Jul 10, 2021 Volume 398 Number 10295 p93-184
COVID-19 in Latin America—emergency and opportunity
Latin America and the Caribbean (LAC) have been hit the hardest by the COVID-19 pandemic, with 25% of recent global infections occurring in the region. Of the top ten countries with the highest death rate globally, eight are from LAC. The deaths from COVID-19 in the region stand at nearly 1.3 million people, but the pandemic will continue to drive excess mortality because of disrupted health services, economic instability, and deepening of existing inequalities. In addition, countries with high levels of infection can result in the emergence of more transmissible and vaccine-resistant variants. The region has not garnered global attention and now it faces new challenges that will likely worsen the situation and pose a threat to the rest of the world.
The relentlessness of the pandemic is exhausting public health interventions to contain viral spread in LAC countries, which are highly populated and have informal economies. Despite the persistent political instability in the region, the pandemic has further increased the frustration over entrenched inequities and corruption, and countries such as Peru and Brazil are currently facing civil unrest. There is distrust in governments, and more alarmingly, a widespread absence of social cohesion in the region, which hampers compliance to public health measures. Concomitantly, several variants are spreading in the region. The well known variant of concern, gamma (P.1), initially found in Brazil, has now spread to neighbouring countries and has become dominant in Uruguay. Lambda (C.37), first detected in Peru and currently considered a variant of interest, now makes up 80% of infections in Peru. More worryingly, the highly transmissible delta (B.1.617.2) variant now spreading in Europe has also been detected in at least 16 countries in LAC and there is already community transmission.
Mass vaccination is urgently required. However, only 11% of the entire population of LAC have been fully vaccinated, and although Chile has achieved a vaccination rate of more than 65%, in other countries such as Honduras and Guatemala it is less than 1%. LAC has an impressive track record in existing vaccination programmes, with low vaccine hesitancy. The bottleneck with the COVID-19 vaccine is a major limiting factor. Confronted with the global shortage, individual countries have little influence or will to secure vaccines. Less wealthy countries such as Colombia and Paraguay are relying on COVAX. But vaccine delivery to LAC is too slow to control the high infection and death rates. Regardless, COVAX distributes doses until all countries reach a 20% vaccination rate, independent of their existing epidemiology. There are also bilateral donations, but mostly driven by geopolitical motivations. Vaccines should be prioritised for the most affected countries with lower vaccination rates in LAC.
Presently, LAC urgently needs the global community to help control the pandemic in the region, but that should not stop the region from building internal capacity to manage the pandemic. Expanding local vaccine manufacturing to other countries besides Brazil and replicating COVID-19 vaccine hubs such as the one established by the South Africa consortium supported by WHO would be a start. Genome sequencing, which is essential to monitor the surge and spread of different variants, is scarcely available in the region, but PAHO has set up the COVID-19 Genomic Surveillance Regional Network to strengthen the genome sequencing capacity. According to researchers in the region, recovery and pandemic preparedness requires countries to become more self-sufficient in the production of vaccines, tests, personal protective equipment, and genome sequencing.Given the persistent political instability and poor leadership in some countries in LAC, the region would benefit from non-governmental leadership led by civil-society organisations or professional groups to push for the right to health and hold governments accountable.
Strong collaboration of countries in the region is needed and has failed catastrophically so far. In Oct, 2020, Foreign Affairs Ministers from the region signed a declaration calling for solidarity, multilateralism, and international cooperation, which has yet to be actioned. Prompted by flaws in the pandemic response, the inter-American dialogue, a network of global leaders launched a health task force, which is due to publish a White Paper in July to improve cooperation in future health emergencies in LAC. Region-led initiatives could have the potential for lasting change by developing health programmes and technological infrastructures to increase resilience and equity. The current dire situation in LAC should prompt serious reflection about the failings of regional entities such as PAHO. A much better co-ordinated response across the region is urgently needed.