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During the Cricket World Cup in June 2024, while thousands of fans attended the matches that took place in Caribbean countries, teams of epidemiologists, doctors and health workers worked quietly behind the scenes using an electronic platform to report and respond promptly to possible disease outbreaks in the mass gatherings. A total of 146 cases were digitally reported to be taken care of, including persons with fever and respiratory symptoms or with heat-related illnesses, using a novel disease surveillance system for mass gatherings developed by the Caribbean Public Health Agency (CARPHA) in coordination with its Member States and other agencies, and including support from a Pandemic Fund grant implemented through the IDB.
Such investments in surveillance and early warning platforms, as well as the general strengthening and resilience of health systems, are needed at a greater scale to protect Latin America and the Caribbean (LAC) against future pandemics.
The Wake-Up Call of COVID-19
It was only five years ago that COVID-19 revealed the triple vulnerability of the LAC region concerning health, the economy and social outcomes. The excess mortality rate due to COVID-19 in the LAC region (1.99 deaths per 1,000 population) was almost twice the world average (1.04), according to a retrospective analysis published in the Lancet in 2024. The regional GDP shrank by 6.6% in 2020, more than twice the world average (-2.9%), and in the Caribbean, which is more dependent on tourism, it fell by 9.6%. The pandemic also increased poverty and exacerbated pre-existing inequities: It affected women and people in poorer households disproportionately.
The COVID-19 crisis sparked quick changes in 2020. Health became momentarily the foremost priority. By June 2021, central governments of LAC countries had committed on average US$60 per capita to COVID-19 in the health sector, and US$231 in social safety nets and other sectors, according to an OECD study. Despite falling tax revenues, countries were able to mobilize additional resources, to which multilateral development banks made a key contribution. At the IDB, total approvals in response to COVID-19 –including new loans and reformulation of existing ones– amounted to US$1.4 billion in health sector projects and US$3.1 billion for vulnerable populations.
The Pandemic Fund was set in operation in 2022 in record time. It provides non reimbursable resources to beneficiaries in low-and middle-income countries for investing in disease surveillance capacities, including public health laboratories and human resources, and channels the resources through implementing entities such as the IDB.
The Pandemic Preparedness Agenda After COVID-19
Addressing regional vulnerability requires improving capacities for prevention and early response to emerging threats, as well as general health system capacity to scale up services in an emergency.
Epidemiologic surveillance, which refers to carefully monitoring of disease emergence and spread, is the starting point for improving preparedness. It is a complex task that requires a sophisticated information management capacity to process alerts from health providers, laboratories and other sources, in order to respond promptly.
The One Health approach, which addresses human, animal and environmental health with an integrating perspective, is essential in this context. Almost 75% of new diseases originate in animals and pass on to humans, as was the case with COVID-19 (and with AIDS decades ago). Among the greatest threats in this context is the spread of anti-microbial resistance, which is estimated by the World Health Organization (WHO) to have caused 1.27 million deaths globally in 2019, and is a shared responsibility of the health, veterinary and agriculture sector.
Countries in the region receive assistance from the Pan American Health Organization (PAHO) in a wide range of technical areas related to prevention, detection and response to infectious disease threats. Also, countries invest in preparedness with grants from global initiatives like the Pandemic Fund, as well with as national and multilateral sources (Bolivia, and the Brazilian States of Sergipe and Bahia, for example, are investing in upgraded public health laboratory equipment and facilities in IDB-supported operations). The investment portfolio of the IDB includes projects in agricultural and livestock sanitary and phytosanitary services, including veterinary laboratories and eradication of animal diseases.
Despite these efforts, significant gaps in pandemic preparedness still exist in the region. Every year, countries report their capacities to implement the International Health Regulations (IHR), such as surveillance, public health laboratories or emergency management. The latest overall score for the region is 61.8, which is below the world average and second to last among the six WHO regions.
And the risk of new epidemics and pandemics is ever present. The fact that in 2024 the LAC region had the most severe dengue epidemic on record is a reminder of the vulnerability to infectious diseases. The monkey-pox outbreak was declared a global emergency, although the more severe impact continues to be in Africa. The recent spread of avian influenza to more species is of scientific concern and has also disrupted the food production chain, leading to scarcity of eggs in the US. The avian influenza virus has not shown the capacity to spread from human to human, unlike COVID-19, but its recent mutations increase the probability of it being able to do so at some point in the future, which could potentially lead to a pandemic scenario.
Five years after the COVID-19 pandemic began, in the face of these vulnerabilities, investments in pandemic preparedness require a booster shot of sorts, to sustain and strengthen the defenses of the region against infectious disease threats that are known to affect the health and the social welfare of the population and the economy.
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