What Can the Coronavirus Teach Us About Regional Integration in Health?

María Belén Herrero

Researcher, Department of International Relations, Facultad Latinoamericana de Ciencias Sociales (FLACSO); Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET).

28 February 2020  |  #20.3

The World Health Organization (WHO) has declared the outbreak of the new Coronavirus (called COVID-19), as a public health emergency of international concern. COVID-19 has caused almost 2700 deaths to date, and the number of infected in Chinese territory has exceeded 78,000 cases (82,000 cases worldwide). The origin of the outbreak, of which the first cases were detected in December, has been pinpointed to a seafood and fish market in the city of Wuhan, capital of the province of Hubei in the People's Republic of China. Regarding the spread of the epidemic globally, there have been cases in more than 47 countries.

It is an airborne virus and, although many details of COVID-19 are still unknown, the WHO has assured that "most likely an animal source is the primary source of this new coronavirus outbreak." For its part, the Chinese Health Minister, Ma Xiaowei, has confirmed that this coronavirus is contagious even before showing symptoms, which could make controlling its spread difficult, since the incubation period is between 1 and 14 days. However, so far, the virus maintains a low lethality rate of 2.3 percent.

As in other cases where a “serious, sudden, unusual or unexpected” disease may constitute a risk to the public health of other States through the international spread of the disease, WHO has decided to declare the coronavirus an international emergency, precisely in fear that the disease "will continue to spread outside of China and reach countries with weak health systems that are not well prepared to respond to the spread of the epidemic."

This is the sixth time that WHO has declared this type of global emergency, which was triggered with the outbreak of the H1N1 flu (2009), Ebola in West Africa (2014) and in the Democratic Republic of the Congo (2019), polio in 2014, and the Zika virus in 2016.

Thomas Peter, Reuters

Health: An international issue

The circumstances of this new epidemic outbreak highlight the importance of coordinated action across countries, especially taking into consideration the particularities of this disease. Therefore, it is imperative to reflect on what kind of cooperation is necessary, under which modalities, and what roles countries can play. Added to this is the fact that the epicentre of the disease is in China, and this is not trivial in terms of international relations and foreign policy.

Faced with the urgent task of stopping the spread of the virus, China, which so far concentrates 96% of cases, has been demonstrating a solid response capacity through record time investigations of rapid detection tests; the reduction of circulation in the city of Wuhan, among others; quarantining 40 million people (which would be equivalent to quarantining almost the entire population of the Argentine Republic); through the closure of its main international tourism points, and the suspension of the new year celebrations (of which carry enormous significance in the country), and finally, with the construction, in 10 days no less, of a hospital with more than a thousand beds in Wuhan. These measures are, in part, because of the lessons learned following the SARS epidemic, none more significant than the fact it is better to act quickly than to try to hide what is happening, but also to reduce the impact that the disease can have in terms of commercial and economic outcomes, if it continues to expand. This is not a minor issue for China that aspires to maintain and increase its international leadership.

However, in a context in which international health is becoming increasingly important and is occupying increasingly noticeable spaces in the global foreign policy agenda, realising the impact of globalisation, and also in the field of medical, technological and pharmacological advances, it is clear that the control of this epidemic cannot depend solely on what China can implement in isolation. In an increasingly interconnected world, China is today one of the states with the greatest demographic and commercial expansion outside its borders, through a notable increase in the transit and migration of people to and from the country for financial operations, student and academic activities, and tourism.

This shows, once again, that viruses and bacteria know no borders, and that social, economic, political and cultural transformations, and the intensification of economic and social processes, have a significant importance on the health of populations, especially affecting the most disadvantaged sectors.

The Coronavirus, at the international level, begs some key points for  discussion, which may have never lost their validity throughout history yet which are re-signified according to the historical moment in which we live: the close relationship between commerce and public health; the contradictions between economic interests and the right to health; the usefulness and likelihood of certain public health measures, such as mass quarantine, in a globalised world (only the city of Wuhan has direct connections to Europe, the Middle East and the United States); the importance of universal access to health systems as the main health policy, and cooperation between countries as an epidemiological tool. It is on these final two points that I want to further reflect.

From the local agenda to the regional health agenda

Latin America has a long history linked to health as an international issue. What is more, most of the countries in the region have a double burden of disease – that is, non-communicable diseases and the persistence of infectious and communicable diseases that mainly affect the most vulnerable groups.

In the case of an international emergency, the situation triggered by the Coronavirus reinstates, once again, the need to fundamentally re-examine two aspects in the field of health as an international issue. One of them I consider has to do with the local / national level, fundamentally linked to health systems. The control of these epidemics depends on the response capacity of the health system, the effectiveness of its information systems and, therefore, on the resources allocated to this sector, as well as the access capacity of the population and, above all, of the effective presence of the State as the main guarantor. The strengthening of public health systems and the universality of access to timely diagnoses and effective treatments (and not depending on the ability to pay for it) are the cornerstone of dealing with epidemics such as the Coronavirus, as well as in addressing problems and pressures that still persist and continue to see people suffer in matters of health (such as tuberculosis or congenital syphilis, to name just a few).

