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Lancet study finds U.S. has, by far, the world’s most-overpriced medical care

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On September 1st, Gallup headlined “50% in U.S. Fear Bankruptcy Due to Major Health Event” and reported that last year only 45% did. Both percentages are the world’s highest. One of the world’s leading medical journals had just published a study which explains why it’s the case.

The medical journal, The Lancet, is one of the world’s Big Three scientific journals of medicine; that’s the triumvirate of authorities for physicians worldwide, and the other two are the Journal of the American Medical Association, and the New England Journal of Medicine. On August 27th The Lancet published “Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories”. Here is the visual that’s in it, which shows the United States as having, by far, the world’s costliest medical care, at around $9,000 per person per year, and yet as having lower quality of health care than virtually all other industrialized nations do:

Here is another such study, showing the same thing, and calculating it more simply:

What explains this?

Quite simply, the United States is the world’s most corrupt nation, and medical care is such an extreme necessity when a citizen needs it, so that they’ll pay whatever the system charges them for it — and investing in healthcare products and services is therefore enormously profitable in the United States. Actually, the only other market-sector that competes with it for providing simultaneously high returns and low risk (the combination that offers the best of both worlds to investors) is consumer staples, such as foods, which likewise are necessities of life. When people are desperate, they’ll pay, whatever the cost, because these are things they don’t just want — they need. Here, from Maksim Papenkov’s award-winning 6 February 2020 paper, “An Empirical Asset Pricing Model Accommodating the Sector-Heterogeneity of Risk”, is his sector-specific calculation of stock-market profitability during 2000-2018, showing that “HC” Health Care, and “CS” Consumer Staples, were the best at combining low risk with high returns, during that 19-year period: 

(“CD” there is Consumer Discretionary and includes Automobiles and Hotels. It’s the only sector that has higher returns than Health Care, but those returns are twice as risky. The S&P500 have lower returns than Health Care and slightly higher riskiness. At the opposite end, “IT” Information Technology is both the riskiest and the least profitable; and “F” Financials are the second-worst sector for investors. The most-profitable sectors are the necessities, the sectors that take the most from the most-desperate.)

In May 2017, Axene Health Partners published their actuary, Chris Slaybaugh’s, study, “International Healthcare Systems: The US Versus the World”, which stated:

The United States is the only industrialized country in the world that does not have Universal Health Coverage for all citizens. … Rather than one system, United States citizens and residents are insured under a variety of sometimes overlapping systems. The United States is also the only developed country where a significant number of citizens are permitted to be uninsured and where a person’s employment can determine whether they have insurance and what insurance they have. … The extent to which medical bills contribute to bankruptcy is hard to tease out from other factors, but even those who are skeptical of the claim that medical costs cause the majority of bankruptcies concede that they are a significant contributor.13

In the rest of the developed world, by contrast, medical costs are rarely or never cited as a driver behind personal bankruptcy.

In fact, CNBC headlined on 11 February 2019, “This is the real reason most Americans file for bankruptcy” and reported that, 

Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall.

While the high cost of health care has historically been a trigger for bankruptcy filings, the research shows that the implementation of the Affordable Care Act [“Obamacare”] has not improved things.

What most people do not realize, according to one researcher, is that their health insurance may not be enough to protect them.

While Barack Obama was running for President in 2008, he was promising to provide Americans with a “public option” in order to reduce profits for health insurance companies and thus lower costs, but he dropped that proposal immediately when he won the 2008 election, and he never pushed for it (not even to use as a bargaining chip with the Republicans in shaping his Obamacare). (In fact, Obama chose the conservative head of the Senate Finance Committee, Democratic Senator Max Baucus, to draft his Obamacare, because Baucus was against there being a public option, and because the progressive Democratic Senator Ted Kennedy’s Health, Education & Labor Committee had just drafted an Obamacare with a public option — Obama refused to have Kennedy draft his healthcare legislation. Obama was actually against there being a public option; only his public rhetoric was for it. Joe Biden is apparently now following the same tactic, of lying promises to the public, and true promises to his billionaire backers, to win the White House.) Obama promised the public “universal coverage”, which means 100% of the population covered, like in all other advanced economies, and his Obamacare increased the percentage insured from 84.5% when he came into office in 2009, to 87.7% two years after Obamacare started in 2013 — around 3%, by 2015 (which was after two years). That was still far short of the promised 100%. He was lying through his teeth in order to win election, and the ‘news’-media still hide (instead of expose) the fact that he did, and that he was actually an agent of the billionaires. He’s now the big hero among Democrats, because maybe Trump is even worse. Trump is up-front about his fascism. And Trump’s opponent now is another hypocrite (after Obama), Obama’s V.P., Joe Biden, who was the U.S. Senate’s leading Democratic Party segregationist and won his nomination by claiming to have been instead a civil-rights champion. Everything in U.S. politics is bait-and-switch. That’s the reality in America’s ‘democracy’: a bait-and-switch ‘democracy’, which serves actually only the wealthiest few. The politicians who are elected serve only the wealthy and well-connected.

