Costa Rica has been facing COVID-19 following three major principles in trying to protect the people. Moving fast, basing our decisions on available scientific evidence, and considering the need to explain and convince our people of doing the right thing. We support our actions on specialist opinions and recommendations coming from our social and health Institutions.
After the celebration of our Bicentennial Anniversary in 2021, we recognized that we have been privileged for over 100 years with a strong Health Sector. This demonstrates our belief that health is an undeniable human right for everyone. Because we abolished the army 75 years ago, we were able to invest better in health and education.
The first Review of the System of Health Accounts: Costa Rica 2011-2016, details that in 2016 spending was 7.8% of GDP, with a sustained average of at least 8% in the previous 5 years. Unsurprisingly, using our health policies as a “spearhead” we started to become endorsed by the OECD Technical Committees in 2016 shown in the OECD Reviews of Health System: Costa Rica 2017 report. But, unfortunately, investment in health has been decreasing recently, and in 2019, we were able to reach 5,6% of GDP as public expenditure in health, according to the Review of the System of Health Accounts: Costa Rica 2017-2022. We should reach 6% again and invest better.
The Caja (CCSS), is our social security institution founded 82 years ago and is our main healthcare provider, offering renowned universal coverage, according to the research published in The Lancet as Health-system reform and universal health coverage in Latin America and based on a strong primary care network call Basic Teams of Integral Health Care (EBAIS). It is the largest company in the region and its annual budget exceeds $10 billion.
Between 2017 and 2018, $1.15 billion was invested in renovating infrastructure, programs for chronic diseases control, training epidemiologist, the Single Digital Health File (EDUS), and in financing the first Emergency Medical Team (EMT) in the Americas accredited by PAHO/WHO in 2016.
In 2018, the EDUS, became the first in the Americas with universal coverage in the 3 Levels of Care including the EBAIS and received the United Nations Public Service Award 2019. Its app has more than 5 million free downloads in a country with a population of more than 5 million and was used to identify the level of risk of contagion by COVID-19. The digitization of the health sector (2014-18) and telemedicine have been fundamental. Since April 2020, 60% of specialized consultations were by videoconference and medications for at-risk patients are distributed in paper bags to their homes.
Also, in 2016 we invested in medical equipment such as ventilators or mechanical respirators that in 2018 reached the level of 8 for every 100 thousand inhabitants. In January orders were made to increase this by 80% and now we have produced our own ventilators and masks too. Innovation and creativity have been pushed to the limit. The CCSS transformed one of the specialized centers into a COVID-19 Patient Care Center (CEACO) in 11 days. The new coronavirus is here to stay.
But we have previously faced novel epidemics or pandemics. For example, Dengue, Chikungunya or Zika, are all transmitted by Aedes. Or pandemics such as HIV/AIDS, treated in a dignified way, or H1N1 influenza.
Against old acquaintances, in 2016 we were recognized by PAHO/WHO for our elimination of Measles and Rubella and given the certification of Malaria Champion of the Americas. Thanks to the intense control of vectors and the solid National Vaccination Scheme (with 96% coverage in 2018), recently reinforced by increasing influenza vaccinations in 2016 and adding two new vaccines (Rotavirus and HPV) in 2017-18.
Experience has shown us that it is essential to protect the most vulnerable. Against COVID-19, we have protected older adults and young people with health and social risk factors.
From the beginning, Costa Rica carried out an aggressive “track and trace” of every Covid-19 case. Evidence of this is that before confirming our first case on March 6, several suspects from abroad had already been ruled out. The Costa Rican Aqueduct and Sewer Institute (AyA), which is the main water administrator in the country, is detecting traces of the virus SARS-CoV-2 in wastewater of small towns, buildings and specific areas. Costa Rica was able to develop its own COVID-19 detection test.
In the beginning, we had to closed borders, tourism, massive events, discotheques, bars, and scholarly activities but, while keeping restaurants running at 50% of capacity, full industrial production, basic commerce, and trade. We applied social distancing without “turning off" the country, based on citizen obedience and conviction of society. Because we do not have an army since 1948, we cannot force people to do so. We apply a “moderated” lockdown. But now we are completely open, and we can offer a safe environment receiving tourism again from 2022.
The CCSS in conjunction with the Clodomiro Picado Institute was able to produce various types of SARS-CoV-2 antivirus serum, because of a long experience producing anti-venoms for snakebites. In 2017, the WHO has placed snakebite envenoming as a neglected disease, accepting the proposal of Costa Rica. But also, clinical trials are on the way, we already have a genetic map of virus strains and biomedical research that is running again since 2015, will provide us final conclusions.
In the same way, WHO and Costa Rica preview technology pooling initiatives to ensure access to COVID-19 health products for all. Our proposal was made, to seek wide access to health technology for the people of poor countries facing COVID-19. The COVID-19 Pool has received the support of 37 countries and two Nobel Prizes winners, and it is still growing.
For Costa Rica, Health has always been a political option and we have never stopped investing in providing people with access to health.