Highly prestigious prepaid healthcare schemes are saying that there are already scenes of patients being attended on seats in corridors. Is that the case?
This is a time of much tension for the health system. That is not infrequent in winter when respiratory illnesses peak. What we’ve been saying and what worries us is that the health system cannot respond. The private system has different scales of clinics with other ancillary sectors which can respond. That does not mean that the health system is overwhelmed but, beyond doubt, for private clinics on the front line the demand and occupancy rates are very high. There are difficulties, tension and also much hope. The health system must continue looking after the population. That’s why we need to lower the transmission and the circulation of people to slow down this accelerated number of cases which translates into more people going into hospital and intensive care.
There’s been a lot more testing than last year. What’s more important, the number of cases or intensive care occupancy?
That’s very important to explain. The expanded testing with not only PCRs but also Argentine kits with the isotherms and antigens to permit testing on the ground, means that Argentina has greatly increased its testing capacity. An important percentage of cases is lighter than last year although more cases always end up translating into more people in hospital and intensive care, which is the true indicator of the gravity of the situation and also on the rise along with the cases testing positive.
It is said that more young people are being infected but need less intensive care although the therapists affirm that older people average 10 days in hospital while the young can withstand a month of intensive care. Does one thing balance the other?
In medicine two and two is never four, it’s always much more complex in epidemiology. Although young and healthy people have less chance of falling seriously ill, that possibility is not zero. As the absolute number of cases rises, the absolute number of young people seriously ill in hospital also rises. In the event of a serious illness requiring intensive care and mechanical respiratory assistance, the reactions of a young person’s organism to inflammation are generally more robust than in older people, making their syndrome more serious and longer-lasting. It’s not one thing or the other but both.
If there are no more beds and the situation is extremely serious, would it be logical to expect the restrictions not only to continue into May but to be more severe?
What we achieved last year was that our health system responded, an achievement which we do not value highly enough. It was a curve with a very important number of cases but distributed over more time. What is happening now is a very steep, vertical curve, thus placing the health system at the risk of being overrun. It hasn’t happened yet. There is a great deal of tension with less urgent surgery being reprogrammed and the intensive care beds increased. Buenos Aires Province has placed 250 more beds, the City has also added in both the public and private sectors, as have all the provinces. They continue increasing but there’s always a limit. If we don’t get transmission down, the health system will collapse. The measures being taken are in reaction to the infections of a fortnight ago. We have to see this week how the cases evolve in the light of the measures. We insist on the general public only going out when necessary and indispensable. The less people circulate, the less risk there will be and this will tend to diminish the tension of the health system, thus needing less restrictions.
Do the forecasts point to a peak in the second half of May?
Colder temperatures favour the transmission of the virus with more people indoors without ventilation. May, June and July are the biggest risks. We saw it in the Northern Hemisphere and we saw it in Argentina last year. We cannot say when it will peak. Every measure will be tried to continue giving priority to health and delaying the peak as much as possible while attempting to be the least traumatic possible in social, economic and emotional terms.
Last year the peak was expected at a given time and arrived later…
That was the work of you, the media.
From the side of the state you’ve tried delaying the peak while increasing the number of respirators and intensive care wards. When you take anticipatory measures, you also delay the peak and end up with a much longer conflict. How do you resolve that conflict?
That’s semantics as to when the peak will come. The point is that it depends on us. We thus succeed in not needing stricter measures because we are more organised, we understand, we again have that perception of risk which we lost in summer. We thought that what had happened in all the world wouldn’t happen to us. If we can work towards that, strict measures will become less necessary.
There will always be a peak.
There will always be a moment with the highest number of cases. We will try to make it the least high possible and the most spread out over time. We need the health system to be able to respond. Now we have the vaccination campaign. If you vaccinate the people with the greater risk of complications and dying, lowering mortality becomes more feasible. But there are also these new variants, more lethal with greater transmission and affecting young people. That’s more complicated, a new factor. We must eradicate the idea that if you’re young, nothing is going to happen to you. We’re seeing young people in intensive care because there are less people aged over 60 due to vaccination and because they take better care of themselves and because of the new variants. Taking measures does not solve the problem – the impact in terms of cases and deaths is much more complex.
How was the decision to close down schools as well as shops and services after 8pm taken?