America is the most libertarian, or “neo-liberal,” of the advanced industrial nations, and this is why it has the world’s most overpriced medical care. It provides the most liberty for the billionaires.

One of the few extremely bold Americans who rose high in the U.S. healthcare system and tried to tell the public how intensely corrupt it is, has been Marcia Angell, M.D, who held numerous prestigious posts in the U.S. medical system, and she was for a while the Editor-in-Chief of the New England Journal of Medicine. On 15 January 2009, Dr. Angell headlined “Drug Companies & Doctors: A Story of Corruption”, and wrote:

Conflicts of interest pervade medicine. … It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine. … So many reforms would be necessary to restore integrity to clinical research and medical practice that they cannot be summarized briefly. Many would involve congressional legislation and changes in the FDA, including its drug approval process. But there is clearly also a need for the medical profession to wean itself from industry money almost entirely. … Breaking the dependence of the medical profession on the pharmaceutical industry will take more than appointing committees and other gestures. It will take a sharp break from an extremely lucrative pattern of behavior. But if the medical profession does not put an end to this corruption voluntarily, it will lose the confidence of the public. … 

She had said, nine years earlier:

If we had set out to design the worst system that we could imagine, we couldn’t have imagined one as bad as we have. … Our health care system is based on the premise that health care is a commodity like VCRs or computers and that it should be distributed according to the ability to pay. … That market ideology is what has made the health care system so dreadful, so bad at what it does. … That is a fundamental mistake in the way this country, and only this country, looks at health care. … The only way to both reduce cost and increase access and quality is to change the system, to scrap it and start over. … I would pay for health care in a single payer system, and what goes into that pot can vary. In Germany, employers have to contribute to that pot. I don’t think that’s a good idea. I would rather see it come straight out of tax revenues.

Experts who are that public-spirited and knowledgeable about the system should be appointed by U.S. Presidents to lead the FDA and the Department of Health and Human Services, but the billionaires prevent that (of course).

On June 27th, NPR headlined “After Pushing Lies, Former Cigna Executive Praises Canada’s Health Care System”, and interviewed a retired PR executive for America’s health insurance companies, who said that maybe the work that he had done smearing Canada’s socialized health insurance — “to spread misinformation about Canada or use cherry-picked data and anecdotes” so as to deceive Americans to accept America’s existing medical system — was partly to blame for America’s having performed significantly worse than Canada had done on the coronavirus crisis. (As of 29 August 2020, Canada had 3,378 cases per million and was the 76th worst out of 215 countries, whereas U.S. had 18,522 cases per million and was the 9th-worst. On deaths, Canada was the 27th-worst at 241, whereas U.S. was the 11th-worst at 564.) 

America’s billionaires derive the vast majority of their net worth from stocks (capital gains and dividends), and from interest that’s paid to them; and, since nothing does this for them better than healthcare investments, the current for-profit system in health care is terrific for them; and these few hundred people, billionaires, extract this wealth from the hundreds of millions of Americans, the general public, and want to continue doing so, and they consequently finance politicians such as Joe Biden and Donald Trump (and their predecessors, such as Bush and Clinton), and they also set up ‘charitable’ foundations, and donate to medical schools, so as to inculcate this libertarian belief, not just into the public, but especially into the students and professors, who receive that trickle-down from them, as employees and future employees. While many in academe are against it, they’re not the ones who get advanced to the prestigious and high-paid positions. “He that pays the piper calls the tune.” It’s top-down (aristocracy), and it only pretends to be bottom-up (democracy). And, so, the corruption continues, and Americans die younger, and poorer, because of this aristocratically controlled system. It’s the American way. It’s the American system. Of corruption. Americans call it “capitalism.”

