Rafael Bengoa: "I fear that the coronavirus is just a dress rehearsal for another worse pandemic"

Irene Hartmann

10/31/2020 21:09

• Clarín.com

• Society

Updated 10/31/2020 9:40 PM

-This week you met with the Minister of Health, Ginés González García.

Did they talk about the coronavirus?

-Yes.

Ginés asked me how things are going and I, who am in Bilbao, confirmed that obviously we cannot give any lessons from Europe.

I humbly said to him, '

.'

Later we will be able to talk about the role of the media in all this, but scientists who have been in public health have not had any impact on decisions, despite the thousand webinars ... they have called me from other countries, but not from Spain or the Basque Country.

From where?

I can not say it.

English-speaking countries.

- Did he give you any recommendations on the management of the pandemic?

-By not having been there ... but I can tell you the things that failed in the countries that I advised.

There was a first wave that was well controlled, but the political decision-makers made the mistake of thinking that, after confinement, with the summer one could return to a normal life.

We lost sight of the fact that the coronavirus is a permanent threat and, thus, we created good conditions for the second wave.

This is a highly transmissible virus, although not very deadly.

I think that at the latest next week, Spain is going to

.

You will only go to school and essential jobs.

The situation is similar to that of March and April.

Of the flu of the last 250 years, it is known that the second waves are worse than the first because the guard is lowered.

So Europe cannot teach anyone any lesson.

We should look to the East.

I am not saying countries like China, with a semi-democracy in many ways, but South Korea, Australia, New Zealand.

You have to be humble and assume that in the West we don't have all the answers.

Hopefully in this second confinement we understand what we did not understand in the first and avoid a third wave.

-You worked 14 years at the World Health Organization.

How do you evaluate the role of the organism in the pandemic?

-Swiss cheese.

Many retaining walls have been broken.

The issue is that the WHO was gradually denied the possibility of having a strong role in cases of pandemic, since SARS1.

The governments jumped on them and were gagged.

They could not fulfill their alert function with the necessary speed.

Now that President Trump is leaving office, I think Americans will have to see how they return to the WHO.

It is important.

I understand that the next meeting of the body will be important, now in November.

I have my spies there

!

But the bottom line is that WHO tends to cover too many topics: it needs to focus on a few.

If you continue to pretend to work on all health issues, you will continue to dilute.

"Like Argentina, we all have the same dilemma: how to face the tsunami of chronic diseases that are coming our way", evaluated the doctor and health advisor Rafael Bengoa.

-In Argentina, many criticize the authorities for not having stopped the infections, that is, for not having set any other objective than to avoid a health collapse.

What do you think of that position?

- I did not speak of this with the authorities.

What I can say is that the

has not been done well almost anywhere.

In the East they did act very quickly.

They created facilities for testing, isolating the person and searching for their close contacts, on average, eight to twelve people for each confirmed.

In Argentina, I don't know, but in Spain, the average number of people we managed to contact was between one and three.

An infected, a contact.

It is insufficient.

In this the western world failed.

I am not talking about the United States because they are not even trying to identify anyone.

Trump - and also Brazil - without saying it, goes to a herd immunity.

Sweden too, but they say so explicitly.

Today it is estimated that the United States has 220,000 dead.

Regardless of what happens in the elections - although I assume that the Democratic party will win - they go for the 400,000 who died at Christmas.

-A problem here was the lack of communicating vessels between the three health strata: municipal, provincial and national.

An example of this are the distortions in the data load in the epidemiological system.

Where should one start to improve that structure?

-In Spain and France we have the same topic: decentralized countries.

Germany gives us an interesting lesson: they achieved a reasonable understanding between President Merkel and the regions.

Political disunity did not win them over and they understood that the collective was more important.

Italy and England had greater tension.

But we know one thing since the 1918 flu: there are reports from the United States that show how in regions with good political union, the confinement was shorter and there was lower mortality.

A country needs uniformity in the data system.

That is good public health, be it for Covid, cancer, obesity or hypertension.

None of this has been fixed with political disunity.

-Why did the quarantines fail so much?

-We have a bias, a psychological bias.

We are programmed for normality.

When you have a shock in life, of whatever kind, the mind quickly wants to return to normal.

