Losing Ground Against Infectious Diseases

LAC countries were at the forefront of the 20th century’s public health successes. They eradicated smallpox and polio before any other region. They made notable progress against diseases such as malaria, yellow fever, and dengue and mounted effective programs to immunize children against pertussis and measles. However, the region’s progress slowed and even reversed in some cases during the past few years. Diseases such as dengue and measles have reemerged as threats, whereas new infectious diseases are now appearing increasingly often (see Box 1).

Without regular investment and upgrading, public health systems cannot keep up with new and emerging health threats. Even before COVID-19, analysts recognized that LAC countries had weak disease surveillance systems, which undermined epidemic detection, monitoring, and response (OECD, 2020).

For example, the region’s diagnostic laboratories are often few in number and geographically concentrated. This leaves many areas without timely detection and creates bottlenecks to identifying and treating illnesses during pandemics. In addition, the region’s health infrastructure is relatively old and poorly maintained. Consequently, it is harder to respond adequately when there is a surge in demand caused by a disease outbreak (IDB, 2021).

BOX 1

New infectious diseases are part of the new normal

New infectious diseases are becoming increasingly common, in part because of the way people are damaging the environment and contributing to climate change (IDB, 2021, p. 7). Since 2000, the world has experienced outbreaks of SARS (2002), H1N1 (2009), Middle East respiratory syndrome (2012), Zika virus (2015), and COVID-19 (2019). Many of these illnesses spread to human beings from animals that are displaced by deforestation or expansion of settlements. Societies cannot ignore this trend. Rather, they must invest in preparing for future outbreaks of unknown disease.

The pandemic showed that the LAC region is vulnerable to disease outbreaks because its countries lack effective public health programs. To prepare for the future, countries must invest in regular data collection to facilitate informed decisions. They need to develop emergency plans and test those plans through periodic exercises. They also must have strategies and tools for effectively communicating with the public, along with specific protocols at the national level for testing, tracing treatment (Smarter Crowdsourcing: Coronavirus 2020), and isolation of infectious cases (IDB, 2021). 

The COVID-19 pandemic has exposed another vulnerability in the region: LAC countries rely on imports for both sophisticated and basic medical supplies, including vaccines, therapeutic drugs, masks, gloves, plastic tubing, and cotton swabs. The region invests little in research and development, which is crucial to the development of new diagnostic methods, medicines, and vaccines that could be responsive to the region’s epidemiology (e.g., dengue and chikungunya). Many good reasons exist to import goods and services rather than produce them in the region. However, the current pandemic has shown that the world needs production and distribution channels that are less concentrated and more geographically diverse than those of today if our global civilization is going to have the resilience it needs to confront future diseases. 

The world has taken steps in the direction of greater preparedness with agreement on a set of International Health Regulations (IHR 2005). Because these regulations were either too limited or poorly implemented (Aavitsland et al., 2021; Independent Panel, 2021), LAC countries were unprepared to prevent or control the spread of COVID-19. The region must learn from the countries that more successfully contained or limited the spread of COVID-19, such as China, New Zealand, Singapore, and South Korea—all of which institutionalized emergency preparedness plans after the first SARS epidemic in 2003 (SFD 2021 ; Chen et al,. 2021). Ultimately, preparing for the future requires significant ongoing investments in emergency planning and preparedness.

Chronic illnesses: The region’s biggest disease burden

Progress against infectious diseases in the 20th century explains part of the shift of the region’s disease burden toward chronic illnesses. Today, noncommunicable diseases (NCDs) are responsible for about 77% of the disease burden in the region—ranging from 60% in Haiti and Guatemala to almost 90% in Barbados, Uruguay, and Chile. The main causes of NCD-related deaths are cardiovascular diseases, neoplasms (cancers), and diabetes. The rates at which people contract and die from many of these NCDs are declining, but some important ones—notably, diabetes—are actually increasing. The region will not be able to reduce the burden of chronic illness without reducing risk factors such as obesity, smoking, alcohol consumption, and unhealthy diets. Addressing these risks would not only improve populations’ health but could also slow the growth in spending on health care services (Rao et al., 2022; IDB, 2021).

FIGURE 1  DEATHS BY SELECTED CAUSES AND RISK FACTORS IN LAC, 1990–2019 (PER 100,000 PEOPLE)

Source: Authors’ calculation based on the Global Burden of Diseases data from the Global Health Data Exchange, Institute of Health Metrics and Evaluation (IHME).

Reaching for universal health coverage: Many paths, few successes 

Universal Health Coverage (UHC) is a goal of most of the region’s health systems, but despite progress in the last couple of years, many challenges remain. On the one hand, access to health care services has expanded across the LAC region, and essential services are more equitably distributed than they were 2 decades ago (Sanhueza et al., 2020; Wagstaff et al., 2015).

However, quality of care and productivity are generally low and uneven across countries (Figure 2) and across regions within countries. An estimated 70% of preventable deaths in LAC can be attributed to poor-quality care, such as unskilled staff, inadequate surgical facilities, or improperly managed chronic conditions (Kruk et al., 2018). According to an index of health care access and quality across 195 countries, LAC countries ranked between 49th (Chile) and 168th (Haiti).

Making further progress toward UHC in LAC will require increasing levels of health spending in many countries. The region’s spending on health is lower and more fragmented than in the countries that have made more progress toward UHC. On average, public health spending in the region is about 3.6% of GDP compared to 6.6% in OECD countries. 

Moreover, health care systems in the region are generally inefficient. A recent study showed that people in LAC could live three years longer if the region’s countries operated with the same efficiency standards as OECD countries (Pinto et al., 2018). Some of the main sources of inefficiency include: poor quality of care, which can lead to medical errors and unnecessary tests; emphasis on curative interventions instead of preventive activities; paying higher-than-necessary prices for medicines and using them improperly (Andia, 2018); financing interventions that are not cost-effective, whose effectiveness is limited or uncertain, or that are more expensive than others that are available in the market with similar therapeutic effects; underspending on maintenance, which causes equipment to fail and leads to rapid deterioration of physical infrastructure; and poor management of medical staff, which reduces time spent with patients and time dedicated to upgrading skills (Leslie et al., 2021), among others.

The disorganization of health financing and health care facilities also leads to duplication of diagnostic tests, consultations, databases, and infrastructure that could be avoided through better management and coordination. It creates obstacles to adopting practices that are known to make health care systems more effective—namely, making services more patient-centered, more engaged with communities, and more integrated across medical disciplines (Pinto et al., 2018).

Another source of inefficiency is out-of-pocket (OOP) spending, which accounts for 33% of total health expenditure in the region compared to only 22% among OECD countries. In nine LAC countries, OOP spending exceeds 40%. This is problematic because OOP spending is less effective at improving health and tends to exacerbate inequities by consuming a larger share of household budgets among the poorest households (IDB, 2021). 

In sum, the old normal had its problems and challenges. The region needed to invest more in the prevention of infectious disease outbreaks; reduce the burden of chronic illness; and improve the quality, equity, and universality of its health care services. Despite warnings and calls for reform, the region has not been equitably addressing its population’s health needs. Accordingly, it was ill-equipped to cope with the pandemic that arrived in 2020.