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.

2022-2023 Annual Report Is Now Available!

Our 2022-2023 annual report is now available to view. WFPHA’s major initiatives and activities to protect people, prevent diseases, and promote health and wellbeing globally are highlighted in this report.

Driving Resilient Pediatric Immunization Programs Globally

Vaccination is one of the most powerful and cost-effective tools in the history of public health, with important health, economic, and social benefits. Pediatric vaccinations help protect children and adults from serious, preventable, and sometimes life-threatening diseases and are a key contributor to supporting global health security.

Globally, vaccination coverage has stagnated at around 85 percent from 2011 to 2019, with some regions reaching excellent results. However, since the onset of the COVID-19 pandemic, global childhood vaccinations have experienced the largest sustained decline in 30 years. Globally, in 2021 alone, 25 million children missed out on one or more doses of diphtheria, tetanus and pertussis (DTP3) through routine immunization services. 18 million of the 25 million children did not receive a single dose of DTP during the year, the vast majority of whom live in low- and middle-income countries, with India, Nigeria, Indonesia, Ethiopia, and the Philippines recording the highest numbers. The figure is extremely alarming because DTP3 is considered a marker for immunization coverage within and across countries and broader healthcare access; if children are missing these vaccinations, they are probably also missing preventive care visits and crucial vaccinations for many other diseases.

Nearly 25 million children missed their first measles dose in 2021. Almost 15 million children did not receive their needed second dose. In 2021, compared to 2019, nearly 7 million more children missed the third dose of polio vaccine. Inadequate coverage levels have already resulted in avoidable outbreaks of measles and polio, underscoring the vital role of immunization in keeping children, adolescents, adults, and societies healthy.

Conflicts worldwide and related population displacement are placing additional pressure on health systems and exacerbating disruptions to routine immunization programs. To date, the war in Ukraine has led to at least 5.6 million refugees being hosted in European Union countries. This has resulted in an increased threat of vaccine-preventable disease outbreaks in the region.

We live in a world where health systems are constantly facing threats, and preventing the spread of vaccine-preventable diseases is a key component of global health security. Recent pressures on the health system and geopolitical conflicts underscore the need for resilient immunization programs that are able to withstand major shocks and disruptions, quickly adapt to changing circumstances, and maintain high vaccine uptake and acceptance over time. Prioritizing immunization as an essential health service and ensuring pediatric immunization programs are resilient in the face of current and new threats are of the utmost importance to ensuring populations are healthy.

The WFPHA and the World Association for Infectious Diseases and Immunological Disorders organized a World Leadership Dialogue (WLD) session “Driving Resilient Pediatric Immunization Programs Globally” during the 17th World Congress on Public Health (WCPH), on May 02 to 06, 2023, to provide a platform to engage health leaders from governments, public health authorities, communities, and advocacy groups to discuss how to build resilient pediatric immunization systems through effective monitoring, communication, legislation, funding, and crisis-preparedness planning.

This WLD session is organized to highlight progress in pediatric vaccination and discuss the impact of COVID-19 and other external factors on vaccine coverage rates; to utilize real-life experiences from select countries to discuss barriers and opportunities to developing resilient immunization systems and ensuring health system strengthening; and to create a sense of urgency to drive policy decisions that support resilient immunization systems and concrete crisis preparedness plans globally to ensure efficient pediatric immunization programs.

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.