Determination, Dependence and Lack of Coordination in SARS-CoV-2 Vaccines in Latin America and the Caribbean
Within the collection of “Notebooks of Latin American critical thought”, CLACSO presents “Determination, Dependence and Lack of Coordination in Vaccines for SARS-CoV-2 in Latin America and the Caribbean”, by Gonzalo Basile and Oscar Feo.
Determination, Dependence, and Lack of Coordination in SARS-CoV-2 Vaccines in Latin America and the Caribbean
Gonzalo Basile* and Oscar Feo**
Latin America and the Caribbean, as a space of dependent peripheral capitalism, allows us to study the impacts of the geopolitics of power and knowledge on the response to the SARS-CoV-2 pandemic. This article seeks to demonstrate the articulation between Big Pharma, the World Health Organization (WHO), and other actors in liberal global health, in the response from COVAX, CEPI, and GAVI to the public health emergency created by SARS-CoV-2, identifying the critical links and keys to regional health sovereignty to study access to vaccines in the Global South as public goods based on the categories of the three “D’s”: determination, dependence and lack of coordination.
Despite the fluctuations of the global economy, the pharmaceutical market remains a complex production system and generator of inelastic mass consumer demand with extraordinary profit margins, reaching US$1.27 billion in sales in 2020 (Estatista, 2021). This industrial complex is one of the most profitable sectors for big business and is highly concentrated in the core countries that lead the research, innovation, and development of drugs and vaccines, using patents and aggressive lobbying as instruments of cognitive capitalism. This pharmaceutical world is dominated by 20 companies. Big Pharma mostly from the European Union and the United States, which represent more than 60% of total sales in the pharmaceutical industry globally, creating a clearly North-South or Center-to-Periphery geopolitics.
The medical-industrial-financial complex (MIFC) links pharmaceutical corporations, financial groups, and the active participation of states in the Global North to consolidate transnational capital expansion interests and reaffirm their geopolitical presence. The MIFC represents a constant articulation between states and corporations for the purpose of expanding financial-pharmaceutical capital. This pharmaceutical complex has been involved in the governance of research, development, and validation., production, sale and distribution of SARS-CoV-2 vaccines.
Hence, rather than repeating premises of positivist international public health, the aim is to provide a critical analysis matrix to review the responses to the SARS-CoV-2 epidemic, problematizing vaccines as one of the coping strategies. Based on this matrix of links under the three “D’s”, this article develops a review of these processes to characterize, analyze and interpret the access and use of vaccines in response to the SARS-CoV-2 epidemic cycle from the Latin American critical thinking in health.
The “D” stands for International Determinants of Health, Vaccines and the Global Pharmaceutical Complex
Understanding the overall dimension of epidemic crises and access to public goods such as medicines and vaccines requires adopting an observational scale based on the category of international determination of health which assumes the complexity of conditions and adversities of Latin America and the Caribbean as a space of peripheral capitalism and buyers to the medical-industrial-pharmaceutical complex, who uncritically assume the patterns of “universal” response to health emergencies, such as empirical quarantines, neo-hygienism and punitive vigilantism, geopolitics of global health security and militarization in the face of epidemic threats to the Global North.
The international determinants of health manifest themselves in different dimensions and levels, demonstrating the reductionism of the idea that responses to health and disease processes rely solely on what occurs between and within each nation-state, without fundamentally linking or acknowledging the geopolitical determinants of health and life in the Global South. If the unit of analysis for studying global epidemiological events and access to vaccines is the nation-state, the relationships of determination and dependence within the contemporary world system are underestimated. To understand access to SARS-CoV-2 vaccines, it is relevant to use an analysis based on the international determinants of health.
It is crucial to recognize that global inequalities in access to vaccines between and within states/national societies are isolated, disconnected pieces of evidence. The unequal distribution of resources for domination, exploitation, dependence, and subjugation constitutes the overarching dimension of determination of international health This allows us to understand global public goods like vaccines from a general perspective. In other words, the current world-system is the result of a complex process that, in our region, is related to the historical colonial constitution of Latin America and the Caribbean within colonial/modern, fluid, and Eurocentric capitalism as a global power structure.
