On June 24th, Mexican Undersecretary of Health Hugo Lopez-Gatel reported that coronavirus cases would peak this week, that the pandemic would end in Mexico in October, and that Mexican cases had been on a plateau for 22 days already. He predicted a total of 25,000 to 30,000 deaths in Mexico. The official website presented a graph the same day demonstrating a significant decline in daily cases beginning June 16th and falling from a peak of 5,564 on June 9th to fewer than 200 on June 23rd. The Mexican government has also decided that massive testing is a waste of resources because what is important to know is trends and spikes in symptomatic cases and those can be picked up as they present themselves.
On the same day, the Johns Hopkins Center for Health Security reported that Latin America continued to be a COVID-19 hotspot, with Mexico fifth globally for daily incidence of cases. Worldometer reported 4,577 new cases on June 23rd rather than the less than 200 cited by the official Mexican website. Its data also demonstrated that Mexico is testing the least among the top 11 countries for confirmed cases, at one third the rate of Brazil and about 5% of the US rate per one million inhabitants. With three months to go until the expected end of the pandemic in Mexico (October) the government itself was reporting more than 24,000 COVID-19 deaths, making a total of 30,000 by October appear as a fantasy.
Why do the official picture and pronouncements regarding COVID-19 contrast so much with that reported by independent analysts following the pandemic? National health policy, like any public policy, is first and foremost about politics. In Mexico, as in many other countries, the government’s national agenda can be negatively impacted by a pandemic and leaders need to decide whether to prioritize public health or their vision for national development in the medium term. Mexico’s President, Andrés Manuel López Obrador (AMLO) has, since the appearance of COVID-19 in Mexico at the end of February, given precedence to the national program that swept him and his MORENA party into power in 2018.
AMLO and the Fourth Transformation
AMLO has a single-minded commitment to develop and implement what he calls “the Fourth Transformation” of Mexico after Independence, the Reforma and the Mexican Revolution. The plan consists of ending corruption, expanding social programs to reduce poverty and inequality, building infrastructure, reducing violence, and developing the Mexican economy. Given his background of coming of age as a politician in the old Institutional Revolutionary Party (PRI) one-party state, he believes that a president should be able to determine policy virtually unilaterally.
AMLO is dealing with a legacy of corruption, economic crises with bailouts for the wealthy at the expense of the average and poor citizens, and a country virtually split in half between North and South by the economic development plans since the “neoliberals and technocrats” liberalized the economy beginning with NAFTA. Though AMLO is considered to be nationalist and left-wing, he realizes the importance of not only maintaining good relations with the US but promoting further integration of the Mexican economy into the US and Canadian economies.
Even before COVID-19, however, AMLO was clearly having difficulties making progress on the Fourth Transformation.
Responding to COVID-19 within the context of the Fourth Transformation
Mexico has an extensive healthcare system that reaches the most vulnerable populations during normal times with local clinics and even dealt with the less contagious but deadly H1N1 virus in 2009. But COVID-19’s healthcare demands exceed the resources and specializations of local clinics, therefore the health infrastructure to deliver COVID-19 testing and care to the bottom of the social scale is significantly limited. To further complicate matters, even before the onset of COVID-19, AMLO’s desire for state companies and agencies to regain dominant positions across the economy led to a decision to centralize the medical procurement system, resulting in a shortage of cancer and HIV drugs. His suspicion of everything accomplished by prior governments led him to create a new universal healthcare program, Instituto de Salud para el Bienestar (INSABI) to replace a fairly well-functioning Seguro Popular health program just two months before the pandemic hit Mexico. The healthcare transition process complicates the national response.
There is medical consensus, upheld by the experiences of countries that quickly responded to the pandemic, that the key means for dealing with COVID-19 until a vaccine is developed and distributed are to restrict its transmission via social isolation and distancing and wearing masks. All but the latter require keeping people out of their normal work and socializing environments as much as possible. A significant economic package to enable people to stay at home, tide businesses over until the economy can be reopened, and provide the health sector with the means to treat severe cases is necessary.
AMLO, however, perceives indebtedness and fiscal stimulus as ways to subsidize the rich, enrich the corrupt and have the poor pay for it, and derail his plans for putting Mexico back on the correct path to national development. The government’s provision of small loans (not grants) for small businesses is insufficient to support the limited closing of the economy that began in late March. The poor in the informal sector (almost half of the labor force) must work outside the home, even more so as the economy collapses (estimates are that GDP will fall 7 to 12% in 2020).
AMLO understands the need of the poor to work in this scenario and wants to move quickly to legitimize what has been going on de facto by beginning a re-opening as quickly as possible, ostensibly in “safe” municipalities, those with no cases and neighboring others with no cases. The extremely low level of testing in Mexico gives these designations little credibility, and some governors (even the Puebla governor from his own party) refused to accept the early opening. AMLO also has the political problem that, under pressure from the US government, Mexican factories tied into US auto supply chains began working June 1st. To permit that activity while leaving the rest of the economy on hold will reinforce the economic inequality in Mexico that he condemned so vigorously in his electoral campaign.
Where to from here?
Subordinating Mexico’s response to COVID-19 to the Fourth Transformation is a risky bet. The Fourth Transformation was already in trouble before the pandemic and limiting public health measures will not save it. But it’s not just AMLO who favors these priorities. AMLO’s public approval ratings have fallen, but from an amazing 80% before the pandemic to a still high 60% at the end of May. Unfortunately for Mexicans, viruses have their own logic and the country’s pandemic is surely going to get far worse despite wishful thinking.
 . mexicanist.com/coronavirus
 . Johns Hopkins Center for Health Security <firstname.lastname@example.org>