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Exploring the determinants of regional health governance modes in the Global South: A comparative analysis of Central and South America

Published online by Cambridge University Press:  17 May 2021

Giovanni Agostinis Open the ORCID record for Giovanni Agostinis [Opens in a new window]  and
Kevin Parthenay Open the ORCID record for Kevin Parthenay [Opens in a new window]
Giovanni Agostinis*
Affiliation:
Instituto de Ciencia Política, Pontificia Universidad Católica de Chile, Santiago, Chile
Kevin Parthenay
Affiliation:
Department of Law, Economy and Social Sciences, University of Tours, Tours, France
*
*Corresponding author. Email: [email protected]
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Abstract

What explains the variation in how states collectively deal with public health challenges across different regions? We tackle this puzzle by comparing the regional health governance efforts pursued within the Central American Integration System (SICA) and the Union of South American Nations (UNASUR). We show that Central America's health governance has been driven by external actors, whereas South America's was driven by states within the region, and remained insulated from external actors’ influence. We argue that the explanation for such variation lies in the interplay of state capacity and regional leadership. In Central America, weak state capacity combined with the absence of a regional leader willing to provide governance resources. This opened up space for external actors to contribute actively to regional health governance, complementing the governance of Central American governments. In South America, Brazil's regional leadership mobilised neighbouring states’ capacities by promoting a South-South cooperation agenda based on intra-regional exchanges among national health bureaucracies, which, however, proved vulnerable to intergovernmental conflicts. Through the comparison of Central and South America, the article bridges the gap between global health governance scholarship and comparative regionalism, providing new insights on the determinants and effects of regional health governance modes in the Global South.

Keywords

Regional Health GovernanceState CapacityRegional LeadershipComparative RegionalismCentral AmericaSouth America
Type
Research Article
Information
Review of International Studies , Volume 47 , Issue 4 , October 2021 , pp. 399 - 421
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the British International Studies Association

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References

1 Lederer, Markus, ‘External actors’, in Risse, Thomas, Börzel, Tanja A., and Draude, Anke (eds), The Oxford Handbook of Governance and Limited Statehood (Oxford: Oxford University Press, 2018), pp. 191–208Google Scholar; Krasner, Stephen D. and Risse, Thomas, ‘External actors, state-building, and service provision’, Governance, 27:4 (2014), pp. 545–67CrossRefGoogle Scholar.

2 Since 2018, UNASUR has undergone a disintegration process caused by intergovernmental conflicts related to the Venezuelan crisis, which led nine out of twelve member states to withdraw from the organisation. In the conclusion, we discuss the impact of UNASUR's breakdown on regional health governance and South American states’ capacity to respond to the COVID-19 pandemic.

3 Acharya, Amitav, ‘Rethinking demand, purpose and progress in global governance: An introduction’, in Acharya, Amitav (ed.), Why Govern? Rethinking Demand and Progress in Global Governance (Cambridge: Cambridge University Press, 2016), pp. 1–27CrossRefGoogle Scholar; Rosenau, James N. and Czempiel, Ernst-Otto (eds), Governance without Government: Order and Change in World Politics (Cambridge: Cambridge University Press, 1992)CrossRefGoogle Scholar.

4 Dingwerth, Klaus and Pattberg, Philipp, ‘Global governance as a perspective on world politics’, Global Governance, 12:2 (2006), pp. 185–203CrossRefGoogle Scholar.

5 Davies, Sara E., Elbe, Stefan, Howell, Alison, and McInnes, Colin, ‘Global health in International Relations: Editors’ introduction’, Review of International Studies, 40 (2014), pp. 825–34CrossRefGoogle Scholar; McInnes, Colin and Lee, Kelley, Global Health and International Relations (Cambridge: Polity Press, 2012)Google Scholar; Thomas, Caroline, ‘On the health of International Relations and the international relations of health’, Review of International Studies, 15:3 (1989), pp. 273–80CrossRefGoogle Scholar.

