David Raby writes: The Covid-19 pandemic, the worst such event in a century, has laid bare the best and the worst among governments around the world. The efficiency of China and South Korea – two neighbouring but politically very different countries – contrasts with the complacency, followed by panic, of several Western countries, notably the US and the UK.
The most chaotic and tragic failure is that of the US under Trump, followed in the Americas by its client states in Brazil and Ecuador. This contrasts dramatically with the success of socialist Cuba, Venezuela and Nicaragua in protecting the health and welfare of their peoples, with Cuba’s extraordinary medical internationalism once again earning praise from around the world.
Mexico has had to confront this unprecedented crisis just as it embarks on an ambitious programme of radical transformation under President Andrés Manuel López Obrador, inaugurated in December 2018. His “Fourth Transformation” (4T) aims to establish social and economic justice, eliminate corruption and create real participatory democracy in the country by peaceful and consensual means.
The drive to create a Mexican NHS
Before López Obrador’s inauguration on 1st December 2018, Mexico had a patchwork and incomplete health system which had never covered the entire population and which had been seriously run down by the neoliberal governments of the previous three decades. The ISSSTE (Institute of Social Security Services for State Workers) covered public-sector workers; the IMSS (Mexican Social Security Institute) encompassed many private-sector workers in formal employment; the Armed Forces and PEMEX (the national oil company) had their own systems; and those who could afford it used private medicine.
The neoliberal governments of the previous three decades had splashed public money around with abandon, encouraging patronage and corruption, with the result in the health sector that scores of “new” hospitals were incomplete, some in ruins and others requiring substantial new investment to get them up to standard. When López Obrador took office in December 2018 his team found 217 health centres and 110 hospitals abandoned. By May 2020 54 of these health centres had been completed, 56 were in process of reconstruction and 107 had been condemned as unfit for use; of the hospitals, 18 had been completed, 50 were in process of reconstruction and 42 condemned.
A key component of the new government’s Fourth Transformation was to integrate these diverse institutions and create a universal service, a Mexican NHS. In mid-2019 López Obrador began systematically visiting hospitals in the most deprived areas so that his team could gather information on their shortcomings and on the health needs of local communities. His government prepared a legislative initiative to reform Article 4 of the Mexican Constitution (which deals with social security in general), among other things to establish the universal right to health care as a fundamental principle; this was passed by both Houses of Congress and officially became law on 4th April 2020 following approval by a majority of the State legislatures.
With the decision to make health care a fundamental right, the Department of Health budget was increased by 40 billion pesos (about 1.6 billion dollars), and a new institution, the INSABI (Institute of Health for Welfare) was created to provide free services to all those not covered by the existing programmes. INSABI was inaugurated on 1st January 2020 and by 31st January 23 of 32 States had affiliated to it. Also from 1st January to early May 2020 over 40,000 more doctors and nurses were hired by the various public health institutions.
With a universal health system in process of construction, the country inevitably faced problems in dealing with the pandemic, but its rapid and organised reaction to the emergency enabled it to take appropriate measures when Covid-19 arrived. In addition to the measures outlined above, in mid-April the government negotiated an agreement with private hospitals which agreed to provide free treatment to non-Covid patients in order to relieve pressure on public institutions.
López Obrador also made personal contact with President Trump and with Chinese President Xi Jinping to request assistance with the supply of medical equipment. A formal agreement with China created a “puente aéreo” (a special airborne connection) to supply ventilators, test kits and protective equipment (PPE), and Trump also agreed to facilitate a ventilator deal with a US company.
The first flight from Shanghai arrived with 200 ventilators on April 8th (although already on April 1st 50,000 test kits had arrived), and weekly flights have continued with more supplies. These are commercial purchases at favourable prices, but Mexico has also received donations from China, the US, South Korea, Denmark and Switzerland.
Communication with the population about the pandemic has been exemplary: in addition to the President’s morning press conferences where the health chiefs are often present, Dr López-Gatell gives daily briefings with exhaustive information and responds in detail to questions, refusing to be provoked by hostile and ill-informed queries.
At the time of writing (mid-May 2020) Mexico has just announced its plan for exiting from lockdown. At the mañanera of May 13th López Obrador, accompanied by Health Secretary Dr Jorge Alcocer, Deputy Health Secretary Dr Hugo López-Gatell and several other ministers, explained in detail how they will ease restrictions in three stages. Restrictions will be lifted on a regional and sectoral basis depending on data regarding Covid-19 infections and deaths, and will be subject to weekly review. Non-essential economic activities will be resumed and schools will reopen on this same regional basis, and guided by a four-colour traffic light system (red, orange, yellow and green). Economic reactivation will take place but the first priority will always be public health.