The second aspect, referring to the regional / international level, is linked to the ability of the countries of a region to respond in a coordinated and joint way to these epidemics that, as we see, know no borders. Latin America remains the most unequal region in the world. What health systems do the region need based on its specific problems and epidemiological profiles? How should it best coordinate notification and surveillance systems? How can it generate mechanisms for the joint purchases of medicines and medical supplies in the face of these emergencies, and others of equal importance? How does the region engage in dialogue with other international actors in the field of health and how does it cooperate on the international stage, for example in the face of these epidemics? These are just some of the many issues to discuss when it comes to how to address health as an international issue and human rights in the region.

The processes of ​​regional integration in health in South America, and the international cooperation strategies of the South sought, to some extent, to address some of these questions. The experience of the Union of South American Nations (UNASUR) in the field of health accounts for this, where the practice of member States also made health one of the most dynamic areas of regional cooperation within UNASUR. UNASUR proposed a novel health agenda that leaves some lessons that the new coronavirus invites us to reflect upon. First, because of how UNASUR set up an agenda focused on conceiving and addressing health as a human right and, secondly, for the opportunities for cooperation it has opened, particularly in South-South cooperation (SSC).

SSC became a fundamental strategy for the countries of South America based on a horizontal relationship and peer cooperation. This is no less if we consider that the SSC in health in Latin America, especially in recent decades, has sought to move towards more horizontal and transversal approaches in the field, taking distance from the vertical policies of suppliers and recipients of traditional cooperation, and classically targeted to specific diseases through specific programs (for example, HIV or tuberculosis). SSC as such is more oriented to the exchange of good practices in relation to systems, services and experiences in prevention, promotion and health care, as well as towards institutional strengthening, deepening the leading role of the State and expanding access to health care services from the public sphere.

We face an opportunity to think of regional strategies to address outbreaks and epidemics such as the Coronavirus, or the shared Dengue outbreak that currently has many countries in the Southern Cone at odds. Vertical and focused policies are effective in the short term but do not contribute to the construction and enlargement of capacities, something essential for the structural improvement of health systems, not just in Latin America but in other regions as well. The alert by COVID-19 shows us the importance of deepening collective strategies in health in order to be prepared to face not only the health problems that persist in our region and those that warrant a response, but also to new epidemics that, in an increasingly globalised world, are spreading at a rising pace. Focused and vertical-cut policies do not anticipate these needs, but act when the problem arises, and this is often too late. SSC can address health from a more structural, transversal, horizontal and solidary point of view. The experience of UNASUR demonstrates that some regional blocs can avoid unilateral and vertical transfer policies and that they have the potential to propose agendas that are more oriented to the needs of their public.

Final thoughts

The Coronavirus outbreak reminds us that the debate about which health agenda our region needs, based on its specific problems and its own capabilities, is still open. The issue of regional health sovereignty that occupied part of the debate about the right to health in our region is a horizon that we should not lose sight of. This requires strengthening regional integration spaces, as well as international cooperation mechanisms. South-South cooperation in this scenario becomes an essential health tool because of its characteristics of horizontality, solidarity, mutual respect for the sovereignty and autonomy of the countries, and through attending to the dynamization in the capacities of their health systems. Indeed, in recent times, the integration processes in Latin America showed that, through utilising South-South cooperation mechanisms, it is possible for a region to cope with outbreaks and epidemics in a coordinated manner.

Health, understood in its broader social conception, is an unquestionable international objective and, therefore, its approach must also be international, assigning the States a central role. Today, especially in the face of global health problems such as the Coronavirus, the answers can only be found across all levels (local, regional and international), as they have to be collectively and synergistically constructed between countries, attending to their strengths and their differences, in an urgent, coordinated and supportive manner. The Coronavirus is not the most serious of health problems that our countries must face – much less the only one – but it is the one that once again puts the topic of health as an international issue and as a human right on the agenda. The paramount question we face now, as a matter of urgency, is what path we must take, and how to be prepared.

María Belén Herrero is former researcher in the ESRC-funded project on “Poverty Reduction and Regional Integration: A Comparative Analysis of SADC and UNASUR Health Policies (PRARI) (see, http://cris.unu.edu/esrc-funded-project-poverty-reduction-and-regional-i...) in which UNU-CRIS participated. She is also a former participant in the annual UNU-CRIS Doctoral School on Comparative Regionalism in Quito. Currently she is a researcher in the Department of International Relations, Facultad Latinoamericana de Ciencias Sociales (FLACSO); Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET).

A first version of this article was published in Spanish in “El País Digital”. Available at: https://www.elpaisdigital.com.ar/contenido/qu-nos-muestra-el-coronavirus...