We don’t just look at the activity but many other factors. The number of people in a shop is minor when compared to classroom education. That’s what I try to explain all the time talking about individual and collective risk and also circulation in times of intense community transmission. In recent days the exponential increase has made viral circulation much greater when the circulation of people is intense. Schools mobilise more people than any other activity. There is a lot of informal activity after class which is the focus of contagion. We have taken intensive and transitory measures with a focus – it’s important to say that the Buenos Aires Metropolitan Area (AMBA) is not the entire country. In most of the country there are children in class. In some departments they have also been interrupted for defined transitory periods. Those activities, along with nightlife and indoor social activities where you have great trust in the other people, are when the defences and the recommended preventive measures are lowered. They are times of risk. We are limiting the activities which generate the most risk.
So the shops between 6am and 8pm mobilise less people than schools?
Beyond any doubt. Another axle is the economy. The aim of these measures is to diminish the circulation of people with virtual classes because the cases aren’t going away. It’s not as if we go into May with, say, 20,000-25,000 cases that we will continue the same throughout the year. It’s not the same logic as last year. It’s not a matter of waiting for the cases to come down. The aim is to slow the velocity of contagion and the entry of people into intensive care wards. People talked about the longest quarantine in the world. But the only place which was in strict ASPO isolation the whole time was AMBA. As from May or June an important number of activities was authorised and circulation was not restricted. Activities were restricted throughout the world and still are. It seems to me important to demolish that myth. The circulation in AMBA since last June has been very important.
Are we going to have half a year without classroom education?
Winter, May, June and July, especially the first of those months, will determine the evolution of the pandemic. It does not only depend on the state action of the national government, whose priority is to preserve health while accompanying socio-economic life at a critical time. It will really depend on how we can transmit it.
The media have a key role here, as do the provincial and municipal jurisdictions and society at large. We hope to be able to make a phased return to classroom education. We are working with Unicef, the Pediatrics Society and the Education Ministry. We would like society to be part of a virtuous circle sustaining classroom education.
How do you explain the numbers by the City Mayor showing that the transport in his district has not increased?
We have the data of the national Transport Ministry showing the use of public transport in AMBA to have increased 25 percent since the return of classroom education.
But what about the City, not AMBA? Perhaps the difference lies there.
I wouldn’t want to lie to you about specific data. The figure for circulation has to be homogeneous. There are people living in the City and working in AMBA and vice-versa. AMBA is considered an indivisible urban agglomeration.
You continued to defend classroom education until just a few hours before the president announced that it would have to close down in AMBA.
Supplying vaccines is the task of the National Health Ministry but does day-to-day responsibility correspond to your provincial or municipal colleagues? Claudio Belocopitt (the owner of Swiss Medical Group prepaid) has often met with Cabinet Chief Santiago Cafiero and with President Alberto Fernández, but never with you.
Let’s not mix apples and oranges. The national government has the responsibility of acquiring the vaccines and distributing them among the provincial and municipal jurisdictions. The Cabinet chief has explained that last November’s law did not impede anybody from buying. We know that many tried and could not get vaccines. The national government is distributing them.
Affirming that I said classroom education had to continue is incorrect. When Easter was under discussion, they also said that [Tourism and Sports Minister] Matías Lammens prevailed over me in the internal debate. What [Education Minister] Nicolás Trotta and I said was that the classroom as such was not contagious with the problem being the circulation of people and the risk of the informal activities accompanying classroom education. As for this being a federal country with health delegated to provincial and municipal jurisdictions, the Health Ministry’s role is clearly consensus, harmonising policies as homogeneously as possible – for example, the acquisition of respirators, the distribution of vaccines and the mobility of health professionals. Finally, the president has not only received Claudio Belocopitt but also a very important number of healthcare providers.
But he never met you.
Not Belocopitt but I have met other representatives of the private sector. From the very first day we have coordinated the increases for the prepaid. I signed the ministerial resolution and spoke to the president about it. We’ve also worked with their collective bargaining as well as providing respirators via the provincial and municipal jurisdictions, also the private sector. We’ve sought to diminish the fragmentation of the health system.
AMBA is Latin America’s third-largest urban agglomeration with 17 million people after Mexico City (25 million) and São Paulo (23 million) but there is no other Argentine city in the region’s top 40, while Brazil has 12, Mexico six and Colombia four. Does Argentina having only one agglomeration concentrating such a large percentage of the population make its fight against coronavirus sui generis?
Argentina has eight urban agglomerations with over half a million inhabitants, incomparable with AMBA. It doesn’t matter who governs, nor where each person lives, nor the geographical or political borders. The big cities have a dynamic of transmission totally different from anywhere else. If the curve of contagion takes off or the health system collapses in an urban agglomeration like AMBA, the possibility of interrupting it is much more complicated and demands more time. That’s why it’s so important to take as many measures as possible beforehand. The lower the population density, the easier things are. If you close down or diminish circulation for a fortnight, you lower the contagion. It’s not like that in AMBA, there’s no linear analysis as to what you have to do, very much more complex.
