Inequality and corruption: Why Peru is losing its COVID-19 battle

WASHINGTON — Peru began its COVID-19 lockdown on March 16, when there were only 71 reported cases of the coronavirus in the country of 32 million. President Martin Vizcarra closed the country’s borders and mandated a 15-day quarantine, restricting domestic travel and all nonessential activity.

That nationwide quarantine order was extended and is now lifting for most of the country Wednesday, over 100 days after it first went into effect. But even though the government acted swiftly to restrict the coronavirus’s spread, Peru has recorded the third-highest number of COVID-19 cases in the Americas, after the U.S. and Brazil. As of July 1, there have been 282,365 cases diagnosed and 9,504 deaths.

According to data from the Pan American Health Organization, cases have been increasing exponentially as the pandemic progresses. Public health experts say that the deep inequality of Peru’s health system, high levels of informal economic activity, and corruption have contributed to a massive loss of life.

Dr. Ruben Mayorga, PAHO representative in Peru, said the country developed a national plan to respond to the coronavirus just days after the World Health Organization deemed it a public health emergency of international concern. PAHO has a representative at the Peruvian government’s coronavirus command center in Lima, where data on the number of cases, deaths, and hospital capacity are gathered, and it is coordinating closely with the government by providing technical support.

“The health system was not prepared for this,” Mayorga said. “The epidemic is catching up very fast.”

The country has seen shortages of needed supplies, particularly in regions that had especially weak health systems before the pandemic began, Mayorga said. While the government has been increasing the number of beds available in intensive care units — from 217 in April to over 1,300 now, according to Mayorga — the acceleration of infections has not allowed Peru to stay ahead of the virus for long.

Care in hospitals that do have capacity remains out of reach for many Peruvians. The health system is decentralized and split into five entities, resulting in “multiple providers of services and insurance” with “a high degree of overlap and little coordination.” Despite public health care options, extreme inequality still restricts access to care for many who cannot pay.

Lionel Vigil, regional director for Latin America and the Caribbean at World Neighbors, said that during a public health emergency like a pandemic, the Peruvian government can allocate health resources to those who need it most. But some private hospitals are charging around $3,000 per day for coronavirus care, he said. And the government cannot afford to subsidize the entire cost of public care when someone needs hospitalization.

“The whole health system has collapsed in Peru — the whole public system. And the few beds that [are] needed that [are] empty in private clinics [are] controlled by the corporations that want a huge amount of money,” Vigil said. “The government doesn’t have the power to negotiate with the clinics because of the clinic associations.”

World Neighbors works in rural areas to provide support to smallholder farmers, including training in agricultural practices and access to water, sanitation, and hygiene. Education campaigns on proper hand-washing with soap and water aim to stop the virus’s spread, but Vigil said they will not be effective everywhere in the country since only 60% of Peru’s population has access to clean water

Management Sciences for Health’s Peru office has used its experience executing public health projects in the country to help with pandemic response at the regional and municipal levels. Behavior change — washing hands, wearing a mask, social distancing — is key to fighting the disease, said MSH-Peru Executive Director Edgar Medina Figueroa. Getting the government to finance such activities is not always easy, he said.

“The problem is that they don’t like to invest in what is not tangible. The authorities like to invest in a hospital because it'll last,” Medina said. “But if you tell me we’re going to invest in training people or invest in a virtual platform to reach everyone with public health messages, that’s not very popular.”

‘The lockdown has failed completely’

PAHO is working with other United Nations agencies across Peru, including on a joint $5.5 million project with the World Food Programme in the region of Ancash to help strengthen the regional government’s response. PAHO has also worked with the government to protect people in high-risk environments like prisons and in crowded public places like markets, where social distancing is difficult. Areas outside of the Lima region, which is home to nearly one-third of Peru’s population, were even less equipped than the capital area to respond to coronavirus.

Although different ministries in the government have worked well together on pandemic response, Medina said, there have still been some major issues, including access to appropriate supplies.

“One of the failures of the Ministry of Health is having enough personal protective equipment,” Medina said. “A lot of medical personnel have died because they were missing personal protective equipment.”

According to a Devex analysis of funding announcements, Peru has received bilateral support to aid its fight against COVID-19 from Spain, the U.S., and Canada, as well as loans from the International Monetary Fund and World Bank for $11 billion and $35 million, respectively. The U.S. Agency for International Development allocated $2.5 million to Peru for “aggressive contact tracing” and testing aimed at stopping community spread of the virus. That funding will mobilize an additional $1 million from Partners in Health for health workers. USAID has also donated 250 ventilators and accompanying equipment.

Peru has struggled to support people who are suffering economically as a result of the lockdown. Corruption has long been an issue in the public sector, with the country scoring 36 out of 100 on Transparency International’s 2019 Corruption Perceptions Index. This environment can prevent people from receiving government payments meant to offset economic losses caused by COVID-19 lockdowns, Vigil said.

“Cash didn’t arrive to the ones most in need because [of] high corruption at the municipality level,” he said. “They distribute to their friends and families or … they give it to themselves.”

Many in the country lack access to a bank account or formal registration with the Ministry of Development and Social Inclusion. This means government efforts to provide financial assistance directly to vulnerable populations have not always succeeded, leaving many people with no choice but to defy lockdown orders.

“The lockdown has failed completely,” Vigil said. “Of course, at the beginning, people were very careful and following every step — everybody: the poor, the rich, the middle class. But the social situation is that in Peru, 75% — 75% — of the [economy] is informal. … And those people, if they do not work one day, they cannot eat.”

Getting a grasp on the true incidence of COVID-19 will be key to blunting its spread as Peru opens on Wednesday. PAHO’s Mayorga said it is important to note that Peru is not using the same type of COVID-19 testing as its neighboring countries, making it difficult to compare case and death rates. Peru has used serological testing, which detects antibodies, while many other countries use molecular testing, which detects the virus itself. This is because Peru only had access to serological testing when it first began fighting the pandemic, Mayorga said.

Getting its testing capacity up to speed is now even more important for Peru as influenza season approaches, Mayorga said. Labs will need to have the capacity to test for both infections and to tell the difference between them, and Peru will need to continually update its response plan in coordination with PAHO.

“All these plans are very dynamic and they have to adapt and respond to the situation,” Mayorga said. “What was important three months ago may not be as important now.”