Inaugural address of Dr. Jarbas Barbosa as PAHO Director, 31 January 2023

31 JANUARY 2023
Washington, DC

WELCOME AND RECOGNITIONS

Ministers of Health,

Ambassadors,

Ladies and gentlemen:

Thank you all for your presence and the many people around the Americas watching this ceremony today.

I want to thank my dear friend, her Excellency Minister Nísia Trindade Lima, for her kind words. Nísia recently started her position as the leader of the Brazilian Health System and was still able to be present here today. I wish you the best, Nísia, and am confident you'll be very successful.

Thank you so much, Directors Emeritus Carlyle Guerra de Macedo, Sir George Alleyne, and Mirta Roses. It has been a privilege to have crossed paths with you in different phases of my professional life. I take your words as invaluable encouragement and inspiration to carry on my new duties.

Thank you Dr. Tedros for your kind words and pointing out these challenges we are facing in the Americas and in the world. We’ll work in close collaboration, PAHO and WHO, to respond to them.

To my friend and mentor, Carissa Etienne: I am deeply thankful for the opportunity to have served as your Assistant Director. Even though we come from countries that seem so different, I was always amazed at how similar our perspectives and approaches are.

I believe this is because at heart, we are both guided by our commitment to public health and the fundamental belief that every person has a right to healthcare.

You've achieved so many critical goals for our Region and helped strengthen our Organization to better serve our Member States. From building our institutional capacity to navigating the challenges posed by the Covid-19 pandemic and a financial crisis, Carissa has led PAHO with bravery, commitment, and passion. On behalf of the Secretariat and our Member States, I want to thank you for your excellent leadership. I also want to thank all the teams at the Brazilian National Health System and within PAHO that have worked with me over the years and inspired me with your commitment to improve the health of our populations.

I want to thank my family for being a source of happiness and for your continued support, but also for teaching me so many important things and making sure I keep a good balance between work and life. Fernanda, my wife, has always been on my side, through good and bad times, encouraging me to move forward, giving me wise advice, criticizing me when hard truths are needed, and, more importantly, loving me.

INTRODUCTION

Your excellencies, my dear friends:

For all my professional life I’ve been enthusiastic about the possibilities that public health can offer to build a better, more equitable more united world, with universal health for all.

Furthermore, like all public health workers in the Americas, I am passionate about PAHO and the crucial role this Organization has been playing for 120 years. I clearly remember the first time I visited PAHO in 1997. My fellow citizen Ciro de Quadros, a public health hero and a champion for immunizations, invited me to participate in a preparatory meeting to discuss the measles outbreak in Brazil and other countries of our Region. I was thrilled to enter the building that served as a beacon of public health in the Americas. This enthusiasm for public health and PAHO is still with me today.

I am proud and excited to lead this Organization. I am grateful to our Member States to have received the mission to be the next Director of PAHO. I commit to serving PAHO to the best of my ability, guided by the knowledge and experience I have accumulated during my years working in public health.

PAHO’S IMPORTANCE IN THE REGION

PAHO is an essential organization for the health of the Americas.

It has a unique capacity to provide high-quality technical cooperation, strong country presence, and agility in responding to Member States' needs and priorities. PAHO is also an impartial and irreplaceable mechanism for promoting dialogue, solidarity, and cooperation among the countries in the Americas. These unique characteristics have made PAHO a prominent, respected institution globally, and have helped the Region overcome many critical health challenges.

I will work hard to protect this significant legacy, while also working to prepare PAHO to face current and future challenges to the health and well-being of our population.

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 non-communicable diseases, the damage caused by traffic accidents and violence, and the impacts of climate change. Additionally, the Region faces significant inequalities between and within countries and an accelerated demographic transition in Latin America and the Caribbean.

This situation requires national health systems to respond urgently with a wide range of integrated actions that include improved disease surveillance and prevention, strong and renewed Primary Health Care (PHC), quality hospital and specialized services, and a robust, well-trained health workforce.

To respond to these challenges, we need strong, resilient health systems that can perform all the Essential Public Health Functions adequately and lead multisectoral actions on the social, economic, and environmental determinants of health.

My vision for the future of PAHO is to make it the leading Organization supporting the countries of the Americas to improve the health and wellbeing of their populations. Working together with Member States, PAHO will help countries to overcome persistent inequalities, build health systems that can respond to emerging threats, recover from the pandemic stronger than they were before, and achieve universal health care.

