COVID-19: Any Lessons Learned?

“We are not ready to face a new pandemic.” – Ricciardi (UNICATT)

“No country is safe until all countries are safe.” – Krech (WHO)

The 17th World Congress on Public Health, taking place in Rome from May 2nd to May 6th, coincides with a critical juncture for our world as we continue to deal with the COVID-19 pandemic, which has caused significant changes and exacerbated existing inequalities.

It is no coincidence that one of the key Plenary Sessions of the event is dedicated to a very pressing and painful subject: COVID-19: The Ongoing Challenge, Lessons Learnt, and How to Prevent the Next Pandemic.

The COVID-19 outbreak resulted in the loss of almost 7 million lives worldwide. This recent pandemic has also been a formidable stress test, examining the resilience of global health systems and exposing weaknesses in public procurement processes. However, managing COVID-19 has brought the healthcare sector, which is usually on the fringes of political debate and largely overlooked by the media, to center stage.

Why the situation went out of control?

“It’s beyond argument that not a single state in the world had adopted a perfect strategy during the pandemic. However, some of the states, like, for example, the UK, the USA, and Brazil have paid a very huge price in terms of losses and deaths because their governments, being directly dependent on public opinion, didn’t listen to the scientists, they didn’t lockdown immediately and they didn’t enforce vital public health measures”, – underlines Walter Ricciardi, Professor of Hygiene and Preventive Medicine at the Catholic University of the Sacred Heart and Scientific advisor to the Minister of Health for COVID-19 emergency from 2020 to September 2022. “It’s necessary to underline”- suggests Professor “that the responsibility still lies in the hands of the national governments. In some cases, the difference between the global response and the national was very divergent”. Ricciardi also emphasized that the so-called “infodemic (* false and misleading information about a disease outbreak) has led to mistrust in health authorities and has undermined the public health response”.

“The COVID-19 pandemic didn’t fall from heaven, it wasn’t the first wake-up call in this young century – we had the bird flu (H5N1), the swine flu (H1N1), Ebola, and in some regions, we had also Zika and then eventually we faced COVID. After each of these crises, external experts around the world looked at what the governments did right and what they did wrong, what the WHO did right or wrong and what is need to be done in the future. There were a series of recommendations already in 2015. However, countries didn’t address the root causes before in order to be better prepared for the epidemical pandemic. We needed a comprehensive understanding of the weaknesses in countries and resolute action to mitigate those weaknesses. Unfortunately, that has not happened”, stresses Dr Rüdiger Krech, a senior official at the World Health Organization (WHO).

What does COVID-19 teach us or should teach?

Now that the COVID-19 pandemic is in a state of transition, it is an ideal time to reflect on the valuable lessons we have learned.

“I’m not sure that the lessons were learned. I would say that certainly the lessons were taught”, Ricciardi says by highlighting two main lessons to focus on:

• Targeted healthcare investments are essential to strengthen public health systems and prevent pandemics in the future;
• A more determined and less selfish attitude toward investments in global collaboration and in human capital is needed.

What if the next pandemic happens tomorrow?

It is impossible to predict when the next pandemic will occur, but as experts suggest it is inevitable. Thus, it is extremely important to understand whether current national public health systems are ready to face another significant challenge.

“It’s not a question of whether or not we are going to see the epidemics or the pandemic but only when we are going to face it. The biggest mistake would be to ignore the weaknesses that we see in our own countries and that we monitor globally. As the pandemic went on, we learned a lot about how it evolves and every pandemic will evolve differently. Therefore, we will always learn with the development of the pandemic but the key benchmarks (for instance, the social distance) needs to be kept and the main 30 risks that can potentially lead to the next pandemic should be addressed“, underlines Dr Krech.

“It depends on the country but the majority of them unfortunately are not ready. Some of them are too relaxed now and it seems like they haven’t made any conclusions from the previous pandemic experience. As we see, less money is invested in public health and in particular in public care”, – says Walter Ricciardi who, nevertheless, hopes that the next time the reaction would faster because “now we are certainly more experienced”.