6 Buse, Kent, Hein, Wolfgang, and Drager, Nick (eds), Making Sense of Global Health Governance: A Policy Perspective (Basingstoke: Palgrave Macmillan, 2009)Google Scholar; Clinton, Chelsea and Sridhar, Devi, Governing Global Health: Who Runs the World and Why? (New York: Oxford University Press, 2017)Google Scholar; Richard Dogson, Kelley Lee, and Nick Drager, ‘Global Health Governance: A Conceptual Review’, WHO (Geneva, 2000); David Fidler, ‘The Challenges of Global Health Governance’, Council on Foreign Relations (2010); Harman, Sophie, Global Health Governance (Abingdon: Routledge, 2012)CrossRefGoogle Scholar; McInnes, Colin, ‘Global health governance’, in McInnes, Colin, Lee, Kelley, and Youde, Jeremy (eds), The Oxford Handbook of Global Health Politics (New York: Oxford University Press)CrossRefGoogle Scholar; Youde, Jeremy, Global Health Governance in International Society (New York: Oxford University Press, 2018)CrossRefGoogle Scholar.

7 Anna Holzscheiter, ‘Health’, in Risse, Börzel, and Draude (eds), Oxford Handbook, pp. 438–58; Kirton, John, Cooper, Andrew, Lisk, Franklyn, and Besada, Hany (eds), Moving Health Sovereignty in Africa: Disease, Governance, Climate Change (Aldershot: Ashgate 2014)Google Scholar; Patterson, Amy S., Africa and Global Health Governance: Domestic Politics and International Structures (Baltimore, MD: Johns Hopkins University Press, 2018)Google Scholar; Marco Schäferhoff, ‘External actors and the provision of public health services in Somalia’, Governance, 27:4, pp. 675–95.

8 Shiffman, Jeremy, ‘Has donor prioritization of HIV/AIDS displaced aid for other health issues?’, Health Policy and Planning, 23:2 (2008), pp. 95–100CrossRefGoogle ScholarPubMed; Sridhar, David, ‘Post-Accra: Is there space for country ownership in global health’, Third World Quarterly, 30:7 (2009), pp. 1363–77CrossRefGoogle Scholar.

9 Those scholars who adopted a regional perspective focused on the relationship between specific regions and global health institutions, at the expenses of the analysis of regional health institutions. See Lee, Kelley, Pang, Tikki, and Tan, Yeling (eds), Asia's Role in Governing Global Health (London: Routledge, 2012)Google Scholar; Kirton et al. (eds), Moving Health Sovereignty in Africa; Patterson, Africa and Global Health Governance.

10 Börzel, Tanja A. and van Hüllen, Vera (eds), Governance Transfer by Regional Organizations: Patching Together a Global Script (London: Palgrave Macmillan, 2015)CrossRefGoogle Scholar; Börzel, Tanja A. and Risse, Thomas (eds), The Oxford Handbook of Comparative Regionalism (Oxford: Oxford University Press, 2016)CrossRefGoogle Scholar.

11 Marks, Gary, Hooghe, Liesbet, and Blank, Kermit, ‘European integration from the 1980s: State-centric vs. multi-level governance’, Journal of Common Market Studies, 34:3 (1996), pp. 341–78CrossRefGoogle Scholar.

12 See Börzel and van Hüllen (eds), Governance Transfer.

13 Andrea Bianculli and Andrea Ribeiro Hoffmann (eds), Regional Organizations and Social Policy in Europe and Latin America: A Space for Social Citizenship? (Basingstoke: Palgrave, 2016); Börzel and van Hüllen (eds), Governance Transfer; Bob Deacon, Maria C. Macovei, Luk Van Langenhove, and Nicola Yeates (eds), World-Regional Social Policy and Global Governance: New Research and Policy Agendas in Africa, Asia, Europe, and Latin America (London: Routledge, 2009).

14 Börzel and van Hüllen (eds), Governance Transfer.

15 Daniel Flemes (ed.), Regional Leadership in the Global System: Ideas, Interests and Strategies of Regional Powers (Burlington: Ashgate, 2010); Mattli, Walter, The Logic of Regional Integration: Europe and Beyond (Cambridge: Cambridge University Press, 1999)CrossRefGoogle Scholar; Detlef Nolte, ‘Regional powers and regional governance’, in Nadine Godehardt and Dirk Nabers (eds), Regional Powers and Regional Orders (New York: Routledge, 2011), pp. 49–67.