This flow of international health determination has a dynamic of reproduction within the very architecture of the Medical-Industrial-Financial Complex (MIFC), acting as a link in the unprecedented acceleration of economic accumulation, commodification, medicalization, and financialization of health and life. This includes a dimension of political ecology that emerges when analyzing the processes of signification, valorization, and appropriation of nature. The MIFC is a framework that articulates a triple field of power: geopolitical, technical, and economic-financial. This triquetra implies a mechanism that intertwines pharmaceutical corporations, health technology industries, the medical supplies industry, private healthcare providers, and the health insurance industry.
For many years, it has been warned that "vaccines" have become a business opportunity for the pharmaceutical and biotechnology industries. In the transitions from market colonialism to industrial capitalism and the current accelerated, extractive global financial system, a shift occurred in the exchange value and use value of vaccine production. The global vaccine market generated $59.2 billion in revenue in 2020. This is almost double the market size in 2014 ($32.200 billion), according to a report by Zion Market Research. The most profitable vaccines in the 2017-2024 period were Prevnar 13 (Pfizer Daewoo), Gardasil (Merck & Co.), Pentacel (Sanofi), Fluzone (Sanofi), and the respiratory combination vaccine (Novavax), not including COVID-19 vaccines.
These are no longer the old vaccines, like those used against smallpox, polio, measles, or tetanus, to name a few that were of great value to humanity. Vaccines were not produced back then, driven by an accelerated logic of capital accumulation, even though infectious health and disease processes were critical issues affecting commercial expansion, the loss of labor, and the conditions of consumption in the core societies of the Global North. Vaccination became a vehicle for immunizing societies, especially those of the Global North, to protect that superior humanity from the world system, but especially to safeguard consumers and the workforce. Vaccines have always operated within a conception of the health and disease process shaped by the hegemony of biomedicine and functionalist public health.
There is a long-standing debate on this because, while vaccines are being discovered as a biological immune response without transforming the determinants of health and life, many health-disease processes persist within an epidemiological dynamic shaped by North-South geopolitics, colonialism, and social class, ethnicity, and gender, despite the existence of vaccines. Vaccines are a necessary global public good and a specific but insufficient component in responding to an epidemiological crisis, assuming that the priority is the comprehensive care of collective health, which operates as a flow in the general society-nature metabolism, and specifically in the lifestyles and healthcare systems that respond to the determinants of health.
In the 20th century, while Western clinical biomedicine was consolidating, monopolistic private capital and the states of the Global North promoted the formation of what we now know as the global pharmaceutical industry (GPI). It is illusory to characterize the global pharmaceutical complex without understanding the hegemony of the biomedicalization of health and medical education, and its geopolitical, regulatory, and financial articulation with the states of the global core. This network also colonizes a space of knowledge through universities and research centers. This situation became more complex with the emergence of the biotechnology industry in the field of vaccines and the entry of pharmaceutical companies into the circuits of financial capital accumulation. Traditional vaccines—made with attenuated or inactivated pathogens—were replaced by more sophisticated vaccines, called modern or second-generation vaccines—protein subunit, recombinant, conjugate—and even third-generation vaccines—virus-like particles, RNA or DNA vaccines, vector vaccines.
In the field of intellectual property, a new regime accompanied these changes: it went from a Western regulatory system of open science that perceives itself as the unique and totalizing "Science", to a transition and mixture with a system that, based on that symbolic-scientific power, advanced to patenting scientific/technological developments articulated to financing by the States, which led to the appropriation of biomedical knowledge by pharmaceutical corporations.
The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) was the mechanism by which the World Trade Organization (WTO) imposed the interests of the pharmaceutical industry on states and health systems, with serious consequences for countries dependent on pharmaceutical imports and with trade deficits, as is the case in Latin America. These patent rights on vaccines and drugs placed the profits of pharmaceutical companies above public health.
Susan Sell's book Private Power, Public Law (2003) describes in detail the capture of the TRIPS Agreement by the International Property Committee, comprised of Bristol-Myers Squibb, CBS, DuPont, General Electric, General Motors, Hewlett Packard, IBM, Johnson & Johnson, Merck, Monsanto, and Pfizer. This committee exerted extraordinary influence on trade negotiations and succeeded in enshrining its private corporate objectives into a uniform global law that is applied and enforced in all WTO member states.
