Donald Trump y Jair Bolsonaro debilitaron las defensas sanitarias de América Latina contra el COVID-19

Donald Trump And Jair Bolsonaro Weakened Latin America’s Health Defenses Against COVID-19

The coronavirus was gaining lethal speed when US President Donald Trump met his Brazilian counterpart, Jair Bolsonaro , on March 7 for dinner at Mar-a-Lago. That week, Bolsonaro had canceled trips to Italy, Poland and Hungary, and the Brazilian health minister had urged him to stay away from Florida.

But Bolsonaro insisted, eager to reinforce his image as the “Trump of the tropics.” His aides smiled as they posed at the US president’s resort in green “Let’s Make Brazil Great Again” caps. Trump declared that he was “not concerned at all”, before walking Bolsonaro around the club and greeting him with a handshake.

Twenty-two people from Bolsonaro’s delegation tested positive for the virus after returning to Brazil, but the president was not alarmed. Bolsonaro told his advisers that the US president had shared a cure: a box of hydroxychloroquine , an anti-malaria drug that had not been tested as an effective treatment and that Trump promoted as a remedy for COVID-19.

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“He said that the trip was wonderful, that they had a great time, that life in Mar-a-Lago was normal, that everyone was cured and that hydroxychloroquine was the medicine they were supposed to use,” recalls Luiz Henrique Mandetta , who was then the Minister of Health but was fired by Bolsonaro the following month for opposing dependence on that drug.

“From that point on, it was very difficult to get him to take science seriously.”

The Mar-a-Lago dinner, which would be remembered for spreading the infection, cemented a partnership between Trump and Bolsonaro centered on their shared contempt for the virus. But even before dinner, both presidents had launched an ideological campaign that would undermine Latin America’s ability to respond to COVID-19.

Together, the two men who are fierce opponents of the Latin American left, aimed against the great pride of Cuba: the doctors it sends around the world. Trump and Bolsonaro expelled 10,000 Cuban doctors and nurses from various impoverished areas of Brazil, Ecuador, Bolivia and El Salvador. Many left without being replaced, just months before the pandemic hit.

Later, both leaders attacked the international body most capable of fighting the virus, the Pan American Health Organization (PAHO), citing their participation in the Cuban medical program. With the help of Bolsonaro, Trump nearly bankrupted the agency by withholding promised funds at the height of the outbreak, in a move that had not been previously disclosed.

And with Trump’s help, Bolsonaro made hydroxychloroquine the centerpiece of Brazil’s pandemic response , despite medical consensus that the drug is ineffective and even dangerous. The U.S. Food and Drug Administration warned in April against most uses of the drug to treat COVID-19. A month later, Trump announced after a phone call with Bolsonaro that the United States would send two million doses of that drug to Brazil.

Poor healthcare systems and overcrowded cities made Latin America very vulnerable. But by expelling doctors, blocking assistance and pushing bogus cures, Trump and Bolsonaro made the bad situation worse by dismantling defense mechanisms.

With a third of the deaths registered worldwide, Latin America has suffered more acutely from the onslaught of COVID-19 than any other region.

The two most powerful leaders in the Americas, Trump and Bolsonaro, are ardent nationalists who defy mainstream science. Both have privileged economic growth and short-term policies over public health warnings. Both are deeply hostile against leftist governments in the region, especially Cuba, a cause that helps Trump with Cuban-American voters in one of the crucial states for the elections, Florida.

“In its quest to get rid of Cuban doctors, the Trump administration has punished every country in the hemisphere and, without a doubt, that has meant more cases of COVID and more deaths from the virus,” said Mark L. Schneider , former chief of strategic planning at PAHO and who was also a State Department official during the Bill Clinton administration. “It is outrageous”.

Smaller and less powerful countries, like Ecuador, were hit hard. Ecuador acceded to US pressure and, shortly before the pandemic, returned nearly 400 Cuban health workers. Then the country also suffered from the Trump administration’s funding freeze for the healthcare organization, hampering its ability to provide emergency supplies and technical support.

“No one from PAHO was here and we are sorry for their absence,” said Washington Alemán, an infectious disease specialist and former Vice Minister of Health in Ecuador, who diagnosed the first confirmed case of COVID-19 in that country. “The support was no longer like in previous years, in previous epidemics.”

Almost all previous Republican and Democratic administrations considered the public health of Latin America to be an urgent national interest, because infectious diseases can easily spread between South and North America.

White House officials say the government withheld payments from the health organization to demand transparency. They note that the United States helped the region in other ways such as donating tens of millions of dollars through organizations such as the World Food Program, UNICEF and the Red Cross. During the summer, Washington sent hundreds of ventilators directly to government health systems.

