People walk in the street, as the coronavirus outbreak continues in Mexico City. (Photo: Carlos Jasso / REUTERS)

Latin America is the region hardest hit by the Covid-19 pandemic, with more than 10 million cases. In the midst of the health crisis, the attention being paid to other diseases is lagging, the population at risk is unprotected, and in there will be a long road ahead to improving health systems after the pandemic.

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Pandemic or Syndemic?

Before Covid-19, chronic non-communicable diseases (NCDs) such as diabetes, hypertension, heart disease, and cancer caused 2.5 million deaths in Latin America, according to the Institute for Health Metrics and Evaluation (IHME).

Now, the pandemic has led to a 50% to 80% reduction in the care and detection of NCDs.

“We’re facing a syndemic, i.e. two pandemics. On the one hand, the novel coronavirus and on the other, NCDs in a context of poverty, inequality, and discrimination,” said Felicia Knaul, Director of the Institute for Advanced Study of the Americas and professor at the Miller School of Medicine (UM).

The problem of the syndemic is that one in five inhabitants suffers from an NCD, and they are more susceptible to developing severe symptoms from the novel coronavirus. As if that were not enough, the context of confinement has made the population more vulnerable to NCDs due to the lack of adequate food and exercise.

In a syndemic, two or more diseases interact to make the damage greater.

Several researchers argue that it is necessary to look at Covid-19 from the perspective of a syndemic in order to address not only the infectious disease, but also the people’s social context.

“There is no single dose vaccine for poverty or discrimination,” said Felicia Knaul. Therefore, there must be a change in health systems, from the distribution of medical personnel to solving the issue of the lack of medicines.

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Towards a new health system

“In Latin America, there are 2.3 doctors for every thousand inhabitants, on average. Furthermore, this distribution is not equitable, i.e. specialists are concentrated in the big cities,” shared Germán Fajardo Dolci, director of the Faculty of Medicine at the National Autonomous University of Mexico (UNAM) during Roche Press Day, a virtual event bringing together specialists from all over the region.

Dolci explained the urgent need to change the distribution and training of health experts, as “patients are generally only seen when they are sick. We must change the model to one of prevention, and leave single-occasion care in the past,” he said.

Personalized medicine is still a utopia for Latin Americans, although there is an uneven lag between different countries, revealed the report by the Economist Intelligence Unit (EIU) at The Economist, supported by Roche Latin America.

“Personalized medicine is not about treating diseases, but people,” explained Alan Lovell, author of the report and Senior Associate for Health Policy and Clinical Evidence at EIU.

The report classified countries into three levels according to their degree of progress, led by Argentina, Brazil, Colombia, Costa Rica and Uruguay at level 1, followed by Chile and Mexico at level 2, and finally Ecuador and Peru at level 3.

Level 1 marks countries “ready to decide” to implement this type of medicine. At level 2 are regions that intend to “strengthen their bases” and the third level are “just setting out on the journey”.

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Technology applied to healthcare

Personalized medicine requires technology to advance, and “a very common problem is that when a patient changes from the IMSS to ISSSTE, for example, the new doctor must start from scratch. We should share the clinical history of patients when they change institutions; that way everything can be expedited. That’s what data science is for,” added Germán Fajardo Dolci, who is a doctor at the UNAM.

Anja-Alexandra Duenne, Head of Medical Affairs Pharma International at Roche explained that technology such as open data is essential because it is “open for patients, doctors and researchers to share information in real time to improve the treatment of diseases.”

In this way, medical advances, technology, genomics, and data science come together in a new approach accompanying each patient on their own journey, from prevention to treatment, and allow for the provision of unique and individualized care.

But the region faces great obstacles to achieving personalized health care according to the report: the lack of political will, the lack of a holistic vision, inefficient regulations, and a vision that perceives health as an expense rather than as an investment.

The protection of sensitive data was also discussed. Although data represents an important development for the treatment and advance of medicine, it is important to take into account that these databases require special treatment including patient permission, storage, handling, and legal issues.

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The new role for patients

As the experts pointed out, responsibility not only falls on the health system, but also on patients. They must modify their visits to the doctor. They should not only go when they are sick, but regularly under a prevention model.

In this way, diseases such as diabetes, hypertension, heart disease, and cancer can be prevented or detected in time. And the population vulnerable to a new virus would be smaller.

“Pandemics will continue to occur; we will continue to elect people, but we need to create a bond that is currently absent,” said Alberto Alemanno, professor at the Jean Monnet School of European Law and Policy at HEC Paris. Therefore, it is necessary to mitigate the lack of opportunities for participation by patients.

Above all, changing the thinking that people have about the role of patients. In Latin America, citizens are still seen as if they were patients and not as participants who can contribute to public health,” concluded Alemanno.

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