India and South Africa proposed to the TRIPS Council in mid-October 2020 a temporary suspension of the implementation, enforcement, and compliance with certain intellectual property obligations under the TRIPS Agreement, including matters related to patents, copyright, industrial designs, and information protection in connection with SARS-CoV-2. This proposal was debated and rejected during the WTO General Meeting in December 2020, despite already having the support of more than one hundred countries.
While this is happening at the WTO, Chatham House, also known as the Royal Institute of International Affairs, is also involved. thinkthank In March 2021, the British government convened a closed-door Global Summit on COVID-19 Vaccine Manufacturing and Supply Chains, co-sponsored by COVAX, the Biotechnology Innovation Organization (BIO), the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), CEPI, and GAVI. The WHO was also present. This Summit addressed the needs of global pharmaceutical companies in supply chains, trade mobility, distribution and tax barriers, accelerating industrial production for geopolitical distribution through COVAX, and the commercialization of surplus production, among other topics. Representatives from Big Pharma (IFPMA), CEPI, GAVI, BIO, and the WHO itself participated in the summit.
The vaccine business model no longer involves immunization to protect societies within a productive capitalist system, or even all of humanity. It now focuses on maximizing cost-benefit ratios by incorporating vaccines into national immunization programs, influencing expert committees, and expanding sales through public-private partnerships that minimize risks and guarantee substantial profits. In other words, the vaccine business plan aims to make vaccines mandatory in immunization programs through public-private partnerships, thereby creating increasing dependency.
In summary, what is happening demonstrates that the international authority known as the World Health Organization (WHO) is colonized by the interests of the global pharmaceutical industry, thanks to an accelerated privatization process that strips it of any role in public health. Almost 90% of the WHO's Medicines Programme is funded by the Bill and Melinda Gates Foundation, which allocates funds to issues of interest to it. 80% of the WHO's budget depends on donations (not contributions from states), which are known as voluntary contributions.which are concentrated in various countries, in the Bill and Melinda Gates Foundation and in the pharmaceutical industry»[1]When a donor gives money, for example, the pharmaceutical industry, its representatives request to be present on the expert committees of the different [WHO] programs. This had already happened with the H1N1 epidemic, where vaccine and drug manufacturers, such as Gilead's Tamiflu, had seats on the expert committee that was deciding whether to declare an epidemic.
“D” for Dependency: The geopolitics of power and health knowledge in SARS-CoV-2 vaccines
The concepts of development and underdevelopment are not fixed; they are two sides of the same coin, says Dos Santos (2020). They have a history woven from the conflicts and mutations of the International Division of Labor (IDL) that spans five centuries of capitalist colonial globalization and the production of dependencies.
First, the multiple frameworks within global health security theses imply approaches and lenses that have produced a dependency in international health for the past three decades. Global health security compels states of the Global South to adopt health measures that respond to the needs of states of the Global North. There is a link between security and health that becomes the dominant narrative in the field of international health. Flor presents global health security as the product of a process of biomedicalization of international relations which prioritizes the geopolitical interests of the Global North and control. The WHO, the international health authority, itself articulates and promotes the demands of the Global North, especially the US, UK, and Europe, for “more” health security. In other words, if an epidemic crisis is a security threat, vaccines become a strategic input in the conception of a matrix of epidemiological “warfare.”
A prime example of this geopolitics of dependency, which operates within the framework of health security as an international imperative, is the international issue of access to SARS-CoV-2 vaccines. This dynamic of dependency is exemplified by the paradigmatic case of the networks that currently operate and govern the COVID-19 Vaccines Global Access Facility, known as the “COVAX Facility,” of the WHO, in conjunction with the GAVI and CEPI alliance.
This mechanism represents a scheme where vaccine patent rights were guaranteed under the logic of the market and health security, where they only commit to donating a proportion of the production surpluses, which implies more of a sense of “global charity and philanthropy"with the South in access to a global public good in the face of the need for immunization of 7000 billion people in the world."
In other words, what the COVAX Mechanism reveals is that pharmaceutical companies, along with the states of the Global North, are directly influencing access to SARS-CoV-2 vaccines. CEPI and GAVI were the primary actors influencing the WHO's global strategy and policy on SARS-CoV-2 vaccines. Characterizing and mapping these actors can contribute to a deeper understanding of the complex systems at play in responding to epidemiological crises such as COVID-19 and other pandemics and/or epidemics of international scope (past or future).
