Public Health, the Seed of Pan American Multilateralism
The origins of PAHO date back to a fever sprout that began in Brazil in 1870 and then extended to the south of the United States. Its effects were felt for many years and motivated, largely, the creation of the Sanitary International Office, precursor of the nowadays PAHO, during the first International Sanitary Convention of the American Republics, celebrated in Washington, D.C. in december of 1902.
Its creation was led by the then president of the United States Theodore Roosevelt, who already ambitioned to finish the construction of the Panama Canal, a project that had been paid for by France after the death of more than 20.000 workers due to the yellow fever and malaria. Cooperation between regional governments to control these diseases was a necessary condition for the success of this infrastructure project, and to avoid the increase of international commerce leading to the propagation of new epidemic sprouts.
Because of this during its firsts year the main purpose of the Office was to gather and share information about the sanitary state of the seaports. However, its action range widened rapidly to also focus on the study, monitoring and eradication of tropical diseases, and was strengthened legally with the signature of the Pan American Sanitary Code in 1942, which is still in place.
After becoming part of World War II, the United States increased its resources to strengthen public health, including its contributions to the International Sanitary Office. This allowed this last institution to have, in 1946, a permanent staff of 17 professionals, four subdivisions, three sections and two regional offices in Guatemala and Peru.
International Cooperation beyond ideology
The creation of the United Nations in 1945 set a new overview for international organisms. In this context, the Sanitary Office signed an agreement in 1949 with the newly founded WHO, by which it became its regional office for the Americas. However, the Office was not integrated to the United Nations System and it kept its autonomy regarding the United Nations.
This implied, in theory, a separation from the Pan American Union, since it had decided to join the United Nations System via the Bogota Treaty of 1948, in which it also took its current name, OAS. But, in the practice, its bonds persisted through collaboration agreements between the International Health System and the Pan American Health Organization, the name that the International Sanitary Office adopted in 1958.
During the 1960’s decade, PAHO was in charge of the public health projects of the Progress Alliance, promoted by the United States through OAS to contain the advance of communism in the region. However,despite the removal of Cuba from this last organization in 1962, PAHO has maintained close relationships with the island and is practically the only regional forum where both the United States and Cuba participate.
Indeed, PAHOhas been a fundamental ally for Cuba’s health system development and for its soft power approach through medical missions around the world. The most illustrative example is the triangular cooperation programme for the eradication of poliomyelitis in Angola in 2005, of which both the Island and the Organization benefited from.
During the the eighties and nineties it had an accelerated expansion and it positioned as a key actor in the humanitarian and sustainable development programmes of the United Nations agencies. By 2002, year of its first century, PAHO had harvested important achievements such as the increase in 35 years of life expectancy, eradication of chickenpox and polio, a significant decrease in childhood mortality and it had positioned Latin America and the Caribbean in the forefront of the fight against HIV en the southern globe.
Reserved Diagnosis
PAHO´s work, however, has also been subject to criticism that has become stronger every time in the last years. In 2010, PAHO was widely questioned because of its inability to contain a cholera sprout in Haiti, only 8 months after the devastating earthquake that ravaged the country. Five years after, WHO and PAHO who were pointed at because of their late response to the Zika sprout in Brazil, that put in risk Rio’s Olympic Games of 2016.
In 2018 PAHO was involved in a scandal due to the hurried exit of 8.000 cuban doctors that had arrived in Brazil as part of the More Doctors programme launched by the government of Dilma Rouseff in 2013. PAHO was sued in a court in Miami by a group of cuban defected cuban doctors because of its intermediation in such programme, which has been described as wor exploitation and, even, human trafficking due to the low wages and the precarious ocnditions in which cuban doctors work in Brazil.
This case echoed again in the recent claims of the United States Secretary of State, Mike Pompeo, and of the brasilian president Jair Bolsonaro, whom had conditioned the payment of the debt and the continuity of their countries contributions to PAHO till its participation in the More Doctors programme is cleared and till it is guaranteed that its actions are aligned with the “democratic ideals” of their governments.
PAHO, an indispensable organization today and tomorrow
A good part of these critiques are legitimate and reflect structural deficiencies that, as many analysts have pointed out, must be reformed both at the heart of the WHO as of PAHO. Covid- 19 has made evident, once more, the difficulties of international sanitary agencies to respond quickly and effectively every time more numerous and complex public health threats, and to coordinate national and local sanitary authorities actions towards them.
It is important, however, to point out that many of these claims, specially those coming from leaders such as Trump and Bolsonaro, are motivated by their desire to feed nationalists discourses than by a true concern for the improvement of public health in other countries and in the region.
Health and life of the people of the american and caribbean continent largely depend on the outcome of the crisis that PAHO is currently undergoing because of three main reasons. First, because of the capacity of dialogue that PAHO maintains with Cuba, Venezuela and Nicaragua, despite the political differences between their governments and other countries in the region, which is fundamental to answer threats to health that don´t know boundaries or political colours.
Second, because of the dependency of many small countries with low income levels, especially in Central America and the Caribbean, of Paho´s Revolving Fund for Vaccine Procurement to protect their population of some of the more serious diseases on the planet. By means of this mechanism of equality and solidarity, PAHO buys wholesale vaccines to pharmaceutical firms to distribute them to more favourable prices between its members according to their financial capacities.
Lastly, because PAHO has positioned itself as a key actor for human rights assurance in the region, framing the threats to public health as human rights violations. Thus, PAHO has become an example for other international sanitary agencies around the world and has laid important cross-departmental work precedents for global governance. While the pandemic is ravaging particularly harshly the whole region and its real evolution is still unpredictable, it is evident that multilateral coordination and PAHO´s expertise are more necessary than ever.
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Miguel Gonzalez Palacios | Radio Free (2020-08-11T04:08:23+00:00) Pan American Health Organization in Intensive Care. Retrieved from https://www.radiofree.org/2020/08/11/pan-american-health-organization-in-intensive-care/
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