Tatiana Gardellini

La pandemia de COVID-19 constituyó uno de los mayores desafíos para la salud pública global del siglo XXI y expuso profundas desigualdades estructurales en el acceso a tecnologías sanitarias esenciales. Aunque el desarrollo acelerado de vacunas representó un logro científico sin precedentes, su distribución estuvo condicionada por factores económicos, políticos y geopolíticos que favorecieron a los países con mayor capacidad financiera y tecnológica. El presente ensayo analiza las inequidades en el acceso a las vacunas contra la COVID-19 desde la perspectiva de la salud pública internacional y la gobernanza global de la salud. Se examinan las relaciones de poder entre Estados, organismos internacionales y corporaciones farmacéuticas, así como el impacto del nacionalismo vacunal, la protección de la propiedad intelectual y las limitaciones de los mecanismos multilaterales de cooperación. Asimismo, se analiza cómo estas dinámicas profundizaron las desigualdades sanitarias y afectaron los determinantes sociales de la salud, especialmente en los países de ingresos bajos y medianos. Se dedica especial atención a América Latina y el Caribe, región que enfrentó importantes barreras para acceder oportunamente a las vacunas debido a limitaciones estructurales, dependencia tecnológica y capacidad restringida de producción. Finalmente, se destaca la necesidad de fortalecer la cooperación internacional, la soberanía sanitaria regional y los mecanismos de preparación ante futuras emergencias de salud pública.

Malaria is still one of the biggest global health problems, especially in parts of the world, such as sub-Saharan Africa, which remains most heavily affected. Despite significant advancements in testing, treatment, and prevention, malaria continues to seriously impact millions, primarily young children and populations in rural and impoverished areas. This paper looks at how the malaria parasite works inside the body, how it avoids the immune system, and how it becomes resistant to current drugs. Thanks to new advances in genetic and biochemical research, scientists are discovering new weak points in the parasite that could lead to better treatments. New vaccines, like RTS, S and R21, along with antibody-based therapies, offer renewed hope; however, extending the duration of the immunity they induce and ensuring effectiveness across diverse parasite strains remain significant challenges. Solving the malaria crisis will require more than science—it also necessitates equitable and timely access to treatments, robust health systems, and international collaboration. Continued research and global cooperation bring the world closer to ending malaria for good.

Ecuador has gone through a significant reduction in new cases from 2000 (106) to 2023 (12), suggesting a trend towards zero leprosy. An ecological spatiotemporal study design was used to describe the epidemiological distribution of the disease in the country during 2000–2023. Leprosy cases registered by the surveillance system of the Ecuadorian Ministry of Public Health were the data utilized for the study. From January 2000 to December 2023, 1539, incidence cases were diagnosed with leprosy in Ecuador. At the time of diagnosis, the median age was 54 years. Most of the cases were males (71.5%). The proportion of incidence cases in subjects over 50 years was 63% and 1.5% in children ≤ 15 years old. The yearly incidence rate ranged from 8.5/1,000,000 population in 2000 to 0.68/1,000,000 population in 2023, remaining within the low-endemic parameter. In total, 35 cantons reported newly detected leprosy cases in the year 2000. By the end of 2023, only eight cantons actively reported cases of leprosy. High-risk clusters for leprosy were detected in the tropical coastal region of Ecuador. The provinces with the highest number of cases during the study period were Guayas (44.8%) and Los Rios (15.7%), with zero cases being found in the Galapagos Islands. Our study is unique in that it documents a retrospective dataset over a two-decade timespan from a South American country that has effectively applied global guidelines for the control and elimination of leprosy.