Roundtable: Integrating COVID-19 Management into the Health Agenda in Mexico

The Council of the Americas held roundtable discussions in Mexico City on January 24, titled “Integrating COVID-19 Management into the Health Agenda in Mexico,” as part of a series of roundtables focused on developing recommendations for addressing the impact of COVID-19, as well as improving preparedness and response to future pandemics. These by-invitation-only dialogues convened senior-level government officials, policymakers and representatives from multilateral organizations, medical experts, academics, and influential members from patients' organizations to discuss lessons learned and develop recommendations and strategies to be adopted by the government going forward.

Participants: 

• Celia Alpuche Aranda, General Director, Center for Research on Infectious Diseases (CISEI), National Institute of Public Health (INSP) 
• Laura Cecilia Bonifaz, Head of Health Research Coordination, Mexican Social Security Institute (IMSS) 
• Narly Camacho, Director of New Projects, Mexican Health Foundation (FUNSALUD) 
• Carlos Castro, President, Asociación ALE 
• Patric Devlyn, President of the Health Committee, Business Coordinating Council (CCE) 
• Giorgio Franyuti Kelly, Director Ejecutivo, Medical IMPACT 
• Kenji López, President, Cancer Warriors 
• María Julia Marinissen, Health Attaché, United States Department of Health and Human Services (HHS) 
• Francisco Moreno Sánchez, Head of Internal Medicine and Manager of the COVID-19 Program, ABC Medical Center 
• José Gerardo Moya Medina, Representative in Mexico, Pan American Health Organization (PAHO/WHO) 
• Ector Jaime Ramírez Barba, Secretary of the Health Commission, Chamber of Deputies 
• Judith Senyacen Méndez, Deputy Director of Research and Specialist in Health and Public Finance, Center for Economic and Budgetary Research (CIEP) 
• Jorge Valdez Garcia, Director of Strategic Relations, TecSalud
• Eric Farnsworth, Vice President, Council of the Americas (moderator) 

In the context of Mexico, participants noted the importance of evaluating the lessons learned from the past four years of the COVID-19 pandemic to have a clear vision of the challenges the government faces to maintain an adequate response to the virus and to be prepared for a next pandemic. Moreover, it is imperative that national and sub-national governments integrate COVID-19 prevention and management mechanisms into their national health agendas. Roundtable participants evaluated the lessons learned, shared their experiences navigating the pandemic from their different roles, and offered recommendations for the Mexican government to take into consideration moving forward.

The priorities that participants recommended that policymakers consider incorporating into the Mexican health system centered around:

Excess Mortality. According to participants, the Mexican healthcare system was ill-equipped and underprepared to deal with a crisis of this magnitude, causing the primary care system to collapse. Patients with chronic diseases experienced neglect and inadequate health care as the system did not have the capacity to effectively manage the pandemic while offering and continuing the provision of regular care. Participants indicated that a relevant proportion of deaths was the result of heightened non-COVID-19 medical conditions that remained undiagnosed or untreated, resulting in Mexico being among the countries with the highest excess mortality rates in the world during the pandemic.

Participants stated that the government needs to invest in building a robust healthcare system that is able to respond more appropriately when a health emergency hits. Participants stressed the importance of having a preventive system instead of a reactive one, so that when the next pandemic hits Mexico, the healthcare system can continue operating in parallel with a health crisis and avoid disruption. Moving forward, the government must prioritize prevention and preparedness. To do so, participants highlighted the importance of first addressing pre-existing structural weaknesses of the health system while responding to social gaps. Additionally, it is crucial to strengthen the epidemiological surveillance system, address shortages of health personnel, and promote adoption of digital healthcare services to increase efficiency.

Financing. Participants stated that public health expenditure has been insufficient to respond to growing health services demand, particularly during the pandemic, which has resulted in a lack of patient care and excess mortality. Participants explained that due to insufficient provision of funds, the public was dealt a double blow as the government did not increase investment to ensure proper access to quality care nor did they protect households financially so that citizens could comply with the “stay at home” campaign. Instead of taking fiscal action to protect the population, the government followed a path of fiscal austerity, consistent with the executive branch’s desire not to issue new debt for spending, despite the damaging effects of the pandemic.

Participants stressed that it is necessary for the government to increase the budget allocated to health. Most importantly, they added that these funds need to come from a stable source to ensure sustainable financing even when there is not a pandemic. Additionally, participants argued that there still remains a lack of political will to invest in preparedness and response, particularly now that COVID-19 is moving from a pandemic to an endemic stage. There needs to be a continuous investment in pandemic preparedness. Participants suggested that the legislative branch needs to take a leadership role by introducing cross-cutting reforms that ensure a constant source of financing that can be used in the case of emergencies.

Leadership and communication. Roundtable participants mentioned that it is crucial that the government keep in mind that not everyone can be a source of information. Therefore, public figures that regularly communicate with the population need to receive training on how to effectively deliver coherent messages backed by data. Another important point was the primacy of politics over science. Moving forward, government officials should be governed by scientific evidence and avoid politicizing the messaging as this can result in demagoguery and misinformation. In terms of communication there is a need to improve communication strategies while disseminating information to citizens in a clear, continuous, and precise manner. Participants recommended that the government create a strategic plan that promotes effective management of information and incentivizes clear communication. Most importantly, there needs to be continuous communication so when the next pandemic hits, the population is already inoculated against falsehoods.

Public-private partnerships. Roundtable participants agreed that there is an urgent need to develop robust public-private partnerships to improve the supply of medical products, strengthen technological development, and implement innovative policies that are able to reach even the most vulnerable populations. There was a strong consensus among participants that this is an area that needs to be discussed in greater depth. 

As further dialogue is required, the Council of the Americas will continue to engage with experts around public-private partnerships in the Mexican healthcare system, with a view to finding solutions that can be shared with key decision makers.