But public health experts say that the Pan American Health Organization, with offices within each health ministry and nearly 120 years of experience fighting epidemics, was in a unique position to tackle COVID-19. Even some critics of the Cuban program say that punishing the health agency sabotaged that effort.

“PAHO didn’t have the tools and they didn’t have the money,” said Mandetta, the former Brazilian health minister who worked with Bolsonaro to expel the Cubans. “PAHO could not expand in the way it was needed and in Ecuador, in Bolivia, there were people dying in their homes and bodies left in the streets due to lack of assistance.”

To know how that happened is to enter the history of a political battle that moved between many fronts, from Brasilia to Miami and Washington. He left scars from towns in the Amazon basin to the neighborhoods of the Ecuadorian city of Guayaquil.
Bread from heaven

In October 2018, Jair Bolsonaro came to power in Brazil calling himself a Trumpist populist, speaking favorably of the “dictatorship” and accusing his country’s traditional left of learning lessons from communist Cuba. In addition, he promised to expel more than 8,000 Cuban medical workers.

Five years earlier, one of his predecessors had invited Cubans to help care for more than 60 million people, mostly in small communities in the Amazon basin , many of whom had never seen a doctor before. Academic studies reported high levels of patient satisfaction and reduction in infant mortality rates. PAHO supervised Cuban doctors in Brazil and promoted their work as a model, at the time, the Obama administration did not object.

For decades, Cuba has sent medical workers to fill the gaps in health systems in Latin America and many other regions. Cuba paid doctors up to $ 900 a month, compared to the $ 50 a month they could earn at home. But Havana charged its host governments much more (about $ 4,300 for each doctor in Brazil) and kept the difference. Cuba described the program as humanitarian, while its critics point out that the island’s regime limits the freedom of doctors, to the point of qualifying it as forced labor and human trafficking.

During Bolsonaro’s fierce election campaign, a newspaper released diplomatic cables – dating back six years – suggesting that Brazilian officials had routed payments for the program through the health organization, in part, to avoid debate. in the Brazilian Congress on the agreement with Cuba.

Bolsonaro accused PAHO of being an accessory to “modern slavery” and promised to get rid of the doctors. Cuba ordered them to return even before he took office.

In Miami, some 10,400 kilometers away, Tony Costa saw a unique opportunity.

Costa, 80, a veteran of the failed Bay of Pigs invasion, has spent decades working to overthrow the communist leadership in Havana. When he linked the allegations of Cuban forced labor to the Washington-based PAHO, he knew he had something that would captivate Congress and the White House.

Remember that he thought it was “like bread from heaven!”

Soon, Costa discovered Ramona Matos Rodríguez, a Cuban doctor who had defected to Miami from a mission in Brazil, and helped her become the main plaintiff in a judicial process accusing the Pan American Health Organization of forced labor and trafficking. of people.

In a court file, the organization’s lawyers said that the accusations were “extremely inaccurate” and that they “almost did not resemble reality.” Experts say the lawsuit is a long shot at best but, politically speaking, it had a big impact.

Without waiting for a court ruling, Costa, who is the founder of the Miami-based Foundation for Human Rights in Cuba, brought the lawsuit to the attention of his powerful friends in Congress and the White House. “It’s just despicable what they’re doing to these poor doctors,” Sen. Rick Scott, R-Florida, said in an interview last month.

Citing the accusations, the State Department pressured Ecuador, Bolivia and El Salvador until last year they expelled more than 1,000 Cuban medical workers.

But the biggest blow came from the Pan American Health Organization.

It is often referred to as the regional arm of the World Health Organization, but it is decades old and receives much more funding from member states. Public health experts attribute the eradication of smallpox, polio and measles to Latin America long before they were eliminated from Africa and Asia.

The Trump administration focused heavily on the organization’s ties to Cuba, even though its relationship with that country’s doctors had ended about a year earlier, when they left Brazil. The United States stopped paying its annual dues of $ 110 million, more than half of the agency’s core budget. The Bolsonaro government also froze the payment of its $ 24 million quotas.

Bolsonaro and his staff declined to comment for this article. John Ullyot , spokesman for the National Security Council, defended the suspension of US funding as an important step “to hold all international health organizations that depend on the resources of American taxpayers to account.”

In late 2019, the agency faced a serious funding crisis. It slashed international travel, froze hiring, and drastically cut back on the medical consultants who do most of the practical work.

In six weeks, COVID-19 began to spread throughout Latin America.
Bodies in the streets

Located on the southern coast of Ecuador, Guayaquil is a port city surrounded by slopes covered in slums.