Of those 17 million inhabitants in AMBA, the City has only three million or 17 percent. Does the problem lie there?
It’s not so clear because that only applies to the place of residence. A very important number of people come from Greater Buenos Aires to work in the City. Buenos Aires Province Governor Axel Kicillof speaks of that geographical and cultural diversity, urban and rural. There are many provinces in one. The City has totally different dynamics in its workforce and health system. It’s impossible to think of it apart and not to implement at least similar measures to diminish circulation.
Other mega-agglomerations are Asian – Canton and Tokyo 40 million, Shanghai 30 million. Why did they control the situation better?
The social, cultural and economic situation is what explains how societies like Japan or China find it possible to control an epidemic like SARS-CoV differently. Latin America has enormous income gaps with overcrowded shantytowns and major socio-economic difficulties which have deepened in recent years.
Mexico has 50 percent poverty yet less cases of coronavirus than Argentina. Do you trust their data?
It’s not that they’re hiding information. When there is an exponential increase in the number of cases and somebody cannot attend them or there are difficulties in the access to the health system, it is not always specifically registered. We are completing an analysis of excessive mortality, looking at each Argentine province and also the data of countries like Mexico where the mortality percentages are excessively high. Perhaps they had some difficulty in registering data. You have to analyse it in a more global context, how and what is registered in each country. Statistical comparisons are still difficult.
Does the government as a whole include advisors from other specialties? Do you take the mental health or isolation of the youngest into account?
In the advisory committee we have specialists in infectious diseases, epidemiologists, specialists in vaccines and also sociologists, very prestigious mental health experts, psychologists, psychiatrists and anthropologists. The Dirección Nacional de Salud Mental is working with jurisdictions at every level to accompany the health teams against tension and stress. The impact of the pandemic is different in every age-group. In children and adolescents it impacts their socialisation and relationships with schoolmates. In older adults at a time of life when their futures are shorter, each year weighs so much more. Isolation is an important risk factor, as is having to go out to work and thus being more exposed. The mental health teams are working very intensely.
So not only epidemiologists are at work...
It would be very good if the media could also be a mouthpiece for those who speak of mental health from a standpoint of empathy. The impact in no way can be denied but nor can we ignore that we are in a pandemic. We have to find a way of approximating those two situations.
A great deal has been said about the personal links between [previous Health Minister] Ginés González García, Tucumán Governor Juan Luis Manzur [Cristina Fernández de Kirchner’s last Health minister] and [Grupo Insud businessman] Hugo Sigman. What links should there be between Health Ministry officials and the labs?
The state should be permanently in contact with the pharmaceutical industry regarding the supply, prices, stocks and inputs, for example. The pharmaceutical industry is a strategic partner of the state but the leading role to define the guidelines and make the decisions must come from the national government. Nothing wrong with having links and contacts with the industry and nor is it synonymous with the industry doing what it likes with the state. A hands-on state organises maximum prices for medications with all the players. The pharmaceutical industry is part of that virtuous circle. If the state does not pay the pharmaceutical industry or takes 100 days to do so, it is more logical that the pharmaceutical industry sets higher prices or wishes to sell to the private sector or to other people.
Hugo Sigman has denied rumours that he lobbied negatively against Pfizer. How would you describe the competition between vaccine manufacturers?
The pharmaceutical industry competes with different products. They have the capacity to influence not only buyers but also public opinion and the media. The ideal would be each one discussing the strengths and weaknesses of their products while also competing in price. But we did not invent that and nor are we going to solve it. The competition within the pharmaceutical industry is a reality which transcends the vaccine situation.
As for the purchase of vaccines against Covid-19, we are making contracts with countries or labs committed to producing vaccines. For example, the Russian Federation began to produce vaccines, making agreements with India and South Korea, and that set things back. Now the Russian Federation is trying to step up production with the private manufacture of an Argentine lab here. We have our own contract with the Russian Federation. AstraZeneca drew up a technological transfer agreement with mAbxience of Hugo Sigman and with a Mexican lab. They had difficulties with the access to inputs and delays in their timetable. But AstraZeneca is working to accelerate its deliveries according to the contracts which it made with all Latin American countries. Nor is it up to the national government to define with whom they deal. Everything was done to make Argentina part of the chain of production. That strengthens the country, favours access and is important from an economic viewpoint.