16 Mattli, The Logic of Regional Integration.

17 Pedersen, Thomas, ‘Cooperative hegemony: Power, ideas and institutions in regional integration’, Review of International Studies, 28:4 (2002), pp. 677–96CrossRefGoogle Scholar.

18 Börzel and van Hüllen (eds), Governance Transfer; Buzdugan, Stephen R., ‘Regionalism from without: External involvement of the EU in regionalism in Southern Africa’, Review of International Political Economy, 20:4 (2013), pp. 917–46CrossRefGoogle Scholar; Jetschke, Anja and Murray, Philomena, ‘Diffusion regional integration: The EU and Southeast Asia’, West European Politics, 35:1 (2012), pp. 174–91CrossRefGoogle Scholar.

19 Sören Stapel and Fredrik Söderbaum, ‘Mapping and problematizing external funding to the African Union and the regional economic communities’, in Ulf Engel and Frank Mattheis (eds), The Finances of Regional Organizations in the Global South: Follow the Money (Abingdon: Routledge, 2020), pp. 112–25.

20 Scott L. Greer, Nick Fahy, Sarah Rozenblum, Holly Jarman, Willy Palm, Heather A. Elliot, and Matthias Wismar, Everything You Always Wanted to Know About European Union Health Policies But Were Afraid to Ask (WHO Regional Office for Europe, 2019); Mossialos, Elias, Permanand, Govin, Baeten, Rita, and Hervey, Tamara K. (eds), Health Systems Governance in Europe: The Role of European Union Law and Policy (Cambridge: Cambridge University Press, 2010)CrossRefGoogle Scholar.

21 Amaya, Ana, Rollet, Vincent, and Kingah, Stephen, ‘What's in a word? The framing of health at the regional level: ASEAN, EU, SADC and UNASUR’, Global Social Policy, 15:3 (2015), pp. 229–60CrossRefGoogle Scholar; Marie Lamy and Kai Hong Phua, ‘Southeast Asian cooperation in health: A comparative perspective on regional health governance in ASEAN and the EU’, Asia Europe Journal, 10 (2012), pp. 233–50.

22 Agostinis, Giovanni, ‘Regional intergovernmental organisations as catalysts for transnational policy diffusion: The case of UNASUR health’, Journal of Common Market Studies, 57:5 (2019), pp. 1111–29CrossRefGoogle Scholar; Herrero, María B. and Tussie, Diana, ‘UNASUR health: A quiet revolution in health diplomacy in South America’, Global Social Policy, 15:3 (2015), pp. 261–77CrossRefGoogle ScholarPubMed; Riggirozzi, Pia, ‘Regionalism, activism, and rights: New opportunities for health diplomacy in South America’, Review of International Studies, 41:2 (2015), pp. 407–28CrossRefGoogle Scholar.

23 Andrea C. Bianculli and Andrea Ribeiro Hoffmann, ‘Regional integration and health policies: Regulatory governance challenges in Mercosur’, in Bianculli and Ribeiro Hoffmann (eds), Regional Organizations and Social Policy, pp. 251–70; Andrea C. Bianculli and Andrea Ribeiro Hoffmann, and Beatriz Nascimento, ‘Institutional overlap and access to medicines in MERCOSUR and UNASUR (2008–2018): Cooperation before the collapse?’, Global Public Health (2021), available at: {DOI: 10.1080/17441692.2020.1867879}; Queiroz, Luisa G. and Giovanella, Ligia, ‘Mercosur's regional health agenda: Architecture and themes’, Pan American Journal of Public Health, 30:2 (2011), pp. 182–8Google ScholarPubMed.