In January 2016, at the World Economic Forum meeting, a unique project was launched with the aim of exploring new ways to address the challenges posed by the neoliberal global health agenda in relation to emerging infectious diseases. This initiative was conceived within the WHO, involving corporations and governments from the Global North. The project was formalized as the Coalition for Epidemic Preparedness Innovations. (CEPI)Its promoters were the WHO, the Glaxo Smith & Kline philanthropic fund, and the Welcome Trust.[2], the Bill and Melinda Gates Foundation and the World Economic Forum[3] and had a budget of at least $1 billion in its early years, with three objectives: 1000) to stimulate, finance and coordinate the development of new vaccines against infectious diseases capable of causing outbreaks and epidemics, 2) to advance the development of vaccine candidates for the diseases of greatest interestand 3) develop a technical and institutional platform to coordinate the response to pathogen emergencies. In short, a “sort of global insurance market policy"[4] according to Rottingenwhich sparked great interest in governments of the Global North and the International Federation of the Pharmaceutical Industry (IFPMA).
In addition to characterizing CEPI, it is necessary to describe the Global Alliance for Vaccines and Immunization (GAVI), whose geopolitical impact is based on the strengths of its main partners: the WHO, UNICEF, the World Bank, and the Bill & Melinda Gates Foundation, and the participation of the global pharmaceutical industry itself, which provides 60% of GAVI's funding. Representatives of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which represents more than 55 global pharmaceutical corporations, including Johnson & Johnson, GlaxoSmithKline, Merck & Co., Novartis, Sanofi Pasteur, the vaccine division of Sanofi-Aventis, and Pfizer, hold a seat on GAVI's board of directors.
Regarding the COVAX Mechanism, it is easy to see a relationship of dependence on the Global North. The key question is whether COVAX has been inefficient in achieving its objectives, or whether it is actually fulfilling the function for which it was designed.
SARS-CoV-2 Vaccine Production: Big pharma, production surpluses from the North and patents
According to the WHO's COVID-19 vaccine tracker, 126 vaccine candidates are being tested in human clinical trials, 196 in preclinical studies in animals, and 33 vaccines have been approved. The speed of SARS-CoV-2 vaccine production was not due to the brilliance of pharmaceutical monopolies in research and development (R&D), but rather to a combination of public funding shocks—where the risks and benefits of vaccine development are shared in the new cognitive capitalism—and previous research by coronavirus centers (MERS, SARS), including existing mRNA biotechnology platforms that made the progress on these vaccines possible.
The 21st-century medical-industrial complex (MIC) involves alliances that triangulate the state, universities, research centers, and the private medical-industrial complex, in which the state's presence is structured to contribute to knowledge development and financing, ultimately placing production within the private sector. Moderna, founded by billionaire American university professors under the dynamics of corporate biomedical science, counts the Gates Foundation, Merck, and AstraZeneca among its investors. Moderna's objective was to build an mRNA technology platform, and it received approximately $2.5 billion in federal research funding for the SARS-CoV-2 vaccine and funding for supplies from the U.S. federal government. The Moderna case and the expansion of a multi-billion-dollar biomedical academy through the monetization of knowledge are relevant for understanding knowledge production in the 21st century, a phenomenon known as cognitive capitalism.
The alliance between Oxford University and AstraZeneca is also based on public funding. In Latin America and the Caribbean, the largest platform that attempted to monopolize SARS-CoV-2 vaccine production (with significant supply chain failures and production-distribution capacity issues) was the pharmaceutical consortium AstraZeneca with the Carso Group.[5] by Carlos Slim (Mexico) and the Insud group[6] Hugo Sigma (Argentina) with his mAbxience laboratory and his philanthropic foundation Mundo Sano, which had financial and operational support from several Latin American and Caribbean states.
From a production standpoint, of the 33 approved vaccines, only 5 were produced in research centers that can be characterized as state-run; the rest were developed by private corporations and public-private partnerships. Only Russia, China, and Cuba are doing so with a strong state presence and through direct diplomatic negotiations. In fact, China (through Sinovac and Sinopharma) achieved the most effective access to vaccines in the first half of 2021 through sales agreements or partnerships with Latin America and the Caribbean, which allowed for progress in vaccination strategies in several countries of the region. Cuba is a special case; suffering an economic blockade for 60 years, it has developed a biotechnology industry that has allowed it to produce four vaccines and immunize its population with its own resources, in addition to offering them to other countries in the Global South.
