BUENOS AIRES — The geographical proximity of Chile and Argentina and their undoubted cultural and historical links can give the impression of that so much is the same. The dramatic contrast between the pace of their coronavirus vaccine rollouts paints a very different picture. While Chile has injected almost 11 million doses, Argentina has delivered just over a third of that figure. Chile has vaccinated nearly 27% of its population — Argentina stands below 4%. Why this significant difference?
Comparing oneself to others, particularly neighbors, probably isn't the best way to improve. But it can be useful when it comes to governance: seeing an alternative model that works can prompt you to consider it for your plans.
From Argentina, it's difficult to understand how Chile has been able to receive and stock sufficient vaccines to immunize all its risk groups by the end of March. That means 32% of all Chileans — everyone Chilean over 60 years of age, and all those over 18 years with comorbidities.
Here, we're waiting for more flights with supplies, hoping it will be "our turn" and fearing all the while that the 7,000 or so infections a day could spin out of control.
Communication is one outstanding difference between ourselves and Chile in this pandemic. While Chile's information database SAS offered clear data from day one of all details of the vaccine situation (who has been vaccinated, where, dosage and vaccine brands), Argentina created a Vaccination Public Monitor after reports of "VIP" or out-of-turn vaccinations sparked public outrage.
Everything was prepared far in advance.
Our country's weak vaccination campaign probably began in the early stages of the pandemic, when as some in the healthcare sector have put it, "we were sleeping." Meanwhile, countries like Chile began planning agreements to buy future vaccines as early as May 2020. As one Chilean deputy-health minister, Paula Daza, said, "Everything was prepared far in advance... in May and June, conversations began to sign agreements with various laboratories, which allowed us to have today this amount of doses."
These agreements meant advance payments (nobody knows how much) to finance the development of vaccines. In exchange, the laboratories assured the virtual "investor" they would have vaccines when these were prepared. The Chilean approach was, "the more agreements signed, the better."
Adolfo Rubinstein, a former Argentine health minister and clinical epidemiology professor, says the government had various problems on this front. Firstly, he says, "compared to Chile, Argentina is a less reliable buyer. You cannot get over this. A country that has defaulted on debt 20 times, which had to restructure its debt ... isn't reliable for pharmaceutical firms. Also, while others purchased in advance, Argentina has no dollars. It is a macroeconomic restriction that puts us at a disadvantage."
He cites the example of a breakdown in early talks with the firm Pfizer, because as the last health minister Ginés González García said, they wanted to impose "unacceptable conditions" on Argentina. These conditions, sources in the presidential palace told Clarín, included providing "excessive" collateral in the form of sovereign assets. A recent report by a group of investigative journalists, the Red de periodistas de América Latina para la Transparencia y la Anticorrupción, PALTA, found that these were the conditions of several various pharmaceutical firms and some regional states even changed their laws to meet their conditions. Did Chile cede to such pressures?
While contracts and the tenor of negotiations are rarely revealed, unnamed sources inside the Chilean government told Clarín Pfizer did not set draconian conditions. We may conclude then that the different treatments given to the two countries are to do with Argentina's standing with international agencies.
We're not the worst in everything
Rubinstein says Argentina turned to Russia's Sputnik V vaccine as soon as talks with Pfizer and AstraZeneca began to falter and firms started talking of delays in production and deliveries. In terms of Chinese vaccine agreements, "the Argentine government didn't control them, they slept on the job," says Rubinstein, who admitted nevertheless that "the Sinopharm vaccine is considerably more expensive, but we could still have reached an agreement earlier. It's all speculation, but one imagines in any case that China bargains hard, in the sense that 'if I give you this, what will I get?' The same with Russia. There is an enormous geopolitical component involved that goes beyond healthcare."
Duke University's Global Health Innovation Center believes Chile signed four agreements to pre-purchase 34 million vaccine doses, enough to cover all its population aged over 16 years. They have agreements in force for 60 million doses to cope with future coronavirus waves. A breakdown of figures shows agreements were signed with all the big firms, and there are also preliminary talks with the Gamaleya Center, which makes Sputnik V.
Duke University highlights a depressing contrast here: Argentina was promised 47 million doses (when it needed 60 million) of various vaccines, but just more than four million had been delivered when this article went to press. With Sputnik V, 20 million doses were promised and only 2.5 million doses have arrived. Likewise, only 580,000 doses of AstraZeneca have been delivered. The proportions give an idea of the state of our vaccination program.
But "we're not the worst in everything," says the former minister Rubinstein loyally. In terms of complex healthcare facilities, Argentina is ahead of Chile, which has nevertheless provided better primary care. Likewise, Argentina's national government has not handled the pandemic badly given the potentially disruptive role of intermediate powers in provinces.
In Chile, there have been no registration issues for vaccination. As Paula Daza points out, Chile's government has made weekly announcements on which age or risk group is next, and people turn up to have their jabs at the local national health clinic. "The primary care system allows us to reach everyone, even the most isolated, as we have already gained experience from past inoculation programs," she said.
In Chile, districts are in charge of primary medical care. They pay clinics $15 a month per patient, which motivates them to attract more patients. It's certainly a novel way of doing things: the system seeks you out, not the other way around.
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