Dr. Maureen Birmingham: ‘This is an opportunity to transform Argentina’s health system’

The World Health Organisation has been an ever-present hot topic on the global stage over the past few months. 

US President Donald Trump announced on May 29 that Washington would sever ties with the United Nations agency and officially began the United States’ one-year process of the separation earlier this month. The move has drawn criticism from the international community, which says it threatens the WHO’s funding in the middle of a global pandemic and the body's immediate future. 

As that storm rages on, however, the organisation continues to play a vital role in addressing the coronavirus pandemic across the world, especially in Argentina. Through the Pan American Health Organisation (PAHO), a subsect of the agency, officials have worked in close coordination with the National Health Ministry and provincial governments to help the country contain and manage the outbreak.

Dr. Maureen Birmingham, the WHO/PAHO representative in Argentina, spoke with the Times to explain how the organisation is assisting the country in combating the virus and what the immediate post-pandemic future might look like.

What have been PAHO's priorities during the quarantine regarding Covid-19?

As for Covid-19, our central priority has been to provide the best evidence and recommendations on the control of this new virus and to accompany the efforts of the health authorities to contextualise quickly in the reality of Argentina. This includes support to install increased health capacities, proven tools to make work more efficient, and the acquisition of necessary supplies. 

The main objectives are to save lives and contain the virus in a way that allows an exit from quarantine to resume socioeconomic life in a new normal.

Movement restrictions and quarantine help lower transmission intensity and buy time to better prepare the health system for an increase in cases and to scale up measures to contain the virus. But we know that these restrictions are not sustainable in the long term due to their great socioeconomic and psychosocial cost. 

To be able to lift these restrictions in a phased manner and, at the same time, avoid uncontrolled acceleration of the virus, a comprehensive set of key measures must be scaled up and sustained that puts maximum pressure on the virus as restrictions are lifted. Then we have to keep up this pressure in case there are new case shots, until we have a vaccine. The experience of other countries shows us that these measures, if well implemented in a proactive, exhaustive and sustainable way, break the transmission chains, allowing sustained containment and a return to a new normality.

In addition, we facilitate the continuous exchange of experiences, knowledge, and lessons learned on many topics related to Covid-19 between Argentina and other countries. We are all learning on the go with a lot of innovation at the local level, so this exchange is key. Argentina is very active and proactive in these spaces.

Looking to the future, how do you think PAHO will work with the Argentine government to mitigate the damage caused by the virus?

This pandemic is going to continue for a while until we have a vaccine. So for the foreseeable future, we need to focus on our goals of saving lives, protecting health workers and other essential workers, securing essential health services, and containing transmission sustainably in order to lift restrictions and return to a new normal. We are also already working so that Argentina has access to Covid-19 vaccines when they become available.

Additionally, we are already working with a look to the future on how to better recover each country in the region, including Argentina. In this region, there have been great advances in health in recent decades. However, there has been chronic underinvestment from the public sector for many years in health systems and also in the public health architecture, despite many warnings about the risk of more pandemics and other health emergencies due to climate change; we are paying heavily for this underinvestment. 

It is important to invest in public health architecture -– that is, preparedness, risk reduction, surveillance, laboratories, rapid response teams for health emergencies and trackers. This investment must be sustained to protect health and economies. Yes, this costs, but the investment is minuscule compared to the tremendous cost of closing the economy to control an epidemic.

Furthermore, a better recovery in Argentina means an investment in an efficient and effective way to have a health system based on primary care that is accessible, effective and efficient. There is extreme fragmentation of the health system in Argentina, which is a great source of inefficiency, inequity, and variability in the quality of services. Now is a great time and opportunity to transform the system, defragment it, restore its stewardship and governance, ensure adequate and efficient inputs and financing, and ensure equitable access, especially to the first level of care. 

It is time to work with other sectors to address the social determinants of health such as poverty, malnutrition, inadequate housing, inadequate education, working conditions, among others.

It is time to change the concept – in other words, an investment in health is an investment in the well-being and productivity of the population, and not just an expense. What is needed is the political will from the national level and in the jurisdictions to overcome the other interests and challenges.

What challenges do you anticipate in the future?

We have a lot to learn about the long-term care needed for people badly affected by Covid-19. In addition, in all countries, mental health services and psychosocial support must be scaled up due to socio-economic damage, the psychosocial effects of the pandemic and quarantine, and the drama that many people lived dealing with this virus. 

This includes survivors of Covid-19, people who lost a loved one, people who lost their livelihood, people subject to gender-based violence due to quarantine, as well as caregivers and health workers who worked tirelessly, taking their own risk to care for and care for Covid-19 patients and seeing first-hand the tragedy of each person and family member affected. 

In addition, significant collateral damage must be managed due to the decline of other health services. For example, in many countries there is a significant increase in deaths from cardiovascular events.

Another immediate challenge is the development of therapeutic products and a vaccine. At the global level, WHO is coordinating an initiative called ACT-A (Access to Covid-19 Technology-Accelerator) to accelerate the development of diagnostic products, therapeutic products, and vaccines. This initiative is harnessing the existing capabilities of various international organisations in response to a call from the WHO’s 194 member countries during the World Health Assembly in May 2020 that Covid-19 vaccines are public goods, thus that all countries should be able to access them. 

Of great importance will be the return to a new normality to resume socio-economic life, reopen schools and manage all the effects and collateral damage. What should this new normal be like? How can we and should we recover better, in a more sustainable, more equitable and greener way? What lessons have we learned from the pandemic? How can we take advantage of all the advances and accelerated learning incorporated during the quarantine, for example, the best use of technology, digitisation and remote assistance? 

This pandemic is the event of the century. It represents a deep trauma throughout society. It uncovered all the good and the bad of our humanity. It also showed that with more unity within a country and more solidarity at the international level, we can do better. Despite all the tremendous damage, this situation represents a great opportunity that we must take to rethink the society we want. It can be a great turning point in Argentina to better prepare, transform and move forward together towards sustainable, equitable and green development that leaves no-one behind.