The Cabinet Chief of your Ministry, Sonia Gabriela Tarragona, was director-general of the Fundación Mundo Sano directed by Silvia Gold, Sigman’s wife and co-founder of the Grupo Insud. You direct the Master’s degree for Pharmacological Policy at the Universidad Isalud founded by Ginés and also teach there. Is the health and lab world so small that you are all interlinked?
That happens everywhere. The suspicions are published according to convenience. Sonia Tarragona is an economist with an extremely broad CV and did direct Fundación Mundo Sano. She has no commercial links with Hugo Sigman. I’ve known Ginés since I was born.
Literally. My track record goes back to when Isalud was born. I studied there. And when they dropped me from the previous government, I created a studies centre. I dedicated myself to working at the university, collaborating by teaching the master’s graduate students. Sonia and I are so proud of that and we can say that anywhere to anybody who has doubts about our antecedents.
If it was not possible with Pfizer for questions which are public domain, why not with Moderna either?
With Pfizer we haven’t managed it yet but we’re still working and we haven’t excluded any bilateral deal. Ditto for Janssen, a United States lab which started a little later. With Moderna we had a meeting with the president himself as to the possibility of their supplying vaccines but they told us that they would be unable to do so until after September. We’ve also continued working with CanSino, with Bharat, an Indian lab, and via Covax with Novavax, a US lab.
Faced with shortage, Argentina has placed its focus on two vaccines – AstraZeneca, whose active component was to have been manufactured in Argentina and thus supposedly advantageous, and Sputnik for its capacity to produce the active component. Could that be part of the explanation as to why Uruguay, Paraguay or Chile have Pfizer or other types of vaccine?
We spoke with Pfizer from the start. Our focus was not on one vaccine in particular. Pfizer could not sign on time due to one of its requirements not being in accordance with Argentina’s legal framework. But we tried and we’ve spoken to them from the start.
Did the problem revolve around the word “negligence”?
The word “negligence” and the concept of sovereign assets. They are specific legal points. Pfizer bases itself on US law but their requirements could not supersede Argentina’s legal framework. We bought from every lab except Pfizer. It always depends on your viewpoint.
But, for example, the European Union accepted those conditions.
We’re working to sort out that difficulty and will keep trying. Pfizer settled with every country except us while we settled with every lab except Pfizer. We have real expectations of sorting out the situation.
The AstraZeneca vaccine costs US$3-5 while Pfizer costs US$20 and it’s also easier to stock for reasons of temperature. Might not the preference have been logical?
We’ve tried to buy them all. We did not go for one country or one vaccine or one price. We knew that it was going to be very difficult to get them so we tried with all the labs. AstraZeneca has a great many price advantages because it is non-profit while the pandemic lasts, it’s multi-dose and can be stored between two and eight degrees Centigrade apart from being produced in Argentina. We worked with the Russian Federation because we trusted in their vaccine from the start. We approached them and received first-hand information. We could accelerate the paperwork and that was a bridge for all Latin America counting on the vaccine. We worked with CanSino, Moderna and Janssen from the start and with the Covax mechanism which gives access to various countries. Other countries signed with Pfizer. The reality is that Pfizer’s supply was also delayed and it is still not supplying the region with the necessary velocity. Both Chile and Uruguay made a bilateral purchase of China’s Sinovac vaccine and have advanced in that production.
AstraZeneca has pledged itself to selling at cost while the World Health Organisation (WHO) considers coronavirus a pandemic. That’s something a state might consider.
When we justify our purchases, we weigh different conditions and circumstances. That’s one factor and timing is another. If a dearer vaccine can be supplied sooner, that is an opportunity which must be taken into consideration.
All things being equal, if the delivery and the benefit are the same, you would have to choose, for example, AstraZeneca. Why does the Chinese vaccine cost US$20 like Pfizer while Sputnik costs US$10?
Pfizer does not cost US$20 but a lot less. But there are two doses. Each lab fixes its prices.
You say “a lot less,” how much?
US$12. The Pfizer vaccine costs a bit more than half Sinopharm while the Russian vaccine is half.
Why does Sinopharm cost almost double?
Ask the labs. They define their prices according to investment, the economies of scale and the market. It does not depend on the countries.
Have the labs oversold like airlines at one time? Could a price of US$20 respond to the shortage?
