Chapter I
If not now, when?

In 2015, Bill Gates opened his TED Talk by saying: “If anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus rather than a war. Not missiles, but microbes.” 1

Many people were informed of or had at least heard of the exponential risk of a global health crisis. However, the scale of the COVID-19 pandemic took a poorly prepared world by surprise.

In December 2019, humanity faced something that seemed like a scene from a movie, a shock impossible to sum up in a few short paragraphs. This tragic alteration n the very fabric of reality spared no one

In LAC, the cost has been staggering. In 2020 alone, the region had 28% of all confirmed COVID deaths and 18.6% of cumulative cases,2 despite only being home to 8.4% of the world’s population. These statistics show how little prepared the region was for this type of event. Even these numbers are considered to be underestimates3 made by overwhelmed health systems with no way of accurately gauging the real toll.

Other data also speaks to the devastating impact on LAC. In 2020, the region’s Gross Domestic Product (GDP) dropped 7.4%,4 total employment fell 14%,5 and the total number of people in poverty rose to 209 million, or 22 million more people than the previous year.6 LAC countries took measures that cost 4.6% of the region’s GDP to support their populations, ratcheting up the regional deficit by nine percentage points. All told, the ramifications of this event rank it as LAC’s worst economic, social, and productive crisis in 120 years. 7

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Health systems now face an enormous challenge. In upcoming years, LAC countries will need to combine efforts to combat the pandemic with measures to reactivate other health services, including those interrupted by the crisis, prepare for future emergencies, and tackle the rising costs of healthcare. 8

However, the crisis also prompted constructive changes in the region. Countries designed and implemented innovative social programs to meet the new challenges, and digital behaviors expanded in all social and economic spheres.

These trends converge to present a historic opportunity—and responsibility—to address structural problems in health systems and change them on a fundamental level, harnessing the transformative power of technology. To achieve this change, it is critical to prioritize the DT of the sector to usher health institutions, workers, patients, and the entire ecosystem into the digital age.

Leon C. Megginson paraphrased Darwin's theory of evolution as follows: “it is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.”9 Now it is up to the region to decide how, and if, it will continue adapting. It must choose whether, as a new normal crystallizes, it will take the opportunity to build back national health systems better.

If not now... When will it be more pressing to have data to better inform diagnoses and reduce medical errors? When would be a better time to empower patients, encouraging self-care and cutting costs for all involved, or to give vulnerable and remote groups better access to health? And how long can countries afford to wait to prepare their health systems for future epidemics?

References:

1 Bill Gates, “The next outbreak? We’re not ready,” recorded in March 2015, TED video, 8:24, https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready?language=en.
2 Calculations by the Inter-American Development Bank (IDB) based on data from the Johns Hopkins Coronavirus Resource Center. .
3The Economist, “Tracking covid-19 excess deaths across countries,” The Economist Group Limited, https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker
4 IDB, “Opportunities for stronger and sustainable post pandemic growth: 2021 Latin America and the Caribbean , https://flagships.iadb.org/en/MacroReport2021/Opportunities-for-Stronger-and-Sustainable-Postpandemic-Growth.
5 IDB COVID-19 Labor Market Observatory IDB, “Evolución del empleo 2020,” IDB, https://observatoriolaboral.iadb.org/es/empleo/.
6Economic Commission for Latin America and the Caribbean (ECLAC), Panorama Social de América Latina, (Santiago: ECLAC, 2020), 13.
7 ECLAC, Preliminary Overview of the Economies of Latin America and the Caribbean 2020, (Santiago: ECLAC, 2021), 11.
8The real per-capita cost of healthcare is expected to rise 1.5% per year in the region from 2015 to 2040. See 2021 Health Sector Framework Document, 17.
9 Megginson, ‘Lessons from Europe for American Business’, Southwestern Social Science Quarterly (1963) 44(1): 3-13, at p. 4.