24 Penfold, Erica and Fourie, Pieter, ‘Regional health governance: A suggested agenda for Southern African health diplomacy’, Global Social Policy, 15:3 (2015), pp. 278–95CrossRefGoogle ScholarPubMed; Mooketsane, Keneilwe S. and Phirinyane, Molefe, ‘Health governance in sub-Saharan Africa’, Global Social Policy, 15:3 (2015), pp. 345–48CrossRefGoogle ScholarPubMed; Edefe Ojomo, ‘Fostering regional health governance in West Africa: the role of the WAHO’, in Leonie Vierck, Pedro Villarreal, and Katarina Weilert (eds), The Governance of Disease Outbreaks: Lessons from the Ebola Crisis and Beyond (Berlin: Nomos), pp. 273–300.

25 Miguel A. Centeno, Atul Kohli, and Deborah Yashar, ‘Unpacking states in the developing world: Capacity, performance, and politics’, in Miguel A. Centeno, Atul Kohli, and Deborah Yashar (eds), States in the Developing World (Cambridge: Cambridge University Press, 2017), p. 9.

26 Ibid., p. 10.

27 The analysis of health bureaucracies’ quality and institutional mandates’ coherence would require an investigation of the multilevel interactions that take place within each state, which goes beyond the scope of this article.

28 Flemes (ed.), Regional Leadership; Nolte, ‘Regional powers’; Pedersen, ‘Cooperative hegemony’.

29 Adler, Emanuel and Greve, Patricia, ‘When security community meets balance of power: Overlapping regional mechanisms of security governance’, Review of International Studies, 35:1 (2009), pp. 59–84CrossRefGoogle Scholar.

30 Mattli, The Logic of Regional Integration.

31 Paulo Buss and Sebastián Tobar, ‘Health diplomacy in the political process of integration in Latin America and the Caribbean’, Oxford Research Encyclopedia of Global Public Health (26 April 2018).

32 Roa, Alejandra C. and Santana, José P., ‘Regional integration and South-South cooperation in health in Latin America and the Caribbean’, Rev Panam Salud Publica, 32:5 (2012), pp. 368–75Google Scholar.

33 There is a wide consensus that much of the foreign policy of Central and South American states can be explained through the analysis of presidents’ ideological orientations due to the fact that all those countries adopt a presidential system, with the exceptions of Guyana (semi-presidential) and Belize (parliamentary). See Merke, Federico and Reynoso, Diego, ‘Latin America: Experts’ perception of foreign policy dimensions’, Estudios Internacionales, 48:185 (2016), pp. 107–30Google Scholar.

34 A comprehensive ideological classification of Latin American heads of state can be found in Manuel Alcántara (ed.), Proyecto Élites Latinoamericanas (PELA-USAL). Universidad de Salamanca (1994–2018).

35 Merke and Reynoso, ‘Latin America’, pp. 118–20.

36 Tansey, Oisín, ‘Process tracing and elite interviewing: A case for non-probability sampling’, Political Science and Politics, 40:4 (2007), pp. 765–72CrossRefGoogle Scholar.

37 Ibid.

38 The Central American states comprise Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Dominican Republic.

39 The South American states comprise Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela.

40 Dabène, Olivier, The Politics of Regional Integration in Latin America (New York: Palgrave Macmillan, 2009)CrossRefGoogle Scholar.

41 Mowforth, Martin, The Violence of Development: Resource Depletion, Environmental Crises and Human Rights Abuses in Central America (New York: Pluto Press, 2014)Google Scholar.

42 José L. Valverde, ‘Latin American pharmaceutical overview’, Pharmaceutical Policy and Laws, 16 (2014), pp. 179–206.

43 Central American Data, ‘Pharmaceutical Products: Central American Market Figures’, available at: {https://www.centralamericadata.com/en/article/home/Pharmaceutical_Products_Central_American_Market_Figures} accessed 20 October 2020.

44 Chameleon Pharma Consulting, ‘Unveiling the Promising Growth of Central America's OTC and Pharma Industry – Panama’, available at: {https://www.chameleon-pharma.com/unveiling-the-promising-growth-of-central-americas-otc-and-pharma-industry/} accessed 20 October 2020; The Central American Group, ‘Pharmaceutical Industry Overview, Costa Rica's story’, available at: {https://www.thecentralamericangroup.com/pharmaceutical-manufacturing-costa-rica/} accessed 20 October 2020.