Bella Lamilla, 70, arrived from Spain on February 15 to visit her birthplace. But, while there, he developed pneumonia.

Ecuador did not have laboratories with the supplies or the capacity to carry out tests to detect the coronavirus, but Lamilla’s family transferred her to a private clinic where Alemán, the former deputy minister of Health, works. The doctor used his contacts to send a sample to the Centers for Disease Control and Prevention (CDC) in Atlanta.

On the night of February 29, she became the first confirmed case in Ecuador. Within two weeks, all the intensive care units in the city were overwhelmed.

Doctors in Guayaquil say that if they had had more practical recommendations from the Pan American Health Organization, they could have helped detect the virus long before it penetrated so deeply into the city.

Then misinformed health officials and local doctors compounded the crisis with a basic mistake: The Public Health Ministry recommended cheap coronavirus antibody tests, rather than genetic tests that are more expensive and difficult to process.

Antibody tests returned false negatives when patients were most contagious, leading them to unknowingly spread the virus.

“It was ignorance, absolutely,” said Juan Carlos Zevallos , a US-trained epidemiologist who, in late March, was appointed as minister of public health.

More direct support from PAHO consultants “could not only have prevented that mistake, but many others,” said Alemán.

For many families, those mistakes meant heartache. In July, Patricio Carrillo , 70, visited a doctor at his local health center located near Quito, the capital of Ecuador. Your son recalls that he had received a negative antibody test result and was given penicillin for pharyngitis.

“I have nothing but the flu,” Carrillo assured his family in a voice message. He sounded hoarse.

Days later he died of COVID-19.

In Guayaquil’s main public hospital, Paola Vélez Solórzano, 38, an infectious disease specialist, had urged administrators since February to prepare a 29-bed coronavirus isolation room. She seized 900 disposable biological protection suits that were mistakenly ordered for maintenance workers.

But when the pandemic hit, their preparations were “like nothing,” he said. So many people died that doctors had to step over the bodies piled up on the morgue floor. “Wherever you were, it smelled like rotten meat,” he said.

His colleague Galo Martínez , 34, remembers looking out the window of the intensive care unit. “All I could see was a crowd of people calling for help,” he said while shaking his head.

Because they did not have enough protective equipment, half of the employees of the Ministry of Public Health in Guayaquil fell ill, the doctors said. More than 130 doctors died.

“We didn’t even have masks,” said Zevallos, the minister.

During previous outbreaks, local doctors credit PAHO with purchasing supplies or sending trained consultants to provide technical assistance in laboratories and hospitals.

Agency officials say they faced special challenges this time. Test materials and protective equipment were in short supply around the world. In late March, the suspension of commercial air travel made it difficult for the experts to deploy.

The funding crisis caused by Trump’s decision to freeze the funds was enormous, although leaders tried to compensate for it by shifting resources to prioritize the response to COVID-19.

Jarbas Barbosa da Silva Jr. , deputy director of the agency, acknowledged that the impact of the US funding freeze was “severe,” but argued that its consequences were difficult to assess accurately.

It claims that, by spring, the suspension of funding was not yet “a life or death situation” for the organization and even with more comprehensive funding, the travel ban would have limited its options to offering virtual training sessions.

However, other senior agency officials – who spoke on the condition of anonymity to avoid angering the Trump administration – said that if they had had more financial resources they could have provided more practical help. Regional meetings that could have discussed efforts to combat the virus were consumed by the funding crisis.

“Should the headquarters be closed? All these discussions were on the agenda, ”said Felipe Carvalho, an advisor to Doctors Without Borders, a non-profit organization.

Carmina Pinargote, a veteran official of the Ministry of Health on the Ecuadorian north coast, felt the difference. Pinargote recalls how PAHO immediately dispatched 15 epidemiologists and technical experts after the 2016 earthquake. This year, he said, only one consultant from the agency came to his region.

“We haven’t seen the same intensity,” he said.

The forced departure from the country of 400 Cuban medical workers did not help either. Hugo Duarte, director of the Martha de Roldós Health Center, outside Guayaquil, said that two Cubans had to leave months before the pandemic.

Ecuadorian doctors would have been just as good, if the Public Health Ministry had paid enough to fill the vacancies, he said. But the loss of human resources hit the clinic, especially when he was sick for weeks.

“People were falling dead on the sidewalk, right outside the health center,” Duarte said.
God is Brazilian

As the epidemic raged in Ecuador, Bolsonaro returned to Brazil from Mar-a-Lago. He quickly called Nise Yamaguchi , an oncologist from São Paulo who had become a prominent advocate for hydroxychloroquine.

Yamaguchi told the Brazilian president that the outbreak did not leave time for the kinds of clinical trials that other doctors were waiting for.

