Zika and the political battle of rights

By Pia Riggirozzi, Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


 

In recent years there has been growing global awareness of the interplay between rights and social development. In 1997, in an attempt to mainstream human rights as a central feature of all UN programmes, the UN Secretary-General Kofi Annan, called for a reorientation of the UN’s mission to reflect the realisation of human rights as the ultimate goal of the UN (UNDP 2005). Within this approach, the UNDP declared that human rights should not be regarded as the outcome of development but should rather be seen as the critical means to achieving it. With the signature of the Millennium Declaration and more recently the Sustainable Development Goals (SDG) there has been a renewed focus on the links between global poverty and human rights in development. As a consequence, protecting and promoting rights, and creating opportunities for individuals and groups to access, enjoy and reproduce those rights have increasingly been furthered in transnational campaigns promoting broader civil liberties, the ‘right to development’ (Grugel and Piper 2009) and ‘human right to health’ (Oslo Declaration).

However, as Easterly (2009) argues ‘which rights are realised is a political battle’ contingent on a political and economic reality often determined by what is considered (national and internationally) visible and urgent. The response to the outbreak of the Zika in South and Central America is manifestation of that battle.

Zika and systemic injustices

In February 2016, South America became, for the first time, the epicentre of a Public Health Emergency of International Importance when the World Health Organisation (WHO) declared that the Zika virus and its link to neurological disorders deserved global attention. After nine months Zika dropped from the international radar as the WHO declared it was no longer an international emergency. But the crisis is not over. The Zika outbreak that began in 2015 and has now spread across much of Central and South America has implications over the medium and long term on equity, health, education, gender and community relations. The challenges of managing the medium/long-term impact of outbreaks, as previously seen in the case of Ebola, are still poorly understood, and so are the prospects of safeguarding the right to health and the right to development in policies advanced by international and national health agencies addressing those amongst the most vulnerable.

The Zika virus, as with other insect-borne diseases such as Dengue and Chikungunya, is part and parcel of troubling inequities, amongst which health inequality is key, based on deprived living conditions. What raised international alarm in 2015 was the number of cases of microcephaly detected in countries affected by the Zika virus, particularly in Brazil. Microcephaly is a condition where babies are born with unusually small skulls. It is a developmental defect and is usually also associated with serious nervous system disorders – including deficiencies in mental functions and muscular weaknesses of varying degrees (WHO 2016). More than 1.5 million people in Brazil have been stricken with the mosquito-borne Zika virus, and since the outbreak began in 2015, the country has logged around 4,000 confirmed and suspected cases of microcephaly. This is alarming, particularly compared to 2014 when there were 147 cases.

Economically disadvantaged segments of the population are at higher risk of exposure to Zika, of being infected, and of their children of being born with microcephaly or other genetic conditions that require special care in the long term. The Zika crisis has also reinforced the socio-cultural expectations about the role of child-raising/caring that disproportionately fall on women, limiting even more opportunities to engage in education programmes or seek/obtain formal employment. Finally, promiscuity, lack of education and the simple fact that poor women might spend more time at home and thus are more exposed to dirty water, sewage, and mosquito breeding grounds than men, also means that women bear the burden of the prospect of infection. This drama typically unfolds in conditions where infrastructural deficiencies and lack of quality medical care and social services are the norm.

Consequently, poor women and their families are likely to be stigmatised as poor, as women, as sexually irresponsible, as families marked by disability. The Zika crisis is, in effect, a window that exposes systemic injustices related to poverty and marginalisation of poor women and children. It also a constitutive dimension of the ‘structural violence’ as global, regional and national responses to the Zika outbreak have disproportionately concentrated on prevention of infection and transmission which although necessary and urgent do not change the structural and related socio-cultural conditions that perpetuate injustice and inequality in these societies.

Which rights are right? 

The Zika crisis is not gender neutral and a focus on women is needed. Take Brazil, where there is a large proportion of single parent families, the majority of which are headed by women. These households are more likely to experience perpetual cycles of poverty as a result of the economic shock of disease. In addition, where children are born with potentially disabling impairments, they are often further isolated by limited support or social protection. The significant increase in the number of infants with microcephaly in the Northeast of Brazil which triggered of the WHO declaration of international emergency, highlights the centrality of the social determinants of health in the transmission chain, as well as issues such as the social division of care and debates on sexual and reproductive health.

During 2016, a roll out of official declarations put women at the centre: the High Commissioner for Human Rights and the WHO reinforced the importance of women’s human rights being central in the response to the Zika outbreak in many states (Gostin and Phelan 2016), while the US Center for Disease Control and Prevention advised pregnant women to refrain from travelling to countries affected by the Zika virus. Most dramatically, health officials in El Salvador urged women not to get pregnant until 2018; Colombia called on women to delay pregnancy for six to eight months.