45 Homedes, Núria and Ugalde, Antonio, ‘Improving access to pharmaceuticals in Brazil and Argentina’, Health Policy and Planning, 21:2 (2006), pp. 123–31CrossRefGoogle ScholarPubMed.

46 Domestic production in Argentina, Brazil, Chile, Colombia, and Venezuela accounted respectively for 9.3, 42.5, 3, 4.3, and 14.6 per cent of those countries’ total pharmaceutical markets in 2010. See Maruja N. Crisante, ‘Mercado Farmacéutico y Acceso a Medicamentos en el Perú’, available at: {https://www1.paho.org/per/images/stories/FtPage/2013/Mercado_farmaceutico-acceso_medicamentos-Peru.pdf} accessed 26 October 2020.

47 CILFA, ‘La Industria Farmacéutica Argentina: Su Carácter Estratégico y Perspectivas’, available at: {http://cilfa.org.ar/wp1/wp-content/uploads/2018/10/Presentación-institucional-CILFA-2018-VF-ns.pdf} accessed 18 April 2020.

48 Fraundorfer, Markus, Brazil's Emerging Role in Global Governance: Health, Food Security and Bioenergy (London: Palgrave Macmillan, 2015)Google Scholar.

49 Fraundorfer, Brazil's Role in Global Governance.

50 FIOCRUZ, ‘Production and Innovation’, available at: {http://portal.fiocruz.br/en/content/production-and-innovation} accessed 20 April 2020.

51 Author's interviews with José Gomes Temporão.

52 Victor Bulmer-Thomas, The Political Economy of Central America since 1920 (Cambridge: Cambridge University Press, 2010).

53 WHO, ‘COVID-19 Technology Access Pool: Commitments to Share Knowledge, Intellectual Property and Data’, available at: {https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/covid-19-technology-access-pool} accessed 30 January 2021.

54 Olivier Dabène and Kevin Parthenay, ‘Regionalism in Central America: An “all-in” strategy’, in José Briceño-Ruiz and Isidoro Morales (eds), Post-Hegemonic Regionalism in the Americas: Toward a Pacific-Atlantic Divide? (London: Routledge, 2016), pp. 159–73.

55 Burges, Sean W., ‘Consensual hegemony: Theorizing Brazilian foreign policy after the Cold War’, International Relations, 22:1 (2008), pp. 65–84CrossRefGoogle Scholar; Vigevani, Tullio and Cepaluni, Gabriel, ‘Lula's foreign policy and the quest for autonomy through diversification’, Third World Quarterly, 28:7 (2007), pp. 1309–26CrossRefGoogle Scholar.

56 SAE/PR and IPEA, Cooperação brasileira para o desenvolvimento internacional: 2005–2009 (Brasilia, 2010), p. 38, available at: {http://www.ipea.gov.br/portal/images/stories/PDFs/Book_Cooperao_Brasileira.pdf} accessed 18 April 2020.

57 Fraundorfer, Brazil's Role in Global Governance.

58 Ventura, Deisy, ‘Public health and Brazilian foreign policy’, SUR International Journal On Human Rights, 10:19 (2013)Google Scholar.

59 Buss, Paulo, ‘Brazilian international cooperation in health in the era of SUS’, Ciência & Saúde coletiva, 23:6 (2018), pp. 1881–90CrossRefGoogle ScholarPubMed; Ventura, ‘Public health’.

60 Gomez-Mera, Laura, Power and Regionalism in Latin America: The Politics of MERCOSUR (South Bend: University of Notre Dame Press, 2013)CrossRefGoogle Scholar.

61 Author's interview with Sebastián Tobar.

62 Although Central American states’ health authorities continued to meet throughout the 1990s, COMISCA formally emerged only in March 2001, when the members of SICA approved COMISCA's internal regulations.

63 Parthenay and Dabène, ‘Regionalism in Central America’.

64 As pointed out by regional bureaucrats from SICA's institutions, external funds are often grabbed by member states to meet basic administrative needs at the domestic level (for example, computers and cars). Author's interviews with Ondina Castillo and with Omar Orozco.

