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Latin America and the Caribbean’s Growth Will Slow to 2.1% in 2022 amid Significant Asymmetries between Developed and Emerging Countries

In its annual report Preliminary Overview of the Economies 2021, ECLAC emphasizes that 2022 will be a year of major challenges for growth, job creation and tackling the pandemic’s social toll.

(January 12, 2022) The Latin America and Caribbean region will see its pace of growth decelerate in 2022 to 2.1%, after reaching 6.2% on average last year, according to new projections released today by the Economic Commission for Latin America and the Caribbean (ECLAC).

This slowdown takes place in a context of significant asymmetries between developed, emerging and developing countries with regard to the capacity to implement fiscal, social, monetary, and health and vaccination policies for a sustainable recovery from the crisis unleashed by the COVID-19 pandemic.

This is according to the annual report by ECLAC entitled Preliminary Overview of the Economies of Latin America and the Caribbean 2021, which was unveiled today during a virtual press conference held from Mexico City by the United Nations organization’s Executive Secretary, Alicia Bárcena.

The document indicates that the region is facing a very complex 2022: uncertainty regarding the pandemic’s ongoing evolution, a sharp deceleration in growth, continued low investment and productivity and a slow recovery in employment, the persistence of the social effects prompted by the crisis, reduced fiscal space, increased inflationary pressures and financial imbalances.

“The expected slowdown in the region in 2022, combined with the problems of low investment and productivity, poverty and inequality, calls for growth and employment creation to be central elements of public policymaking while at the same time addressing inflationary pressures,” Alicia Bárcena stated.

According to ECLAC, the 2.1% average growth foreseen for this year reflects great heterogeneity among countries and subregions: the Caribbean will grow 6.1% (excluding Guyana) and Central America will grow 4.5%, while South America will expand by 1.4%. Meanwhile, in 2021, the region experienced higher-than-expected growth, averaging 6.2% due to the low baseline established in 2020, to greater mobility and to a favorable external context.

According to the Preliminary Overview 2021, estimates point to advanced economies growing by 4.2% in 2022, being the only ones to resume the growth trajectory foreseen before the pandemic over the course of this year. Emerging economies, meanwhile, are seen growing 5.1% in 2022, but they will only resume the growth trajectory forecast before the pandemic in 2025. In 2021, 11 countries in Latin America and the Caribbean managed to regain the GDP levels seen prior to the crisis. In 2022, another three countries will join them, accounting for a total of 14 countries of the 33 that make up the region.

It is of central importance that the combination of monetary and fiscal policies prioritizes growth stimulation as well as inflation containment, ECLAC adds. This entails the need for coordinated fiscal and monetary policies and the use of all available instruments to adequately prioritize the challenges of growth with monetary-financial stability.

In terms of the labor market, employment recovered at a slower pace than economic activity last year: 30% of the jobs lost in 2020 had not been recuperated by 2021. Furthermore, the inequality between men and women was accentuated, reflecting the larger care burden on women and less dynamism in the sectors in which female employment is concentrated, such as services. In 2022, ECLAC projects an 11.5% unemployment rate for women – slightly below the 11.8% recorded in 2021, but still well above the 9.5% existing before the pandemic in 2019 – while unemployment among men is forecast at 8.0% this year, nearly identical to that of 2021 (8.1%) and still far above the 6.8% seen in 2019.

The report also addresses one of the most worrisome economic issues today at a regional and global level: the rise in the price of products and services. In 2021, inflationary pressures were observed in the majority of the region’s countries, led by price increases in food and energy (inflation reached 7.1% on average by November, excluding Argentina, Haiti, Suriname and Venezuela), and these pressures are expected to continue in 2022. Countries’ central banks anticipate that inflation levels will remain above the target range established, although they will tend to converge towards the end of 2022 or early 2023. Once again, the price of energy and food in international markets, along with the evolution of the exchange rate, will be critical to determining future price dynamics.

ECLAC underlines that inflation is a multicausal phenomenon, which means that monetary authorities should continue utilizing the full range of instruments (monetary, foreign exchange, and macroprudential) that they have, beyond the interest rate, to confront inflationary pressures without hindering the impetus for recuperating growth and employment and attaining sustainable, inclusive and more equal growth, the document indicates.