Of course, another area in which the U.S. Government is extraordinarily corrupt is its Military-Industrial Complex; and, on August 28th, a former top official of the NSA, Bill Binney, provided, online, an in-depth description of what he personally knows about that. His personal knowledge is enormous concerning within the Government itself, but not outside it — i.e., not regarding the corporations and billionaires who control the economic rewards system that the top public officials, who typically are agents of  the “Deep State” (the billionaires), are serving. However, what he says there is informative and highly reliable regarding the way that the Government’s bureaucracy itself functions, and he is extraordinarily honest about the intense corruption within the official Government. He makes clear that the U.S. Constitution is being systematically and routinely violated by top U.S. officials; so, the U.S. Government routinely violates the U.S. Constitution, in this ‘democracy’, where the system functions like clockwork, for the billionaires.

Author’s note: first posted at Strategic Culture

Investigative historian Eric Zuesse is the author, most recently, of They’re Not Even Close: The Democratic vs. Republican Economic Records, 1910-2010

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Is the Washington-initiated Climate Summit a Biden Politrick?

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Earlier on, climate skeptics had wondered if President Biden’s January 27 Executive Order on “climate crisis” was “climate politrick?” Now, scholars in China have likened the US climate envoy’s hurried China visit last week to “a weasel calling on a friendly New Year visit to a chicken” – or a visit with evil intentions. Some overenthusiastic critics of the US in Beijing are even warning President Xi to not login for the online Earth Summit in Washington this week.

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People in China believe a snake and a wolf must never be rescued. The belief comes from a popular idiom: the Zhongshan wolf or “The Wise Old Man and the Wolf.” In a few words, the essence of the popular Chinese adage is well-captured in the following sentence: a popular fairy tale about the ingratitude of a creature after being saved. Last year, the idiom entered China’s foreign policy discourse as several IR commentators employed it to describe “ingratitude” of the Trump-led America towards the Peoples’ Republic. Following the ascent of President Biden in the White House, the Chinese commentariat quickly course-corrected itself, i.e. neither Trump nor Biden, it is the US bipartisan anti-China consensus which is the real “wicked wolf.”

Just like the curt and bland statement issued by China’s foreign ministry acknowledging China will host the US climate envoy Kerry for three days in Shanghai, 14-17 April, China released on last Sunday the text of the joint China-US statement following Kerry’s departure on Saturday. The statement said: “The United States and China are committed to cooperating with each other and also with other foreign governments to tackle the climate crisis which must be addressed with seriousness and urgency it demands.” Interestingly, or rather conspicuously, the statement neither indicated nor was followed by another press release regarding whether China will be represented at the upcoming crucial 40-nation Earth Summit being hosted by President Biden.

While it is true a few Chinese scholars and think tanks have welcomed the worlds’ two largest carbon emitting nations to come forward to cooperate with each other upholding the spirit of the Paris climate agreement. What is perhaps unprecedented and more significant is the warning to President Xi by a section of China’s leftist intelligentsia to beware of Biden’s “climate politrick.”

Talking of those who welcomed Xi-Biden climate cooperation initiative – the first sign of bilateral cooperation since the Trump interregnum, Zhang Jianyu, chief representative and vice president of the non-profit Environmental Defense Fund’s China Program, reacted positively and said: “The fact that the joint statement has been signed, means that both Beijing and Washington believe in climate change. We are hoping both China and the US take bold actions.” Li Shuo, senior climate adviser for the environmental group Greenpeace, said China could soon respond to a new U.S. pledge with one of its own, building on the “momentum” of the Shanghai talks.“The statement in my view is as positive as the politics would allow: It sends a very unequivocal message that on this particular issue (China and the United States) will cooperate. Before the meetings in Shanghai this was not a message that we could assume,” Li added. 

