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February 2022 President's Message: Better to jaw, jaw...??

Publication date: 22.02.2022
Author: John Middleton

As Churchill said, ‘it is better to jaw, jaw, than to war, war’. Never has that been more starkly obvious than in the Europe of early 2022. If you step out of the recently reopened ASPHER office in Brussels you come to Montgomery. Montgomery’s first rule of war was: ‘don’t march on Moscow’. No-one should ‘march on Moscow’, literally or figuratively.

Our thoughts are with our members in Ukraine and Russia and other Eastern European countries. ASPHER is very limited in its ability to bring about world peace, but we will take the steps we can. We will encourage our members to forge links across political divides. Health promotion is peace promotion and the health community can be a bridge for peace, as we suggested last year in the Israel-Palestine conflict. We must avoid stereotyping and demonising and seek to find common areas of interest and concern which can lead us to deeper mutual security. I have nothing to say in criticism of any regime that cannot now, sadly, be levelled at my own UK government: corrupt, greedy, repressive, and brutal. You can add to ‘careless’, ‘callous’, ‘incompetent’, ‘thoughtless’, ‘ignorant’, ‘entitled’. The inept actions of our prime-minister and foreign secretary can only add to the uncertainty and fear created for people a very long way from Westminster. Vacuous threats only increase the level of tension. Incompetence and ignorance only weaken negotiation and create justifiable derision. As some Western European governments apply diplomacy, others sabre rattle irresponsibly and posture emptily, playing with the futures of citizens of Eastern Europe. In the meantime, effective actions to address exported Russian wealth in other countries is barely touched, indeed there is a resurfacing of interest in collusion with Russian business interests; the disinformation war continues; and the price of oil and gas spirals, further threatening our cost of living. We call on governments of all sides to reject violence and strive for diplomatic solutions.

In early 2022, European governments seem to be having difficulty calibrating risk – the danger of Russian invasion being played up; the danger of the pandemic is being played down. Both judgements combine to present ever greater uncertainty and threats to the health of Europeans.

We should listen when great public health voices like Devi Sridar tell us that COVID-19 has been ‘defanged’; when Chris Murray of the Institute of Health Metrics and Evaluation talks about ‘the end of the pandemic’; and Tom Frieden and David Heymann also prepare us for the end. But there are judgements to be made.

None of these illustrious commentators have entertained the next variant being more severe, with vaccine escape, although there is no reason to believe this could not happen. I have only part-joked that there will be a new variant of concern in March – it would be consistent with experience so far….

With the United Kingdom deciding the pandemic is finished, and Denmark pulling all restrictions, the pressure on other countries to do the same gathers pace. Pretty soon the sacrifices millions have made over the first two years of the pandemic will be consigned to history. For the moment, they can be summarised in Figure 1 which shows the cumulative mortality in selected European countries over the last two years: human tragedy on an almost unimaginable scale.

Figure 1.

The peak of omicron may be just passing, but the deaths remain at a very high plateau (Figure 2). Numbers of cases are at and outcomes have largely been more mild because of the protective effect of vaccines.

Figure 2.

Children are paying a high price from omicron with high levels of children’s hospital admissions and deaths. The acceptance of these is extraordinary and unbelievable. The 'adverse childhood experience' of the pandemic is now a direct adverse childhood experience of COVID infection. There are high levels of hospital activity, exhausting for health care staff, and preventing other treatments being done. There continue to be high levels of sickness absence in key sectors. Vaccine effectiveness is waning. There are still high levels of unvaccinated young adults. Indeed, the announcement of all restrictions ending creates the message that the pandemic is all over; the vaccination programme has all but ground to a halt in England and France. Suggestions about reducing isolation periods and ending protective measures threaten to allow a second spike of omicron infections. The US Veterans Administration study shows evidence of increased risk of thrombotic disease, which may be a ‘long COVID’ mechanism, or may be a late complication. A second recent study also reports late and persistent sequelae of COVID-19.

ASPHER remains of the view that ‘living with COVID’ means recognising that what we previously called ‘restrictions’ should be called ‘protections’. Living with COVID might not mean living a ‘pre-covid normality’ if there was ever such a thing. There are helpful behaviours people adopted and governments mandated during the first waves of the pandemic, and which we should keep, to protect our health in winter in the future, whether from COVID or other respiratory viruses. They are in the box:

Good lessons from the COVID pandemic

  • Presenteeism – just don’t go to work if you are ill.
  • Work from home if you can – Reduces congestion, reduces CO2 emissions good for people, good for business, and good for the planet.
  • Wash your hands – good for any infection prevention.
  • Wear a well-fitting N95/FFP2 mask – protects user and others from respiratory infection.
  • Improve indoor air quality in classrooms, businesses and homes.
  • Have your health care consultation by remote means if you can - reducing nosocomial infection, reducing traffic.
  • Of course there are more – please add to the list.

ASPHER also recognises the need to learn from the new phase of the pandemic and strengthen primary and community services, school health and occupational health. ‘Living with COVID’ also means ‘Vaccines plus’ – no single measure can protect us from COVID-19 so we need to have all our armoury of measures available at the same time to reduce transmission, disease and deaths.

Other ASPHER activities this year

In other news I presented my take on the pandemic and other planetary health concerns to a group of doctors in Norfolk UK, on January 21st 2022. HERE.

ASPHER and WHO EURO successfully launched the road map for professionalisation of public health, on February 8th 2022. You can find more later in the newsletter. ASPHER is working with colleagues in the Global Network for Academic Public Health and the World Health Organisation Geneva to develop this work for the global stage and a presentation for a future World Health Assembly. We owe it to all our excellent young professionals to develop and establish careers and a recognised, respected professional position in the health systems of all countries. We owe it to the public to ensure we grow a generation of expert, caring and committed public health professionals.

I am going off to explore a mystery shopping experience in the NHS so I will be out of action for a few weeks., I thank everyone for their good wishes. I thank as ever, our wonderful secretariat for their incredible hard work for all of us and for doubling that workload to get things done before my time out. Thank you all.

Professor John Middleton
President ASPHER, February 16th 2022

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