This particular response focusing on behaviour is problematic for at least three reasons. First, implementing vector control programmes in the poorest areas is particularly challenged by more structural issues of lacking infrastructure, running water and access to healthcare. And even if such operations are conducted, mosquitoes have previously shown their capacity to quickly resurface whenever there is inadequate funding or surveillance. Second, shifting responsibility to women’s behaviour delinks the disease from its social determinants and their rights; not least because most pregnancies amongst poor and vulnerable women in the region are unplanned. As Davies and Bennett (2016: 1046) note, responses tend to focus on the ‘immediate’ health-care problem, while the status of gendered inequality that underpins the prevailing unhealthy conditions is considered ‘beyond’ the capacity of public health interventions. Add to this prevailing high rates of sexual violence, elusive contraception, teen pregnancies and the lack of sexual education prevalent in Zika-affected countries. According to a study published by the Guttmacher Institute in 2014, as many as 56 per cent of pregnancies in Latin American and the Caribbean are unintended, either because of lack of access to contraceptives or because of associated forms of gender violence.

Third, reducing the problem in this way to a few modifiable behaviours ignores factors of social determinants of health and poverty. Responses to communicable diseases such as Zika, and before Ebola, have so far tended to focus overwhelmingly on short-term-vector control and surveillance (Gostin and Hodge 2016; Davies and Bennet 2016). Such responses may be effective in terms of disease containment, effectively masking the precarious social conditions in which they live, in which many rights remain merely notional.

A final issue raised by the Zika crisis is that of reproductive rights. In a region where birth control is limited and sexual violence is widespread, the debate on legalising abortion has gained prominence. Last February, the Obama administration put under Congressional consideration $1.8 billion in emergency funding to help prepare for and respond to the threat posed by the Zika virus. But abortion politics sterilised these discussions as Republican lawmakers leading a congressional hearing on the Zika outbreak made funding conditional on anti-abortion policies in recipient countries. And while Pope Francis hinted at softening the rigid stance of the Catholic Church on contraception because of the threat posed by the Zika virus, it is the region’s restrictive abortion laws that remain a critical problem. In most Latin American countries affected by Zika, abortion is illegal or can only take place in exceptional situations. In El Salvador, for instance, where more than 7,000 cases of Zika were reported between December 2015 and January 2016, abortions are illegal under any circumstances and miscarriages could even lead to homicide convictions if proven to be self-induced.

Advocacy groups in Brazil are increasingly presenting legal cases to the Supreme Court to legalise abortion and secure reproductive rights for women under the principles of the 1988 National Constitution that guarantees the right to health. But the challenges ahead are many, not least in what a human rights-based approach to health may mean in addressing the long-term consequences of Zika (and other such health crises).

To be clear, vector control actions are imperative, but policies and recommendations based on behaviour, control and prevention are not only not enough to address women’s marginalisation in society and the effect this has on their health, they may further exacerbate this problem in addressing the immediate health risk. More academic and policy debate is needed on the scale and nature of future needs (health, social, economic, educational, welfare) of vulnerable communities particularly women and children, and how to calculate them. Government awareness of this issue is still low in Central/South America and although regional, global and expert/practitioner networks might be able to provide support in the future (Riggirozzi 2015; Riggirozzi and Yeates 2015) both in defining the scale of need and in providing support to governments in developing policies to address them, their roles over the medium/long term require greater definition.

Governments in South and Central America are in urgent need of a multi-policy approach – and funding- if they are to put in place effective responses to mitigate long-term effects and not derail progress in terms of meeting the SDGs targets on gender, childhood, disability and inclusive growth. Vector control and compliance could be seen as first step. The right to health needs to be delivered with a view that development in general and the delivery of health in particular should be anchored in an understanding of the inequalities, discriminations and power relations that prevent many people having access to good healthcare systems, care provisions and education and a view that states have legal and ethical obligations under international law to ensure the best possible provision of services for all.

 

Pia is currently involved in a funded project on regional organisations and access to medicines in South America.

 

Lessons for Jeremy Corbyn from the Argentinian left

By Pia Riggirozzi, Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


 

Jeremy Corbyn won a decisive victory over Owen Smith in a second Labour Party leadership contest on Saturday. With it Corbyn not only strengthened his authority but also the right to lead his party. This election was interesting on many counts, not least because it opens questions about where political power and legitimacy reside. The emergence of Corbyn in Labour politics has been politically and ideologically divisive from the outset, confirming a chasm between what is considered the Labour establishment, and ‘the people’ who have rallied to Corbyn’s support, including unions and local activists. Corbyn has revealed his intention to give more prominence to ‘the people’, to ‘do things differently’, and to build a more just and decent society. These promises put a spin on the Labour Party, reclaiming its role within the global resistance to neoliberalism.

