Global health. The current scenario and future perspectives

40 arrived with a strong impact on health, social, economic and even political aspects in all countries. Out of a total list of 80 countries, updated as of April 16th, 2021, notable in the region are Peru (#1), Mexico (#3) and Ecuador (#7) within the top 10 of highest excess deaths, and Bolivia, Brazil and the United States within the top 25%, positioning this continent as a leader in excess mortality (The Economist, 2021). Rather than attempts at cooperation initially at regional level, some unfortunate comparisons were made between countries regarding their successes or failures in the early stages of the pandemic, followed by some efforts to exchange protocols and distribute emergency equipment as bilateral humanitarian aid, without this preventing a certain “race” from obtaining equipment and vaccines from exporting centers. Regarding vaccine availability, some countries, such as the United States and Chile, have managed to meet their demand for doses through direct and early contracts with laboratories or domestic entities. As of April 9th, 2021, the PAHO reported that over 247 million doses had been administered in the Americas region, covering 24% of the population. However, only 28 countries had received them through the COVAX initiative, which delivered only 3 million doses globally, a very small proportion of the needs of even the poorest countries. Additionally, the distribution practices in certain countries, such as through private pharmacies, may lead to increased socioeconomic inequalities and delayed achievement of adequate coverage to prevent future lockdowns. The differing responses within and among countries demonstrate a clear lack of cooperation and of space for technical and political dialogue to join efforts, share experiences and undertake common initiatives. Each country has indeed been operating independently, without considering others, which indicates a lack of collective action to build an influence center. This also points to weaknesses in guidance and support from the regional multilateral health and development organizations such as the PAHO and the IDB. Additionally, it takes place in an environment where the Americas, apart from a few countries, are considered a middle-to-high income region, which implies that it does not require as much resource support as other more vulnerable regions, like Africa or parts of Asia. The PAHO, an organization expected to provide strong support in controlling any regional health emergency, has faced difficulties since the beginning of the pandemic - partly reflecting criticisms of the WHO -, especially after the United States declared its withdrawal from the organization and suspended its financial contributions. The United States is now normalizing its contributions to the WHO as well as the PAHO under the Biden administration.