RUTHFULLY YOURS

After decades of underinvestment in health systems, most of Latin America and the Caribbean are nowhere near ready for a pandemic. The region’s average annual health-care spending per capita is $949: less than one-fourth of average spending across the Organization for Economic Cooperation and Development, and only two-thirds of the level in the Middle East and North Africa. The region’s health systems are already stretched beyond capacity to meet the needs of a “normal” year; going into the crisis, Mexico had fewer than 6,000 ventilators for a population of almost 130 million, and even relatively well-developed Costa Rica has less than half as many hospital beds per 1,000 people as the U.S.

While conditions vary both among countries and within them, “social distancing” of the type employed in Asia, Europe and North America faces stark limits in Latin America. Across the region, 50% or more of the population work in the “informal sector,” performing domestic labor, casual construction, working in markets or other undocumented jobs. If they don’t go to work in the morning, many will have nothing to eat. Even workers with formal jobs often live in sprawling, underserved urban slums. Millions suffer from malnutrition and untreated health conditions that are risk factors for severe coronavirus complications. Guayaquil may not be the only city where a surge of infection and mortality swamps local services; much of South and Central America lies virtually helpless before the advancing disease.

It isn’t just the disease. The region is experiencing the greatest economic shock of modern times. Capital flight, along with the simultaneous collapse of commodity prices, tourism and export markets, has knocked the supports out from under the region’s always fragile economies. Remittances from workers abroad (up to 20% of gross domestic product in the Northern Triangle countries of Honduras, Guatemala and El Salvador) will fall sharply as unemployment grows in the U.S. Even the region’s problematic economic success story of recent decades—the boom that has made its drug cartels the richest and most powerful in the world—has come under threat. The impact of the pandemic both reduced production of raw materials for drugs like crystal meth in China and disrupted the transport chain, leaving drug cartels short of critical supplies. The closure of frontiers and the abrupt decline of civilian air and maritime transport has crippled the traffickers’ distribution networks. These violent cartels and their private armies, which in many places exercise more power than national governments, may now fall into anarchic and murderous competition over dwindling resources.

The potential for economic and humanitarian disasters to create social unrest in Mexico is something no American president can afford to ignore. The Trump administration’s achievements in managing migrant flows with cooperation from Mexico and its Central American neighbors are unlikely to survive these troubles. Waves of refugees in a chaotic region pose grave humanitarian and political challenges. U.S. voters won’t easily welcome large numbers of possibly infectious refugees pouring across the border. Yet the American conscience also won’t tolerate the suffering that, absent a decent provision for desperate people, will accompany the closing of frontiers throughout the region, including our own.

Venezuela is in no shape to withstand even a relatively limited Covid-19 outbreak. The collapse in world oil prices means that Venezuela can’t sell oil for more than its cost of production. Its hospitals—understaffed, underequipped, often without power or clean water, to say nothing of medications—are inadequate even for everyday needs. Much of the population is malnourished and stressed. Millions have already fled the collapse, and millions more will seek to follow them. In the next few months, if it accepts America’s offer to drop sanctions in exchange for a move to free presidential elections, Venezuela may begin to return to some kind of civilized order—or descend to depths of misery on a scale rarely seen.

Even if the worst-case scenarios prove overstated, the pandemic has already disrupted U.S.-China relations, opened up a colossal rift in the European Union, thrown global energy markets into disarray, and set both America and the world on course for a greater economic disaster than the 2007-09 financial crisis. Tempted as they may be to overlook the Western Hemisphere in the face of dramatic events elsewhere, Washington policy makers need to remember that the security and prosperity of our home region remains a core national interest. Geography matters; this is a time when the U.S. must stand with its neighbors.