On the contrary, Big Pharma Companies like Pfizer, Moderna, and Janssen only began, from June 2021 onwards, once they had made progress in fulfilling their vaccination supply agreements with their core companies in the Global North, with a clear delay, to place their production surpluses in direct deliveries to countries, or through vaccines marked via COVAX. Also evident is the advertising war and the systematic smear campaigns against vaccines from Russia, China, or Cuba.
Furthermore, there are significant gaps in our knowledge regarding immunogenicity. The duration of the immune response to SARS-CoV-2 is unknown, especially in relation to the various variants. Studies in Israel and China with different types of vaccines suggest the need for booster doses. These gaps in knowledge make us easy prey for the interests of pharmaceutical capital, which is transforming this pandemic into a business opportunity.
Regarding the distribution and application of COVID-19 vaccines, 47,9% of the world's population had received at least one dose by the end of October 2021. Six billion doses have been administered worldwide, but only 5,2% in Africa. According to the World Health Organization, 95% of coronavirus vaccines are concentrated in ten countries: the United States, China, the United Kingdom, Israel, the United Arab Emirates, Italy, Russia, Germany, Spain, and Canada. Countries in the Global North captured the entire production flow of vaccines from Pfizer, Moderna, AstraZeneca, Johnson & Johnson, and Novavax in the first half of 2021, meaning that the distribution of surplus production and the fulfillment of contracts only began in June of that year.
In Latin America and the Caribbean, as of November 9, 2021, the countries with over 75% of their population fully vaccinated (with two-dose schedules) are Chile (80%), Uruguay (75%), and Cuba (69%). Conversely, in the same region, another group of countries is still below 50%, including Bolivia (39%), Paraguay (41%), Honduras (38%), Venezuela (48%), Nicaragua (20%), and Haiti (1%), among others.
There is no doubt that vaccination is one of the most effective strategies, although a critical review of the pandemic response is necessary, and how Latin American states were reduced to preparing a bureaucratic apparatus external to societies in the dynamics of confronting SARS-CoV-2 that took shape and institutionalization through experimental trials of empirical quarantines, (neo)hygienism of individuals, punitivism/medical vigilantism in the 21st century, hybrid arrangements in chronically fragile, precarious and financialized health systems, a biomedicalized government of clinical specialists making decisions about population epidemics, the transfer of control and prevention protocols of hospital infections to life in society, among other critical links.
The governance of SARS-CoV-2: between clinical experts and their organic links with the CMIF
In characterizing the response to the SARS-CoV-2 public health emergency, it is important to identify the government of clinical “experts” and the institutionalization of guberbiologization of public health. A review of emergency operations committees or COVID-19 response committees, as well as national expert committees in the region, reveals: 1. An overabundance of biomedical clinical specialists, virologists, and/or infectious disease specialists; 2. Many of these specialists have direct links to the pharmaceutical and medical-industrial complex, insurance companies, and private healthcare providers, influencing decision-making. in of the State.
The “D” for Lack of Coordination: gaps in regional integration in health in the production of and access to SARS-CoV-2 vaccines
Pan-American international health and liberal global health respond to a geopolitics of power and knowledge within the contemporary world system. The entire matrix for operationalizing global mandates on vaccine access could not have expanded without the platform of the Pan-American doctrine, which operated in Latin America and the Caribbean as a territory of its technocratic-diplomatic dominance and its political and health interests. From one point of view decolonial It is important to describe Pan-Americanism as the current that has dominated international public health in Latin American territory since the end of the 19th century and throughout the 20th century. That is, the strategies, policies, programs, and interventions that were implemented in the region of the Americas The COVID-19 situation cannot be understood without this Pan-American health framework..
