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.

The Role of Thought Experiments as Sources of Insight and Lessons to Tackle Pandemics and Other Existential Challenges

“We invite people to exercise their imagination and think collectively on the failures of the current global health governance.” – De Souza (WFPHA) and Jadad (Center for Digital Therapeutics)

In February 2022, the World Federation of Public Health Associations (WFPHA) encouraged the use of thought experiments to improve humanity’s ability to manage pandemics and other existential threats. Delegates of the 17th World Congress on Public Health (2nd – 6th May, Rome), the overall public health community, and civil society members are invited to contribute to the further exploration of this method.

“What we tend to see is that the public health problems become visible only during the crisis and that’s why somebody needs to clean the mess. But it’s extremely difficult to do because the mess is getting bigger and bigger. The public health community is pretty powerless to deal with this problem. I think that the 17th World Congress on Public Health provides an opportunity for the public health community to reflect upon its role“, underlines Prof. Alejandro Jadad, a physician from the Center for Digital Therapeutics and one of the promoters of the Thought Experiment.

The imaginative capabilities of the human mind enable us to travel through time and space. Scientists and philosophers use this ability to create hypothetical situations, also known as Thought Experiments, to explore alternative approaches to complex issues, particularly when challenging the existing norm.

The creation of a Thought Experiment, which Albert Einstein used in some of his most important studies, involves five steps: beginning with a hypothesis or question, followed by assumptions, a hypothetical scenario, mental analysis, and communication of findings to others.

“It is important to note that this scenario is entirely fictional and not a recommendation or proposal for action. Our main goal is to help people to reflect collectively on the failures of the current global health governance. What really strikes us is that in 2019 we had international health regulations in place and nevertheless the best-valued countries in terms of capacity to respond to the epidemical crisis failed. Thus, it’s not a problem of the text of the regulation itself but how the members of the World Health Organization (WHO) and the United Nations (UN) took their responsibilities regarding the protection of people’s health”, – explains Prof. Luis Eugenio de Souza, the WFPHA president.

“The Thought Experiment is a very powerful tool. We invite people to exercise the power of their imagination and create situations that due to the knowledge acquired during the pandemic will allow us to come up with solutions to the problems that we face today”, specifies Prof. Jadad.

In a hypothetical scenario, a team of public health experts in 2023 discovers a time machine that could take them back to the beginning of the pandemic.

After conducting extensive research, the team identified a trustworthy group of people to represent humanity’s interests and ensure the equitable and efficient use of resources to halt the virus’s spread and mitigate consequences of the pandemic. This group was named the Planetary Health Protection Council (PHPC). The team was transported via the time machine to the UN headquarters in New York City, where they arrived on March 11, 2020, during the President of the Security Council’s presidential statement.

To explore the potential of thought experiments in pushing boundaries and stimulating fresh thinking about how to tackle pandemics and other existential threats, a hypothetical question was formulated:

If we had the power to travel back in time and add one resource to the available resources on March 11, 2020, to improve our response to the COVID-19 pandemic, what resource would we choose?

• “The response to this question can be summed up in two words: a coordination failure. We are failing to coordinate our response and it makes us unable to deal not only with the pandemic but also with climate change, with drought, with hunger, and with the war”, Prof. Jadad says.
• “We came to the conclusion that humanity lacked a species-wide governance system in 2020. There was a lack of accountability on the issues that went beyond the national jurisdiction. To be able to move towards effective global governance, we need to raise some specific questions to promote further reflection on the subject: 1) how far can national sovereignty go? 2) what could be done to protect the democratic decision-making mechanism, and how it can couple with the global one?”, Prof. de Souza adds.

Prof. Luis Eugenio de Souza notes that during the pandemic, the decision-making process was unbalanced. Therefore, it is extremely important to create a completely new, transparent, and impartial system. This role can be potentially fulfilled by the Planetary Health Protection Council (PHPC).

The imaginary composition of the PHPC:

• The government sector: Heads of state of all members of the UN
  Role: Providing high-level political leadership for rapid and coordinated action, advised by UN specialized agencies

• The corporate sector: Members of the World Economic Forum (WEF)
  Role: Facilitating the deployment of privately-owned technical and financial resources within and across national boundaries

• The academic sector: Experts selected by the International Association of Universities
  Role: Strengthening of evidence-informed decision-making by the other groups

• Civil society: Leaders selected from the 24,000 entities registered in the Integrated Civil Society Organizations System
  Role: Involving communities, especially giving voice to disadvantaged populations

“I would like to stress that our proposal to create the PHPC is not mature enough and thus it can be modified. We just want to put it on the table and open the discussion not only with the experts and political leaders but also to listen to the local communities and the people that suffered a lot but weren’t given the possibility to express themselves so far. We want to create such a representation which would give the floor to everybody who wants to participate“, specifies the WFPHA president.

Two independent and closely-related structures complement the PHPC:

• A digital platform to facilitate transparent and equitable participation of representative samples of the world’s population in key decisions (e.g., lockdowns, vaccine certification)
• A system of in-person and virtual tools designed to encourage and facilitate community engagement in controversial issues and adversarial situations, from villages to the entire globe.

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.

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.

Eliminating HPV Globally: From Strategy to Implementation

Cervical cancer is a disease that exemplifies global inequalities to a significant extent. Each year, more than 600,000 new cases of cervical cancer are diagnosed globally. Around 90% of the approximately 342,000 deaths resulting from cervical cancer in 2020 took place in low- and middle-income countries (LICs/LMICs).

Human papillomavirus (HPV) is responsible for over 95% of all cases of cervical cancer. Cervical cancer is the fourth most common form of cancer among women worldwide, but it is preventable and curable if detected early and managed effectively. HPV additionally causes anal, penile, oropharyngeal, vulval, vaginal, and other cancers. At least 10%, and possibly up to 40%, of cancers caused by HPV are in men.

The global coverage of the first dose of HPV vaccine in girls is only 15%, and the COVID-19 pandemic fueled the largest continued backslide in vaccination and screening. While in high-income countries people can be vaccinated against HPV and women have access to regular screening and treatment, this is not the reality in LICs and LMICs. Moreover, males are currently excluded from most HPV vaccination programs. Gender-neutral vaccination would protect women and men and accelerate the elimination of cervical cancer.

The World Health Organization (WHO) has developed an aspirational strategy to eliminate cervical cancer as a public health problem (Global strategy towards eliminating cervical cancer as a public health problem, adopted by the World Health Assembly in 2020), aiming to increase HPV vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%.

In line with the global strategy as well as Europe’s Beating Cancer Plan, the WFPHA, the Union for International Cancer Control, and the European Cancer Organisation organized a World Leadership Dialogue (WLD) session “Eliminating HPV Globally: From Strategy to Implementation” during the 17th World Congress on Public Health (WCPH), on May 02 to 06, 2023, to provide a platform for health leaders from governments, United Nations agencies, the private sector, civil society, and patients to share progress and challenges toward eliminating all HPV-related cancers.

This WLD session is organized to highlight progress towards the WHO’s 90-70-90 cervical cancer elimination goals; to discuss the determinants of health that limit women’s access to health services, screening, and treatment, starting from the real experience of some countries; to consider the merits of gender-neutral HPV vaccination; and to create a sense of urgency to direct policy decisions toward concrete actions to prevent and treat HPV-related diseases and to increase investments to scale access to these tools.

During this WLD session, health leaders listen to and discuss with communities and policymakers to define the best approaches and leverages to implement concrete actions based on the WHO global strategy to prevent and treat HPV locally and worldwide and to facilitate intersectoral collaborations to achieve this common goal.

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.