A Pandemic that Compels a Nation’s Self-Assessment: Dr. Patricia J. García on Perú’s Leadership During the COVID-19 Crisis
Perú has the second-highest number of confirmed COVID-19 cases in Latin America. This is despite the fact that the country was the first in the region to order a lockdown and roll out economic packages to its citizens. Its socio-economic context has played a significant role in its setbacks, despite good leadership and a great start.
Dr. Patricia J. García, Perú’s former minister of health and a global leader on public health issues, currently chairs a commission that advises the health ministry on technological innovations to COVID-19 responses. She works with 16 scientists, molecular biologists, and engineers to advise the Peruvian government on the current pandemic. On May 21st, 2020, she spoke to the audience of Voices in Leadership at the Harvard T.H. Chan School of Public Health about Perú’s response to the COVID-19 pandemic.
Effective Response and Communication
Perú started to prepare for the pandemic relatively early. Describing Perú’s response as “really fast and right on time,” Dr. García explained how the Ministry of Health had a national plan for preparation and response against COVID-19 ready by February 2nd. Even though the first case of COVID-19 in Perú was confirmed on March 6th, the leadership had processed the information they were receiving, anticipated the next steps, and made decisions swiftly. Within ten days of Perú’s first case, the country was under complete lockdown.
The president of Perú, Martín Vizcarra, addressed the country every day at noon to give an update on the situation. He connected with the citizens, showing them how to use a mask and signaling to them that they were not alone.
With inadequacy and ambiguity of information about the virus floating across continents, just like the virus itself, one wonders how Perú was able to make timely decisions. Dr. García explained how the leadership focused on their country’s shortcomings, as well as its social and environmental context. She expounded that Latin American people generally tend to be extremely social; therefore, many of the cultural norms around the region are quite contrary to the social distancing requirements necessary to prevent the spread of the virus.
Secondly, Perú became very cognizant of the limitations of its public health system. The fact that there were only 100 intensive care unit beds for the whole country meant that the government needed to buy time even to make an attempt to prepare for what was coming next.
Another identified shortcoming was the Peruvian government’s inability to identify people who really needed monetary help and did not have access to social safety nets. 70% of Perú’s economy runs on the informal sector, which means that there was no way of differentiating people who worked in jobs regulated by the state from those who worked unregulated jobs. Those who work in the informal sector and rely on daily wages also needed to regularly step out of their homes to get food and medication, in contradiction to the key prevention strategy of staying at home. In addition, the bank regulatory agency of Perú reported last year that only 38% of Peruvian adults have bank accounts. This meant that the economic roll-outs by the government would have to be collected in person to receive payments in hand, leading to gathering in large numbers outside banks, once again defeating the physical distancing requirement to prevent COVID-19 from further spreading.
This points to an area of technological innovation that is underutilized in Perú: internet and mobile banking.
Financial Technological Innovation as Opportunity
Adoption and diffusion of mobile banking as a means of financial inclusion has been catching on in Perú for the last two years, but the pandemic could be a turning point for such digital financial services. Countries in Asia and Africa have been leading the way in digital financial inclusion, but the adoption has been much slower in Latin American countries. According to the International Monetary Fund, digital transaction payments in emerging and developing economies reached US$1.5 trillion in 2019, and the number of users of digital payments reached 4 billion or 64% of the population. During COVID-19, digital financial services could serve as an opportunity in many ways, including ease of transfer of subsidies and cash assistance from the government directly to the accounts of households, digital wage payments, contactless digital payments for services or goods purchased, lending, and remittances during the crisis.
Disconcertingly, fraudulent activities and data breaches continue to make online banking a security concern. They also raise concerns about privacy and continuous monitoring of one’s financial transactions and spending patterns by the government or private companies.
Numerous studies have been conducted to show the impact of lockdown on economies, as public health experts and economists struggle to find the balance. Some reject the idea of a trade-off between public health and the economy altogether, yet others argue that failing to protect the economy is what will lead to further damage to public health. Depending on the country context and economy, as well as the robustness of its 1) public health systems and 2) model estimations of COVID-19 spread, duration, strength, and infectivity, countries have been experimenting with various strategies of opening up the economy. Perú’s case is representative of the impact on the economies of similar countries’ encounters with the pandemic.
As Dr. García expressed, Perú chose to prioritize the health of its people above the economy, fully aware that more than 70% of the economy being made up of the informal sector would create unique challenges: “placing people in front of anything… everything, actually. The health of the people in front of everything”.
There is no simple answer to opening up the economy while reducing the number of cases. However, Dr. García pointed out that the economy will need to reopen; Perú will not have enough resources to continue fighting the disease. As per reports, Perú’s economy, which has been one of the strongest economies in Latin America, sank by more than 40% in April.
National Capacity-Building and Self-Reliance
While the pandemic is truly global, we are yet to see a global collaborative response in fighting the SARS-CoV-2 virus. A coordinated response that transcends borders is unlikely, evidenced by the fact that one of the largest funders to the World Health Organization, the United States, decided to withdraw in the middle of the pandemic. So it may be prudent for each country to focus on assessing its own abilities and furthering its research and technology until a global response is feasible. A similar sentiment was expressed by Dr. García:
“We had some money, but we could not get supplies for tests, or PPE [personal protective equipment], because as a small market, we don’t count in the world, so we have realized the importance of start[ing to invest] in research and biotechnology. And that’s part of what we are trying also to push. How can we start creating capacities within the country to try to solve our own situation, and help this response, and maybe prepare for the next pandemic?”