65 Paulo Buss and Sebastián Tobar, ‘Health diplomacy’; Riggirozzi, ‘Regionalism, activism’.

66 Julio C. Valdés Díaz, Nelson Guzmán Mendoza, and Ligia Carmona Barrios, Pensamiento regional en Salud 10 años de la Secretaría Ejecutiva del Consejo de Ministros de Salud de Centroamérica y República Dominicana (El Salvador: COMISCA, 2017).

67 Author's interviews with Pedro Caldentey del Pozo and Rolando Hernandez.

68 ISAGS was endowed with legal personality and headquartered in the city of Rio de Janeiro, where it operated on the basis of a Headquarters Agreement between UNASUR and the government of Brazil.

69 ISAGS was run by a small group of experts selected by the UNASUR member states upon the proposal of ISAGS’ director (who was also chosen by member states for a two-year mandate).

70 Author's interviews with Mariana Faria and Felix Rigoli.

71 Author's interviews with José Gomes Temporão and Henri Jouval. On the Brazilian concept of structuring health cooperation, see Buss, Paulo M., ‘Structuring cooperation for health’, Lancet, 377:9779 (2011), pp. 1722–3CrossRefGoogle ScholarPubMed.

72 SE-COMISCA, XLIV Reunión Ordinaria del COMISCA, Informe de Gestión Financiera (2016), available at: {https://www.sica.int/busqueda/Centro%20de%20Documentaci%C3%B3n.aspx?IDItem=111623&IdCat=12&IdEnt=143&Idm=1&IdmStyle=1} accessed 23 September 2020.

73 Author's interview with José Gomes Temporão.

74 UNASUR, Reglamento General de UNASUR (2012), Art. 52, available at: {http://www.itamaraty.gov.br/images/ed_integracao/docs_UNASUL/RES16.2012ANEXOI.pdf} accessed 20 April 2020.

75 Author's interview with David Álvarez.

76 UNASUR, ‘Decisión para el Establecimiento del Consejo de Salud Suramericano de la UNASUR’, available at: {http://www.itamaraty.gov.br/images/ed_integracao/docs_UNASUL/DEC.2008.CSS.PDF} accessed 20 April 2020.

77 COMISCA, ‘Reglamento del Consejo de Ministros de Salud de Centroamérica’, available at: {https://www.paho.org/resscad/index.php?option=com_docman&view=download&alias=24-reglamento-comisca-4&category_slug=comisca-665&Itemid=192} accessed 18 April 2020.

78 UNASUR Health, ‘Estatuto del Instituto Sudamericano de Gobierno en Salud’, available at: {http://www.itamaraty.gov.br/images/ed_integracao/docs_UNASUL/DEC02.2012ANEXO.pdf} accessed 20 April 2020.

79 COMISCA, ‘Resolución de la Reunión extraordinaria del Consejo de Ministros de Salud de Centroamérica y República Dominicana’, available at {https://www.sica.int/documentos/resolucion-de-la-reunion-extraordinaria-del-consejo-de-ministros-de-salud-de-centroamerica-y-republica-dominicana-san-salvador-el-salvador-10-de-septiembre-de-2007_1_106950.html} accessed 20 April 2020.

80 Valdés, Guzmán, and Barrios, Pensamiento regional.

81 COMISCA, ‘Health Plan for Central America and the Dominican Republic 2010’ (2015), available at: {https://www.paho.org/blz/index.php?option=com_docman&view=download&alias=66-health-plan-for-central-america-and-the-dominican-republic-2010-2015&Itemid=250} accessed 6 November 2020.

82 COMISCA, ‘Informe Comisión Técnica Subregional de Medicamentos’, available at: {https://www.sica.int/documentos/2-ctsm-xxxiv-comisca-junio-2011_1_60652.html} accessed 10 April 2020.

83 Fondo España-SICA, ‘Memoria de Labores 2006–2009’, available at: {https://www.sica.int/documentos/memoria-de-labores-2006-2009_1_58793.html} accessed 10 March 2020.

84 Fondo España-SICA, ‘Evaluaciones del Fondo España-SICA 2010-2013’, available at: {https://documentop.com/queue/informe-final-evaluacion-rev-19-11-cooperacion-espaola_598439f51723ddb404626f82.html} accessed 10 March 2020.