Solutions on the table:

In March 2023, the World Health Organization began negotiations on a global accord for pandemic prevention, preparedness, and response. The “zero draft” serves as a basis for the negotiations in order to create an accord that will protect nations and communities against future pandemic emergencies.

“The global pandemic treaty should be the first step towards the global management of the future pandemic. We have been discussing this document for the last two years and I have to admit that we are still very slow because major countries are not in favor of this initiative. And the second and the third steps should certainly be the major investment in the public care system and the better coordination“, – Prof. Ricciardi concludes.

In Dr Krech’s opinion, in health promotion it is very important “to codesign, to empower and include in the policies and recommendations the people we want to reach” and to understand “how people behave and what they accept and do not accept”.

At the international level, collaboration should be considered an essential element.

“Virus do not know borders and we shall remember for the future: no country is safe until all countries are safe”, – concludes Dr Rüdiger Krech.

No Public Health Without Planetary Health

“Fighting climate change today is the best public health opportunity.” – Maria Neira (WHO)

“We are all responsible for the health of the planet.” – Emma Te Patu (WFPHA)

Since the outbreak of COVID-19, the concept of “global health security” has become a topic of academic and popular debate as health specialists gather to discuss various approaches to avert the next pandemic. In an increasingly interconnected world, the primary goal of this agenda is to identify and prevent health concerns that impose a burden on populations, society, and the global economy. One of the Plenary sessions of the 17th World Congress on Public Health (2nd – 6th May, Rome) entitled “No Public Health Without Planetary Health” speaks for itself.

“There is no such thing as the health of only one country. We are all responsible for the health of the planet and understanding and drawing on the Indigenous people’s knowledge systems that have been in place from time immemorial and authentically engaging with this knowledge and using it to inform our global health needs collectively and from an understanding that health is a human right and is, therefore, a priority above all”, – underlines Prof. Emma Te Patu, WFPHA Vice President & MAORI.

The promotion of global health is a vital mission in the modern world of globalization. It requires the cooperation of governmental bodies, global health organizations, medical professionals, educators, volunteers, and advocates within local communities.

Prof. Te Patu has defined the five global health initiatives that play a crucial role in the current context:

• Decolonising public health – Removing systemic barriers to Equity
• Proper resourcing of public health
• Legislative mechanisms to ensure countries are accountable for public health
• Health and growth of the public health workforce
• Accessible and relevant public health education

The WFPHA Vice President has also classified the biggest public health threats:

• Ego and the commercial financial imperative
• Reactionary responses as opposed to strategic responses
• Lack of proper resourcing

Why should climate change be considered the biggest global health threat of the 21st century?

Global crises are closely linked with climate change. Therefore, we must not overlook the existential threat that ecological degradation poses to planetary and human health.

“Climate change is definitely touching all the pillars and supports of our health: access to food, to safe drinking water and to clean air. It is changing the way we will protect our help and the way we need to prevent the worst impacts of climate change. People need to understand that climate change is not just something that will happen to the Planet in the future but it is affecting our health right now: it affects our lungs, and it causes diseases. We are already paying for it. I am convinced that addressing the causes of climate change today will be the best public health opportunity. It will bring benefits to the health system, to the economy, to the population, and make our society more sustainable. We need to increase the speed at the national level, set more ambitious goals, and, therefore, provide ourselves with well-covered health insurance. Our life and survival will depend very much on that.”, – underlines Maria Neira, Director of the Department of Public Health and Environment at the World Health Organization (WHO).

According to the WHO’s estimates:

• Between 2030 and 2050, it is expected that climate change will cause approximately 250 000 additional deaths per year from malnutrition, malaria, diarrhea, and heat stress.
• The estimated direct damage costs to health (i.e. excluding costs in health-determining sectors such as agriculture and water and sanitation) are between USD 2-4 billion per year by 2030.