The field of international health in Latin America cannot be understood without considering the Pan-American framework in its constitution and genealogy. It is a hegemony shared with liberal global health. The theoretical and methodological framework of Pan-American healthism takes nation-states as its unit of analysis in the control of diseases, within a dynamic of international disease management. Its theoretical foundations lie in colonial international health, tropical medicine, and health development. In this sense, regarding vaccines, medicines, and supply chains in Latin America and the Caribbean, the main health evaluation agencies operated with technical assistance from PAHO/WHO, but in a disjointed manner with respect to the evaluation and approval processes, especially for the multiple SARS-CoV-2 vaccines used in the region (as in the cases of ANMAT, ANVISA, CECMED, COFEPRIS, etc.).
Within these frameworks of dependence on Pan-Americanism and liberal global health, it is from this perspective that a [something] grows and takes root. regional lack of coordination in international health from the South.
This lack of coordination reveals processes of a fragile (regional disintegration in health as a dependent peripheral geopolitical space, which was visualized in public policies on SARS-CoV-2 vaccines during the period 2020-2021:
- The weak autonomy that each State had to deal with dependencies on global value chains in health markets, on the medical-industrial-pharmaceutical complex in access to supplies, equipment and vaccines.
- The absence of strategic stocks of supplies, health technology and medical equipment implied a great dispersion and disparity of purchasing efforts, availability of financing and international negotiations to acquire ventilators, intensive care monitors, personal protective equipment, syringes, needles, among others.
- Through PAHO/WHO, all the nation-states of Latin America joined the COVAX mechanism, deactivating the approach of vaccines as public goods.
- Latin America has a high dependence on imports of medicines, technology and active ingredients from the global pharmaceutical industry, and a permanent trade deficit with the medical-industrial-pharmaceutical complex (ECLAC, 2021)[7].
- The business chambers of the national pharmaceutical industries in Latin America have policies, practices, and business plans similar to those of the big pharma.
- The region has become an open-air laboratory for experimental phase clinical trials by the pharmaceutical industry, using Latin American bodies and lives as subjects. Currently, there are more than 600 clinical trials underway, many of them related to COVID-19, and the states in the region are seeking to provide this phenomenon with a kind of platform for economic promotion and lax regulation, ignoring the implications of the science/business and risk/benefit dynamics surrounding its implementation for bioethics and public health.
- The COVID-19 expert and emergency committees in each country included clinical and public health experts openly linked to the local and global pharmaceutical industry complex.
- The process of developing national COVID-19 vaccines was fragmented and at best involved scattered bilateral negotiations.
- The regional lack of coordination in cross-border cooperation in health where each Nation-State took border measures and restrictions with closures, openings, land and air barriers, in disparate formats, times and depths that also affected supply chains.
In response to this process, the need to broaden the frameworks of South-South international health is reinforced, placing at the center the international determinants of the contemporary world system in the geopolitical production of ways of living, becoming ill, and dying (Basile, 2020b). Health dependency operates on the basis of a stabilization and naturalization of the regional discoordination and disintegration of health from the Global South.
In short, approaching the notes on the "D"s of determination, decoordination, and health dependence is a phenomenon that implies rethinking from the perspective of Latin American critical thought on health, starting from the premise that dependencies exist. spoiled y satellites to Pan-American doctrine as well as to global health. Overt (consensual) or covert (satellite). Starting from this relational epistemic-political problem, the significance of thinking and practicing Health from the Global South is not only a decolonial and epistemic shift. It is perhaps the path that Latin America still owes itself: to deepen the study, training, and construction of a regional political thought-action on health.
Countering the hegemonic logics of Pan-American and liberal global health is a premise that will allow for the genuine formulation of emancipatory policies, goals, and strategies based on the actors and voices of the Global South. This is conceptualized as an approach to Health Sovereignty.
Creating territories and territorializing regional health sovereignty involves more than just greater autonomy for nation-states and national societies. National sovereignty alone is insufficient. Health sovereignty is not a concept conceived solely from the perspective of nation-states, nor is it simply about updating national development theories, import substitution, or building a complex industrial health production system.
Undertaking a strategy autonomizing National discourses and practices in relation to the world system often result in isolation, blockages, and the disciplining of the local by the global. Maturana (1994) explains that the mechanism that makes us autonomous is autopoiesis. To understand the autonomy of a living being, we must understand its internal structure. To understand health sovereignty in Latin America, we must understand the structure of the contemporary world system, especially the foundations of dependency, subordination, and coloniality in health.
