COVID-19 kit distribution in six Latin American countries: bureaucratic autonomy, populism, and evidence-based policymaking.

During the COVID-19 pandemic, governments varied widely in the extent to which policy decisions aligned with scientific evidence. We examine decision-making regarding the public distribution of COVID-19 kits containing ivermectin in six Latin American countries in 2020 and 2021, despite international scientific authorities advising against using these medicines outside of clinical trials. We focus on institutions, ideology, and interests. Theories emphasising the centrality of institutions predict that autonomous scientific institutions are more likely to resist political pressure to adopt ineffective interventions. Theories focused on ideology suggest that populist leaders may favour highly visible policy responses, including ineffective treatments, even when these diverge from expert advice. A third approach emphasises the relative power of interest groups favouring or opposing kit distribution. Using the comparative case study method, we analyse policy processes across Guatemala, Peru, Mexico, Costa Rica, Colombia, and Argentina. We find that neither bureaucratic autonomy, nor populism, nor interests alone explains policy variation. Instead, the findings are consistent with a conditional relationship in which populist leaders are more likely to favour kit distribution, but autonomous National Medicines Regulatory Agencies appear to moderate the influence of populist political pressures. Countries with non-populist leaders but low institutional autonomy were also likely to distribute kits if powerful political actors favoured such policies. These findings suggest that institutional design and political context jointly shape the capacity for evidence-informed decision-making during public health emergencies. Strengthening the autonomy of regulatory agencies may help support evidence-based evaluation of emerging health technologies during future crises.