Never in contemporary history has vaccine research gone ahead and contracts been signed ahead of the results of Phase 3, a risk for both the countries and the labs, starting to produce vaccines at risk with theoretical timetables. The labs estimated production and then scaled it up with timetables which nobody met. It wasn’t so easy to put into practice due to the complexity of the vaccine and because inputs ran short in the pandemic. The whole world is trying to get a vaccine at the same time along with the tubes, the filters, the aircraft, the refrigeration and the syringes. There were bottlenecks which delayed production and for sure some commercial strategy along the line.
On what combination of first and second vaccine doses are you working?
There’s no scientific evidence that the various vaccines are interchangeable. Everybody starting a scheme of vaccination must complete it with the same vaccine. With AstraZeneca or Sinopharm it’s the same component while in the case of the Russian vaccine, there are different components so anybody receiving the first component of Sputnik V must receive the second. Like many other countries, we decided [in consensus with the provinces and the experts] to defer the second dose in order to vaccinate as many people as possible as fast as possible. Those who have received the first dose of AstraZeneca can give it three months. We have a contract with them for 22 million doses and we have the perspective of continuing to receive the Astra vaccine. With Sputnik we will receive the second component. With Sinopharm we made one contract for a million doses which have already been distributed and inoculated and another for three million, of which we have already received and applied a million, leaving two million. Since we have no other contract signed nor deliveries pending, those two million will be destined to completing vaccination schemes.
The European Centre for Disease Prevention and Control has recommended that face-masks and social distancing can be relaxed for those vaccinated. Can vaccinated people infect others?
A new stage is beginning. When we receive the vaccines, they generate an individual benefit. When many people are vaccinated, this has a more collective impact which could even eliminate the disease, as happened with measles, or control it like flu. The vaccine against Covid-19 will surely resemble the latter more. In Argentina the vaccine is still at the level of producing an individual benefit. There is still less risk of running into complications and dying but it is not demonstrated that we cannot have the virus and transmit it. To the degree that vaccination is more extensive in Argentina and in all countries around the world, the possibilities of relaxing the preventive measures and controls and reducing transmission will become more concrete.
Your first trip to Moscow was last October. Is it true that not even Ginés González García knew about it?
That’s false. I had the contact via the president to evaluate the information technically. As soon as the possibility of making the flight came up, I commented on it to Ginés at once and he was in the know. No way I’d go without notifying the minister.
Did you ever have any apprehensions about the Russian vaccine?
Ginés never had any apprehensions about any vaccine but he was worried about the steps to take. In hindsight it’s so much easier. At that time it was not known if the vaccines would have positive results in Phase 3. The decisions were very much more complex and uncertain. The worry lay in analysing everything well, especially the designs for clinical testing.
What do the Russian authorities have to say about Alberto Fernández, vaccinated twice with their vaccine, being infected?
They contacted us immediately to find out how the president was doing and to place themselves at our disposal for whatever we might need. They knew that the possibilities of a favourable evolution with two doses of the vaccine were extremely high and that only a tiny percentage of people are infected despite being vaccinated.
Was it bad luck or was he in contact with too many people?
Both things. He got infected somewhere. The president is highly exposed from his form of governance, it’s impossible for him not to see people. There are presidents who cut off all contact with everybody in order to avoid infection. Alberto has contact with officials and people. And he was unlucky because some highly exposed people do not fall sick.
During the Second World War the US government launched a secret project, in conjunction with British researchers at the University of Oxford, to develop penicillin. One of the rules imposed on the pharmaceutical companies involved was that they had to share the information. Why should it be different now?
There is no doubt that something has changed. I recently closed a WHO forum on fair prices where value was placed on the transparency of negotiations, prices and contracts to favour the access of countries to the technologies. Some 130 countries housing over 2.5 billion people have still not had access to a single vaccine against Covid-19 and have no perspectives of receiving anything this year. There has been a change and a big one. Most vaccines, inputs and resources go to the richest countries. A huge number of countries where a very important number of people live have unequal access. The Covax mechanism has tried to minimise this but it is not succeeding, as we have also said. Despite enormous efforts, the problem is still not solved.
In the 1950s Jonas Salk was asked who owned the vaccine against polio …
His reply was: “Who owns the sun?”
That statement by Jonas Salk was made in a United States following the New Deal. Today things are different. Does it respond to different socio-economic notions as not so much a symptom of lab issues as of the economy in general?
Would that there were many Jonas Salks.
We had our César Milstein...
That’s right. Extraordinary times require extraordinary actions, something which does not abound in these times. Ranging from the macro-economic to individual attitudes with some showing solidarity and empathy while others shut themselves into their individualism. Something totally beyond health and the economy. It’s more a social situation.