Brazil was known for having one of the strongest public health systems in Latin America to combat infectious diseases. But when two ministers refused to back the drug, Bolsonaro replaced them with a loyal military officer, while Yamaguchi became his most trusted adviser.

In an interview, he said that Trump’s donation of two million doses made Brazil dependent on the drug.

“It was very important because we had a global shortage of hydroxychloroquine at the time,” Yamaguchi said.

“God is Brazilian, the cure is here!” Bolsonaro told his supporters in late March.

Ignoring medical consensus, the Brazilian Ministry of Health still provides free hydroxychloroquine to anyone with COVID-19. And critics say Bolsonaro’s promotion of the drug, along with his refusal to wear face masks or socially distance himself, has undermined public health.

“People say, ‘If I get sick, I can go out and get hydroxychloroquine like the president,’” said Julio Croda, an infectious disease specialist and former health ministry official. “People believe that they can live a normal life and do not need to do any prevention.”

Brazil has suffered more than 157,000 deaths from COVID-19, a number second only to the United States.

Indigenous communities in the remote Amazon basin, which lost 8,000 Cuban medical workers, have been the hardest hit. Compared to other Brazilians in the Amazon basin, indigenous peoples are 10 times more likely to contract the virus, according to PAHO data.

Cubans had been a critical source of health counseling and treatment, often providing the only primary care for hundreds of miles, said Luiza Garnelo, a physician and anthropologist with the Manaus-based Flocruz foundation.

Without the Cubans, he said, “there are no professionals to diagnose.”
The political game

When the pandemic struck, PAHO began raising $ 92 million to dispatch infectious disease experts and critical supplies. The goal was subsequently raised to $ 200 million.

In normal times, Washington would be one of the biggest contributors. But the main donor agency, the United States Agency for International Development (USAID), is now led by Ambassador John Barsa, a Cuban-American and critic of the Havana regime who in 2019 participated in a press conference to announce the demand. against the Pan American Health Organization.

This time, the United States offered almost no money.

In May, the board of directors of the Pan-American agency warned in an internal report about a looming crisis.

Referring to the organization by its alternate name, the Pan American Sanitary Bureau (PASB), the report said that the Trump administration’s withholding of funds was “significantly reducing PASB’s ability to provide technical cooperation to its states. member, which implies, in the short term, the release of many critical members of the staff and contingent workers ” .

At the end of the month, Trump announced that the United States was withdrawing from the World Health Organization (WHO) and that his government temporarily froze other grants from the Pan-American agency.

USAID made an exception: it added $ 3.9 million in donations related to Venezuela, officials said. That spending is part of the administration’s efforts to topple the country’s left-wing government (the CDC also sent $ 900,000).

But the campaign against the agency intensified. “PAHO must explain how it became an intermediary in a plan to exploit Cuban medical workers,” Secretary of State Mike Pompeo declared on June 10.

Funds from Canada were needed for the health organization to send some protective equipment to Ecuador. It was the first time that the organization did that in order to help a country. On June 25, the Ecuadorian president, Lenín Moreno , received the shipment at the airport.

Finally, and under pressure from the US Congress, the Trump administration released $ 65 million on July 15, avoiding the insolvency of the organization. Pompeo said he had accepted an external investigation from the Cuban medical program and that other funds were unfrozen shortly after, after a suspension of about three months.

“PAHO is in a unique position to execute the response against COVID-19 in certain countries where there is no viable alternative,” wrote a State Department official July 15 in an email informing staff of the Congress on payment.
The consequences

Contracting the virus did not change the perspective of the presidents. Bolsonaro, 65, was infected in July and suffered only mild symptoms. He celebrated his recovery with a motorcycle ride and continues to push for the use of hydroxychloroquine.

Trump, 74, quietly stopped promoting the drug. When he was briefly hospitalized with COVID-19 earlier this month, he received other medications. He began to describe some of them as miracle cures and again downplayed the importance of the virus.

“People are tired of COVID,” he said this week on a campaign conference call. “People say, ‘Whatever. Leave us alone. ‘

Officials at the Pan American Health Organization say they have only raised $ 46.5 million from member states for their $ 200 million goal to fight the virus.

The Trump administration continues to pressure other countries to expel Cuban doctors. During this summer, an organization of Caribbean states condemned the White House for threatening to “blacklist” those who refuse to do so.

Other countries known for their sophisticated health systems have welcomed Cuban aid. A group of 40 Cuban doctors went to Turin, Italy, last spring to help fight the pandemic, said Carlo Picco , who directs health services in the city.

“The Cubans were a success story for us,” he said.

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