Michael R. Reich (Ohio, United States, 73 years old) is one of the “few political scientists” specialized in health. “There are not many of us,” smiles this emeritus professor at the Harvard School of Public Health, who has just visited Madrid, where last Wednesday he participated in an event to commemorate the 30th anniversary of the foundation. Healthy world. An expert in access to medicines, pharmaceutical policy and the strengthening of health systems – an area where experts come mainly from scientific and non-social careers – he believes that the treaty on pandemics that the World Health Organization (WHO) expected to approve next week will be “just a first step.” To face health emergencies such as Covid-19 at a global level, “laws will also be needed in each country,” he warns.
Ask. Next week, WHO Member States are expected to sign an agreement to collectively confront pandemics. Do you think it will be effective?
Answer. It can be effective, but it depends on the definition of effective.
Q. Effective to prevent and respond to future pandemics.
R. What is important is not only how much money will be available, but whether it will promote private sector cooperation and whether treatments or vaccines will be accessible. We have to ask ourselves if it will be effective in preventing a pandemic and managing it, but also in reducing inequality between rich and poor countries, or if it will be equitable for impoverished populations in rich countries. Also if it will be effective in confronting the misinformation that exists, for example, around vaccines.
Q. What do you need to be effective?
R. In an international agreement, sanctions in case of non-compliance are very important. When Covid-19 broke out, there were international agreements, but no sanctions. The treaty against pandemics is a step forward, but it will not be enough, because other pandemics will come and new negotiations and learning will be needed. In addition to the agreement, laws will be needed in each country.
Q. As a public health expert, have you found the formula to strengthen national health systems?
R. There is no formula… I would talk about an algorithm. You have to do what you think is necessary to face health crises. Although we will never know if that is necessary. Because when the next pandemic comes, it will probably be something new and new technologies will be needed.
Q. The motto of the next WHO general assembly is “All for health, health for all.” Is it possible to establish universal access to health?
R. In countries like the United States it is a disaster, there is a chaotic situation that improved after the former president’s health reform [Barack] Obama, but there are still 15% of the population without insurance.
To distribute resources, in addition to quantitative methods, it is necessary to think about ethical criteria
Q. And in low and middle income countries? How can we promote equitable access to vaccines or treatments?
R. It is a very difficult problem, with many levels of complexity. Money is not enough: equitable distribution is needed. But who is going to do it?
Q. Who should do it?
R. It is not only a problem of the private sector, but also of rich countries, which want, for example, to buy vaccines and treatments for their own populations. It is necessary to reflect on how a country uses money. And the money will always be insufficient. But the resources will also be insufficient, because there are not enough vaccines. That means there is a distribution problem.
Q. And how is it resolved?
R. It is a political process. To distribute resources, there are those who defend the need for a cost-effectiveness analysis of the burden of disease. But in addition to quantitative methods, it is necessary to think about ethical criteria. And, at the same time, they also involve political processes, because it means as a country deciding what to do with the money. But the problem is fundamentally ethical.
What happens when the person we need to help comes from another country, we don’t know him, he speaks another language and belongs to another ethnic group?
Q. Because?
R. Because we have to consider what we are going to do to help others. And if it is part of our family, we are willing to pay 10% of what we have, 20%… But what happens when the person we need to help comes from another country, we don’t know him, he speaks another language and Do you belong to another ethnic group? There is no system of thought that says that everything must be universal and for everyone anywhere in the world. Not even within the same country. Right here [en Madrid]you see people on the street, without money and hungry.
Q. How do we achieve more investment to combat neglected diseases, such as tuberculosis, which primarily affect the Global South?
R. People are needed who know how to change the system of perceptions and priorities.
Q. And how do you do that?
R. For example, talking to journalists, using social networks, to change the public and political agenda. There are proven cases of success.
Q. Could you cite any?
R. For example, Mexico’s fight against sugary drinks. A political process was launched with strategies in the different ministries and in Congress to change the perception of the population against the consumption of these drinks and it was achieved. But at the same time, a political decision can sow chaos.
Q. For example?
R. Also in mexico. The Vicente Fox Administration created popular insurance for the population in 2003. But President Andrés Manuel López Obrador [en el poder desde el 1 de diciembre de 2018] decided to eliminate the reform and has created a chaotic health situation throughout the country.
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