Are there also geopolitical questions?
You’re not watching the whole movie if you do not see geopolitics at work behind vaccine supplies. You have Russia, China and the United States. Pfizer’s policies changed following the US elections. There’s a commercial strategy there.
They awaited the results to say that their vaccine worked.
That’s not how I see it. But after the change of government when US President Joe Biden launched a plan to vaccinate 100 million people in 100 days, he could not supply other countries. Vaccines are a critical input, the most valued in the world. And the richest countries have still been unable to satisfy their own demand. There are some countries like Canada which bought 10 vaccines per inhabitant but still have not managed to satisfy the demand of their population at risk. Geopolitics and the commercial issues of the labs plus the move of some countries to ban exports to supply their internal markets means that very many countries have no possibility of access. We do not value highly enough that we continue to receive vaccines.
It would seem that Covid-19 is a unique business opportunity for the pharmaceutical industry.
Not just for them. There are commercial activities which have developed in a way impossible in the usual context. The pharmaceutical industry obviously has the immense challenge of producing the vaccines, besides research and development in the pharmaceutical field. Until now they have invested everything in research and treatments, which have not proved to pay dividends in terms of big profits. It’s the tip of the iceberg.
Moderna was a small lab which had never secured the approval of the Food and Drug Administration (FDA) for a single one of its remedies. But in an instant it became a hit.
That’s the exception which proves the rule. Most pharmaceutical firms do not end up getting their products approved.
Aren’t we facing a new boom like Silicon Valley at its peak?
It’s very difficult to forecast. Coronavirus has surely come to stay. We’ll probably need boosters. The labs must continue investing. I hope we can count on sufficient doses worldwide. The pharmaceutical industry has profit motives and we would view favourably limits on them in this context.
On the one hand you could say that it was a triumph of capitalism that in less than a year six billion vaccine doses were manufactured, something unimaginable, but on the other hand it is a failure of capitalism that they could not be distributed equitably.
It’s never black and white. The triumph belongs to science, which responded in record time to an unprecedented situation. Without capitalism we could not have managed the scale of production to favour access while the truth is that there were many labs with research projects which did not advance. What closes the circle is that if the product can save lives, we’re going to have to team up with capitalism.
In the 1970s, during the Gerald Ford presidency, 40 million people in the United States were inoculated with a vaccine against a feared outbreak of swine flu which did not materialise and as a result some 5,000 people contracted a cerebral neurological disease. The pharmaceutical giants involved did not want to give the 40 million doses to the federal government until they were exempted from any responsibility in the event of an adverse effect resulting from the administration of the vaccine. They got their way. Is what companies like Pfizer are demanding logical?
The situation is totally different in terms of the advance of science, vaccine safety and the technology of development platforms, incomparable. At that time there was exceptional contamination in one batch. But given the speed of the process, it was commonplace for all the labs to ask for consideration if faced with responsibility for an adverse event.
If not, they would go broke.
On the ground and after inoculating very important numbers, we see that the safety of all vaccines is generating calm. That was the deal in the contracts ahead of producing the vaccines and having all the informatión.
Would you change the word “negligence” in the legislation?
That legislation was voted by Congress. The legal framework is complicated. The meaning of that term has to be explained along with some very specific questions.
The 2009 flu pandemic infected a billion people with much lower mortality. Until the next year the same companies now busy with Covid-19 were working on vaccines but they stopped production as the pandemic faded away.
We have anti-flu vaccines, year in, year out. What happened in 2009 was a new strain of the flu virus with a new capacity for person-to-person transmission, thus making 100 percent of humanity susceptible. The companies producing anti-flu vaccines changed the strain and stepped up their production of monovalent vaccines while continuing to produce anti-flu vaccine. We have H1N1 (swine flu) every year – it was a pandemic in 2009 because it was the first time. Now we have it every year with minor mutations. The SARS-CoV2 virus follows the same logic. The variants appear because the virus seeks a way to survive all the time by continuing to transmit.
Will the future of this virus be like the flu?
That’s unknown because if there is a major mutation, another strain might emerge. Or if these mutations are always minor, they could weaken it.
So some mutations can weaken a virus while others strengthen it?
Exactly. What we know is that in a context where increasingly more people have had contact with the virus while more people are vaccinated and the virus becomes seasonal, it may be transformed like the flu. It will have its moments, especially in winter, but it will not do everything which it is doing to us now.
Peronism had two great health protagonists: Ramón Carrillo and Floreal Ferrara, and the Radicals Arturo Oñativia. Where do you think Ginés will rank in this list of Argentina’s great health workers?