Take Argentina, for example. From 2001 to 2015, the challenge to neoliberalism came from electorates that refused to accept parties committed to free markets. Furthermore, Kirchnerismo, the movement associated with the legacy of the 12 years administration of Cristina Fernández de Kirchner and her late husband Néstor, led on the promise of moving beyond neoliberalism, ‘putting politics at the service of people and the economy at the service of the well-being of all citizens’. And it did so in the context of a global political economy where rising commodity prices and strong commercial and financial links with China gave the Kirchners resources to focus efforts on Argentina’s poor. The nation made significant progress on reducing poverty, introduced universal child benefit plan as well as higher pensions, and the expansion of civil rights, including same sex marriage. But this political project undoubtedly proved to be very divisive. For some, it represented a real commitment to prosperity and the expansion of citizenship rights. For others, it represented a quasi-authoritarian, state-led interventionist system, leading to mistaken exchange rate policies, ruinous energy subsidies and unsustainable fiscal deficit. With the economy slowing and inflation worsening, this polarisation explains Kirchnerism’s defeat in November 2015, and a swing to political and economic conservatism with the election of Mauricio Macri.

As for Corbyn, he won the mandate to do something different and he will thus have to provide an alternative to the unravelling of neoliberalism in the UK, where Labour has so far failed to refashion a social contract of ‘capitalism with a human face’ while Conservatives, caught off-guard by the Brexit vote, double-down on their endorsement to an economic model based on rising inequalities.

The shadow of Brexit: delegating or pooling sovereignty?

By Pia Riggirozzi (University of Southampton) and Diana Tussie (FLACSO/Argentina).

Pia Riggirozzi is Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


 

On 23rd June, the United Kingdom voted to leave the European Union through a non-binding yet politically compelling referendum. The result was a close 48% remain and 52% leave, demonstrating a very divided society. This division is largely due to a combination of citizen frustration with an insulated and arrogant ruling elite and insensitive political leadership leading to apparently widespread support for anti-politics parties such as UKIP and insensitive political leadership and, more profoundly, a political-economic project that seems to be cutting away, wilfully and needlessly, at the welfare system and social contract that have hitherto guaranteed social peace in Britain. As we have indicated somewhere else, this is also part of the unravelling of neoliberalism in the UK where the Right is failing to impose an economic model based on rising inequality and the Left unable or unwilling to refashion a social contract of ‘caring capitalism’ or ‘capitalism with a human face’. As a society it manifested some deeply disturbing moral, emotional and human issues of ‘national’ identity preceding any responsibility towards ‘others’, being those immigrants that legally contribute to the UK economic activity and social life, or those ill-fated, dispossessed, immigrants and asylum seekers who are simply trying to survive. Equally disturbing is, as Grugel claimed, how all this ignores both the complexity of identity in Britain and a history of internationalism of the UK in global affairs.

As the British elite spins with the implications of the vote, there is much to reflect on the current crisis in the UK and indeed in Europe more widely. Brexit is about class, inequality, voters feeling excluded from politics, as much as a loss of purpose of what regional integration is for.

 

What regionalism is and is for

Crucially, Brexit revitalised a conventional argument that regional integration is associated with a reduction of state power, especially in terms of the ‘loss of sovereignty’ to markets and normative regulating flows of people, in this case workers and immigrants, to regional institutions. Taking control back of the country was the political platform of supporters who consider that integration in larger multilateral schemes means diminution of state power as a result of the ‘pooling’ of sovereignty or surrender to the regional level. Effectively, once policy measures such as tariff liberalisation are established at the regional level, national governments’ direct control over policy is sharply diminished. Authority is thus removed not only from the state but also from societal influence. But this is not necessarily incompatible with a revitalisation of state power. Aldo Ferrer, former Minister of Economy in Argentina, defended the thesis that a successful integration rests on coordinated ‘construction of sovereignty’. This construction does not rest upon the delegation of sovereignty to supranational communitarian institutions, which in a conglomerate of unequally resourced members could lead to the subordination of the weaker states to the hegemonic power of the stronger states, as the experience of the European Union demonstrates for cases such as Greece, Portugal and Spain, nor does it rest on the transfer of sovereignty to supranational institutions, but rather on inter-governmental institutions and agreements that adequately address regional economic and social disparities within the bloc. Regionalism, from this perspective, enhances governance through cross-border intergovernmental forms of cooperation, and identified instances of regionally coordinated programmes of resource redistribution, social regulation, regional provision of welfare goods and services, social rights (including regional mechanisms that give populations the means of claiming and challenging governments).

As such, the key question is less what regionalism is (in terms of its philosophical, legal, or institutional bases) and more one of how regionalism acts, the roles and purposes to which the practice of regionalism gives expression to political actors and policies. In other words, what practices and political imaginaries specific regional governance enable or obstruct, what issues are made visible as central problems, and what modes of action are supported as a consequence.

