When COVID hit, a border health commission found itself on life support
The U.S.-Mexico Border Health Commission's brightly lit corner office in a brick building at 211 S. Florence St. had been the place for public health workers on both sides of the border to meet, plan and work together on health issues ranging from tuberculosis and Zika to sexually transmitted diseases.
For two decades, the commission delivered crucial federal backing to local health initiatives in the Borderland.
But the U.S. section of the commission found itself in shambles during the COVID-19 pandemic just when experts say it was needed most to coordinate binational communication from the U.S.-Mexico border.
As border communities evaluate lessons learned in the pandemic in hopes of doing better next time, borderland health experts say reactivating the U.S.-Mexico Border Health Commission is one place to start.
"So many people had dedicated their lives to have an institution on the border, for the border, run by borderlanders — yes, with counsel and support from the federal governments — but overseen and exercising leadership in border health," said Eva Moya, an associate professor of social work at the University of Texas at El Paso who served as director of the U.S. section of the commission from 2000 to 2005.
Maria Julia Marinissen, the commission's acting director, said the Biden administration is committed to strengthening the commission and dismissed concerns about any absence on the U.S. side as stemming from "the rumor mill."
"There is no abandonment," Marinissen said during a video call from her office in Mexico City. "The vision is to definitely strengthen the commission and, as I say, give the commission a voice that perhaps it didn't have during the past four years."
COVID-19 slammed both sides of the border within days of each other, taking thousands of lives in waves that hit in mirrored moments. The cost of not engaging in a binational strategy to combat the pandemic was immediate, measured in more than 7,800 lives lost in El Paso and Juárez. Restrictions on non-essential travel at the U.S.-Mexico border separated families and businesses from loyal customers for more than 20 months.
The pandemic also exposed the Borderland's extreme vulnerabilities: Juárez residents suffer the same high rates of obesity, hypertension and diabetes that put El Pasoans at increased risk of complications.
By May 2021, when the commission left its long-time office, any illusion U.S. border communities had that they could overcome the pandemic without coordinating with sister communities in Mexico had evaporated. Even with restrictions on non-essential travel, people were crisscrossing between El Paso and Juárez hundreds of thousands of times each month, reflecting one tightly woven community.
Viewed through the lens of epidemiology, El Paso and Juárez are inseparable.
The commission is "a model for collaboration and cooperation," said Dr. Manuel de LaRosa, vice president for community engagement at Texas Tech University Health Sciences Center and a commission member. "Whether you're Mexican or you're American, you're really a border resident."
"That was the whole concept of the border health commission: Administrations come and go, but people on the border still have problems to solve and look towards each other to solve them," he said.
An 'international leader' in public health
Border communities have always maintained their own formal and informal networks to talk about public health — physician friendships, binational councils and, in COVID-19, even a WhatsApp chat with dozens of participants in El Paso and Juárez.
But the U.S.-Mexico Border Health Commission kept the U.S. and Mexican federal governments informed and involved. It provided a conduit for funding border-wide projects, from early warning disease surveillance to tuberculosis contact tracing, health fairs and work groups to resolve shared problems in infectious and chronic disease.
The commission's offices span the two countries' nearly 2,000-mile border, with a U.S. headquarters in El Paso and the Mexico flagship in Tijuana.
"It is a little-known operation," Jimmy Kolker, former assistant secretary for global affairs in U.S. Health and Human Services, told the Senate Foreign Relations Committee in June 2020, "but when we think about border security it is really important to also think about border cooperation."
He called the commission "a great example where the four U.S. border states and five Mexican border states meet regularly to exchange information about health threats with direct involvement of the populations that live across the border and state departments of health."
In the commission's former Downtown office, a plaque outside its double doors advertised the commission's binational nature, with twin logos for the U.S. and Mexico sections.
The abandoned office is a testament to ties severed during the President Donald Trump years, Moya said.
"The mission of the organization is to be an international leader in people's health at the border. That is why it was created," she said. "So, the question is, where was the commission? And the question remains, where is the commission?"
