Mexico’s president-elect Claudia Sheinbaum recently revealed some of her key cabinet choices, naming eminent physician and researcher David Kershenobich as the country’s new health secretary. When Kershenobich takes office in October he will be inheriting a healthcare system rife with medicine shortages, partially adopted systems and inadequate resources. However, rather than dismantle existing frameworks Dr Kershenobich says he plans to strengthen them.

 

Continuity Instead of Disruption

The 81-year-old Mexican doctor and researcher is a well-respected figure, known for his research career focusing on liver disease and for the leadership positions he has held at a number of prestigious institutions. He created the Mexican Foundation for Hepatic Health and served as its honorary president, was secretary of the Mexican General Health Council, president of the National Academy of Medicine, and most recently director of the Salvador Zubirán National Institute of Medical Sciences and Nutrition (INCMNSZ).

The newly chosen secretary is not a stranger to the sphere of public health, having sought universal vaccination of Mexican children against hepatitis B, as well as influencing public policies for the diagnosis and treatment of hepatitis C. He has also focused on designing actions to prevent non-communicable chronic diseases, such as reducing salt in bread and promoting breastfeeding. He does, however, have his work cut out for him. As one of the most criticized areas during outgoing president Andrés Manuel López Obrador’s six-year term, Mexico’s public healthcare system remains riddled with issues.

Where will Kershenobich begin and what are his priorities? Rather than dismantling current systems and structures as his predecessors were quick to do, Kershenobich plans to build on what is already in place. He said last month that his plans were to “above all, continue with the processes that already exist and propose how to continue advancing them.”

In a 2020 PharmaBoardroom interview as director of the INCMNSZ, Kershenobich commented on finding the right balance for Mexico’s healthcare system. But how will he find that balance? Apart from insisting that the priority for the Ministry of Health would be to “provide care for the entire population, regardless of whether they have employment insurance,” the newly chosen health secretary has not yet laid out any specific strategies.

 

“Healthy Republic”

However, during the presidential campaign, Sheinbaum did present her “Healthy Republic” scheme, which could give some clues as to the administration’s approach to healthcare. Kershenobich, who was already collaborating with the then-candidate, was on hand to explain this ten-point plan in further detail.

The main proposals in the plan, he outlined, were to maintain and strengthen the IMSS Bienestar system, retain consolidated medicine purchases through Laboratorios de Biológicos y Reactivos de México (Birmex), create an infrastructure project that would include digital health, focus on prevention and primary care, and reinforce vaccination programmes for children. By the looks of it, Kershenobich is set to pursue these proposals when he comes into office.

 

Medicine Shortages

Although he may not be aiming to disrupt and reorganize current healthcare systems, Kershenobich will encounter a number of challenges such as Mexico’s widespread medicine shortages.

Outgoing president López Obrador blamed these shortages, a problem that saw a 950-percent increase in the number of appeals for shortages, from 220 in 2018 to 2,307 in 2021, on pharmaceutical companies. He claimed they had monopolized the sale of overpriced medicines and set about implementing various schemes that did not manage to quell shortages, or the resulting protests against them.

One such plan was the so-called Megafarmacia del Bienestar, or Super Pharmacy, a huge 40,000 square metre warehouse near Mexico City he claimed would distribute medicines across Mexico. There has been little evidence of results thus far and when asked about the project Kershenobich only said that he would “continue to make progress towards achieving drug supply.”

Adoption of IMSS Bienestar, Budget

Dealing with the fallout of the ever-changing systems put in place by the previous government to guarantee access for the entire Mexican population is another issue Kershenobich will face. There was the Seguro Popular, a landmark government programme aimed at guaranteeing universal healthcare, then the Instituto de Salud para el Bienestar (Insabi), which took over from the Seguro Popular in 2020.

The COVID-19 pandemic did not help the newly created Insabi to get off the ground and in April 2023 it was absorbed by IMSS Bienestar. But so far not all of Mexico’s 32 states have adopted the programme —only those governed by the outgoing and incoming presidents’ MORENA party and their allies.

Yet a further difficulty for Kershenobich will be a significant lack of resources. Mexico’s public spending on health, which reached 3.4 percent of its GDP in 2003 and 2004, fell to just 2.7 percent in 2023. When asked about whether he would look to increase the budget, the newly chosen secretary said that the most important thing was to “provide quality and efficient coverage” and that he would start by reviewing processes to use the available budget in the best possible way.

 

Looking Ahead

While Dr Kershenobich’s academic and public health credentials are irrefutable, the decision to appoint an octogenarian to one of the key offices of the state could lead to heavy criticism of Steinbaum should the healthcare system continue to underperform. However, this has not been highlighted as a major issue in the Mexican mainstream media coverage, and Kershenobich has shown none of the frailties displayed by US President Joe Biden – also born in 1942 – in recent debates. Steinbaum will hope that this safe and experienced pair of hands can help steer Mexican healthcare out of its multiple current crises.

 

Image Source: INCMNSZ