The Brexit outcome indicates that the Leave platform in the UK successfully created a false sense that Britain would be better off on its own. By capitalizing on anti-immigration sentiments, economic inequality, and lack of understanding of the EU, the Leave campaign won the support of voters that have been in many ways the disaffected – older, less educated, low working class or non working class, and whose concerns focused on the loss of jobs, rising inequality, the supposed misallocation of government funds to the EU instead of British systems, and the increase in immigration. Brexit created a sense of identity and self-image amongst those actors who reacted to a regional integration model perceived as failing to adequately address regional disparities within the economic bloc, and across and within societies.

Likewise, Brexit shows that citizens’ information about and engagement with regional politics and institutions is vital for legitimacy and demands for accountability. A key problem faced by the Remain campaign was the lack of accurate knowledge about the EU, its normative beyond movement of goods and people, and its relationship with Great Britain and the ordinary people, including frameworks for rights, including the right to health. A 2013 EU Survey found that nearly half of EU citizens said that they didn’t understand how the EU worked, or how monetary contributions may support cross national arrangements for free health coverage and tax rebates.

 

Opportunities for reclaiming and rebuilding sovereignty through regionalism

The Brexit vote has led many in Latin American commentators to wonder about the benefits and disadvantages of regional integration. From an economic point of view, there are concerns about the prospects of economic vulnerability led by financial volatility and a halt in ongoing bilateral trade agreements with the EU. Politically, sceptics claims that compared to Europe, Latin America did not develop any ‘integration initiatives meaningful enough for people to even consider leaving’, taking this as a sign of failure. In fact, claims that Latin American regionalism has failed have been common for more than a decade despite the fact that that regional initiatives have proliferated since at least the 1960s and despite its long tradition in a diversity of regional associations.

This conclusion is certainly persuasive given the recurrent politico-institutional and economic instabilities in Latin America and holds up well if regionalism is merely understood as an economic project. However, over the last two decades regional demands for – and supply of – regional initiatives in Latin America increasingly focused not on economic deepening but on regionally-anchored projects addressing social development. These recent developments are significantly different, in content and in institutional architecture, from the experiments of the 1990s or even in the early years of the new millennium. For this reason, the Union of South American Nations (UNASUR) and the Community of Latin American and Caribbean States (CELAC) for instance are seen as a manifestation of post-commercial or what we have identified as post-hegemonic regionalism with distinctive calls for reclaiming sovereignty collectively through, for instance, health and defense. From this perspective, we must pay new attention to the ways southern regional organisations are re-engineering normative frames and debates as to what the purpose of regional integration should be, what kinds of social policies are needed, and what roles regional institutions should play in helping members to achieve those policies. This is significant because regional normative frameworks articulate political forms of thinking that configure political agency; make central or even visible particular issues; and privilege particular forms of political practice. This is also key to rethink how regionalism can serve the purpose of strengthening sovereignty through regional diplomacy.

The case of regional health policy in South America helps to illustrate this point. In the field of health policy there are multiple tensions between the interests of international pharmaceutical industry, developing countries, their national health systems and citizens. UNASUR and Mercosur have taken action on access to medicines, coordinating active resistance to the dominance of pharmaceutical companies under a motto that links regional health diplomacy with sovereignty. As a consequence a new regional ‘Database on Medicine Prices’ was set up revealing the prices paid by South American countries for their drug purchases. By making the information public and comparative, UNASUR and Mercosur are seeking to provide policymakers and health authorities information to strengthen the position of member states in purchases of medicines vis-à-vis pharmaceutical companies. Likewise, UNASUR’s Health Council has recently launched a project for mapping regional pharmaceutical capacities, to coordinate regional policies for production of medicines. Within the WHO, UNASUR as a bloc has pressed to change international norms regarding the combat of counterfeit medical products. The harmonisation of policies on medicines means that MERCOSUR/UNASUR negotiated the price for public sector purchases of the anti-retroviral Darunavir to US$ 1.27 per tablet from up to US$ 2.98 paid by some South American governments; an agreement with the pharmaceutical Gilead for the lowest possible price for essential medicines to treat Hepatitis C. These are the ways in which South America has been constructing the coordinated construction of (health) sovereignty, ways that skew hegemonic heavy riding, do not hit the headlines, careful to keep policy discretion to cope with disparities but important enough to increase bargaining power in asymmetric situations. These features lie at the core of our understanding of post-hegemonic regionalism.

Argentina departs from the Kirchner model, but Mauricio Macri now has to govern a divided nation

By Pia Riggirozzi. Pia Riggirozzi is Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


Read Dr Pia Riggirozzi’s new piece for The Conversation on the outcome of Argentina’s 2015 presidential elections.