There are four key learning flows and movements in this pandemic-epidemic period:
- First, to problematize, study, understand and deconstruct the conditions, adversities, dependencies for health from the South in a decolonial theoretical-conceptual and technical-methodological key at the territorial, local, national and regional level.
- Second, to make visible the sanitary dependencies and satellites, their diplomatic forms, their governmental, technical and academic forms, their mechanisms of reproduction and perpetuation.
- Third, to deepen the theoretical and technical-political foundations for the construction of spaces of regional autonomy (margins of maneuver) that is defined as regional health sovereignty.
- Combining regional vaccine production strategies with the necessary integration of drug and health technology assessment agencies, and undertaking joint negotiations on global value chains is certainly a starting point.
Reviewing and reversing the lack of coordination and dependence in healthcare implies rethinking regional integration based on a strategy of health sovereignty through concentric and progressive circles. This means that, given the intra-regional heterogeneity of processes in Latin America, it seems unfeasible to envision an immediate transition where all territories, countries, and regional blocs immediately adhere to a single roadmap for regional health integration. It is a constructivist process that assumes shared transitional horizons of autonomy and health sovereignty, which can have diverse institutional structures and material realities (e.g., CELAC, social movements, universities, Indigenous nations, and territorial autonomies, among others).
The driving concept is the strategy of health sovereignty. This stems from the cultural, political, and health diversity of territories, territorialities, states, and societies within the processes of regional health. Health autonomy and sovereignty are not stable and permanent achievements. Health sovereignty is not a theory-action based on the unity of analysis of the nation-state and borders, but rather on the ongoing construction of spaces for regional political and health autonomy. This concept arises from recognizing the interdependence within the contemporary world system and its international determinants of health for the Global South.
Moving towards regional integration from a perspective of health sovereignty means combining a concentric territorialization of flows with new territorial, community, management, governance, and academic agendas, priorities, and practices for health from and for the Global South. It is not about Latin Americanizing Pan-American health or decolonizing liberal global health. It is an epistemic rupture that implies a geopolitical rupture of established health power and knowledge.
Access to SARS-CoV-2 vaccines raises the unresolved question of whether to pursue integration with a vision of regional health sovereignty or remain trapped in the accepted, peripheral, and satellite-like health dependency and lack of coordination that characterized the entire response to the international epidemiological crisis in Latin America and the Caribbean. It is essential to place the construction of regional health integration at the heart of the Latin American agenda, based on public structures of autonomy, health sovereignty, and South-South international health principles. This not only concerns and depends on intergovernmental relations between "States and Governments," but regional health sovereignty is a strategic process embedded in the networks of territories, territorialities, and actors involved in building a Health from the South.
From the perspective of Latin American critical thought on health, it is crucial to call for strengthening health policy action to achieve timely and universal access to vaccines as a social public good at the service of the collective health of our peoples, and at the same time to promote a campaign with the imperative need to decolonize our theories and practices and refound Health Systems for effective health sovereignty as an emancipatory horizon for living well.
* [email protected] /ORCID: https://orcid.org/0000-0002-2251-0541Director and researcher of the International Health Program FLACSO Dominican Republic / Coordinator of the CLACSO Working Group on International Health and Health Sovereignty.
** [email protected] / ORCID: 0000 0003 2205 2592 Professor at the University of Carabobo and the Arnoldo Gabaldón Institute of Advanced Studies in Health (Venezuela). Associate Researcher of the CLACSO Working Group on International Health and Health Sovereignty.
[1] WHO. (2019). Contributions. Retrieved from: http://open.who.int/2018-19/contributors/contributor
[2]Welcome Trust. See: https://wellcome.ac.uk/
[3]World Economic Forum. Retrieved from: https://www.weforum.org/
[4] Rottingen JA, et al. (2017). New vaccines against epidemic infectious diseases. N Engl J Med. 2017, January 18.
[5] Grupo Carso – Retrieved from: https://www.carso.com.mx/
[6] Insud Group – Retrieved from: https://www.grupoinsud.com/
[7] ECLAC. (2021). Presentation of the guidelines and proposals for a health self-sufficiency plan for Latin America and the Caribbean. Printed at the United Nations, Santiago, Chile, September 2021.
If you would like to receive more information about CLACSO's training programs:
[widget id=”custom_html-57″]
to our email lists.
