Global health. The current scenario and future perspectives

39 from Chile, elected in 1958. For operational purposes, the Pan American Health Organization (PAHO) maintains a dual status as the regional office of the WHO in the Americas and the health agency of the Inter-American system, led by the Organization of American States (OAS). This situation only exists in the Americas. The PAHO, which predates the WHO by about 45 years, has a regional governance mechanism very similar to that of the WHO, in with initial participation of only the health ministries of the countries in the region as well as the United Kingdom, the Netherlands and France, which are members of the PAHO because of their territorial possessions on the continent. Other entities like social security services have been incorporated later, but always within the government sector associated with health ministries. As part of the Inter-American System, the PAHO maintains relations with different OAS agencies, subregional integration systems such as CARICOM and SICA as well as development banks like the IDB, CAF and ALADI. Under this arrangement, the PAHO has its own regular budget funded by the countries in the Americas, in addition to a regular budget allocated by the WHO (approximately amounting to one-third of the total), which also comes from member countries’ contributions, including the US. For the 2020-2021 biennium, the PAHO’s total budget is USD 620 million, of which USD 215.8 million comes from the WHO. A constant point of discussion has been this dual financing of the PAHO. Unlike the WHO global membership fees allocation, for the PAHO the regular quota component from countries follows the OAS allocation formula, with the US contributing approximately 60% of the total. According to usual multilateral arrangements, each country has one vote in decision-making. The PAHO has kept its revolving funds at a much lower level than the WHO to avoid excessive reliance on them, and it is expected that they will reach around 55% for the 2020-21 biennium (WHO, 2019). In addition, the PAHO manages rotating and strategic funds, which are focused on acquiring vaccines and supplies for public systems to consolidate demand and achieve better agreements with suppliers. Covid-19 and governance in the region The Americas have the highest number of Covid-19 cases worldwide, accounting for 48% of deaths, even though they comprise only 13% of the global population when including Canada, the United States, Latin America and the Caribbean. Except for the former country, the latter three sub- regions have experienced a high number of cases and deaths, the second and third waves of infections having been more severe than the first in most countries . With weeks difference, in one way or another, the pandemic