Follow this link for the full article.

All Change in Argentina as Sun Sets on the Kirchner Era

By Pia Riggirozzi. Pia Riggirozzi is Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


Argentina’s open presidential primary is over, and the stage is now set for the election in October. With the current president, Cristina Fernández de Kirchner, constitutionally barred from running again, the autumn poll looks set to be a fight between Argentina’s two main political coalitions.

On the left is Daniel Scioli, the current governor of Buenos Aires province, who leads the official Peronist party Front for Victory. He is Cristina de Kirchner’s candidate of choice, though has stayed shy of taking on an explicitly Kirchnerist political identity. On the right is the current mayor of Buenos Aires, Mauricio Macri; he heads a coalition of strange bedfellows called Cambiemos (Let’s Change), which comprises Macri’s conservative Republican Proposal party, social democrats, and the Radical Civic Union.

The primary system pits all the parties’ candidates against each other in one poll to determine who runs in the general election. Scioli and the Front for Victory got the biggest share with more than 38%. That sets him up well for the elections in October, bodes well for the nation’s verdict on the highly contentious and deeply personalised Kirchnerist legacy.

Twilight

When Fernández de Kirchner’s term ends in December 2015, she and her late husband and predecessor Néstor Kirchner, who ruled from 2003-7, will have enjoyed the longest unbroken presidential tenure since Argentina became a democracy, in the course of which they left a profound mark on their country. As Juan and Eva Peron did before them, the Kirchners have managed to establish a political style that will bear their name long after Cristina finally leaves office.

Governor Scioli: Cristina’s best hope?
Reuters/Martin Acosta

The political project now known as Kirchnerismo (Kirchnerism) is undoubtedly very divisive. For some, it stands for a return (at least in aspiration) to economic growth, prosperity, and the expansion of citizenship rights, all led by the state. For others, it represents a corrupt quasi-authoritarianism, combined with cynical populism and meddlesome state intervention.

Nonetheless, the expansion of rights and welfare provision under the Kirchners has been so widely welcomed in Argentina that none of this election’s contenders dares to challenge it. And with such a strong consensus on a big tranche of Kirchner-era social policy, the campaign might fast descend into a game of character mudslinging.

That’s partly a factor of the weakness of the candidates themselves. De Kirchner has failed to cultivate a strong heir, and the opposition isn’t faring much better. Cambiemos, for its part, has not developed a convincing and comprehensive political platform to take Argentina in a new direction.

All it seems able to do is mount fierce attacks on the personal and political style of Fernández de Kirchner and her entourage – something the last few years have hardly made difficult.

Counting the days

Throughout their 12 years in office, the Kirchners have been dogged by accusations of corruption, which have badly eroded Fernández de Kirchner’s popularity and legitimacy. Things have only gotten worse in recent years. Discontent and distrust have grown under Kirchnerist statism, with its apparent reluctance to protect private property, and alleged propensity to favour government cronies with subsidies and contracts.

Conflicts with the media and opposition media groups have also led Argentine investigative reporter Jorge Lanata to investigate a possible network of international bank accounts and unaccounted wealth connected with the state.

Things reached a fever pitch when prosecutor Alberto Nisman was found dead in his apartment on January 18 2015. His body was discovered just hours before a judicial inquiry was expecting to examine claims that Fernández de Kirchner and her foreign minister, Héctor Timerman, tried to cover up Iran’s role in the country’s deadliest ever terrorist attack. Nisman’s case against Fernández de Kirchner and Timerman was dismissed on February 2, but it dealt a heavy blow to the government’s credibility and authority.

Adding to the twilight atmosphere is a seriously beleagured economy. Some pessimists are even predicting collapse, a forecast born of creeping inflation, slow to non-existent growth, a serious dependence on commodities markets, and a deeply destructive default.

Detractors of Fernández de Kirchner, and Kirchnerism, want Argentina to save itself from true disaster with a return to capital markets, even becoming a major regional economic power again if the right economic policies are implemented and sustained. Such accommodation with global neoliberalism would mark the true end of the Kirchnerist project.

A lasting legacy

Latin American politics expert Steven Levitsky argued that we might in fact be facing “the end of the left in Latin America”. The commodity boom has all but ended, and many of the leftist movements that rode it to power in Argentina, Brazil, Chile and Uruguay are running out of steam after too many years in power.

But what this analysis misses is the depth of the left’s legacy – a plethora of policies for social inclusion, citizenship and rights that has left a deep imprint on the continent. Kirchner-era Argentina, for its part, has taken bold steps to widen its social safety net and citizenship rights. Targeted cash transfer programmes, which were initially short-term, were extended by the plan Argentina Trabaja, supporting co-operative enterprises in poor neighbourhoods.