In contrast, an article in Utopia, one of the influential “anti-US” platforms for ideological debate in China, cautioned China’s top leadership while questioning Biden’s credentials to host the Earth Summit. The pro-Mao, leftist online intellectual discourse forum advocates Maoist and communist ideology. In a signed article on the forum’s website last Saturday – the day John Kerry concluded his 3-day stay in Shanghai and left for Seoul, a commentator using strong words not only “condemned” Joe Biden for his “arrogant” and “hypocritical” foreign policy thinking, but also urged the Chinese leadership to thwart Washington’s attempt to regain the US leadership by holding the Earth Summit beginning Thursday. The article was entitled: “China must resist and fight back hypocrite Biden.”   

In fact, as early as in November last year, within days of the presidential voting, a section of scholars in China were writing “the election of Biden may or may not turn out to be a turning point for easing Sino-US frictions…with Biden in power, the nature of Sino-US relations will not see a fundamental change, but the mode of confrontation will be relatively soft and the direction of negotiations will be more predictable.” However, with each passing day since taking office, President Biden’s China policy has consistently been predictable in only one direction – in enduring the Trump legacy. The most recent manifestation of which was on display at the testy diplomatic summit last month in Anchorage where senior officials from the two countries “traded sharply critical assessment” of each others’ policies.

Another Chinese commentary has highlighted six ideological “attacks” the US has carried out against China in the international arena under Trump and Biden administrations respectively. First is the classic example of the US-Japan nexus in politicizing and turning on its head the Chinese opposition to Japan’s decision to release radioactive contaminated water from Fukushima into the sea; second is the Western governments and media carrying out slanderous campaign of China’s “economic colonialism” in Africa; third, as soon as China succeeded in containing fight against COVID-19 last year in May and started offering humanitarian assistance abroad, the US-led started defaming and discrediting China by launching “mask diplomacy” campaign against Beijing; fourth, just like vicious propaganda maligning China’s economic assistance to Africa and China’s humanitarian aid by free supply of PPE and masks, the US launched “vaccine diplomacy” campaign to vilify China; the fifth is attacking China using the virus trajectory and accusing China of developing COVID-19 virus and exporting it from chemical laboratory in Wuhan; the sixth and the latest anti-China “false” propaganda is the “genocide” in Xijiang. Unlike the genuine human rights violation by Japan to release the contaminated water into the sea, the false propaganda against China is aimed at creating anti-China world public opinion, creating social unrest and turbulence in China and ultimately achieving their goal of destroying China, the article stated.   

Finally, it is not incorrect to view President Xi’s highly charged remarks made at two most recent international events respectively in the context of strongly-worded articles published in Utopia and other left-leaning online websites in the past few days. Two days prior to the arrival of Kerry in China, President Xi, according to the Xinhua news agency, warned the US in his speech at the China-Germany-France trilateral video conference on climate change: “Climate change could be used as a tool to disparage some countries for not doing enough.” Then two days prior to the Earth Summit, Xi apparently reiterated his stern warning to President Biden: “We must not let the rules set by one or a few countries be imposed on others, or allow unilateralism pursued by certain countries to set the pace for the whole world.” The remarks by Xi were made at China’s annual Boao Asia Forum on Tuesday.    

China’s semi-official “independent” English language CX Daily interpreted Xi’s above remarks as “veiled swipe at the new US administration under Biden” who has been busy forming alliances challenging China over issues such as Taiwan, Hong Kong and Xinjiang. Of late, mainstream media in China has been accusing Biden of not only carrying on and enduring the Trump legacy in relentlessly “attacking” China, but also that Biden has gone far beyond Trump in insulting and condescending Beijing. In fact, the Utopia commentary uses another Chinese idiom “externally strong, empty inside” to caricature Biden’s personality. It cites two recent incidents to establish how weak and hollow is President Biden, i.e. the US-China talks in Alaska and Putin’s resolve to dare the US in the Black Sea – in both instances, Biden simply caved in after he was challenged, the commentary observed. “On Iran nuclear deal issue too we saw Biden acting in the same surreptitious and crude manner. He [Biden] is typical treacherous man,” the Utopia commentary continued its verbiage.

