By Lauren Villagran/El Paso Times

When COVID-19 still seemed far from upending life in the United States, two analysts in Washington, D.C., began worrying about the U.S.-Mexico border.

It was winter 2020 and the Wilson Center’s Andrew Rudman and Duncan Wood had seen little sign of the U.S. and Mexican governments activating the North American Plan for Animal and Pandemic Influenza, NAPAPI. 

They were concerned by what they saw coming, how badly Mexico could fare and what that could mean for the Borderland. The U.S. and Mexico would need a joint strategy to combat it — but the plan seemed to have been forgotten on the shelf.

“Insufficient attention has been paid thus far to the multiple ways in which public health impacts the security and prosperity of the region,” they wrote in a paper published in March 2020. “Of immediate and critical importance is the NAPAPI as a way of coordinating national responses to the COVID-19 crisis.”

In the wake of the COVID-19 disaster, health experts say the NAPAPI is a vital framework for countries seeking solutions for limiting the human and economic consequences of the next global pandemic. The Biden administration agrees and is working to revive it.

The U.S., Mexican and Canadian presidents reconvened the North American Leaders Summit last November for the first time since 2016. Out of that meeting came a new commitment to the NAPAPI, according to the White House. “Ending the COVID-19 pandemic and advancing global health” is the top deliverable, with re-envisioning the NAPAPI a key task.

“There is a big call for trilateral collaboration,” said Dr. Maria Julia Marinissen, health attaché for the U.S. Embassy in Mexico City and acting director of the U.S.-Mexico Border Health Commission.

“Based on COVID, the big commitment that was made is to revise the scope and update the North American Plan for Animal and Pandemic Influenza, the now famous NAPAPI,” she said. “So we’re really well on our way to redesign all that and do the lessons learned process. We need to improve and expand the collaboration in North America above and beyond just influenza pandemic.

The plan, known by its alliterative acronym, is an emergency manual for a three-country region in the throes of a health crisis: a guide to detecting, monitoring and controlling an outbreak; communicating public messaging; slowing the spread; reducing deaths and cushioning the social and economic impacts of a pandemic.

If it was employed extensively during the first two years of COVID-19, it wasn’t evident — not to analysts, border health workers, El Paso public officials or the city’s congresswoman. 

“There are folks in all three governments, in health and foreign affairs, that know of the existence of the NAPAPI,” Wood told the El Paso Times early in the pandemic. “We knew that the pandemic was coming and nobody convened a meeting.”

As much as it was a guide, the NAPAPI was also a promise. The three countries vowed “to strengthen their emergency response capacities as well as our trilateral and cross-sectoral collaborations and capabilities to assist each other and ensure a faster and more coordinated response.

The NAPAPI provides a policy framework to enhance trilateral collaboration to:

• Detect, monitor, and control influenza outbreaks and attempt to limit transmission between animals and humans as well as human to human transmission
• Facilitate communication among relevant authorities of the three countries in order to react and cooperate expediently in the case of an outbreak or a pandemic
• Prevent or slow the entry of a novel strain of human influenza into North America and the propagation of the virus whether it emerges within or outside North America
• Minimize illness and deaths; and
• Sustain infrastructure and mitigate social and economic impact

The urgency of a ‘binational response’

The Borderland ― defined as the region within 62 miles, or 100 kilometers, of the U.S.-Mexico dividing line ― is home to nearly 8 million people on the U.S. side and nearly 7 million people in Mexico, according to the U.S. Census Bureau and Mexico’s INEGI.

When COVID-19 struck, the stakes for U.S. border communities were high: None would be able to control the pandemic or reach herd immunity without Mexican border communities achieving the same on their side.

U.S. Rep. Veronica Escobar recognized that challenge early on.

In July 2020, she wrote an open letter to Presidents Donald Trump and Andrés Manuel López Obrador on the eve of their bilateral meeting in Washington, D.C.. They were meeting to celebrate the new U.S.-Mexico-Canada Agreement on trade. COVID-19 had already killed more than 130,000 people in the U.S. and 30,000 people in Mexico. The pandemic wasn’t the central focus.

“I think both Mexico and the U.S. had a ‘we’ve got this under control’ attitude,” said Rudman. “I’m not sure either government initially was taking it seriously.”

Escobar called on Trump and López Obrador to devise an urgent “binational response” to the pandemic.

“It is vital that you implement a robust border mitigation, testing and contact-tracing plan that protects our shared interests,” Escobar said in the letter. “Without a binational response, the lives, livelihoods, and economies of our border communities continue to be at risk; we need urgent action.”

Border restrictions define the response

The defining feature of the North American response to COVID-19 was instead to restrict non-essential travel at the U.S. borders — a response the NAPAPI signatories sought to avoid and warned could have little long-term value.

“Highly restrictive measures to control the movement of people, live animals and goods might initially delay but would not stop the eventual spread of a novel strain of human influenza within North America, and could have significant negative social, economic and foreign policy consequences,” according to the NAPAPI.

A key goal was to avoid “unnecessary interference” with international travel and trade.

“The NAPAPI outlines how the three countries intend to strengthen their emergency response capacities as well as our trilateral and cross-sectoral collaborations and capabilities in order to assist each other and ensure a faster and more coordinated response to future outbreaks of animal influenza or an influenza pandemic,” according to the agreement’s introduction.

The U.S., Mexico and Canada had known for at least 15 years that if a global pandemic ever hit North America, they would need to face the threat together, in close coordination. In the wake of avian flu, in 2007, the three nations created a detailed emergency plan to address disease threats.

The original framework was known as the North American Plan for Avian and Pandemic Influenza. In 2009, after Mexico’s bout with swine flu, or H1N1, the partners decided to update the plan and changed “avian” to “animal.”

The latest version, in 2012, was a product of two years of work by the North American Health Security Working Group’s technical and subject matter experts. The working group was overseen by the North American Senior Coordinating Body, comprised of assistant secretary-level senior officials from the health, agriculture, public safety, homeland security and foreign affairs sectors of the three countries.

“A critical element of the NAPAPI was to identify the relevant ministries and agencies in all three countries, as well as the existing national emergency plans,” said Rudman and Wood in their paper. “This preliminary exercise helped the parties to bring together relevant agents and to coordinate their actions and responses prior to and during a pandemic.”

According to Rudman and Wood, the countries committed themselves to specific actions. They would:

• Develop streamlined cross-sectoral mechanisms, including up-to-date contact lists for each country, for sharing communications strategies and plans and for identifying and addressing emerging issues;
• Establish procedures and mechanisms for sharing pre-release strategies and plans during an outbreak, including public messaging;
• Share best practices and social science knowledge, including behavioral research, to inform communications planning;
• Share research and communications strategies on vaccine safety and effectiveness, animal health, food safety;
• Commit to developing opportunities to exercise the planned response; and
• Share any post-event evaluations or “lessons learned.”

With the COVID-19 waning somewhat in North America, there is a risk that the U.S. and Mexico move on too quickly, Rudman said.

“In the throes of it, you deal with it and you promise you are going to learn the lessons,” he said. “But you get through the crisis and you are relieved and you move on.”

Lauren Villagran can be reached at lvillagran@elpasotimes.com.