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14 Apr 2020 | Commentary

A Critical Moment for Regional Health Cooperation in the Americas


This post was originally published on April 14, 2020 and was updated on April 15, after President Trump announced the U.S. government would temporarily halt funding to the World Health Organization (WHO).

By Defunding WHO and PAHO, Trump Administration Imperils Fight Against COVID-19

In the midst of a global pandemic, this week President Trump has been threatening to cut off U.S. funding for the World Health Organization (WHO) and within that, WHO’s regional office the Pan American Health Organization (PAHO). On April 14, the president announced that he would halt funding to WHO, accusing the organization of “severely mismanaging and covering up” the spread of the COVID-19 virus.

This is both shortsighted and dangerous, primarily because it ignores the importance of international collaboration in the face of public health challenges that transcend borders.  

Since its founding more than 100 years ago, PAHO has played an essential health function in fostering cooperation in the Western Hemisphere, helping countries accomplish things together—such as effectively controlling communicable diseases—that would be next to impossible for individual countries to accomplish on their own. Like all multilateral institutions, it has faced criticism about specific decisions, and calls for institutional reforms. But these challenges shouldn’t obscure the critical role that PAHO plays, especially in the context of the current pandemic, and shouldn’t lead to politicized attacks. 

Fostering regional health cooperation 

Every time there is a disease outbreak or epidemic, the global health community pleads with government leaders to place greater prioritization on the less visible (or perhaps less sexy) elements of health system infrastructure at both national and supranational levels that are absolutely essential to effectively combating disease outbreaks such as the current COVID-19 pandemic. In the Americas, PAHO has been the primary organization fostering cooperation in disease surveillance, cross-border collaboration, scientific research, information sharing, mechanisms to more expediently and equitably distribute medicines and preventive innovations, or what some have referred to as the generation of “global public goods.”  

For example, in response to the current pandemic, PAHO has quickly mobilized to ensure an evidence-based response to COVID-19 in the hemisphere. It has launched a searchable database with the latest guidance and research on the pandemic in the Americas, a critical tool for national health systems ideating and implementing response plans. It has assisted countries in surveillance of the virus, contact tracing, preparedness, and the implementation of health system resiliency plans. It has even donated test kits and protective equipment for health workers in certain countries. 

The prospect of cutting U.S. funding for PAHO not only endangers progress in the fight against the pandemic in our continent, it also pays no mind to the enormous contributions that international health cooperation can have for the United States and the region.

A history of protecting public health in the Americas

Consider the example from polio and the oral polio vaccine (OPV). In contrast to the more commonly known vaccine developed by Dr. Jonas Salk in 1955, the oral polio vaccine, developed by Dr. Albert Sabin at the same time, was a fraction of the cost and possible to administer widely even in the absence of highly developed public health infrastructure. This made it possible to vaccinate children throughout the developing world (and in poorer communities in the United States) against the dreaded poliovirus. 

In the second half of the 1950s, PAHO (along with a network of researchers and laboratories in the United States and elsewhere throughout the Americas and beyond) helped develop, conduct, and oversee field trials for the oral polio vaccine. Once field trials were done, it was PAHO (with support from the WHO) who hosted two rounds of international conferences where scientists and public health officials from all over the world convened to discuss their experiences with the new and highly innovative vaccine. 

The decision to deny funding to PAHO and its parent organization the World Health Organization could have a disastrous impact, with potentially severe public health ramifications for countries throughout the Americas...

Over the course of the subsequent decades, PAHO helped domestic health officials develop immunization strategies to reach vulnerable populations, negotiated ceasefires so vaccination campaigns could be conducted in areas plagued by civil wars, trained laboratory workers and scientists to quickly identify and track disease outbreaks, and brought together public health officials from throughout the region to share information and best practices along the way. 

The Americas became the first region of the world to successfully eradicate polio in 1994. In the midst of civil wars, transitions to democracy, and broad-ranging economic and political crises, it was regional health cooperation coordinated by PAHO that led the Americas to this incredible outcome. 

This is but one of myriad examples of where regional health cooperation, coordinated by PAHO, has played a critical role in protecting the health of the region’s citizens, which includes the citizens of the United States. Others include the battle to eradicate smallpox (the Americas was again the first region in the world to eradicate in 1973), efforts to combat yellow fever and other mosquito-borne illnesses, increasing coverage for childhood immunizations, fighting cholera outbreaks, addressing gang violence as a public health issue, combating the HIV/AIDS epidemic—the list goes on and on. 

PAHO is a vital global tool for fighting COVID-19

Throughout its lifetime PAHO has helped strengthen national health systems throughout the region, increased and expanded national laboratory capacity, trained tens of thousands of public health officials and medical professionals, established innovative joint purchasing mechanisms for the bulk (and lower cost) purchase of vaccines, helped national governments (including the government of the United States) combat disease outbreaks and epidemics, mobilized communities to demand greater access to health, conducted and widely disseminated groundbreaking research, and helped to establish a robust regional disease surveillance system that rivals surveillance systems anywhere in the world. 

PAHO has, in sum, created and disseminated a vast range of basic public goods for public health upon which the health of the region’s citizens depends. 

As examples throughout the region demonstrate, no individual country can effectively combat COVID-19 on its own. Diseases do not respect borders, making cross-border and regional collaboration essential for any sort of effective and sustainable response. PAHO is working to help shore up domestic health system capacity, providing technical guidelines to all of its member nations (guidelines each country might otherwise not have the capacity to put together quickly on its own), supporting surveillance systems, disseminating new research, and helping to marshall resources for the countries of the Americas as they struggle to respond to this new coronavirus reality. 

Now is not the time to play politics or withhold funding. PAHO is a vital tool in the global toolbox to combat COVID-19. The decision to deny funding to PAHO and its parent organization the World Health Organization could have a disastrous impact, with potentially severe public health ramifications for countries throughout the Americas, the United States among them.