In addition, the United Nations organization emphasizes that it is crucial to increase tax collection levels and to improve the tax structure to give fiscal sustainability to a growing trajectory of expenditure demands. The challenges foreseen in 2022 – including lower economic growth, the risks of higher interest rates, currency depreciations and the possible weakening of sovereign credit ratings – make fiscal policy management more complex. That is why a strategic vision for public spending is required that would link short-term demands with long-term investments and contribute to closing social gaps. In addition, fiscal space must be expanded by eliminating tax evasion (which amounts to $325 billion U.S. dollars, or 6.1% of regional GDP), consolidating income taxes on individuals and corporations, extending the scope of taxes on assets and property, establishing taxes on the digital economy, environmental levies and others related to public health problems, and progressively revising and updating royalties for the exploitation of non-renewable resources.

In another area, financing for development is also key for supporting policy spaces and investment. It is necessary to expand and redistribute liquidity from developed countries to developing countries; strengthen development banks; reform the international debt architecture; provide countries with a set of innovative instruments aimed at increasing debt repayment capacity and avoiding over-indebtedness; and integrate liquidity and debt reduction measures into a resilience strategy geared towards building a better future.

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Karen Weintraub  USA TODAY

A Maryland man has lived for three days with a pig heart beating inside his chest.

The surgery, at the University of Maryland Medical Center, marks the first time a gene-edited pig has been used as an organ donor.

Dave Bennett, 57, agreed to be the first to risk the experimental surgery, hoping it would give him a shot at making it home to his Maryland duplex and his beloved dog, Lucky.

“This is nothing short of a miracle,” his son David said Sunday, two days after his father’s life-extending surgery. “That’s what my dad needed, and that’s what I feel like he got.”

In the nine-hour surgery, doctors replaced his heart with one from a 1-year-old, 240-pound pig gene-edited and bred specifically for this purpose.

Bennett is breathing on his own without a ventilator, though he remains on an ECMO machine that does about half the work of pumping blood throughout his body. Doctors plan to slowly wean him off.

Scientists have worked for decades to figure out how to save human lives with animal organs. More than 100,000 people sit on organ transplant waitlists, suffering terrible symptoms and side effects. About 6,000 of them die every year waiting in vain for someone else’s tragedy to provide them with a kidney, heart or lung.

Pigs have similar organs to humans. If those organs could be used in transplants, the waiting would end. People who would never be considered candidates for transplants – who never make it onto those transplant lists – could look forward to family dinners, playing with their kids or grandkids and simply going back to living their lives.

That’s the promise of so-called xenotransplantation. And the field took a major leap forward with Bennett’s surgery Friday.

“This is a truly remarkable breakthrough,” said Robert Montgomery, a transplant surgeon at NYU Langone and a heart transplant patient himself. “I am thrilled by this news and the hope it gives to my family and other patients who will eventually be saved by this breakthrough.”

In September, Montgomery moved the work forward by becoming the first to transplant a pig kidney into a person, but in that case, and a subsequent surgery in December, the person had been declared brain dead. Montgomery kept the body functioning via machine for more than two days each time, showing that the human immune system would not immediately reject a kidney from a gene-edited pig.

The Maryland procedure “takes what we did in September of 2021 to the next level,” Montgomery said. “At that point, the race was on.”

Others in the field were supportive, if a bit envious.

“We’ve all been doing this for a really long time, and I’m sure it’s got to be fun to be first,” said Joseph Tector, a transplant surgeon and xenotransplantation researcher at the University of Miami.

Tector, who focuses on kidney transplants, said he’s waiting until he’s confident he can provide reliable, durable results, “so that when we do it, we can help everybody.”

Animal rights activists object to the use of pig organs. There would be more human organs available for transplant if health authorities assumed everyone was an organ donor unless they opted out, instead of the opt-in system.

Ethicists have fewer concerns. 

Animal trials are essential to begin a new therapy in humans, said the Rev. Tadeusz Pacholczyk, director of education at the National Catholic Bioethics Center in Philadelphia.

Despite years of research, “there are sure to be many more twists and turns along the road of getting our immune system to play nice with implanted animal organs,” Pacholczyk said. “I suspect this is a first step on the journey from yesterday’s ‘scientifically unimaginable’ to today’s ‘barely achievable’ to tomorrow’s ‘standard of care.’”

Patient experience

Bennett, who has been relatively healthy most of his life, began having severe chest pains in October, his son said.

He went into the University of Maryland Medical Center with severe fatigue and shortness of breath. “He couldn’t climb three steps,” said David, a physical therapist who understood the seriousness of his dad’s condition.

Two months of trying to save Bennett’s own heart didn’t work. A handful of transplant programs either formally or informally rejected him for a heart transplant. He was deemed ineligible for an artificial heart pump because of uncontrollable arrhythmia.

About 3,000 Americans a year are lucky enough to get a new heart, and 20% of those who make it to the waitlist die waiting or become too ill to receive one.