A cradle of binational cooperation
There is evidence that the idea of "border public health" was born in El Paso and Juárez, sister cities that became an early cradle of binational cooperation, according to Julie Collins-Dogrul, an associate professor of sociology at Whittier College in southern California.
The U.S. and Mexico first began cooperating on syphilis control in the 1940s in El Paso and Juárez, and later tuberculosis, through the Pan American Sanitary Bureau. The bureau's El Paso field office became the first public health organization at the U.S.-Mexico border and predated the birth of the World Health Organization, Collins-Dogrul said.
The U.S.-Mexico Border Health Commission was a grandchild of those early initiatives — and no small feat.
The U.S. relationship with Mexico has long been characterized by bouts of friendship punctuated by fits of distrust. When health crises hit, calls for cooperation have sometimes been drowned out by each side blaming the other for its troubles.
In 1917 the U.S. responded to typhus by issuing an "iron-clad quarantine" against Mexicans and requiring they be "disinfected" at the border to control the disease. Mexico retaliated by detaining 200 U.S. citizens who crossed south because they weren't carrying certificates of disinfection, according to Collins-Dogrul.
But in the 1980s and 1990s, "physicians in El Paso and Juárez were concerned there needed to be better coordination between the two nations on matters of public health," said Steve Mumme, a political science professor at Colorado State University who has studied the commission. "It just seemed like an area that was crying out for greater binational coordination and better integration, if not of direct resources, of cross-border communication of health conditions."
After years of diplomatic groundwork, in July 2000, the U.S. and Mexico health secretaries signed the agreement that formed the U.S.-Mexico Border Health Commission.
In California, beginning in 2010, the Commission sponsored a program called Leaders Across Borders. The 10-month program taught health professionals and community leaders "health diplomacy" and how to design projects to address the needs of underserved communities in the Borderland.
For a time, the commission was one of three major transnational organizations focused on cross-border health, including the United Nations' Pan American Health Organization, or PAHO, and the U.S.-Mexico Border Health Association. PAHO closed its El Paso field office in 2013 and the association held its last annual meeting in 2009.
That left the commission.
Although the Trump administration shepherded an important bilateral accord in the United States-Mexico-Canada Agreement on trade — a new NAFTA — the administration let other collaborative efforts with Mexico fall by the wayside. The North American Leaders Summit, an important forum for discussions on regional security, immigration, health and other issues, stopped during the Trump presidency.
The U.S. side of the border health commission lost roughly half its budget, with overall funding dropping to $1.1 million in fiscal 2020 from $2.2 million in fiscal 2016, according to the U.S. Department of Health and Human Services.
The effect was chilling.
"The Commission’s strong connection to (both) federal governments at one time was viewed as a strength, but in the Trump era, this was a weakness, and his government withdrew support," Collins-Dogrul said. "The commission in the U.S. still existed in name but it was curtailed, and unable to provide leadership when the COVID-19 crisis hit the world and the U.S.-Mexico border."
'We've tried to keep advancing'
Dr. Martha Sánchez's office is tucked inside the busy Chihuahua state health department complex on Paseo Triunfo de la República in Juárez. A map on the wall shows the length of the U.S.-Mexico border region; a bookshelf holds 13 copies of the "English-Spanish Dictionary of Health-Related Terms."
"Things had changed even before the pandemic," she said.
The budget cuts in the U.S. led to reduced collaboration between the U.S. and Mexico, she said, given that both countries had agreed to fund projects 50-50. "Even still, we've tried to keep advancing, to keep doing activities," Sánchez said.
Despite the vacuum in federal leadership in border health, locals have carried on nurturing cross-border ties. Sánchez and other Juárez-based colleagues show up for the local collaborations the commission was supposed to amplify.
On a recent February afternoon, Sánchez joined public health colleagues in southern New Mexico and El Paso, virtually, to share a range of initiatives in the Borderland — studies on the health of migrants in Juárez; El Paso's plans to join a Centers for Disease Control study on wastewater; the role of promotoras in COVID-19 vaccine campaigns in southern New Mexico.
