ABSTRACT
The concept of global health security (GHS) was introduced by the World Health Organization (WHO) at the beginning of the present century to minimise the impact of acute health events like pandemics across international borders. The International Health Regulations and related normative documents were published thereafter to establish the measures that WHO member countries had to adopt to guarantee health security in case of global health emergencies. When the COVID-19 pandemic began, WHO’s regulations on the matter had been in place for more than a decade, yet its effects were devastating across the globe. The Americas has been the most affected region, with Ecuador and Mexico among the worst hit in terms of the relative number of cases and deaths. This chapter compares the extent to which both countries, as critical cases, adopted the principles of GHS to prepare their healthcare systems for health emergencies like the COVID-19 pandemic. The analysis compares the healthcare policy architectures of both countries in the first months of 2020 before the health emergency was declared, evaluates policy outputs in relation to the Health Resilience Framework recently published by the WHO, as guidelines to prepare national health systems for health crises, and identifies recent transnational and national political economy pressures that can explain the development of healthcare policy architectures and outputs. The findings show that both countries were poorly prepared to face the pandemic. Fragmented policy architectures obstructed progress towards robust public healthcare systems, with large groups of the population lacking real access to public services and the generation of processes of implicit commodification. In terms of political economy, in Ecuador, pressures by international financial organisations to cut public spending as part of rescue packages led to cuts in the public healthcare system. In Mexico, an attempted conversion of the social assistance scheme left an already problematic public system more vulnerable to health emergencies. Conclusions point to the imbalances that global institutions hold in advancing global policy, with financial institutions enjoying strong leverage upon national policymaking, while social institutions like the WHO exhibited a low capacity to influence policy developments at national levels.