Bennett didn’t qualify for the list, because he had not followed doctors’ orders, missing medical appointments and discontinuing prescribed medications. History has shown that people with that kind of track record don’t do well with an organ transplant.

At first, Bennett didn’t want to participate in the experimental surgery. He had worked odd jobs his whole life – pool repairs, car maintenance, painting – depending on his physical strength, but two months in the hospital had made any kind of surgery risky. He didn’t want to die on an operating table.

Bennett had a change of heart, his son said, when he realized he would probably never be able to leave the hospital otherwise.

“He knew that this was his best option,” David said. “He’s a fighter and has a desire to live.”

Although Bennett has a long way to go, David said he’s optimistic about his father’s future.

“My dad has told both of his sisters and myself, ‘Don’t worry. God is holding my hand,’” David said, describing his father as a man of faith, though not tied to any particular religion. “I believe there’s continued reason to be hopeful.”

Even if it doesn’t change his outcome, the surgery allows Bennett to leave a legacy, David said.

“Regardless of what happens, I want to help other people,” Bennett told his son before the surgery.

Bennett had a pig valve implanted almost a decade ago, and bacon is his favorite food, so the idea of receiving a part from a pig didn’t bother him much, David said, although he still hopes he’ll be able to get a human heart.

Perhaps after six months of showing he can follow doctor’s orders, he’ll be a better candidate for a heart transplant, and the pig heart will serve only as a bridge.

“The last evening I talked with the patient, he said, ‘I really want to have a human heart,’” said Dr. Bartley Griffith, who led the surgery for the University of Maryland Medicine. “I said, ‘I want you to have a human heart. … It would drive us crazy to take that nice (pig) heart out, but it would be your choice.’”

The hardest part of undertaking such experimental surgery, Griffith said, was talking to Bennett beforehand.

“You’re not afraid of demonstrating to the FDA and to the hospital and to your chairman and to your partners that you’re ready, because you’ve got confidence in that, in yourself,” he said. “I think the fear is in being honest to your patient.” 

The surgery was experimental and its outcome was uncertain.

“You’ve got to tell the patient that in essence, we’re ready for liftoff,” Griffith said, adding that others compared him to a shuttle astronaut. “But I kept reminding people: we’re in the control room. It’s the patient who’s shot to the moon.”

Three experiments in one

For years, the researchers in Maryland and elsewhere have experimented with implanting gene-edited pig organs into baboons.

The University of Maryland Medicine team, co-led by Dr. Muhammad Mohiuddin, has kept baboons alive for as long as nine months, when they died of something other than immune rejection. They felt ready to try the procedure in a person.

Taking care of a patient, said Mohiuddin, who directs the University of Maryland School of Medicine’s program in cardiac xenotransplantation, “it’s much, much easier than taking care of a baboon.”

Pulling off the procedure required the right patient – a willing volunteer who had no other medical options – as well as support from the hospital system and three separate approvals from the Food and Drug Administration. (The hospital and academic institution would not reveal the cost of the procedure but picked up any fees not covered by insurance.)

The process began Dec. 15, when Bennett agreed to consider the procedure. Maryland officials scrambled to provide an application to the FDA on Dec. 20, requesting “compassionate use” authorization to proceed.

Then they had to answer a slew of questions, including about the pig.

The pig, provided by Blacksburg, Virginia, company Revivicor, which raises pigs for transplant, was genetically modified in 10 different spots before birth.

“There are 100,000 genes in the pig,” Griffith said Sunday afternoon in a Zoom interview, along with Mohiuddin. “Muhammad wants me to believe that by changing 10 of them, we can transplant a pig heart into a human. Are you kidding?”

“You did it,” Mohiuddin responded, laughing.

Three genes were turned off that might otherwise have triggered an immediate immune rejection – the recognition of a pig organ as coming from a different species. Six human genes were added to prevent blood from coagulating in the heart, improve molecular compatibility and reduce the risk of rejection.

One final gene was turned off to keep the pig from growing too large.

The 1-year-old pig that gave its heart to Bennett weighed about 240 pounds; a standard male pig of the same age might weigh 450 pounds, said David Ayares, Revivicor’s executive vice president and chief scientific officer.

Researchers learned from studies in baboons that without editing out this growth gene, even an organ taken from a young animal would keep growing. In a couple of the baboons, the transplanted pig hearts grew too big for their chests.

“We’ve marched down this road over the last decade, going from a one-gene pig to a two- to a five- to an eight to a 10, and we rationalized each of those and made modifications along the way,” Ayares said.

Ayares has worked for two decades to develop pigs that are suitable for human transplant. Pigs bred to provide kidneys for transplant may need only one gene turned off to avoid immediate organ rejection. Pigs bred for their hearts probably need 10, Ayares said, to allow them to function effectively and safely. 

