Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico

Abstract

We present a new concept, Punt Politics , and apply it to the COVID-19 non-pharmaceutical interventions (NPI) in two epicenters of the pandemic: Mexico and Brazil. Punt Politics refers to national leaders in federal systems deferring or deflecting responsibility for health systems decision-making to sub-national entities without evidence or coordination. The fragmentation of authority and overlapping functions in federal, decentralized political systems make them more susceptible to coordination problems than centralized, unitary systems. We apply the concept to pandemics, which require national health system stewardship, using sub-national NPI data that we developed and curated through the Observatory for the Containment of COVID-19 in the Americas to illustrate Punt Politics in Mexico and Brazil. Both countries suffer from protracted, high levels of COVID-19 mortality and inadequate pandemic responses, including little testing and disregard for scientific evidence. We illustrate how populist leadership drove Punt Politics and how partisan politics contributed to disabling an evidence-based response in Mexico and Brazil. These cases illustrate the combination of decentralization and populist leadership that is most conducive to punting responsibility. We discuss how Punt Politics reduces health system functionality, providing lessons for other countries and future pandemic responses, including vaccine rollout.

COVID-19 and Chagas Disease in Buenos Aires, Argentina

“…There is an important difference in the global mortality rate between the Brazilian series and our study. This difference in the global mortality rate can be because of the circulation of deadly variants, such as the Gamma variant, the collapse of the Brazilian health system during outbreak waves, and public misinformation (20,21). However, both studies, one with high mortality rate and the other with a low rate, still show no mortality difference due to COVID-19 between CD and control groups.…”

Correlation between mobility in mass transport and mortality due to COVID-19: A comparison of Mexico City, New York, and Madrid from a data science perspective

“…For low- or middle-income countries, with important income inequalities and a significant sector of the population working in an informal economy, such as Mexico [ 36 ], NPIs brought devastating consequences: increasing unemployment [ 37 , 38 ], crime [ 39 ], and domestic violence [ 40 ]. Many self-employed people belonging to the informal economy have been incapable of completely following NPIs, and they have been kept exposing themselves despite the epidemiological recommendations of social distancing [ 41 ]. The peak in the daily number of positive cases was reached in CDMX, at the time metro services were reduced by local governments.…”

The New SARS-CoV-2 Variants and Their Epidemiological Impact in Mexico

“…Mexico has had a slowly executed COVID-19 vaccination program compared to high-income countries, as vaccines have only been made available by the official governmental vaccination programs. These were divided by age group and started at different times, based on regional vaccine availability (the national health system is decentralized across 32 states that have partial autonomy over policy decisions) ( 51 ). Roughly, vaccination started in late December 2020 for medical staff in public hospitals and expanded to all elderly (60 and up) in February 2021.…”