That citizens want that, it is understood, but decision-makers must know that this bias is very negative for decision-making.

The attempt to return to normality, even for financial reasons, has worked against us.

The lesson for Argentina is not to lower its guard as Spain and other countries did.

Continue insisting on hygiene measures that we all already know.

That, with confinement, works.

-Before you mentioned that, even with another total closure, in Spain schools will remain open.

It is a very controversial topic here.

What do you think?

-Children are vectors of the virus.

They get quite infected, but they don't infect others as much.

And since they don't suffer much from it, the tendency in Europe is to confine the country, but to let the children go to school.

Of course, they go to school and come home.

They do not attend their extracurricular activities.

Rafael Bengoa, doctor and expert in health management, has been advising the Argentine Ministry of Health

-Going back to your meeting with Minister Ginés González García, what topic was the meeting focused on?

-It was within the framework of the support that the ministry had asked us in the pre-pandemic, through the Inter-American Development Bank (IDB), in relation to a change in the health care system.

Given the conditions, it will clearly be for post-Covid.

But already in the run-up to the coronavirus and during the pandemic, we talked about the strategy to redesign the Argentine healthcare model.

-What does this model consist of?

-It is part of a model of access to services that can be seen in some European countries.

The idea is to find a balance, say, a sustainable model between public sector spending and the quality provided.

Argentina had already been looking at that macro design, thinking of reconfiguring itself to move towards better health coverage.

The change has to do with reinforcing the primary care of some hospital structures and their connection with social services.

But the central thing is a dilemma that we all have: what to do with the chronically ill.

What model do we need for the next two decades, in order to cope with the tsunami of chronic diseases that is upon us.

The only way out is prevention.

-Where is Argentina in terms of chronic diseases?

-They have to make the same transformation that we all have to do, from the Spanish, to the English and the Nordic countries.

Although some have more technology, more access to medicines or doctors, we have the same problem: having built a good system for acute patients.

That is, someone breaks a leg or has an infection and there is a good system that reasons in terms of ransom.

But this system does not serve the chronically ill, those who will need care for 40 or 50 years, due to hypertension, diabetes ... they need a system in continuous contact, all their lives, and that is not offered by a model focused on acute medicine but a model that complements acute and chronic.

-This is related to the increased sedentary lifestyle, the alarming obesity figures and the changes in life expectancy, is that correct?

-It's interesting.

Even before the Covid, in countries like the United States the increase in life expectancy was beginning to slow down, after a hundred years of continuous increase.

Why?

Due to its model of care: not everyone has access to the health system or preventive activities, such as vaccination.

We would have to explore in the post-pandemic if this will also happen in Argentina, France, England ... Covid may put us in a place of gradual braking, in this sense.

That is why it is so important to have a health system, perhaps mixing public and private providers, but ensuring that the population has full access to services.

-What other major issues did the pandemic expose and would it be important to address?

-That even the countries that best believed they controlled this type of thing were surprised and did not control the pandemic well.

This is the case of Belgium or England, both with experience in the control of tropical diseases in places like Africa.

It is clear that we have a very weakened public health and primary care.

This is influenced by budgets.

Those structures must move from third to first division.

I don't know if it is helpful for me to say this, but this pandemic is a dress rehearsal.

Despite the deaths, it is a virus with low mortality and high transmissibility.

There is no reason to think that this may not change in the next pandemic.

We should prepare for a possible future shock.

-What do you think of the statement that "the coronavirus does not distinguish between rich and poor"?

-Not so at all.

This leads to the topic of chronic diseases.

Those who suffer from them and those who live in high vulnerability are more exposed.

A rich person in Hollywood or Madrid, it is evident that he can isolate himself in a different way than if one is an immigrant or has many pre-existing diseases or lives in 40 square meters.

There is a component of great inequality in the virus.

But it is not that the coronavirus prefers some more than others: we create the social conditions for the virus to attack some more.

-Until now you have not mentioned the word "vaccine".

What does it say to those who put all their expectation on a saving drug?

-It's a simplistic vision.

The first vaccines are not going to be as strong as we need to achieve group immunity.

Assuming there is a vaccine in January and February, we will need the whole year to vaccinate enough people, and that it will be a vaccine that will only produce defenses and antibodies in 60% of those vaccinated.

