations, which, too often, were of doses nearing expiry.
Today, the coronavirus pandemic may have subsided, but the real enemy of health has survived: a patent system that keeps medicine recipes secret, a trade system that allows corporations to price medicines out of reach, and a global governance system that keeps the power to change any of this from poor countries.
If we want a better international health system, we are going to have to build it ourselves. With Luiz Inácio Lula da Silva’s victory in Brazil and the rise of new progressive governments across the region, Latin America is well-poised to begin this urgent work.
In my previous roles as Ecuador’s health minister and director of the Health Institute at the Union of South American Nations (UNASUR), I have seen possibilities take shape when countries work together under the principles of equity and social justice, bound by a common vision, and with the power to bring that vision to life.
To break the current system’s power and forge a new one, we need to challenge it at four levels: transparency, knowledge, industry and governance.
First, we need collective pricing and purchasing. The primary reason companies get away with arbitrary pricing of drugs is secrecy in trade deals.
Once again, I don’t think we can overestimate the importance of the language of trade deals. The left and liberals have pretty much ceded the field on this in the United States and other western nations. It’s detailed and boring and has a ton of power over people’s lives. Cheap bromides about free trade cover up the very real inequalities written into the system to help western corporations at the expense of poor nations. The impact of trade cannot be properly measured by just looking at a few numbers like GDP or per capita income from 30,000 feet. It has to be examined on the ground, with a tactile understanding of how these deals impact people on the ground. This is not a shot against trade. It’s that we have to reconsider what these trade deals do and how they are written and enforced. This requires people taking them far more seriously than they do. Anyway, back to Mafla a bit more here.
We can turn the tables by creating a Medicine Price Bank and begin to collectively purchase medicines. We launched such a bank in 2016 when I was director of health for UNASUR. It was a simple database of drug prices, made up of an initial list of 34 medicines. The 12 participating countries shared the prices they were offered by pharmaceutical companies – to, in turn, see the prices offered to others.
Armed with comparative stats, governments successfully drove down prices at the negotiating table, enhancing access to medicines for everyone in the region while challenging the secrecy built into big pharma contracts. At the time, UNASUR estimated that if all 12 countries bought necessary quantities of the 34 medicines listed at the lowest price in the region, total savings would amount to about $1bn per year.
We could relaunch this price bank and take it further. Once we have the price information in place, we could negotiate for collective purchasing, further driving down prices with our bulk ordering. Through collective purchasing, we can squeeze the inflated profit margins of big pharma and instead turn that into healthier lives for our peoples.
Good idea and she presents other good ideas here too. Again, let’s take this stuff seriously.