THE FIVE PILLARS

To implement this vision, aligned with Member States' decisions in recent years, I will focus on five strategic pillars during my tenure. Grounded in the legacy of this organization, the accumulated experience of our staff and the commitment of our Member States, I am ready to take on this challenge, just as PAHO is ready to respond to the needs of our region:

1. The first pillar is a commitment to help Member States end the pandemic in the Americas with the best tools we have at hand, especially surveillance and vaccines.

PAHO is ready to work with countries to end the pandemic by strengthening health surveillance to monitor any changes in the epidemiological trends and new variants, as well as ensuring adequate vaccination coverage. This includes increasing access to boosters for vulnerable groups, identifying appropriate strategies to address vaccine hesitancy and improving access to effective antivirals.

Our Region was the epicenter of the pandemic due to poverty and inequalities that jeopardized the public health measures adopted before vaccines were available. In countries where so many rely on informal economic activities, so many live in slums with poor access to water and sanitations and so many depend on crowded public transportation, it was almost impossible to keep people safe from getting infected.

Even when vaccines were developed, we faced unconscionable obstacles: our vast region struggled to access sufficient supplies, just as misinformation increased vaccine hesitancy. Against these barriers, PAHO has worked hard to support National Immunization Plans, reinforce the cold chain capacity, provide training for health workers, improve communication strategies, and expedite access through our Revolving Fund.

Now, we have the tools to control transmission and must work hard, together to reach the groups that are not yet vaccinated and end the pandemic in the Americas.

2. The second pillar is a push to apply the lessons we learned from the pandemic and actively address our vulnerabilities, so that we are much better prepared to face new threats as they emerge.

PAHO is ready to support the implementation of the crucial lessons from the pandemic across several issues.

We will support our Member States to strengthen their national capacity to detect and respond to public health emergencies, build strong health surveillance systems based on the "One Health" approach, ensuring countries can rapidly scale up these capacities in the event of an emergency or disaster.

We will also reinforce our ability to provide regional coordination by implementing the recommendations from the external evaluation of our performance during the pandemic.

PAHO will work with the countries to expand the development and production of medicines, vaccines, and medical products in Latin America and the Caribbean, strengthening regulatory capacity, and implementing strategic, sustainable projects that benefit all countries in our region, including by making better and expanded use of regional mechanisms like the Revolving and Strategic Funds.

We must also support our Member States' participation in the global debate about the new instrument to respond to pandemics. COVID-19 has revealed the critical importance of guaranteeing genuine equitable access to vaccines, medicines, and health products during a pandemic.

I believe this is the only way the world will be better prepared for future emergencies and ensure that the people who lost their lives during this period did not do so in vain, including the brave health professionals that continued to provide care even without proper protection.

There is one more lesson that we must take with us as we grow from this pandemic. Any problem, no matter how small, must be approached together, as a region. By working across sectors, across borders, and across languages, we will be able to achieve a healthier region. In this spirit, allow me to switch to Spanish.

3. The third pillar is to ensure timely and equitable access to health innovations for all countries in the Region.

PAHO stands ready to support countries in building back from the negative impacts of the pandemic on priority health programs. But this alone is not enough; we must go further and ensure that all countries, and all population groups within each country, are on track to achieve the Sustainable Development Goals for health.

We will support countries toward a more rapid incorporation of new technologies and implementation of innovative and more effective strategies, all based on the best available scientific evidence, adapted to each national reality. This will allow us to protect existing achievements, build back priority programs, and make faster progress in improving the health of our populations.

This transformation is particularly urgent so that we may:

• reduce maternal and child mortality more quickly;
• hasten elimination of cervical cancer, TB, HIV, malaria, leprosy, and other neglected diseases;
• strengthen and modernize immunization programs with renewed, high-level political and social commitment, new tools for analysis to identify groups that are being left behind and the barriers that hinder their access, and innovative communication and social mobilization strategies to recover adequate vaccination coverage;
• boost the use of telehealth and telemedicine as tools to achieve greater response capacity in Primary Health Care; expand access for all, especially those most vulnerable groups; and improve the quality of care, including mental health care.

We must urgently transform the excellent pilot projects which have already proved successful in the Region into policies for incorporation into health systems and into PHC.

4. The fourth pillar is to build resilient national health systems based on renewed and strengthened Primary Health Care.