It is very good and we have to produce it, but it will take a long time to have enough people with enough immunity to have the virus controlled like others.

I am of the idea that, if we do not have it, we have to imagine other scenarios and that each country do a planning.

Have a plan B.

Rafael Bengoa is 68 years old and is co-director of the Spanish institute SI-Health, after his time in the Spanish public administration and 14 years working at the OMS.

Borges, Obama and the dark side of medicine

“I do not miss any of the direct contact with the patient.

The only difference between what I did when I graduated and what I do today is that I now evaluate many patients, without physically seeing them.

That is epidemiology and public health: seeing the health of a population and thinking about how to manage it.

But, yes, it can be said that I went to 'the dark side of medicine': management ”.

Rafael Bengoa is critical: things are not done well;

the horizon of making them better is there, achievable.

A man closing his sixties, with categorical statements and clear definitions ("

"), he understands that his curriculum is full of tedious institutional references, so, practically, he suggests : “Doctor, international advisor on health systems.

Harvard

”.

It is key to understand his professional north to understand him.

Bengoa is a fervent believer in public health management, which over the years has convinced itself of a certain lag, causing the malfunction of health systems, burdened by the irremediable economic burden that sustaining a healthy population represents.

The fracture occurs because an old paradigm prevails that is deaf to the needs imposed by demographic, epidemiological ... social changes, in short.

The thesis is this: at least three decades ago, the health blanket fell short of people.

The urgency is covered, but, "however sexy hospital life may be," the paradigm must be changed because "

", that is, chronic non-communicable diseases.

This circumstance, that is, that a large part of the population needs “for thirty or forty years to have a close and continuous link with the health system”, requires a change of outlook, aggiornation, and a shift in health systems towards

.

That's when the talk with Bengoa becomes more interesting: he knows how to move in a fair counterpoint that goes from the panoramic to the particular, without neglecting either of them.

Know the globe and also its corridors.

He knows the gossip, the postponed projects, the projects in the portfolio.

"I have my spies in the WHO," he laughs, and refers to the advice he gave Barack Obama in the famous reform known as "

."

In the middle, he defenestra under his breath - without even saying it - the figure of Donald Trump.

"I take it for granted that the Democrats will win," he bet.

Argentina is on his agenda, but not because he was “a

since he was 20”, when “that magical world that transports you” caught him, but because the Ministry of Health of the Nation summoned him thinking, precisely, in the health problems linked to "chronicity".

Speaking of learning, Bengoa knows the root of his concerns.

“We are a family of doctors.

My two sons are doctors, too.

And with my father, between the two of us we spent 35 years at the World Health Organization.

I am 14 years old and he is almost 20 ”, he reviews, referring to José María Bengoa, a well-known nutritionist in Venezuela, where he arrived pushed by the Spanish Civil War.

There, in Caracas, Rafael was born: “But I was only there for a while.

I lived in the United States, Denmark, Switzerland and Spain ”.

A man of the world.

Itinerary

Rafael Bengoa was born in Caracas (Venezuela), in 1951, but resides in Spain, where between 2009 and 2012 he was Minister of Health and Consumption of the Basque Country (equivalent to Minister of Health).

He worked 14 years at the WHO (until 2006), where he led the Health Systems area.

In 2013 he advised former US President Barack Obama on the famous "Obamacare" health reform.

He is a surgeon (University of the Basque Country) and a Master's in Community Health and Management (University of London).

Today he co-directs the Institute for Health and Strategy (SI-Health), from where he led a committee on Health Reform in Northern Ireland (“System, not structures”).

Since 2013 he has been a “Senior fellow” at Harvard University, he is a member of a health reform committee in Scotland and he is vice-president of the Horizon 20/20 program of the European Union.

Right now

A leader:

 (Robert Francis) "Bobby" Kennedy.

A challenge:

Transforming health systems towards more preventive models.

A book:

“El Aleph”, by Jorge Luis Borges.

A sport:

Soccer.

One team:

Athletic de Bilbao.

A drink:

Coffee.

A meal:

Anyone who comes from the Basque Country, where undoubtedly the ten best restaurants in the world are.

A place:

Copenhagen (Denmark).

A memory:

It is a really very bad one, the death of a nephew in a road accident.

A passion:

The motorcycle.

ACE

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