On to the next one.
Reuters/Marcos Brindicci

Cristina’s government also introduced a targeted programme for children, the Universal Child Benefit (Asignación Universal por Hijo or AUH). It’s not the country’s first child benefit scheme, but it covers the population on an unprecedented scale. The AUH provides around 200 Argentine pesos (US$50) a month to nearly 4m children and families, and 80% of Argentina’s children now receive some form of child benefit.

For the first time, the government is extending welfare programmes directly to children and to workers who are not unionised. In fact, most beneficiaries will be self-employed or in the informal economy – groups that were particularly active in the protests of 2001.

The Fernández de Kirchner government also introduced a “reasonable” minimum wage for non-unionised workers (including domestic workers) in 2008, and has put pressure on private health companies to extend their coverage and reduce their charges. An anti-poverty strategy has brought poverty down to around 25% from more than 50% in the wake the 2001-02 economic crisis.

In this scenario, it is not surprising that the poor voters who have benefited from state largesse over the past eight years remain loyal to the Kirchnerist project. This explains why Scioli is riding high, for now at least. His ascendance is a sign that despite all the problems they and their country have faced, the Kirchners have managed to construct a legacy of inclusion and social rights that may yet endure.

This article was originally published on The Conversation. Read the original article.

Bargaining for Developing Countries in Access to Medicines

By Pia Riggirozzi. Pia Riggirozzi is Associate Professor in Global Politics at the University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


An earlier version of this piece first appeared at Latin America Goes Global.

By bringing together the 12 South American countries, the Union of South American Nations (UNASUR) is advancing an effective rights agenda in access to medicines and attention to developing country demands. 

In an open letter to the heads of government of all Trans-Pacific Partnership Agreement (TPP) negotiating countries, Médecins Sans Frontières / Doctors Without Borders, expressed serious concerns over provisions under TTP and bilateral trade negotiation that threaten to restrict access to affordable medicines for millions of people in low- and middle-income countries, and hence their right to health as expressed by the UN Committee on Economic, Social and Cultural Rights in numerous international declarations. This is the case for instance of the EU-Andean Trade Agreement on Access to Medicines in countries such as Peru and Colombia. It is estimated that the introduction of the measures on patent protection would lead to an increase of 459 million USD in Peru’s total pharmaceutical expenditure by 2025;    and of 756 million USD in Colombia’s total pharmaceutical expenditure, leading to a significant decrease in consumption of life saving medicines.

Facing this scenario it is not surprising that attention to access to medicines as an issue of rights is increasing. In 2014, a joint commission from the medical journal The Lancet and the University of Oslo published policy report in which it cited the imbalance of political power between nations as a major cause of health care inequality across the world. According to the report, disparities in health are not just linked to poverty but also to the unequal distribution of material and knowledge resources across nations and the capacity to influence global governance.

While there have been tremendous global advances in expanding civil liberties—through international laws and practice—much of the normative infrastructure and policy to support rights was crafted and is still shaped by the interests of the developed north.  Even in the morality of rights—civil, political, social, and economic—power rules.

International frameworks pushing for universal human rights in relation to social and economic development are still filtered through institutions such as the UN, the Bretton Woods institutions (the International Monetary Fund and the World Bank) and northern donor organizations.  These are conservative institutions that have been slow to embrace broader economic and social rights, including health.

Today, though, in the new rash of regional organizations, can the Global South reset the norms and rework global (health) governance in support of rights and social justice goals?

While the Global South has struggled to advance broader economic and social rights in the development agenda, the Union of South American Nations (UNASUR) has focused on a significant concern for its regional members: the right to health.

 

Access to medicines and the right to health

In the area of health, developing countries have historically been disadvantaged in the access to medicines and influence in setting the global health agenda—a result of they weaker status relative to business and the developed north.  Developing countries’ access to medicines has been hampered by trade negotiations that reinforce existing intellectual property standing and international institutions and laws governing intellectual property rights that favor business over patients in the developing world.

In South America, the high cost of medicine and the lack of alternatives to existing drugs is particularly acute.  Medicines not only define who lives and who dies but also why (and how) countries in the south.  According to the Secretary General of UNASUR, Ernesto Samper, almost 30 percent of the total public and private health care in South America is spent on medicine. UNASUR picked up this challenge, creating the UNASUR Health Council—one of the first councils created by the new regional group—and forming an alliance with the regional health think tank, the South American Institute of Health Governance (Instituto Sudamericano de Gobierno en Salud, ISAGS), in Rio de Janeiro, Brazil.