While Perú did not have the capacity to do molecular testing, the country was able to use serological tests. In a timely move, the government bought 1.5 million serological tests when nobody was paying attention to them and were able to test rapidly.
Molecular and Serological Testing
COVID-19 testing can be done by either molecular or serology testing. Molecular tests, also known as the nose swab tests, examine if someone is currently infected with the virus. A positive result means the person has SARS-CoV-2 in their body. In addition to determining present infection status, they can add value in patient management and prevent transmission. Serology tests, which use blood samples, determine if someone was previously infected and has developed antibodies. However, the immunoglobulin M (IgM) type of antibodies can take anywhere between days to weeks and immunoglobulin G (IgG) can take weeks to months before they show up after infection. This test is more valuable for tracking and surveillance. Molecular tests can be advantageous over serological tests in that they can detect the presence of a microbe much sooner in the course of an infection. Pointing to the challenge of missing out on active cases because the serology tests would not show antibodies that were yet to appear, Dr. García expressed:
“And that’s one of my lessons, and I think a lesson for other people that are starting to use serologic tests. They’re quite good to increase access, especially if you want to find symptomatics, and you don’t have molecular tests. You can use it for contacts; you can use it for vulnerable populations. But if you find a positive, fine. Quarantine them. Try to identify contacts, etc. It can give you a lot of epidemiological information that is good and can help you clinically…But if a person is negative, you have to understand the whole concept and the risks that are behind. And you cannot consider that [as] just a healthy person, because every single person outside the place where I’m in quarantine can be infected and can replicate the disease.”
The Spread of COVID-19 to Rural Areas
The challenge of rural to urban migration for livelihood is not unique to Perú. Compared to the world average of 55.5% urban population in 2015, 82.9% of Latin America and the Caribbean’s population was urban. Lima, Perú’s capital and megacity, holds one-third of the country’s 32 million people. With a large number of migrants losing employment during the lockdown and without much else to do, urban centers across the world, including Lima, saw an exodus of people returning home to their rural regions. While many started making the journey back to their provincial regions on foot, hundreds of thousands registered with local governments, seeking help to return to their communities with their families.
This reverse exodus had its repercussions. COVID-19 reached remote areas where it wouldn’t have otherwise, and where the public health infrastructure is insufficient to support primary healthcare, let alone an infectious disease pandemic. Some provincial regions had migrants quarantine in large tents at their borders, while other regions did not have any such mandates. For migrants sent home through their regional governments, planning was even more haphazard. People who needed to be isolated stayed at different locations outside the capital for months. Those who did not test positive for COVID-19 through the serological tests were not quarantined for two weeks; they were allowed to leave for their home regions. According to Dr. García, this was a colossal mistake that contributed to the virus spreading rapidly in the provincial regions.
Assess, Learn, Collaborate, and Communicate
Dr. García highlighted the importance of learning from each other during this complex global pandemic. She also expressed concern that in this day of extensive social media communication, misinformation needs to be curbed and handled adequately, and academic advice needs to be prioritized. Talking about the awareness that the epidemic enabled and highlighting the lack of preparedness and investment in public health, biotechnology, and the sciences, Dr. García said:
“We’re still facing the fact that there had been decades in which we were not investing, really, in public health. And we have not been investing in biotechnology and science. And thank God, I think the country and the government is realizing that. So we’ll see what happens, and we’ll keep you informed.”
Parsing the different layers of the global crisis as it continues to unfurl before us, it is easier to appreciate the competencies of crisis leadership even more. Crisis leadership is not merely about bettering policies and planning; it involves continuous learning about the complexities of an evolving situation, paying attention to experts, extensive collaboration with a keen focus on implementation, and being able to masterfully tie it all together with effective communication.
Story written by Anshu Shroff. Anshu is a Doctor of Public Health (DrPH) candidate ’21 at the Harvard T.H. Chan School of Public Health, and a Humanitarian Studies, Ethics, and Human Rights concentrator at the Harvard Humanitarian Initiative. She is a Harvard Voices in Leadership writing fellow and student moderator. Anshu’s interests include: systemic issues of emergency management, crisis leadership, intersectoral approaches to climate risk resilience, inclusion and human rights, international development, access and sustainability of global health systems, and socio-economic equity. Anshu has worked at the United Nations, UNDP, UNICEF, Gates Foundation, and the Institute of Healthcare Improvement.
Story edited by Sherine Andreine Powerful, MPH, a Doctor of Public Health candidate at the Harvard T.H. Chan School of Public Health. A Diasporic Jamaican, she received her Bachelor’s degree in Latin American and International Studies from Yale University and holds a Master of Public Health degree in Population and Family Health, with a concentration in Global Health, from the Columbia University Mailman School of Public Health. Her interests, centered around the English-speaking Caribbean, include feminist global health and development leadership; gender and sexual health, equity, and justice; and pleasure, healing, and liberation.