PAHO stands ready to support countries in achieving sufficient public financing to ensure universal health systems, strengthen governance by their ministries of health, and ensure a sufficient and appropriately trained health workforce.

The core component of a resilient health system is efficient Primary Health Care, capable of concerted action for the promotion, prevention, surveillance, and care of the most prevalent health conditions in the communities it serves.

It is urgent that we prepare PHC to face the challenges posed by a complex epidemiological context and an aging population.

Such action requires the development and implementation of strategies to ensure adequate financing for the health sector, training and retention of human resources, improvement of information systems, the use of technologies such as telemedicine, and digital transformation.

Health systems must increase their capacity to identify barriers to access and establish strategies to address these barriers, while listening to population groups and communities.

We must not forget that we live in a region beset by historical inequities between and within countries. No health system can respond to the needs of the population unless it is permanently concerned with identifying those groups that are being left behind and promoting equity.

Indigenous peoples, Afro-descendants, poor families living in peripheral urban and rural areas, women, and LGBTQIA+ people need health systems to see them and hear them so that their needs are reflected in ensuring access to respectful and welcoming health care.

5. Finally, the fifth pillar is strengthening PAHO’s capacity to support Member States.

PAHO stands ready to move forward and further secure the advances that Dr. Etienne implemented during her term to streamline its management, promote increased transparency, and improve agility, efficiency, and gender equity.

Our staff, at Headquarters and in our Country Offices, is our greatest strength in providing high-quality technical cooperation. They are committed to the principles of the Organization and spare no effort to support countries as their endeavor to improve the health and lives of their populations.

I will always seek to recognize their achievements, keep an open and transparent dialogue, strengthen their growing professional qualifications, and maintain a respectful and welcoming work environment.

I will improve our prevention programs and zero-tolerance policy against any form of sexual harassment, exploitation, or abuse of PAHO employees or populations served by PAHO.

I will work tirelessly, with our qualified and committed personnel, to ensure that PAHO maintains all of its many achievements to date, renewing itself every step of the way, always building networks, and working as a bridge for understanding, solidarity, and innovation.

This is how I see our Organization: strengthening itself to respond to current and future challenges and to place health at the heart of the development agendas of the Americas.

Allow me to conclude in my mother tongue.

A CRITICAL INFLECTION POINT FOR HEALTH

Health has been the object of unprecedented attention since the start of this pandemic.

Never have people placed such value on universal systems that ensure access to testing, hospitals, vaccines, and medicines during a crisis of such dramatic proportions.

Never have heads of state, lawmakers, the media, and the general public given as much attention to health issues as in recent times.

It is urgent that we make use of this attention to strengthen health systems, address persistent issues and shortcomings, and ensure the right to health of all peoples in our Region.

It is urgent that we place health at the heart of economic recovery and of policies to fight poverty, which has grown so much these past few years. And we must consolidate health as the heart of effective, equitable development.

If we are to rise to this challenge, it will be more important than ever to strengthen the bridges between our countries and exercise solidarity.

I invite you all to five years of an intense and unceasing pursuit of actions to ensure that all people in the Americas can enjoy the highest attainable standard of health.

We know that national averages hide unacceptable inequalities. We know that poverty and illness exist in a vicious circle, because the poorest are those most likely to fall ill, and, in falling ill, become even poorer. PAHO stands ready to work with you all and contribute to a healthier, more equitable Region.

To borrow the words of a writer from Pernambuco, I define myself as neither an optimist nor a pessimist, but rather a hopeful realist. I am aware of the hardships and challenges that lie ahead, but also of the power we can harness when hearts and minds come together to turn dreams into reality.

CONCLUSION

One hundred and twenty years ago, our countries proposed an alliance to improve the health of our peoples and face outbreaks and epidemics together.

Building the necessary consensus to establish and strengthen this Organization was no easy feat. However, I am sure that our predecessors were only able to overcome such difficulty because they were driven by a dream.

The dream of pan-Americanism.

The dream that solidarity among the countries of the Americas is a powerful force that can improve the lives of our peoples.

As a poet from my country once said: “Dreams never grow old”. We stand here today, 120 years later, encouraged by these very dreams, which remain very much alive and continue to inspire us.

Muito obrigado. Muchas gracias. Thank you. Merci.

Dr. Jarbas Barbosa