The new alliance is in a far strong position to pursue South America’s agenda in medicine than the traditional Washington, DC-based Pan-American Health Organization (PAHO) UNASUR/ISAGS is in a better position to deliver effective health governance than PAHO, which is focused on “health coverage” instead of UNASUR/ISAGS’ more ambitious agenda of “universal access to health.”  These two approaches represent different ways of addressing how health care reaches societies, and ultimately speak of different conceptions of entitlement and equality. ISAGS focus has been on the broader idea of strengthening health governance capacity, advocating the right to health and supporting policymaking and policy reforms towards the universalization of health care. In this capacity it has trained policy-makers and practitioners by setting up UNASUR-sponsored public health schools in Bolivia, Guyana, Peru and Uruguay, and assisted in the creation of a UNASUR network of public health schools.

ISAGS has also provided support directly to ministries of health in Guyana and Paraguay on primary care and the preparation of clinical protocols, and has supported reforms aimed to move towards universalization of health sector provision in Bolivia, Colombia and Peru.  ISAGS is involved in the diffusion of information on combating HIV/AIDS, influenza and dengue fever across the region, and has developed mapping techniques to coordinate shared policies for the production of some key medicines.

Policy advances of this sort—concrete, modest, focused and cheap to deliver taken in a relatively short timeframe and below the radar of political commentary—are unusual in previous efforts in at regionalism in South America.  And they stand as evidence of UNASUR’s focused, grounded approach.

ISAGS has begun to scale up its level of activity on behalf of UNASUR, once again with relatively little attendant publicity. ISAGS has been quietly targeting global health governance forums and is trying to establish a joint bargaining position for South American negotiators vis-à-vis pharmaceutical companies and in the World Health Organization (WHO). ISAGS now holds meetings prior to each annual gathering of the WHO, so that UNASUR member states coordinate their actions at the WHO.  It’s an approach that both UNASUR and ISAGS are now using to speak out more widely on behalf of other developing countries.

 

Reclaiming sovereignty, rebuilding diplomacy

As part of this campaign, UNASUR has also begun to take action on access to medicines.  The strategy centers on coordinating active resistance to the dominance of pharmaceutical companies under a motto that links regional health diplomacy with sovereignty.

For instance, UNASUR is setting up a “Medicine Price Bank”, a computerized database revealing the prices paid by UNASUR countries for drug purchases.  By making the information public and comparative, UNASUR is seeking to provide policymakers and health authorities information to strengthen the position of member states in purchases of medicines vis-à-vis pharmaceutical companies. Likewise, UNASUR’s Health Council has approved a project for the mapping regional pharmaceutical capacities in 2012, to coordinate common policies among member states for production of medicines.

Within the WHO, UNASUR has pressed to change international norms regarding the combat of counterfeit medical products. Until recently that effort was spearheaded by the International Medical Products Anti-Counterfeiting Taskforce (IMPACT), an agency led by big pharma and the International Criminal Police Organization (Interpol) and funded by developed countries engaged in intellectual property rights enforcement.

At the 63rd World Health Assembly in 2010, UNASUR successfully proposed that an intergovernmental group replaced IMPACT to act on, and prevent, counterfeiting of medical products. This resolution was approved at the 65th World Health Assembly in May 2012. In the course of the meeting, UNASUR also lobbied for opening negotiations for a binding agreement on financial support and research to meet the pharmaceutical needs of developing countries, and issue that was resumed at the 67th WHO meeting last May.

More recently, a key policy has been agreed in support of the establishment of a fund to negotiate centralized purchases of the Hepatitis C virus treatments. This proposal, agreed by UNASUR Health Council in July 2015, will represent a milestone in the region in savings through price negotiation on an innovative and expensive medicine. It could also create incentives for the industry as centralized purchases could be a more conciliatory route towards medicine price reduction rather than the practice of compulsory licenses and direct government price cuts in the region.

The presence of UNASUR in this type of health diplomacy, and its coordinated efforts to redefine rules of participation and representation in the governing of global health, demonstrate that there is a new logic and momentum in regional integration and regional policy-making in Latin America. These actions create new spaces for policy coordination and collective action.  In the all-important case of health rights, UNASUR—and other regional institutions too—can become an opportunity for practitioners, academics and policy makers to collaborate and network in support of better access to healthcare, medicines and policy-making.

 

Author’s note: This article draws on a combination of documentary analysis and interview data. Some of the research was carried out in the context of the research project Poverty Reduction and Regional Integration: SADC and UNASUR Health Policies (PRARI)’, supported by the Economic and Social Research Council (ESRC), grant ref. ES/L005336/1. The article does not necessarily reflect the opinions of the ESRC. For information on the project: http://www.open.ac.uk/socialsciences/prari/

 

What Is Going on in Argentina with President Fernandez de Kirchner?

By Pia Riggirozzi. Pia Riggirozzi is Associate Professor in Global Politics at University of Southampton (@PRiggirozziAcademia.edu). You can find more posts by Pia here.


