ESPAÇO TEMÁTICO: COVID-19 – CONTRIBUIÇÕES DA SAÚDE COLETIVA
THEMATIC SECTION: COVID-19 – PUBLIC HEALTH CONTRIBUTIONS
COVID-19 and opportunities for international
cooperation in health
La COVID-19 y las oportunidades de cooperación
internacional en salud
COVID-19 e as oportunidades de cooperação
internacional em saúde
Paulo Marchiori Buss 1
Sebastián Tobar 1
doi: 10.1590/0102-311X00066920
On March 11th, 2020, the World Health Organization (WHO) declared COVID-19 (the disease caused 1 Centro de Relações
Internacionais em Saúde,
by the novel coronavirus SARS-CoV-2) a pandemic. As of this article’s writing, more than 1.3 mil-
Fundação Oswaldo Cruz,
lion people have been infected, with more than 80,000 deaths worldwide (case-fatality: 5.9%). There Rio de Janeiro, Brasil.
have been some 400,000 cases and 12,000 deaths in the Americas as a whole, with the United States
accounting for 85% of both cases and deaths. In Brazil, the country most affected in South America, Correspondence
P. M. Buss
there have been 14,000 cases and more than 700 deaths (case-fatality: 5%). Centro de Relações
The pandemic is proving to have profound impacts on the global economy: trillions of dollars Internacionais em Saúde,
evaporated from the world’s stock exchanges before they closed their doors to avoid absolute collapse, Fundação Oswaldo Cruz.
Av. Brasil 4365, Rio de
either because the brokers had fallen ill or the financial assets had plummeted; millions of people Janeiro, RJ 21045-900,
have lost their jobs, at least temporarily, and millions more of informal workers, excluded from social Brasil.
protection systems by negligent governments, have been left with a tragic choice, either to leave [email protected]
home to earn their daily bread and expose themselves to the virus or remain in social isolation and
die of hunger.
Governments have either had to open their coffers to spend on health services and economic
assistance for companies and workers (in that order) or stand by and watch the social and health situ-
ation deteriorate even further. The G20 countries promised to inject USD 4.8 trillion into the global
economy; the United States has earmarked USD 2.3 trillion in stimulus packages for its domestic
economy, but has invested nothing in international aid for global health, an area where that country
had been one of the champions in the past; in Brazil, the statistics announced by the Federal Gov-
ernment are imprecise, but the scrapped Brazilian Unified National Health System (SUS) has been
struggling for years to deal with a complex set of health problems, largely determined by the country’s
immense socioeconomic inequality.
In a scenario of increased vulnerability in which diseases cross national borders and health risks
are globalized, the sub-regional level, associated with initiatives for integration, offers key opportuni-
ties for cooperation in health.
From 2008 to 2019, South America was an example of cooperation in health during the existence
of the Union of South American Nations (UNASUR). As part of the highest governance structure in
this initiative for regional integration, UNASUR featured the South American Health Council, with
12 Ministers of Health from countries of the region. During that period, the countries’ collective
This article is published in Open Access under the Creative Commons
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any medium, without restrictions, as long as the original work is correctly
cited. Cad. Saúde Pública 2020; 36(4):e00066920
2 Buss PM, Tobar S
fight against the H1N1 influenza pandemic and dengue epidemics and the organization of common
measures against other emerging and reemerging diseases, including collective preparations for the
potential introduction of the Ebola virus, were conducted by the Council, supported by the heads of
State and implemented by hundreds of expert staff from the States members’ Ministries of Health
and health systems.
UNASUR’s implosion, or the rejection of regional multilateralism, liquidated this stable mecha-
nism which had functioned effectively for some ten years in South America.
It is essential to restore these political and technical mechanisms in order to deal with the new
coronavirus epidemic, as well as with potential new health challenges of international concern, since
simply closing borders is not the solution. South America has 48 borders with a total of 17,000 kilo-
meters. The population’s daily life in border areas has always taken place with mutual benefits and
intense cooperation to jointly deal with common problems.
The Ministries of Health of South America have been consulting each other, but it would be
advantageous to conduct such relations institutionally at the highest level and to intensify consul-
tations and mutual assistance in order to implement rational technical measures in border health
surveillance, which depend on the 12 countries that have such borders. This kind of cooperation is
beneficial for all countries concerned.
“Time is of the essence – Countries of the Americas must act now to slow the spread of COVID-19. But only
if we act now (…). This virus has not and will not be stopped by borders drawn on maps” 1. Thus stated Pan
American Health Organization (PAHO) Director Carissa Etienne, who called on the countries of the
Americas to take urgent measures to guarantee hospital space, beds, health personnel, and medical
equipment to deal with the growing influx of persons with COVID-19.