Some Chinese scholars, therefore, have welcomed Xi’s remarks as clear rebuff to what the mainstream Western media, in particular the Wall Street Journal has been spreading, i.e. “Xi would participate in the US-initiated climate summit later this week.” These scholars are invoking yet another ancient Chinese proverb “Mouth honey belly sword” or Koumifujian in Chinese. The idiom is used as a metaphor for describing someone extremely sweet on the outside but actually shrewd, cunning and sinister. Most Chinese IR commentators are telling us, the idiom is a perfect description of Biden. 

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Russia Or China: Is Biden Right To Target Russia?

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No one can disagree with President Joe Biden when he wants to overhaul infrastructure — although a single-minded concentration on one aspect is likely to be longer lasting and a legacy.  Consider, for example, a high-speed rail link between New York and Los Angeles,  True high-speed, that is, and truly modern like the new lines in China with a design speed up to 350 km/h (220 mph), or preferably higher by the time the rails are constructed in the US.  It would make overnight coast to coast (3,000 miles) railroad trips a reality.  

What is more difficult to fathom is Biden’s foreign policy.  He appears to have identified Russia as an adversary or worse, starting with calling Vladimir Putin a killer and exposing several Russian companies that possibly support its intelligence services.  Do American companies ever provide cover for the CIA?  That is the obvious question coming to mind with an obvious answer.  Have western intelligence services including the CIA ever carried out assassinations?  If so, would the US president be called a killer?

At the same time, Russia is not the country with a stated goal of becoming the world’s leader in its economy, technology and military.  No, that’s China.  Russia only wants closer ties with the west but is being driven into the arms of China.

Given China’s stated goals and its progress towards them, it is transparent that its aims require the displacement of the US from its leadership position.  Any prospect of thwarting China’s ambitions would impel the US to cordon the  country to some extent or at the very least attempt to challenge its influence.  Instead, China is signing treaties with neighbors.  It is in Iran and it announced that it might send its own troops to Afghanistan to maintain its “peace” after the US departs.  Afghanistan, by the way, is rich in minerals and rare earth elements.  

So far Mr. Biden’s foreign policy initiatives appear tactical with a kind of tit-for-tat approach that is absent a coordinated (with allies) strategic plan to prepare the US for a confrontation politically and economically — not militarily, although as the US ramps up pressure, a skirmish here and there on the high seas could be a possibility.

A string of Chinese bases now ring the Persian Gulf extending west to East Africa and east along the Iran and Pakistan coast to Sri Lanka, across to Burma and then south to the western end of Indonesia.  The recent treaty with Russia allows convenient Eurasian access while the new closeness with Iran permits an overland route to its oil riches.  East of Iran is Pakistan which is a Chinese client state of long standing and where it has built the Gwadar port.

Given the circumstances, the US is obliged to reassess Iran from a geostrategic perspective but also Pakistan, a country that has been on the frontlines of the Afghan war since the beginning.  Pakistan is also a key to long term peace in Afghanistan as its own Pashtun population is connected to Pashtuns there through family ties and a traditionally porous border.  They also command a plurality as the largest ethnic group in Afghanistan. 

Further east China is increasing its influence in Sri Lanka, and is by far Burma’s largest trading partner.  The recent coup in Burma is its own story and an oft-reported tale in that country without noting China’s silence.  

Despite the local politics, the US can ill afford to surrender such a vast region to China without counter moves to ensure some freedom of movement within China’s tight embrace.

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Playing Politics in Times of Covid: AMLO’s Whimsical Inoculation Programme

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Image source: as-coa.org

Andrés Manuel López Obrador (AMLO) has capriciously modified Mexico’s inoculation programme as he sees fit. He has followed an improvised strategy along the way that follow no logical approach.

The initial vaccination schedule was set up in 5 stages that placed frontline and essential workers as priority sectors; the rest of the population would be divided up by age ranges and inoculated accordingly. However, last January, AMLO announced the creation of 10,000 brigades who would oversee the vaccination programme. Each brigade is made up 12 people majority of whose are active members of the president’s political party MORENA. They also were prioritised for vaccination, even ahead, some key workers. This process alone took up 120,000 vaccines that otherwise would have gone directly to frontline workers or the elderly.

As of mid April, Mexico, with a population of 117 million people, has only vaccinated over 10 million people, roughly 8.5% of the population. Only 2.6 million have received the second shot, only 2.2%. The government also announced that it was prioritising the poorest citizens and indigenous communities. In a more recent announcement, he declared teachers would be also bumped up for priority vaccination ahead of the elderly. This again demonstrates the arbitrary standards of his vaccination schedule.