He will surely be in that list. Ginés has been in public health for decades with initiatives which will last forever such as Remediar. He had a key role in the Law of Sexual and Reproductive Health and introduced the hepatitis vaccine, diminishing liver transplants in children under 10 with a single dose. The WHO recommended his strategy. An impressive track record culminating in abortion reform. He trained technical teams with the political leaders and officials of very many provinces. He threw himself into the fight against the pandemic, organising the public health system and the private sector and buying respirators. He engineered a great many of the contracts which we are now translating into vaccines. Without doubt, he should rank fourth on that list.
What is your outlook on his current attitude? Off the record he says that he does not talk because it could affect the government.
Ginés knows the current situation very well. He knows that anything he might say could be used to aggravate the situation. He has plenty of experience and knows that in the medium or long term what I have just told you will be recognised and his fundamental role in the pandemic will also be seen much more clearly. He has the experience and character to await that moment.
You knew him since you were born. How’s your relationship with him?
We have almost family links and it will stay that way. He studied with my father and they graduated on the same day – it’s as if he were my uncle. We’ve been through all the stages of life together although there was a time when we did not see each other. My current activities and work keep us in contact but we do not see each other like beforehand. At some point for sure calm will return and we will resume that daily contact.
When you became minister, your post as deputy minister was taken by Doctor Sandra Tirado. Tucumán Governor Juan Manzur, a former Health minister, wrote: “It makes Tucumán proud to have a new member in the national administration.” Do the posts in your Ministry represent the components of the ruling alliance?
My origins are technical. I had a technical post for a long time and ended up having a political profile. I’ve worked with many ministers. Now I have a political post in a pretty broad front. I’ve known Sandra since I was directing the vaccine programme. She was in the Tucumán provincial Health Ministry. We had many things in common. From then on I’ve stayed in contact with her. Of course I called up Manzur to comment on her and [deputy] Pablo Yedlin too. They are the two people with whom I have worked most in Tucumán. They agreed. It’s an immense achievement to have Sandra as Access to Health Secretary with her experience, enthusiasm and warmth.
In Twitter you present yourself as a minister but [your Buenos Aires Province counterparts] Daniel Gollán and Nicolás Kreplak add the word “militant” to their posts. Would you define yourself as a militant?
A heath militant. I would be lying if I said I was a political militant. I have no track record in party politics but I do in health policy. I’ve felt more comfortable and have been able to develop my deepest convictions in Peronist governments.
Last December Cristina Fernández de Kirchner pointed out: “We have to move towards a national system integrating public and private health and the obras sociales (union-run health schemes) to optimise resources.” Did you experiment with that last week? What role do private institutions have in health?
What happened in Buenos Aires Province was a recommendation to respond to an emergency situation, not a health reform. It’s true that we have a very fragmented health system which generates inequality. There is no doubt that it must be reformed although, of course, now is not the time. But it has to be the time for nobody to doubt ever again that health is the priority. We have to diminish the fragmentation of the health system. A very important number of obras sociales are not self-financing. The private sector must be reworked, it must have a role beyond the commercial, integrated into the health system. There are nuances making for a very profound debate. It requires consensus, teamwork and a lot of discussion.
Prepaid medicine looks a lot like life insurance, like the AFJP private pension funds. From an actuarial viewpoint it seems like (the late) Bernie Madoff, a pyramid scheme needing to add enough new members to cost the older with their contribution. But the birth rate is trending downwards while longevity is on the rise. Will those companies go broke in the future?
That’s something which has been discussed for a long time. That’s why the policies for the prevention of chronic illnesses are so important. If these are minimised, people arrive at a certain age much more healthy and active. The other factor threatening health financing are the new technologies, which have sky-high costs without a demonstrable cost-benefit ratio while the coverage is vulnerable to litigation. It’s part of what must be revised, things which could place the entire health system in crisis within a short time.
During the Mauricio Macri presidency you headed the Dirección Nacional de Control de Enfermedades Inmunoprevenibles, until you were removed by Macri’s Health minister Jorge Lemus. How was your experience of that and your exit?
I always had a technical profile. Lemus was the fifth minister under whom I worked after Ginés, Graciela Ocaña, Juan Manzur and Daniel Gollán. I handled the post without major inconveniences. I genuinely thought that there would be no great changes in the context that there was very little political discussion of immunisations in the country. I was there from late 2015 until November 7, 2016. Pushing to sustain the investment and the introduction of vaccines which had been achieved was very intense until the tension led to their telling me not to come to work any more. They told me it was a political decision, not technical.