Also on the Zoom call was Angela Mora, El Paso's deputy director of public health. She ended her presentation on the CDC project with an invitation to her Spanish-speaking colleagues: "Aquí tienen su casa," she said. "We'd like to have a closer relationship with you."
A binational strategy on public health
As she watched her community plunge into despair in the fall of 2020, U.S. Rep. Veronica Escobar (D-El Paso) intensified her calls on the Trump administration to work with Mexico to develop a binational strategy to combat the pandemic at the border.
Intensive care unit beds were full, and El Paso had called in 10 mobile morgues to handle the dead. In Juárez, where COVID-19 tests were hard to come by, medical professionals were attributing hundreds of ill-counted deaths to "pneumonia," even when many suspected the novel coronavirus.
The binational strategy never came to fruition — not under Trump and not yet under Joe Biden, either.
Echoing legislation first proposed by former New Mexico Sen. Tom Udall, Escobar introduced bills that would revive the U.S.-Mexico Border Health Commission with new funding and redefined responsibilities. She said she sees in the commission "a vehicle that, in my view, is under-utilized, under-resourced, under-invested in and I want to see that change."
She had dealt with the commission in her previous roles in county government, she said, and rediscovered it during the pandemic when she became frustrated with the lack of high-level strategic leadership on border public health.
"I remember having a conversation with my legislative team," she said, "Like, 'I know somebody has got to be in charge of this. I know we're not reinventing the wheel.'"
Escobar introduced H.R. 1538, the Binational Health Strategies Act of 2021, on March 3, 2021. The bill, with eight Democratic co-sponsors and Republican Rep. Tony Gonzales of Texas, directs Biden to begin negotiations with Mexico to address infectious disease preparedness in the U.S.-Mexico border area and requires the border health commission to submit a binational strategic plan on COVID-19 and for future pandemics.
Separately, Escobar's H.R. 4812, co-sponsored by seven Democrats, would reestablish funding for the commission and task it with improving the health of border residents, engaging in cross-border infectious disease surveillance and creating a system to alert clinicians and public health officials to emerging health threats in border areas. She introduced that bill on July 29, 2021.
The day after each bill's introduction, the House Committee on Energy and Commerce referred it to the subcommittee on health, where both bills have languished for months.
'Put our act together'
The U.S.-Mexico Border Health Commission found a new home in El Paso, according to the General Services Administration, which manages federal properties and leases.
GSA said it assigned and renovated a smaller space for the commission in El Paso's R.E. Thomason Historic Courthouse at 511 E. San Antonio for a 10-year term. But no one has moved in.
Marinissen said the office's two remaining staffers have been teleworking, per federal rules in the pandemic.
At the same time, she said, "We put a lot of emphasis in the last four or five months in reshaping our side, and that's why it took a little bit to sort of put our act together."
The 1,474-square-foot office in the historic federal building faces south. Its double doors were locked on a recent Monday in February; there was no sign of the commission's logo, only a paper taped to the door that read "Suite 306."
"It was one of the greatest mistakes to have essentially dismantled the organizations that could have been deployed binationally to create a strategy — PAHO, for example, or the Border Health Commission," said Tony Payan, director of Rice University's Center for the United States and Mexico.
"I hope that we learned the lesson," he said, "that we need to restore for the future some institutional arrangement that will be called upon quickly to act if there is another emergency such as a pandemic."
If there is any question about the need for a binational institution dedicated to public health, Moya, the former commission director, echoed a refrain that has been a motto for global health experts for nearly a century:
"Disease knows no border," she said. "It travels beautifully north, south, east and west. It doesn't carry any type of border visa or card. And therefore it will kill at will."
This article first appeared on El Paso Matters and is republished here under a Creative Commons license.
This story was produced as part of the Puente News Collaborative, a binational partnership of news organizations in Ciudad Juárez and El Paso.