The government’s decision to inoculate teachers ahead of even health workers does not come as a surprise: they’re a key voting bloc. Mexico is holding mid-term elections this coming July, and vaccinating teachers so close to voting time is the latest evidence that the president is playing politics with the vaccinations. Just like in old times under the hegemonic party, unionised teachers are crucial for AMLO’s political party to win the most votes in the next elections.

Using certain sectors of the population to mobilise voters in favour of political party is not something new in Mexican politics. In Mexico, just like in many other unconsolidated democracies, political parties and candidates themselves can turn to political agents to ensure victory in elections through the use of patronage systems or vote-buying strategies.

To fully understand the role of the Teachers’ Union (SNTE and CNTE) as a political machine, it is essential to understand its history and role in elections over the last decades. The SNTE has more than 1.6 million members nationally, while the CNTE has over 100,000 members, it was founded in 1980 and has considerably less influence than the SNTE.

The SNTE was founded in 1949, and since then they served as a satellite organisation of the hegemonic party, PRI. Up until 1992, it was mandatory for all Union members to register as active party members. Therefore, throughout these years, the PRI, regularly received electoral support from the Union. The alliance between the hegemonic party and the SNTE strengthened in 1989 when Elba Esther Gordillo was appointed as the new leader of the Union.

What was behind the motivation of the SNTE in becoming an electoral agent? For many years, the Union received monetary incentives and access to political posts. Under this arrangement, political parties and even candidates may monitor the performance of such agents to make sure they are still aligned to those of the government, political party or candidate. As long as the interests of both sides are aligned, the electoral agent is expected to work efficiently to deliver the expected results either on election day or throughout the length of the administration.

In 2005, Elba Esther Gordillo was expelled from the PRI, ending the alliance between the SNTE and the hegemonic party. The leader of the Union founded her own political party, PANAL, and participated in the 2016 federal elections. However, due to the number of voters the newly created party attracted, it was only limited to proportional representation positions. Although PANAL, presented its own candidate for the presidency, Elba Esther offered the votes of the Union in the presidential elections to other political parties with greater possibilities of winning.

The SNTE supported Felipe Calderón, the PAN candidate in 2006 and in 2012 they backed the PRI candidate, Enrique Peña Nieto. The SNTE’s geographical outreach and the role of teachers as community and educational leaders facilitate their role as electoral agents. They’re able to influence informally the vote of others as well as the opinions and voting decisions of students and their parents.

In many democracies, it is not unusual for teachers to have strong ties to political parties and their candidates, and this is critical when it comes to explaining their effectiveness as electoral agents. It is not uncommon also for teachers to be appointed as voting stations representatives. The combination of these institutional characteristics opens the door for teachers to continue to influence voters through either legal or illegal.

AMLO’s courting of the Teachers’ Union dates to his electoral campaign in 2018. José Alfredo González, son in law of Elba Esther Gordillo, was seen in a presidential campaign event to support AMLO’s candidacy. He is also an active member of Redes Sociales Progresistas, a newly created party with links to Elba Esther Gordillo. Soon after AMLO’s inauguration in 2018, AMLO set to dismantle the education reform that has been approved by Enrique Peña Nieto in 2012. This was well received by the 2 Teachers’ Trade Unions. In 2020, the SNTE expressed its support for the president, and they also ratified its adherence to the political programme of the president. AMLO also publicly asked Elba Esther Gordillo to talk openly about the (alleged) fraud of 2006. AMLO’s intentions in doing this are very clear: He wants the former leader of the Union to enter the political game by talking about the issue and taking a stance that would not be antagonistic towards the incumbent party.

There is no doubt that the president has an underlying agenda in prioritising the vaccination of teachers when mid-term elections will be held in less than 2 months in Mexico. The president has chosen CanSino as the vaccination to be used to inoculate teachers across Mexico to allow schools to reopen by the end of May in some states. Now, with only less proven vaccine options, CanSino has an efficacy rate of less than 65%, questions undoubtedly arise as to how effective the inoculation of Mexicans will be with the use of these vaccines over the already proven ones.

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