The politics of the pandemic
The expected arrival of Covid-19 in Mexico was eagerly seized upon by the domestic opposition and the international media as a stick with which to beat López Obrador and his progressive plans. Scarcely had the first virus cases been reported than the media began to accuse the President of complacency and to compare him (with no justification) to Brazil’s Bolsonaro.
From the beginning the President insisted that Mexico would avoid panic and repressive measures in dealing with the pandemic; he would be guided by medical and scientific advice at all times. In his daily morning press conferences (mañaneras) he began to be accompanied by leading figures from the Ministry of Public Health, notably Dr Hugo López-Gatell, Deputy Secretary of Health Protection and Promotion, whose clarity, knowledge and attention to detail are outstanding.
Both the President and the Deputy Secretary refused to impose a lockdown when the country still had only a very small number of cases, and for this they were repeatedly accused of complacency and indifference by a hostile media. They pointed out that a premature lockdown would cause massive disruption and hardship for the majority of Mexicans who depend on precarious employment and small businesses for survival.
Unfortunately for those who accuse López Obrador and his government of complacency, as early as February 4th 2020, when Mexico had yet to report any Covid-19 cases, WHO international advisor on health emergencies Jean-Marc Gabastou declared that “Mexico was the first country [in the world]to react and to activate its emergency system along the lines established by international health regulations”.
In March Dr López-Gatell outlined a clear three-stage plan for dealing with the pandemic, based on evidence of the extent of transmission of the virus. Phase 1 is that of containment: detection, diagnosis and isolation, when there are very few cases and they can easily be isolated and contacts followed up. Phase 2 is that of social distancing and mitigation when local transmission has begun. Phase 3 is when community transmission has become widespread, a Health Emergency is declared, all non-essential activities are suspended and people are urged to stay at home and self-isolate.
Phase 1 began early in March when the first cases were confirmed, and phase 2 was declared on March 22nd after confirmation the previous day of the first two deaths, with a total of 251 confirmed cases. A National Safe Distancing Campaign was decreed, with an iconic Superwoman, “Susana Distancia”, as mascot (Su Sana Distancia means “Your Safe Distance”). The Easter school break was brought forward to begin on March 23rd and continue to at least 19 April (later extended); all mass events were cancelled; and a maximum of 50 people with safe distancing was decreed for any meetings.
Unlike many countries that have used draconian decrees and police repression to enforce restrictions during the pandemic, Mexico has relied on persuasion and cooperation to achieve distancing, staying at home and closure of enterprises in non-essential sectors. López Obrador quotes Benito Juárez, “Nothing by Force, Everything by Reason and Law”, and in this field as in everything he relies on voluntary compliance. Time and again he praises the Mexican people for their public spirit and good sense, and this positive social psychology seems to be working: figures indicate that well over two thirds of the population are staying at home and 95% of non-essential enterprises have closed down or adopted home working.
None of this has diminished the right-wing propaganda campaign against Mexico and its 4T transformation, and the complex health situation arising (as in all countries) from the pandemic is being used for this purpose. On May 8th the New York Times published a sensationalist article by Azam Ahmed with the title “Hidden Toll: Mexico Ignores Wave of Coronavirus Deaths in Capital”, and similar articles were then published in the Washington Post, Wall Street Journal and El País of Spain. The article alleges that real deaths are much higher than the official figure and that patients are dying in corridors or on the street while searching for treatment. But it is based entirely on rumours and hearsay, without a single piece of hard evidence, and its arguments for questioning official statistics could be applied to virtually any country, even the most efficient. It should be seen as just one more example of how the mainstream media have become more than ever part of the global establishment, designed to discredit any real alternative to neoliberalism.
As explained above, Mexico’s record on dealing with the pandemic is excellent, and its per capita data on Covid-19 infections and deaths are significantly better than those of major European countries or the US. Its plan for exiting from lockdown is exemplary in its clarity and thoroughness and its insistence on health and welfare as the highest priorities.
The Fourth Transformation and the pandemic
The Mexican opposition and much of the international media have seen the crisis caused by the pandemic as a perfect excuse to derail López Obrador’s 4T agenda for radical change in Mexico. Opposition strategy has been both to discredit the government’s handling of the pandemic and to insist on “business as usual” as the only way forward.
López Obrador and his team are well aware of this and have reacted accordingly. Time and again he has insisted that the real cause of the crisis is neoliberalism and that the pandemic only makes the 4T more necessary: “There can be no half measures, it’s either corruption or transformation!”
Faced with the economic crisis that accompanies the pandemic, López Obrador insists that it is a crisis of neoliberalism and that his government cannot react by rescuing the wealthy and the corporate sector, as used to be the case, “socialising losses and privatising profits”. The priority must be to help the poor and excluded and small and medium enterprises, and to do this the government has a plan which is intended to help 70% of the population, “starting from the bottom upwards”.