The destabilizing impacts of climate change disproportionately affect the most disadvantaged. Many low-income countries are particularly vulnerable to sea-level rise, natural disasters, and food and water scarcity. As a result, the lack of resources can lead to forced migrations. How can we safeguard these “unhealthy” territories?

“We know that an unhealthy environment is responsible for 13 million deaths every year due to the lack of safe water or to the lack of clean air. The toxic air alone kills 7 million people annually. The creation of healthier environments will be the best investment we can make to protect our health by guaranteeing access to safe water, safe food, and clean air and by stopping to pollute our oceans with millions of tons of plastic. It’s important to bear in mind that plastic can end up on the human body because fish contains a high number of microplastics that we throw into the oceans. Only if people see the connection between climate change and their health, they will start to act and become more responsive and more determined to fight the causes of climate change”, says Prof. Neira.

The COVID-19 pandemic has exposed the weaknesses and inequalities in our health systems in the face of global crises. The world requires equitable investment in research, surveillance, and preventive health to strengthen global resilience against these emerging risks. What measures should be taken to ensure global health security?

Prof. Te Patu has laid down the following list of priorities:

• Pandemic treaty – an instrument designed to prepare the world for the next pandemic
• More consultation with civil society
• Decolonising public health
• Greater collaboration between international, regional, national, and local public health communities
• Government transparency in messaging and addressing public health and what it entails

“We are all citizens of the world now. Pandemics do not recognise borders, so a united international response is vital. The same approach is used when we deal with the environment. If, for example, we do the deforestation in the Amazonia, in one way or another it will affect all of us”, concludes Maria Neira.

WFPHA Stands in Solidarity with the Ugandan LGBT Community – Denounces the Ugandan Anti-Homosexuality Act (2023)

On March 21, 2023, the Ugandan Parliament passed the Anti-Homosexuality Act (2023). By criminalizing same-sex conduct, the Act criminalizes all lesbian, gay, bisexual, and transgender (LGBT) Ugandans, the provision of services to LGBT Ugandans, and the dissemination of information about the LGBT community. The Act also requires Ugandans to report any individual who is suspected of being LGBT and forbids the sheltering of a LGBT person. The Act also provides for the death penalty for the crime of ‘aggravated homosexuality’. By undermining access to medical services by at-risk populations, the Act also threatens to undermine Uganda’s proud record of HIV prevention and control built over three decades. President Museveni has agreed to assent to the Act after changes are made regarding ‘rehabilitation’.

LGBT persons have existed throughout human history and across cultures. Natural variations of sexual orientation and gender identity exist regardless of enacted laws and policies. Beyond the direct and obvious consequences that the law will have on the health and human rights of those prosecuted, it will also have broader detrimental public health impacts. Research has shown that structural anti-LGBT legal climates further promote hostility, violence, and harassment against LGBT individuals (Hatzenbuehler et al. 2019; Van der Star et al. 2020) as well as directly jeopardize a plethora of health outcomes across the entire community, including psychological distress (Van der Star et al. 2021), life satisfaction and wellbeing (Van der Star & Bränström, 2015; Pachankis & Bränström, 2018), risk for psychiatric disorders (Hatzenbuehler et al. 2010), and suicidal ideation (Pachankis et al. 2021).

In addition to these direct ramifications for LGBT health in Uganda, the negative public anti-LGBT discourse surrounding the Act may also instigate harassment and discrimination (Hatzenbuehler et al. 2019) as well as reduce psychological wellbeing (Frost & Fingerhut, 2016) among LGBT Ugandans and their families, friends, and close communities.

In 1995, Uganda acceded to the United Nations’ (UN) International Covenant on Civil and Political Rights (ICCPR; UN Treaty Collection, 2023). For some 30 years, the Covenant has been interpreted to include protections against discrimination based on sexual orientation, gender identity or expression, and sex characteristics (UN OHCHR, 2019). UN legal experts have stated that the imposition of the death penalty based on the Act is per se an arbitrary killing and a breach of article 6 of the ICCPR (UN OHCHR, 2023). An official Ugandan Parliamentary briefing on the Bill incorrectly asserted that international law does not apply because the Constitution of Uganda ‘specifically bars sexual acts between sexual minorities’, while it does not. As a matter of international law, no country’s national constitution or other laws can be assumed to override its international legal obligations.