It is possible to identify some lines of work that will definitely contribute to countries’ decisions
related to the COVID-19 pandemic and other diseases, including epidemic viruses threatening the
world and the region:
(a) Data exchanges and follow-up of the epidemic, developing comparative curves in COVID-19
trends in the countries and drawing on measures and solutions adopted in various dimensions (social,
public health, and clinical) for dealing with the epidemic. Exchange of experiences and lessons learned.
(b) Information searches on the diagnosis, surveillance, control, and prevention of COVID-19, iden-
tifying which information is based on scientific evidence in order to support and feed policymaking
and decision-making, while eliminating fake news.
(c) Creation of a regional network of laboratories for the diagnosis of COVID-19 and other viruses,
with a quality assurance program for laboratory diagnosis, applicable to all laboratories in the region.
(d) Adoption of incentives for research, technological innovation, and production of appropriate
health technologies for COVID-19 (medical equipments, respirators, reagents, personal protective
equipment, etc.), joining efforts and promoting scale economies and country capacities, fostering
cooperation.
(e) Adoption of mechanisms for joint negotiation and purchase of strategic inputs for dealing with
the pandemic.
(f) Building regional funds for emergency financial support to deal with the pandemic and other
public health contingencies.
(g) Mobilizing structural networks of existing South American institutions (national institutes of
public health, schools of public health, and polytechnic health schools) for the organization ofto share
timely research, human resources training, and technical assistance and cooperation.
Dr. Etienne 1 also declared, “It will not be easy, and we know we will be asking people to adapt to an
extraordinary situation that is impacting everything in their lives. But let me emphasize: this pandemic is seri-
ous, and we need to do everything in our power to mitigate the impact of COVID-19 on our people”.
Sub-regional integration should stimulate to build health intelligence for surveillance and to define
measures for suppression and mitigation, which can strengthen the response both to COVID-19 and
to the emergence of new viruses with pandemic potential. Meanwhile, it makes no sense to exclude
any territory on grounds of ideology, as Venezuela for example, or any other country. The pandemic
affects all of us, without distinction; either we are all in this together, or we will not be at all.
The formal and institutional structuring of these intergovernmental relations at the highest level
will open the way and encourage vital cooperation between universities, research institutes, schools
Cad. Saúde Pública 2020; 36(4):e00066920
COVID-19 AND OPPORTUNITIES FOR INTERNATIONAL COOPERATION IN HEALTH 3
of public health, and undergraduate schools in the health fields, fostering the establishment of human
resources training and research projects and technological development that respond to the common
needs of countries in our region in coping with the epidemic.
This cooperation in the subregion would reinforce the continental action by the PAHO, which
convenes all the countries of the Americas, in this important initiative in the field of regional
health diplomacy.
A key question remains, namely whether the Forum for the Progress and Development of South
America (PROSUR), spearheaded by neo-conservative governments to replace UNASUR, will put
health above all economic interests, recreating the opportunities for South-South health coopera-
tion offered by the sub-regional level to cope with the COVID-19 challenge. If this epidemiological
intelligence is not established at the sub-regional level through cooperation in health, we will remain
vulnerable to the new coronavirus and to other diseases with pandemic potential.
In this sense, the Caribbean has taken an important step with the creation of the Caribbean Public
Health Agency (CARPHA) 2, while Africa has created the Africa Centres for Disease Control and Pre-
vention (CDC/AFRO) 3, both of which are important organizational and regional health intelligence
arrangements for dealing with the pandemic. What should South America learn from the interna-
tional lessons and take perhaps a similar path?
Finally, if recent communications from the International Monetary Fund (IMF) and World Bank
are sincere and if they materialize, announcing USD 1 trillion and USD 14 billion, respectively, for
soft loans to the most vulnerable and poorest countries, the South American countries should jointly
seek critical economic resources at zero cost from these institutions to deal with the pandemic. This
could be the opportunity to make this proposal and these mechanisms of integration in health a true
“regional public good”.
Contributors References
The authors contributed equally to the article’s 1. Etienne C. El tiempo para desacelerar la propa-
preparation. gación de la COVID-19 se está acortando en las
Américas, los países deben actuar ahora. https://
www.paho.org/hq/index.php?option=com_
content&view=article&id=15762:el-tiempo-
para-desacelerar-la-propagacion-de-la-covid-
19-se-esta-acortando-en-las-americas-los-pai
ses-deben-actuar-ahora&catid=740&lang=es&
Itemid=1926 (accessed on 01/Apr/2020).
2. Caribbean Public Health Agency. Emergency
response and disaster preparedness. https://
carpha.org/W hat-We-Do/Emergency-Re
sponse (accessed on 01/Apr/2020).
3. Africa Centres for Disease Control and Preven-
tion. Emergency preparedness and response.
https://africacdc.org/programme/emergency-
preparedness-and-response/ (accessed on 01/
Apr/2020).
Submitted on 02/Apr/2020
Approved on 03/Apr/2020
Cad. Saúde Pública 2020; 36(4):e00066920