What are the differences between thinking through health issues from within the government and beyond it?
It was very tough. I had passed the last 10 years of my life in the vaccine programme and watched it grow. From one day to the next I not only had no job but no concrete activity, which made me wonder what to do at that stage. I tried to do what would have been important for me in administration. At the Centro de Estudios de Salud [Health Studies Centre] we carried out epidemiological studies with information for decision-making and we created the Sociedad Argentina de Vacunología y Epidemiología. I worked with Pablo Yedlin and we could pass the vaccine law unanimously in a very short time.
Does it seem likely to you what Alberto Fernández attributed to Macri about “let all those die who have to die”?
When you see what happens when no measures are taken with any positive impact to diminish transmission, as happened in the United States and is happening in Brazil, affirming that the economy takes priority is more or less saying that those who have to die should die. We’re talking about health, about life or death.
Was there corruption under [Macri’s Health Secretary] Adolfo Rubinstein? Télam [news agency] reported that you would be lodging a case linked to contraceptives.
Not only with those. It was found that contracts were signed at one price and then the providers requested a correction. That is not done within the framework of public administration. An audit was carried out, that was observed, all payments are being reviewed and the prices not corresponding to the legal framework are being readjusted. The providers are also being asked to return that money because it is public money paid incorrectly. It is also being analysed whether that constitutes malfeasance.
Are you convinced that there was corruption? Was there a personal benefit?
It’s something illegal which cannot be done, signing a tender to pay 10 pesos and then having the lab coming alone to jack up the price. That’s what the courts are for. Ginés said that inaction is the same as corruption. Four million doses of outdated vaccines, 12 million in the Customs and meningococcal vaccination interrupted are not things compatible with efficient administration.
Does the experience of 2020 and 2021 demonstrate that this retreat of the state and globalisation have concrete and measurable effects?
When vaccinologists or I myself talked of abandonment, it was because we were against the government. When everything is so politicised, when somebody gives an opinion, it is received in black or white terms. We should reconsider this as a society, above all in this crisis where everything is so much more exacerbated. The withdrawal of the state meant that we faced the pandemic from a very much weaker position.
How would the pandemic have been fought if Macri had been re-elected?
He said so himself. He would have given priority to the economy.
Like the United States? But that has a truly federal system and many governors in more densely populated places like New York had different policies.
Yet the United States did give priority to the economy in a country with an economic situation totally different to our own. Macri did not handle the economy well either when he had the chance.
You had coronavirus some months ago. How did it go?
I had to take a swab to go to Congress. I had no symptoms then but within 48 hours I began to lose my sense of smell and within 72 hours I began to feel fatigue. I did not have any fever or cough or aches and pains. Since then I’ve felt a bit more asthaenia, that tiredness different from the usual fatigue.
Do you still have that?
Was it common before to call a virus a “bug” or is this the first time?
A bug never lasted so long nor disrupted people’s lives so much. It’s the bug which has brought the most problems to humanity, uncertainty, anguish and fear apart from the social impact.
For whom did you vote in 2015 and 2019?
For Daniel Scioli and Alberto.
When did you get to know Alberto?
I got to know him the day Ginés signed the ministerial resolution for the Protocol for the Legal Interruption of Pregnancy in the Casa Rosada. We went with a group of women who had been working on the issue. We greeted each other. Later, when he began to familiarise himself with SARS-CoV2, we saw each other at the meetings of experts.
Not so long ago.
Not so long ago.
And Cristina Fernández de Kirchner?
I don’t know her. I saw her in many rallies when she was president. I greeted her personally when the first anti-flu vaccine was produced at the Sinergium plant. Afterwards, I never saw her again nor spoke to her.
Is there anything I haven’t asked you in this long interview which you would like to add?
I would like to highlight that we need to be calmer because what is happening is really extraordinary. The increase in the number of cases is very worrying. We have to look after ourselves individually to achieve a collective impact. By that I do not mean to hold the people responsible for the increase in cases but it’s all about transmitting that information and recommendations with the conviction which most people are expecting. The virus must not be underestimated, nor its symptoms. If we have symptoms, avoid contact with other people. If we are close contacts, go into isolation. Go out alone for what is necessary, minimise contact with other people and look at the recommendations in our place of residence. Argentina is not the City of Buenos Aires and the epidemiological situation is totally different. We need to transmit all this with the expectation that our health system will continue being able to respond to every Argentine who needs it in the months to come, which will be diffícult.