After Covid, all over the world we are closer than we have ever been before to the idea that the health care of citizens is something that the state must take on. Yet in America there persists an age-old distrust of any direct intervention by the federal government. From Linkiesta Magazine on newsstands, in bookstores or on Linkiesta Store
Dr. Paul Farmer is co-founder and chief strategist of Partners in Health, a local health care and care organization that focuses its attention especially on those regions and countries that have more scarce resources and suffer from food shortages. Farmer is also president of Harvard Medical School’s Department of Global Health and Social Medicine and is the head of the Division for Global Health Equality at Brigham and Women’s Hospital in Boston. Farmer chatted with Patrick Healy, deputy editor of the New York Times “Opinion” section.
Healy
Paul, you have been working to extend and increase health care around the world for nearly forty years. I would like to know how much closer we are today to a global acceptance of the inclusion of health as a human right than we were when it started its business in the 1980s.
Farmer
I would say that, in any case, we are closer now than we have ever been before, as far as I can remember. And this is also true in the United States where healthcare has not traditionally been considered a right. And we also see it in Asia, parts of Latin America, and Europe. I think that the dramatic events of the last eighteen months have given a strong stimulus. Seeing what it means to go through a pandemic when you don’t have a strong safety net has been an objective lesson for many.
Healy
Speaking of the pandemic – let’s take the United States, for example – there are still, in some ways, differences of opinion about responsibilities and that is what the federal government should do, what states should do, what that local administration should do and even on what rules there should be. And one gets the impression that sometimes the idea of health care as a human right doesn’t work in this discussion. Why do you think this is still the case in the United States and some other countries?
Farmer
I think this is just one of many models that can be used to promote health equality. The others – such as, for example, health as a public good – are just as important. What matters is the idea that there are certain things that a central government takes responsibility for. In many places where I have worked, in Rwanda for example, the real drive to invest in a national health insurance system and to launch a system that provides medical care has been based on the assumption that it is the best way to break the cycle between poverty and illness. Therefore, whether we consider health a human right, whether we consider public health a public good, or whether we believe that a health safety net can be the tool to break the cycle between poverty and disease,
Healy
amazes you that in the past eighteen months, in the United States and some other countries, there has been no more consensus on how to manage not only Covid treatment but also the costs and expenses of health care, especially for people who had previously faced inequalities in the health system? Or is this lack of consensus, at least in some ways, nothing more than an element of a functioning democracy? What do you think of it?
Farmer
Our debate between the federal government and local authorities has been going on for some time. And the question we have to answer, as a nation, is: why have we been so poor in dealing with Covid? After all, we have more resources than most of the world. This has partly had to do with our patchwork system of medical provision and our patchwork system of health insurance, which are themselves a reflection of this long-standing tension: yes, there are some cultural issues that they concern the concept of being libertarian and there is a history of hostility towards government attempts to intervene in the lives of citizens.
Healy
Paul, you have been involved for years in many partnerships – public sector, private sector, donors, governments – to bring resources for health care and aid to the medical sector in various countries around the world. What do you think President Joe Biden and his administration need to do to address the global demand for vaccines and the vaccination campaign around the world? Because in the United States there is a lot of debate as to whether a further recall should be made to a greater number of citizens among those already vaccinated or whether more can be done for other countries.
Farmer
First of all, I want to state that in my opinion, in several respects, the Biden Administration has got off to a pretty good start. Of course, our criterion for talking about success is a high vaccination rate. And we don’t have it. But there are specific problems that have to do with the transfer of technologies that allow vaccines to be produced elsewhere, problems that are encountered, I would say, especially on the African continent. There is a context there that depends almost entirely on the import of vaccines – 99 per cent of the vaccines that are used in Africa are imported – and there is also a very low level of vaccination prevalence that cannot be attributed to reluctance, unless we are talking about the reluctance of local elites to introduce mechanisms to increase vaccines.
However, as far as the transfer of production technologies is concerned, the Biden administration could do more. Donations are not yet an effective tool for vaccinating Africa on a large scale. And the multilateral mechanisms have not worked satisfactorily. So, in my opinion, there are many areas where the Administration can put vaccination equality and vaccination diplomacy at the center. Furthermore, there are also places geographically close to the United States, such as Haiti, which is facing political turmoil and natural disasters as now a wave of refugees returns right in the middle of the crisis. There are therefore contexts, such as Haiti precisely, where we could do a better job by ensuring help not only with regard to Covid but also to tackle the many other problems the country is grappling with. And these are circumstances that change from place to place.