The WFPHA calls on the Ugandan President, Parliament and Government to foster an inclusive and safe environment for all citizens, while safeguarding the human rights of each individual, irrespective of their sexual orientation or gender identity.

A Review of the Impact of the COVID-19 Pandemic on Health Workers’ Sentiment towards Influenza Vaccination

During the COVID-19 pandemic, immunization of health workers (HWs) has become a top priority. According to the Centers for Disease Control and Prevention (CDC), reducing the risk of patients catching influenza from health professionals, protecting healthcare staff and their families against influenza, and reducing health professionals’ absenteeism and consequently costs on the National Health Service are key reasons for the cost-effectiveness of influenza vaccination strategies among HWs. Although healthcare professionals are cognizant of the significance of immunization for protection against infectious diseases, there are various obstacles and factors that impede the uptake of influenza vaccines. Vaccine hesitancy among HWs is one of the major hurdles to optimum immunization practices.

In an article published by the researchers of the WFPHA and its International Immunization Policy Taskforce, they investigated the impact of the COVID-19 pandemic on the sentiment of influenza vaccination among HWs through the identification of relevant determinants, barriers, and interventions to counteract vaccine hesitancy.

Determinants of Vaccine Hesitancy

According to the article, age, gender, comorbidities, profession cadres, and vaccination history are the determinants of vaccine hesitancy among healthcare staff. Within the COVID-19 context, physicians and residents were more willing than nurses to adhere to influenza vaccination. Young HWs, particularly males and those with chronic comorbidities, demonstrated the highest acceptance of the influenza vaccine. HWs’ immunization history is associated with higher influenza vaccine adherence.

Enablers of Vaccine Acceptance

There are several factors that influence the acceptance of influenza vaccines by healthcare staff. According to the article, healthcare staff’s knowledge of the influenza vaccine, concerns about protecting themselves or others, and the rising perception of risk and fear from COVID-19 infection are among the main factors.

Barriers to Vaccine Acceptance

According to the article, the main barriers were negative perceptions about vaccine safety and effectiveness, insufficient time for vaccine uptake, and confidence in natural or acquired immunity.

Interventions for Vaccine Hesitancy

Interventions adopted during the COVID-19 pandemic to increase HWs’ influenza vaccine acceptance ranged from: awareness campaigns alongside education and training to target hesitancy; mandatory HWs’ influenza vaccination; promotion of vaccine culture in workplaces; the incentive approach; and increasing vaccine affordability and accessibility.

According to the article, the COVID-19 pandemic had a critical impact on the success of influenza campaigns among HWs. In the context of COVID-19, confidence in influenza vaccines and the perception of risk from COVID-19 infection have increased among HWs.

The Use of Chemical or Nuclear Weapons in Ukraine or Anywhere Is Unacceptable!

The World Federation of Public Health Associations (WFPHA) and International Physicians for the Prevention of Nuclear War (IPPNW) acknowledge the profound adverse effects of nuclear, chemical and biological weapons on the health and well-being of all people on the planet. The World Health Organization (WHO) recognizes the immense public health threat these weapons pose. This threat exists independent of actual use.

The war in Ukraine, even only as a conventional war, is destroying the lives and livelihoods of the people of Ukraine, their economy and importantly their environment. This produces a massive, multi-generational public health disaster.

The use of nuclear or chemical weapons in this conflict will magnify that public health disaster by orders of magnitude, causing causalities at a scale rendering any medical and humanitarian responses totally inadequate. The suffering resulting would constitute a clear crime against humanity. Even the threat to use such weapons causes needless extra trauma to already severely traumatized people.

Accordingly, the WFPHA and IPPNW demand that all combatants immediately and explicitly rule out the use of weapons of mass destruction in Ukraine.