Some doctors say Mexico could become the new Italy — or worse.
As Mexico fast approaches what’s highly likely to be a large coronavirus outbreak, the country’s leadership — mainly its president — mostly insists that everything is fine.
In speech after speech, President Andrés Manuel López Obrador, known by his nickname AMLO, tells Mexicans they shouldn’t fear Covid-19 even as it’s killed more than 20,000 people and infected almost 500,000 more worldwide as of March 26. Despite warnings from global health officials, he continues to hold political rallies, kiss supporters, and request that Mexicans go out shopping to prop up the country’s sputtering economy during a global slowdown.
“Live life as usual,” he said in a video posted to Facebook on March 22, showing him outside at a restaurant. “If you’re able and have the means to do so, continue taking your family out to eat … because that strengthens the economy.”
AMLO’s advice, experts say, is deadly. What makes matters worse is that his policies over the past few years have set the stage for a profound health crisis. In a major effort to cut government spending, AMLO has reduced funds for the country’s hospitals and medical centers by millions. It’s left the nation short of physicians, medical equipment, beds, and coronavirus tests.
That last part is especially frustrating, because Mexico has been hit hard by outbreaks before. In 2009, the H1N1 influenza originated in Mexico before it spread around the world, killing hundreds of thousands of people. Then, Mexico aggressively tested hundreds of thousands of its citizens to identify clusters of infection and stem the tide against transmission, said Alejandra Macías, the “czar” for the government’s emergency response at the time. “We acted then like South Korea has today,” he told me.
That’s not happening this time. The country has barely tested people, likely accounting for the low official number of 475 cases as of March 26. That comes as millions continued to move freely outside, including tens of thousands who attended a large outdoor festival in Mexico City last week.
And while AMLO’s administration has just started taking some more serious measures, including instituting a social distancing program and suspending all nonessential activities, for many it’s far too little, far too late. The consequences of the inaction, experts say, could prove disastrous.
Mexico once handled a medical crisis much better than this
To understand the extent of AMLO’s failure to address the coronavirus crisis, it’s worth revisiting how Mexico handled the H1N1 influenza outbreak.
The disease, which killed about 17,000 people worldwide, likely circulated for months beginning in 2008 in Mexico. Originally believed to be a bad case of the regular flu, the disease became officially designated as H1N1 in April 2009.
Macías, the H1N1 czar, told me then-President Felipe Calderón and his team sprang into action in two main ways to curb the spread. They had no other choice, he said: “We were the China of that outbreak.”
First, they instituted strict social distancing measures. Calderón shut down government agencies and nonessential businesses, and told everyone to stay inside. “There is no safer place than your own home to avoid being infected with the flu virus,” the president said during an April 29, 2009, national address.
Second, the administration tested as many Mexicans as possible to track the spread of the virus and quarantine the sick and those that may have come in contact with them.
Macías said it also helped that the government had access to a lot of flu medication. It wasn’t always effective for patients with H1N1, but it helped a lot of them. The biggest positive of having those drugs, he claimed, was the calming effect it had on the population. “It was more important than the actual therapeutic benefits of the medicine,” he told me. In the end, more than 70,000 Mexicans contracted the virus.
Mexico’s experience in handling the H1N1 crisis left it in a good position to combat the next health scare. “There is still some capacity from an institutional perspective,” Carlos Pedersen, a former Mexican government official now at the Eurasia Group consulting firm, told me. The country’s deputy health minister today, he noted, played a big role in curbing the influenza outbreak 11 years ago.
But from the moment he came to power, AMLO started making reforms that have left Mexico less prepared for the coronavirus than it otherwise would’ve been.
How AMLO left Mexico vulnerable to the coronavirus
A major part of AMLO’s presidential campaign was his anti-corruption initiative, in which he vowed to end high-level grift for the benefit of the average Mexican. Now in power, he’s kept to his word, but in ways that made his administration less able to confront the coronavirus crisis.
First, he started cutting salaries of public sector workers — a major campaign promise — so there would be more money in the federal budget for private citizens. He even fought the country’s Supreme Court last year, forcing the justices to accept a 25 percent pay cut; AMLO himself makes less money than his predecessors.
“We can’t have a rich government in a poor country,” he’s said many times.
But the unfortunate result is that hundreds of competent officials have left the government because they don’t like AMLO’s meddling and the lower salaries. What’s more, he’s fired others whom he believed to be political enemies or singularly corrupt. That, according to former US Ambassador to Mexico Roberta Jacobson, left the country with fewer seasoned professionals to deal with the crisis.
“He really gutted the technocratic capabilities of the public sector when he came to office,” she told me. As a US official during the 2009 H1N1 outbreak, she remembers working with her Mexican and Canadian counterparts on efforts to find a cure. “You don’t see any of that kind of cooperation now.”
Second, he’s severely cut the health care sector as part of his austerity measures to control government spending. In 2019, for example, around 10,000 health professionals were laid off due to a 44 percent cut to the public health care sector, which is supported by the central and state governments. That’s led to delays in surgeries for children, reductions in staff, and cancellations of many forms of treatments for patients.
The Eurasia Group’s Pedersen, however, told me that previous Mexican administrations had made cuts to the country’s health care system over the years. AMLO isn’t unique in that regard, then, but he is among the most aggressive in cost-cutting measures for that sector.