Revivicor’s parent company, United Therapeutics, aims to get into pig-to-human lung transplants, whose pigs will probably need “at least that many” gene edits, Ayares said.

A second innovative aspect of the surgery is the use of an immunosuppressive medication that seems to be essential for long-term survival of a transplanted organ. Researchers had used a version developed for baboons, but this was the first time using a humanized version in a person. 

The third aspect was the box that the heart was placed in after taking it from the pig. Researchers have learned that simply putting a heart on ice, as is done with a human heart, doesn’t work in between-species transplants. A German team figured out a method of perfusing the heart with nutrients and hormones.

“In the primates, the hearts just weren’t working until they started using that pump,” Montgomery of NYU said. “Nobody understands why.”

Bruno Reichart, a retired German heart transplant surgeon, who tested pig hearts in baboons for years, said he thinks the pig heart probably works better if liquid continually flows through it. But essentially, the proof is that it works. 

“Who is successful is right, who is not successful is wrong. It doesn’t need much more explanation in surgery,” he said.

The FDA granted emergency authorization for the surgery on New Year’s Eve, and it was conducted Jan. 7 from around 8:30 a.m. to 5:30 p.m.

Before pig organs can routinely be used in transplant surgeries, all three aspects have to be further tested in animals to meet FDA standards. Revivicor is building a pig facility that will meet FDA production requirements.

Ayares said he and others are savoring the moment. 

“This is one of the most exciting things in my 20-year-plus xeno career,” he said. 

If they can provide an unlimited supply of organs, Ayares said, the organ transplant list will probably increase by “orders of magnitude,” as more people who aren’t at death’s door begin to see transplant as an option.  

“We’ve done so much work up to this day,” Ayares said. “We’re confident this is going to continue to grow and build and really be the solution.”

What does success look like?

No one has been kept alive before with an organ from a specifically tailored animal. So any survival at all could be considered success.

Montgomery said he considers the surgery a success already. 

“The critical thing here is we’ve moved this thing out of these endless primate operations,” he said. “We’re now going to get real data in humans and really understand this thing.”

Tector, of the University of Miami, said he wouldn’t provide a pig kidney to a patient unless he was sure the person would survive at least a year. “When we do it, we think we’re going to get reasonable survival long-term,” he said. 

Reichart said he would expect Bennett could live indefinitely with his new heart.

“Maybe I’m a little obsolete and maybe from another world, but success would be at least a year,” he said. “Why shouldn’t it work for three years, for five years? We’ll see. That’s part of the experience they’ll gain now.”

Reichart, CEO of a company he co-founded to commercialize pig-to-human heart transplants, called XTransplant, said he’s concerned that Bennett was turned down for a transplant because he didn’t take previous prescriptions.

“The patient has a great responsibility to other patients in the world to behave properly and take his medications,” Reichart said. “He got the chance with the first one and everybody will look at the results.”

Griffith, the surgeon, said he’s been inspired by the efforts of so many to save Bennett and lay the groundwork for animal-to-human transplants.

“It’s been restorative to my soul to see people come together to save just one life,” he said. “They understand the implication.”

Contact Karen Weintraub at kw********@******ay.com.

 

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The United States Coast Guard pulled 176 Haitians from an overloaded, unseaworthy boat as it approached the coast of Florida, officials said late on Monday, amid a sharp rise in Haitians fleeing the crisis-stricken Caribbean nation.

The rescue effort unfolded on Monday, after US border and marine officials spotted the 18-metre (60-foot) vessel some 40 kilometres (25 miles) northeast of the Bahamas, the Coast Guard said in a statement.

“It is extremely dangerous to navigate the Florida Straits in an unseaworthy vessel, especially off the Florida Keys where the water is extra treacherous with shoals and reefs,” said Chief Warrant Officer James Kinney.

“Thanks to the quick coordination among so many different agencies, no lives were lost during this interdiction.”

Crews worked with federal, state and local law enforcement officers to take the people into custody, after providing personal flotation devices to those on the boat, which did not have basic life-saving equipment or navigation lights, officials said.

Ten people were taken to hospital with symptoms of dehydration.

The rescue comes amid a marked increase in migration from Haiti, which has been hit by a series of crises in recent months, including an increase in gang-linked violence and kidnappings in the aftermath of the July assassination of President Jovenel Moise.

In August, Haiti suffered a devastating earthquake that killed more than 2,000 people and destroyed homes in the country’s southwest.

The country also has been suffering from crippling fuel shortages that began in October after a coalition of gangs blocked access to fuel terminals, forcing some businesses and h

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