On April 16th the President declared “Even in this economic crisis, there are solutions: if we take care of the weakest, the poorest and the marginalised”. What is being proposed is a moral economy, not one based on individual gain. While respecting big businesses that pay their taxes and avoid sacking workers, the government will not spend vast amounts rescuing bankrupt enterprises or financial interests as happened in the 1990s with the FOBAPROA scandal, a deposit protection scheme that became a massive corruption scandal and cost the country over 3 billion dollars.
Instead, the economic crisis is being addressed by reinforcing a raft of welfare schemes already begun or planned as part of the 4T. Pensions for Senior Citizens, already established, were brought forward in terms of scheduled payments and distributed directly to over 8 million people. Special credits of 25,000 pesos are being paid to over a million small businesses, 90% of them with no more than 5 employees; they are at the lowest available interest rate of 6%, with 3 months’ grace before repayments begin, and are issued “on trust” (without collateral). Housing credits, also approximately a million of them, are being issued, and in the poorest areas are in the form of grants rather than credits.
The list continues: a grant scheme for young people in neither education nor employment, Jóvenes Construyendo el Futuro (Young People Building the Future) is being extended; the Sembrando Vida (Sowing Life) scheme to support small farmers who combine reforestation with agriculture is also being increased; the new education plan called “The School Is Ours” which allows each community to manage its own school budget is being accelerated; and so on.
A crucial aspect of all these schemes is that payments are made directly to recipients from the Federal Treasury, without intermediaries, to prevent corruption or bureaucratic delays. López Obrador insists that what exists or is being created in Mexico is “a people that governs itself” – “We are governing with the People, so as to create a responsible society, a conscious citizenry”.
Employment is also being generated by a range of public works investments such as the Mayan Train and new suburban railways around Mexico City and Guadalajara, the restoration of the public oil company PEMEX to serve domestic needs rather than export, and the restoration of the Federal Electricity Commission, including support for local renewable energy schemes. The entire welfare and public investment plan with its broader economic implications is so ambitious that it cannot be analysed in one article, and I shall return to it later in more detail.
Mexico’s international role
Most significant has been Mexico’s international role on matters relating to the pandemic. On March 26th López Obrador participated in a virtual meeting of the G-20 countries, in which he pointed out the relationship of the pandemic to issues of inequality and the need to address these issues.
On April 1st at the United Nations Mexico presented a resolution in support of the UN and the World Health Organisation in the campaign against the pandemic, and calling on all countries to stop commercial speculation in medicines and medical equipment and to ensure universal access to any vaccine or treatment for the virus. This resolution was passed on April 20th with the support of 179 of 193 countries.
López Obrador has made it clear that he regards this as a fundamental political issue: on May 5th he wrote an article, which has since been translated into English and French and widely distributed on social media, with the title “Some Lessons from the Covid-19 Pandemic”.
The article does not pull any punches. “First, it is a fact that, during the neoliberal period, public health systems were not a priority for most governments in the world…” and it is clear that “We must strengthen the public health systems, in the understanding that – just as with education and social security – health cannot simply be a commodity or a privilege but is rather an inherent right of all human beings”.
– “We must urgently address the serious problem of chronic diseases which are, de facto, the pandemics that have caused the most deaths in the world…many more lose their lives because of heart attacks, obesity and diabetes than those who, tragically, will die from the coronavirus…”
– “We need a more caring world in order to strengthen universal brotherhood, and we should start by putting an end to the stockpiling of food, medicine and hospital equipment…There must be a guarantee that no-one on the planet is deprived of medicines, medical care or hospital services due to the lack of financial resources or because market forces put these benefits out of reach.”
– “States must stop using a model that creates wealth without wellbeing…It is the responsibility of the State to reduce social inequalities. We cannot continue to leave social justice off the governments’ agenda…”
– “The ideas and actions of the governments of the world should be guided more by humanitarian principles than by economic or personal interests, or by the interests of groups or powers…We must say no to violence or wars of any sort…”
Finally, López Obrador recognises that the coronavirus pandemic will leave us with a legacy of tragic deaths and with a much diminished economy, and declares that as we rebuild, we must do so on a basis of human values and solidarity. His statement is a manifesto for fundamental global change.
David Raby is a writer, political activist and retired academic living in Norwich (UK). Professor Emeritus in Latin American History, University of Toronto, and former Senior Fellow in Latin American Studies, University of Liverpool. Former City Councillor in Norwich. Executive member, Venezuela Solidarity Campaign; Chair, Norwich-El Viejo (Nicaragua) Twinning Link. He can be reached at [email protected] and on Twitter at @DLRaby.