In Mexico, the number of Covid-19 cases is now rising. Despite advance warning, the country still seems unprepared. Of course, Mexico’s public health authorities ran a model to predict when and how hard the virus would hit, but models are only as good as the assumptions they make, and in Mexico, public health officials have made a questionable one: they designed a model without performing enough tests to project rates of infection. This will make it difficult for the country to know what will be required to face the crisis. What led Mexico to this situation?
The personal approach to leadership during the outbreak is puzzling, given that Mexico has institutions to deal with just such contingencies. A key role of the Mexican Public Health Council (PHC), in place for 100 years, is to respond to crises like Covid-19. The PHC is composed of the secretary of health, most cabinet members, the academies of medicine and surgery, representatives of the pharmaceutical and medical device industries, five state health secretaries representing four regions of the country, and more. It is designed to allow public and private sector coordination in order to reach informed, highly technical decisions. In other words, the PHC can function as a kind of “war room” during a pandemic. Its decisions are binding across government and society. It can also cut red tape, if needed. The PHC, for example, handled the A-H1N1 influenza outbreak in 2009 with great success; its institutional design facilitated an effective and timely response.
López Obrador has chosen not to use these mechanisms and to rely instead on his intuition and only a few of his advisors. The reasons are not clear, but the consequences could be serious. The lack of a national strategy is adding to panic and disinformation and even political polarization. This in turn is undermining trust in government, social mobilization, and economic performance. In the absence of a national emergency declaration by the PHC, businesses and event organizers do not feel compelled to adopt protective measures, adding to the risk of contagion. In effect, the PHC was not called until March 19 and did not issue any guidelines until March 23, wasting an important opportunity to coordinate a timely response. By then, as a result of the lack of federal leadership, states and local governments had already implemented their own strategies to protect their citizens, leading to a fragmented, uneven and possibly ineffective response to the problem.
Mexico's Underfunded Health Care System
A second problem of this perfect storm has to do with the state of Mexico’s health care system. Due to an anti-corruption campaign and a misguided austerity program, President López Obrador’s administration only spent about 60% of the amount authorized for health care. He dismantled the Seguro Popular—a decentralized insurance program — to build the INSABI—a centralized insurance program. INSABI was deployed with flaws, including no rules of operation, no clear budget, cuts to public servant salaries, and conflicts with drugs distributors. The result has been a major crisis in the health care system. Even before the pandemic began, public hospitals were short on supplies, drugs, and personnel, leading to public protests by staff and even patients. To understand the depth of the problem, while the immediate emergency worldwide is the lack of ventilators, in Mexico, the problem is a lack of running water and cleaning supplies in public hospitals. During the Covid-19 outbreak, patients will soon be arriving in hospitals and health care centers without even basic resources to prevent the virus’ spread inside the buildings.
Suspicion of the Private Sector
López Obrador is deeply suspicious of the private sector. Early on, he picked a legal battle with Mexico’s pharmaceutical companies, accusing them of corruption and banning public contracts with them. The fight created a shortage of medical supplies and drugs in public hospitals and medical centers. Ill feelings between the government and pharmaceutical companies remain. Faced with Covid-19, however, the Mexican government is now looking for medical supplies, drugs, and medical devices abroad, but it is too late. The global demand for these products far exceeds the supply worldwide. Under these circumstances, López Obrador is in a poor position to count on the private sector to add their supply chains, know-how, and resources to complement his efforts to tackle the pandemic.
Fractured Political Strategy
Compounding the situation is a lack of coordination between the federal government and the states. Aside from the fact that López Obrador has exhibited a disdain for governors and mayors, the Mexican Health Act does not clearly define federal and state powers. Presumably, in a public health emergency, the federal government should dictate guidelines and provide supplies to states and local governments. These localities should implement health policies following federal guidelines and using the resources provided. This has not occurred. Presumably, the PHC can function as an excellent coordinating mechanism, but it has not been used as such. Nonetheless, it is now imperative for the PHC to begin to meet systematically and issue clear rules for all levels of government. The political friction between the federal and local governments, however, may interfere with this effort.
Civil Society: Mexico’s Hope
The silver lining is Mexico’s civil society empowerment. Indeed, Mexico’s civil society has shown solidarity in challenging situations. History proves that. Despite personalistic leaderships, political lethargy, and a poor government communication in critical situations in the past, Mexicans have exhibited solidarity and the ability to organize themselves to solve public problems. Responses to the 1985 and 2017 earthquakes are good examples of this. Moreover, despite government-created confusion, most people already know the basic rules for social distancing and how to behave during a pandemic. And despite poor political leadership, Mexico does have excellent health personnel and technical experts in the areas of epidemiological surveillance and more. This is encouraging, for pandemics are fought as much in the hospitals and medical centers as in the community.
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