[Cross-posted at The Conversation.]

Argentina’s president, Cristina Fernandez de Kirchner, has announced plans to dissolve her country’s intelligence services. President Fernandez de Kirchner’s move comes after the controversial death of a prosecutor, Alberto Nisman, who had accused her of attempting to cover up Iran’s role in the country’s deadliest ever terrorist attack: the bombing of the AMIA (the Argentine Jewish Mutual Aid Society) in Buenos Aires in 1994, which killed 85 people.

How did things get to this point, and how did Fernandez de Kirchner get into such terrible legal turmoil?

Cristina de Kirchner and Héctor Timerman. EPA/Jason Szenes

Muddy waters

Nisman had allegedly been investigating the AMIA bombing for over a decade. He finally brought things to a head in mid-January 2015, when he suddenly brought an indictment against Cristina Fernandez de Kirchner and her foreign minister, Héctor Timerman, for their suspected involvement in the cover-up.

Nisman was then found dead in his apartment on January 18 2015, just four days after serving the indictment and hours before a judicial inquiry was set to begin. His death was declared “suspicious” despite the fact that it seemed like a suicide – and the investigation into it has now turned up evidence he may have been planning to arrest Fernandez de Kirchner herself.

Nisman’s allegations about the Iranian connection must be seen in a wider context. There has been a marked shift in Argentina’s policy towards Iran since 2010, mainly led by Timerman, towards trade and diplomatic relations.

At the same time, Iran has been trying to raise its profile in Latin America in general as it looks for ways to ease the pain of Western sanctions. Tehran has forged close ties with leftist governments in Venezuela and Bolivia, and has been seeking trade agreements with Brazil for food imports.

While the shift to Iran, and the lack of judicial progress in the case of international terrorism striking the country still needs to be accounted for, the death of Nisman and the ensuing political chaos has raised profound concerns about the state of Argentina’s democracy.

Alberto Nisman. EPA/Cezaro de Luca

Nisman’s case against Fernandez de Kirchner and Timerman was dismissed on February 2. It relied heavily on transcripts of wiretapped conversations between Argentine negotiators and Iranian officials, and these recorded conversations – provided by the intelligence services – were found to be inconclusive and the case lacking in substantive evidence.

There are suspicions about whether this evidence was all it seemed, and worries that the intelligence service was up to its old tricks once again – muddying the waters of a highly sensitive case, or even supporting sinister plans to destabilise the government.

But those misgivings themselves show that whatever Fernandez de Kirchner’s real reason for doing it, the intelligence overhaul was undeniably long overdue.

Toxic institutions

During Argentina’s so-called Dirty War in the 1970s and 80s, the intelligence services were dominated by the military, and acted as its instrument in the persecution of opposition leaders and social activists.

After democratisation began in 1983, the government of Raul Alfonsin was mainly focused on reforming two main enforcing agencies: the armed forces and the police. The intelligence services were left for later, despite the fact the secret services were still rampantly active, engaging in political disappearances and the extortion of prominent businessmen to “make up” for the dwindling demand for their services.

In part, this was just one of many difficulties facing a fledgling democracy that was struggling to achieve stability and self-confidence. But the intelligence services were also protected by the fact that even democratic governments found them very politically useful.

Taken at face value, then, Fernandez de Kirchner has done the right thing. Dismantling the intelligence services was necessary, a debt of democratisation in Argentina. And while passing the reform will require parliamentary endorsement, Kirchner’s Front for Victory party controls 39 of the 72 seats in the Senate and 130 of the 257 seats in the lower house, the changes will probably enjoy a smooth ride through both chambers.

But whether Fernandez de Kirchner’s newfound zeal for reform will do anything for the health of Argentina’s democracy is another question entirely.

For democracy’s sake

Instead of opening up engagement with the opposition, Fernandez de Kirchner’s swift intervention has become a piece of partisan grandstanding, and has all but trivialised the judicial process Nisman began.

It has also done nothing to dismiss suspicions about the president’s “real reasons” for dismantling the intelligence service, while sending party politics into a frenzied back-and-forth of accusations and denunciation.

The government stands accused of using Nisman’s case for partisan ends, dodging a major investigation into the president in an election year; it in turn accuses the opposition of not wanting to give up illicit paid access to political information from spooks.

Of course, weak institutions and impunity for the powerful are not the fruits of some latter-day Kirchnerista invention; they are long-established facts of Argentine political life. Still, the current government has done a lot to deepen distrust of the state among its people.

To be sure, the sensation around the death of Nisman made it clear just how badly Argentina’s intelligence system needed reform, and created the context to finally get the job done. But for the sake of democracy, this must not be allowed to descend into a party-political brawl – and certainly not at such a sensitive time, as a two-term-limited president nears the end of her tenure.