Mexico’s health care system is in poor shape. It has about 1.4 hospital beds per 1,000 people, according to the Organization for Economic Cooperation and Development, just over 2,000 ventilators in the entire country, and few coronavirus tests.
“If Mexico has undetected cases circulating, the spread of the disease is going to be brutal,” Moreno, the doctor at the ABC Medical Center, told Bloomberg on March 11.
What’s more, physicians note they don’t have enough personal protective equipment like masks and gloves to treat patients.
“I’m working in the hospital trying to figure out how the hospital is going to be getting through the next weeks because we know the explosion of cases is going to be in the next weeks,” Moreno told the New York Times on Tuesday.
Some medical staff are protesting in the streets to demand the government spend more to provide materials and personnel. “We can’t work without equipment,” a nurse in the state of Tabasco said in a Twitter video this week. “We also have families — children and parents.”
“We’re only asking for basic things, nothing else,” she continued, adding that four of her colleagues now have symptoms that resemble those of Covid-19.
Personal del IMSS en Tabasco protestan por falta de insumos para enfrentar la pandemia de #COVIDー19 #Coronavirus.
Tienen temor por cuatro compañeras enfermeras que tienen síntomas de problemas respiratorios.
@Milenio @mileniotv pic.twitter.com/Af0AxXOZFe
— Elisa AlanísZurutuza (@elisaalanis) March 22, 2020
AMLO also made two reforms that have clearly backfired.
One change was to the Seguro Popular (Popular Insurance), a program in which the central government gave states money to cover some medical expenses for the uninsured. The president worried, rightly, that some officials took the money for their own use or misallocated the funds.
AMLO therefore completely centralized the program and gave it a new name. But that move made some procedures more expensive while also eliminating coverage for others. Lower-income people, then, were made worse off by the change, experts say.
The other reform was in how the Mexican government purchased medicines. In the past, government officials would buy the drugs from distributors, not the companies that made them. To cut out the middleman, AMLO decided his administration would buy directly from the firms.
The problem is that the deals were made poorly, Pedersen said. For example, the cost of transporting the medication wasn’t included in some of the tenders. As a result, the price of certain medications went up, making it harder for non-wealthy Mexicans to buy them.
All these reforms put extra stresses on the already struggling Mexican health care system. “If numbers of coronavirus cases run high, they will be completely unprepared as a health system to deal with it,” Jacobson, the former ambassador, told me.
But it’s not just medicines that are lacking; it’s leadership.
AMLO is prioritizing the economy over public health
Last week, AMLO defied the advice of medical experts and spoke at a large gathering to celebrate the nationalization of Mexico’s oil sector. During the event, he made sure to shake hands and kiss friends, just like he’d done all over the country despite the coronavirus outbreak.
For experts, such an event was emblematic of AMLO’s response to the crisis. Instead of setting an example for people to stay home, he’s prioritizing the economy above all else.
That’s not to say the economy isn’t in urgent need. Petróleos Mexicanos, the state-owned oil company, is deeply in debt and in crisis, especially as global oil prices plummet. The country’s economy contracted by 0.5 percent last year, and many indicators point to a years-long slump. As the world confronts the possibility of a pandemic-induced recession, it’s not unreasonable for AMLO to want to boost the economy.
Experts, though, say he needs to accept reality and start implementing aggressive measures to curb the spread. “You need to prioritize people’s health and worry about how many might die before the economy’s health,” said Macías, the H1N1 czar.
He has the power to do that. AMLO notoriously micromanages every aspect of his administration, which makes his own inaction the greatest impediment to a speedy and effective response. If he took the crisis seriously, Mexico would have a better chance of keeping the crisis from getting completely out of hand.
Other than personally acting in a way medical professionals prescribe, experts want AMLO to offer economic support for hurt by the crisis, help health care workers, and impose stricter social distancing measures.
There are some signs that the Mexican government is moving on those fronts.
In response to the protests by medical staff, AMLO’s team says it will provide $150 million in additional medical supplies and fill the more than 40,000 job openings for medical personnel. In coordination with the US government, crossings between their shared border have been severely limited.
On Tuesday, the government unveiled its most major social distancing requirements yet, including a ramp-up in suspensions of large events. And on Wednesday, AMLO’s team banned all nonessentials activities from happening in Mexico.
The government even created a superhero — Susana Distancia (A Healthy Distance) — to remind people to stay six feet apart.
— SALUD México (@SSalud_mx) March 21, 2020
It’s a start, but large challenges remain.
The biggest challenge outside of the urgent need for medical treatment of coronavirus cases, experts say, will be helping the nearly 60 percent of Mexicans who work in the “informal economy” — the street chefs, musicians, artists.
Without a tax ID number or connection to organized labor, they may not get the economic support from the government they will eventually and desperately need. They also wouldn’t be affected by a government-mandated shutdown of business, which might require federal authorities to force these workers off the streets and to house them humanely.
None of this gets done without AMLO’s buy-in. He may decide it’s time to act now that his poll numbers — once high — have begun to drop sharply. But if he doesn’t, the Eurasia Group’s Pedersen says, “the situation could take a turn for the worse.”
Author: Alex Ward