Public Health

The political fallout of Argentina's dengue fever epidemic.

By Michael Shifter

Mexico's swine flu outbreak has captured the world's attention over the past two weeks. But Latin America's other, less-noticed epidemic is not only more severe, but may have more serious consequences for the government struggling to control it.

The worst outbreak of dengue fever in Argentine history has affected more than 20,000 people since the beginning of this year, including two children born with the disease and at least half a dozen people who died. A tropical disease transmitted by the Aedes aegypti mosquito, dengue is accompanied by severe flulike symptoms, but the vast majority of cases are not lethal. In Argentina, roughly 80 percent of the dengue cases have been in the predominantly poor, rural northern provinces of Chaco and Catamarca, but several cases have been confirmed in the capital, Buenos Aires.

Dengue fever is a wake-up call for one of Latin America's most prosperous and highly educated countries. Argentina enjoyed a period of robust growth between its devastating, unprecedented economic crisis in 2001 and the onset of the current global slowdown. The outbreak is disheartening for many Argentines who had begun to think their country had reversed its recent decline. Dengue is common in neighboring Bolivia, Paraguay, and Brazil, but until a decade ago Argentina had managed to escape the ravages of the fever.

Argentine President Cristina Fernández de Kirchner had already moved the midterm legislative elections up four months to June 28 to avert even greater political damage to herself and her Peronist party in a worsening economy. Now, her government's handling of the fever crisis has emerged as a potentially damaging campaign issue.

In the midst of their heated clash, both the government and the opposition have been criticized for exploiting the dengue epidemic for political gain. Fernández has been accused of downplaying the severity of the outbreak, resisting opposition pressure to declare a national health emergency. Meanwhile, some say the opposition is more focused on pointing fingers than finding a solution, failing to recognize government efforts after a slow start. As the author Mempo Giardinelli wrote in Argentina's left-leaning daily Página/12 on April 30, both sides are guilty of "prioritizing the elections over the health of the population."

Although they responded aggressively to prepare for the possibility of swine flu infection, Argentine officials did not immediately take sufficient measures to deal with the homegrown plague. The problem exposes serious deficiencies in the country's healthcare system -- another example of often precarious public services throughout Latin America.

Preventive measures aside, it is essential at least to have accurate and credible data on the status of the epidemic. Because the Fernández administration's statistics on inflation and other economic indicators are widely seen as underreported relative to rising prices, people are similarly suspicious of government figures related to the spread of dengue cases.

The handling of the dengue outbreak is emblematic of deeper governance and institutional weaknesses, particularly poor coordination and relations between provincial and federal governments. In just two years, the once unassailable public support for Fernández and her husband, former President Néstor Kirchner, has plummeted from about 70 percent to 35 percent. Polls indicate that growing insecurity in urban areas is the top public concern, while the perception of manipulated inflation figures and official corruption also stand out in this distressed economic environment.

Fernández is looking forward to the start of the Argentine winter on June 21, as the cold weather should help contain the fever. But she is most likely apprehensive about the critical elections a week later, when her government could possibly lose its current majority in the legislature. Whatever the outcome, the dengue epidemic has already helped put the country's deepening governance difficulties in even sharper relief.

Michael Shifter is vice president for policy at Inter-American Dialogue and adjunct professor of Latin American studies at Georgetown University's School of Foreign Service.

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Why Obama should appoint a special ambassador for the world's children.

By Jennifer Delaney and Diana Millner

Concerned with global problems from HIV/AIDS to lack of education to unaffordable vaccines, the world can easily sympathize with a child in need, as the Oscar buzz around Slumdog Millionaire has shown. Less attention, however, has been paid to the broken system in Washington that, at least in theory, coordinates the labyrinth of U.S. agencies supporting orphans and other vulnerable children globally.

Today, the flow chart on foreign-aid distribution would puzzle even a string theorist. Programs that support orphans and other vulnerable children abroad are spread across a dizzying number of agencies and offices within those agencies. Yet there is no common system across agencies to track the impact of U.S. programs on children's lives. In a 2007 study, the Government Accountability Office found that due to poor accounting standards at the U.S. Agency for International Development, "it is not possible to determine how much was actually spent on [child survival and maternal health] activities."

Worse, all of these agencies and offices have different goals, different directives, and different evaluation processes, none of which can be compared or compiled. In Uganda, two U.S. aid agencies, with overlapping agendas, were housed in the same building, but neither knew what the other was doing -- a foreign-policy version of a bad Marx Brothers routine.

In the past, the first lady would often moonlight as the country's de facto children's ambassador. But with 132 million orphans worldwide and 75 million elementary-school-age children out of school, more than half of them girls, a symbolic role for First Lady Michelle Obama is not enough.

The Obama administration should appoint someone with the focus and clout to untangle this mess: a children's ambassador.

Modeled after the Office of the U.S. Global AIDS Coordinator, which has done wonders to lower the number of HIV-positive orphans abroad, the ambassador would coordinate U.S. efforts, keep tabs on policy, and formulate responses to issues that affect children worldwide. As the president's envoy, the ambassador could engage heads of state and international organizations to build support for child-friendly policies, from reducing HIV transmission rates to ridding the world's armies of child soldiers.

With strong coordination, the possibilities are vast. Under the global AIDS coordinator, the United States has made significant progress in supporting children orphaned by HIV -- even if children living with AIDS are still about one third as likely to receive antiretroviral therapy as adults. Yet HIV/AIDS is not the biggest killer of children worldwide. Preventable illnesses such as malaria, pneumonia, and diarrhea are to blame for the most deaths.

The survival of these children living in poverty matters for many reasons: Children raised in physically and emotionally nurturing environments are more likely to develop intellectually and socially, allowing them to better contribute to society in the future.

To his credit, President Barack Obama has made children a priority of his administration. In his inaugural address, he called on Americans to end their "indifference" toward the world's poorest. Obama should follow up that pledge by appointing a children's ambassador. Unlike in the movies, orphans need more than luck or a lottery ticket to be rescued from the world's slums.

Jennifer Delaney is executive director of Global Action for Children. Diana Millner is executive director of Save Africa's Children.

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