he Pan American Health Organization (PAHO) is the specialized international health agency for the Americas and works in partnership with ministries of health and other government agencies, civil society organizations, and numerous other partners throughout the region to improve and protect people’s health. In December 2022, PAHO celebrated 120 years of work in the public health arena of the Americas, collaborating with and supporting countries in the region to improve the health and well-being of their populations.

In this interview, PAHO Director General Jarbas Barbosa shares insights on how the organization is adapting to respond to the diversity of health challenges in the region, with a special focus on collaboration as a driving force for ensuring successful and sustainable solutions.

DIA: Throughout its history, PAHO has worked with different stakeholders to support its strategic objectives. Could you provide an overview of how PAHO collaborates with nonstate actors (NSAs) and the value of such collaborations?

Jarbas Barbosa: Since our inception in 1902, PAHO has developed unmatched capacity to provide high-quality technical cooperation, a strong and effective in-country presence, and agility in responding to Member States’ needs and priorities in the populations and communities they serve. PAHO leverages this capacity to promote dialogue, solidarity, and cooperation among countries in the Americas with the goal of helping the Americas region overcome many critical health challenges.

Today, countries in the Americas face a complex epidemiological landscape with the stubborn persistence of communicable diseases, the risk of outbreaks and epidemics, the rise of noncommunicable diseases, damage caused by traffic accidents and violence, and the impacts of climate change. The region also faces significant inequalities between and within countries and an accelerated demographic transition in Latin America and the Caribbean. Successfully meeting all these challenges requires effective coordination across sectors.

We rely on public/private partnerships and on the contributions of a myriad of stakeholders in delivering technical support. These partnerships feature prominently in the success of Vaccination Week in the Americas, held annually; in the launch of the recent report A New Agenda for Mental Health in the Americas by the PAHO High-Level Commission on Mental Health and COVID-19; in the Disease Elimination Initiative, through which PAHO seeks to end more than 30 diseases and conditions by 2030; and in efforts to meet emerging challenges and opportunities in digital health and artificial intelligence.

But no government or institution can tackle public health challenges alone. Each challenge requires a comprehensive approach for sustainability and impact. Governments, nongovernmental organizations, academia and the research community, donors and foundations, the private sector, and civil society are all key to effectively addressing public health challenges in our region.

Public-private partnerships are also essential if we are to advance public health and address the health inequities that have characterized the region for too long. PAHO takes a deliberate and flexible approach to engage effectively with partners, and following our Framework of Engagement with Non-State Actors (FENSA) to bring the best expertise, evidence, and information to bear.

The COVID-19 pandemic reinforced the importance of partnerships to address global health challenges. To mitigate the impacts of the pandemic, PAHO developed innovative partnerships with the private sector that leverage its reach, capacity, and impact. As the director of PAHO, I am committed to expanding collaboration with companies interested in contributing to achieving the UN Sustainable Development Goals (SDG). This includes companies from outside the health sector, such as the technology sector, financial institutions, the entertainment and tourism industries, and others. By using the concept of “health entry points,” PAHO will expand its reach to other sectors.

One example of such expanded collaboration is our relationships with international financial institutions (IFIs). As part of our COVID-19 response, PAHO and several development banks, including the International Development Bank and the World Bank, collaborated in selected Latin American countries to increase their national pandemic response capacity. During this recovery phase, IFI operations in countries in our region will be an important source of investment funding for PAHO Member States, considering the pandemic’s significant negative economic impact.

PAHO’s overall aim is to place health at the center of the development agenda as a pathway to address other issues pervasive in our region, such as social and economic inequality. As director, I am committed to positioning PAHO as the partner of choice and expanding our engagement with multiple stakeholders to improve the health and well-being of all people in the Americas.

DIA: PAHO is a key regional stakeholder in promoting local decision-makers’ understanding of why governments should place health at the heart of their development agendas. What hurdles has PAHO observed in promoting this understanding, and how can external partners help overcome them?

JB: Post-pandemic donor fatigue is emerging. Development assistance is returning to pre-pandemic levels, and countries with limited budgets are again grappling with competing priorities in which to invest. The donor community and governments are also refocusing on other developmental issues instead of health, and quickly.

It is crucial to prioritize health at the highest levels of government and society. Investing in health is essential for economic growth, development, and wellness. Stakeholders must work together to reflect the value-add of effective health policies across the development spectrum. The pandemic put a spotlight on the central role that health plays in the stability of societies across our region. As we recover from this crisis, we must not forget this lesson and need to prioritize health in tandem with the social determinants that fuel inequality in our region. We strongly believe this must be done through a multisectoral approach with health firmly positioned as the essential driver.

PAHO is working with Member States and other partners to help countries overcome persistent inequalities, build health systems that can respond to emerging threats, and recover from the pandemic’s negative impact stronger than they were before, and achieve universal healthcare.

DIA: During last year’s 30th Pan American Sanitary Conference, Member States approved a series of resolutions which included a new Policy to Strengthen National Regulatory Systems for Medicines and Other Health Technologies. For NSAs (especially the regulated sector), what are the roles and areas of collaboration with PAHO and Member States to support this policy’s goal?

JB: Strengthening regulatory systems remains a public health priority for Member States in the Americas, as stated in PAHO’s Strategic Plan 2020-2025 and the Sustainable Health Agenda for the Americas 2018-2030. Member States have prioritized four interventions, which are guiding PAHO’s engagement in this field:

1. Adopting sustainable state policies to strengthen the governance and stewardship of regulatory systems
2. Promoting the strengthening of regulatory systems to ensure consistent, transparent processes based on regulatory science
3. Strengthening regulatory harmonization and convergence within the Americas region
4. Adopting new evaluation systems based on the WHO Global Benchmarking Tool (GBT) and related mechanisms.

NSAs in public health include the private sector and nongovernmental organizations, civil society, academia, and professional associations with a role in healthcare delivery, research, and policy development. These and other stakeholders can contribute to strengthening national regulatory systems for vaccines, medicines, and other health technologies by PAHO and Member States in several ways, including:

• Technical expertise and capacity-building initiatives to enhance regulatory processes and competency development across the region.
• Data and information sharing and improving transparency and publicly available regulatory information related to the safety, efficacy, and quality of medicines and health technologies to strengthen regulatory decision-making, facilitate regulatory reliance, and avoid duplication of effort.
• Supporting efforts to strengthen regional regulatory harmonization and convergence networks to streamline approval procedures and enhance access to essential medicines and health technologies across countries.
• Advocacy and policy support by engaging with policymakers to ensure that regulations strike a balance between fostering innovation and protecting public health without compromising safety, quality, and efficacy.
• Adherence to ethical standards in research, clinical trials, observational studies, and health technology marketing; this can help build trust between NSAs, national regulatory authorities, and the public.
• Investment in research and development of innovative medicines and health technologies that address the region’s unmet public health needs (e.g., medicines for neglected diseases, antibiotics with new mechanisms of action, and vaccines for emerging pathogens).
• Promote access and rational use of medicines and high-cost health technologies by disseminating PAHO policy recommendations and guidelines, including recommendations for evidence-based pricing policy options with relevant experiences for the Americas.

PAHO collaborates with NSAs in a transparent manner, establishing appropriate mechanisms to manage potential conflicts of interest and ensure that public health goals remain the primary focus. NSAs can contribute to regional efforts to strengthen regulatory capacities critical to improving affordability, availability, and (ultimately) equitable access to efficacious, safe, and high-quality health technologies, while expanding manufacturing capacity.