85 IDB, ‘RG-T1272: Central American Protocol for Procurement and Quality Control of Medicines’, available at: {https://www.iadb.org/en/project/RG-T1272} accessed 18 April 2020.

86 María Campos de Murillo, ‘Negociación conjunta de precios y compra de medicamentos para Centroamérica y República Dominicana – Una mirada desde la perspectiva de salud internacional’, SE-COMISCA (2016), available at: {https://www.paho.org/els/index.php?option=com_docman&view=download&alias=1733-negociacion-conjunta-comisca-plsi-final&Itemid=292} accessed 20 April 2020;

87 During the XLVII Ordinary Meeting of COMISCA (held on 5 December 2017), member states approved a regulation on the self-sustainability of the Joint Negotiation Mechanism.

88 COMISCA, ‘Acta adjudicación Ev 02-2019’, available at: {https://www.sica.int/noticias/se-comisca-informa-resultados-del-evento-de-negociacion-conjunta-de-precios-de-medicamentos-2-2019_1_118331.html} accessed 18 April 2020.

89 {https://twitter.com/sg_sica/status/1276570767757651973} accessed 26 October 2020.

90 Campos de Murillo, ‘Negociación conjunta’.

91 Author's interviews with Tomás Pippo, Sebastian Tobar, and José Temporão.

92 Author's interview with Celso Amorim.

93 Author's interview with José Temporão.

94 Author's interview with Oscar Feo.

95 The 2003 CAN-MERCOSUR joint negotiation involved representatives of pharmaceutical laboratories producing generic and patented antiretrovirals (for example, Bayer, Glaxo Smith, Roche, etc.), resulting in a reduction of the cost of antiretroviral therapy between 30 and 93 per cent depending on the country. See ORAS-CONHU, ‘Un Ejemplo de Integración Exitosa: Proceso de negociación conjunta para el acceso a medicamentos antirretrovirales en la Subregión Andina, Argentina, México, Paraguay y Uruguay’, Organismo Andino de Salud (2003), pp. 30–1, available at: {http://www.orasconhu.org/documentos/medica_antirre.pdf} accessed 10 April 2020.

96 Author's interview with Tomás Pippo.

97 ISAGS, ‘Compra Pública de Medicamentos en los Países de UNASUR’, available at: {https://www.academia.edu/36322422/COMPRA_PÚBLICA_DE_MEDICAMENTOS_EN_LOS_PAÍSES_DE_UNASUR} accessed 10 March 2020.

98 Bianculli et al., ‘Institutional overlap’.

99 Author's interviews with Tomás Pippo and José Gomes Temporão.

100 Herrero and Tussie, ‘UNASUR Health’; Riggirozzi, ‘Regionalism, activism’.

101 For a detailed analysis of UNASUR's joint positions, see Andrea Ribeiro Hoffmann and Jana Tabak, ‘Discussing global health and access to medicines in the UN system: the case of the Union of South American Nations (UNASUR)’, in Karen Smith and Katie Laatikainen (eds), Group Politics in UN Multilateralism (Leiden: Brill, 2020), pp. 219–40.

102 Riggirozzi, ‘Regionalism, activism’.

103 Brazil pursued its own global health diplomacy, which extended beyond South America to include South-South cooperation with African and Asian countries. See Fraundorfer, Brazil's Role in Global Governance.

104 Author's interview with Tomás Pippo.

105 Malamud, Andrés, ‘Latin American regionalism and EU studies’, Journal of European Integration, 32:6 (2010), pp. 637–57CrossRefGoogle Scholar.

106 UNDRR Regional Office for the Americas and the Caribbean, ‘Central America Allied against the Coronavirus COVID-19’, available at: {https://www.undrr.org/publication/central-america-allied-against-coronavirus-covid-19} accessed 10 March 2020.

107 CEPREDENAC, ‘Plataforma de Información y Coordinación SICA COVID-19’, available at: {https://plataformaregional.cepredenac.org/portal/apps/webappviewer/index.html?id=ebfc9c26673b44f6a9ca5a8e215b90fd} accessed 10 March 2020.

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