TH Tulchinsky, MD MPH
Emeritus, Braun School of Public Health, Hebrew University, Jerusalem
Emeritus, School of Health Professions, Ashkelon Academic College, Ashkelon, Israel

ASPHER’s position paper on COVID-19 describes the importance of a strong professional voice in public health policy making, strengthening training, ensuring adequate resources and raising the mandate of the European Regional Office of the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) to a higher level.^[1] The calamitous COVID-19 pandemic currently is by far the most acute threat to the public’s health in Europe and globally.^[2],[3]

However, over the past decade, the European Region has faced multiple measles outbreaks with loss of life from a totally preventable disease which globally used to kill over a million children annually as late as 1990. The recent large-scale measles epidemics across Europe point to policy and structural issues that need to be addressed. Lack of harmonization of immunization policies in the European Union coupled with unfettered movement of people within the EU creates potential for perfect storms in infectious disease control. In 2019, WHO reported that after ten years of epidemics, measles remains endemic in ten countries “including Belgium, Bosnia and Herzegovina, France, Georgia, Germany, Italy, Romania, Russian Federation, Serbia and Ukraine”^[4]

COVID -19 is not the first, nor will it be the last challenge in the field of public health as the 1918 Swine flu, SARS in 2002-03, H1N1 influenza in 2009 and measles in the second decade of the 21^st century demonstrate. With global warming due to climate change, the potential for entry of new viral or parasitic diseases may well emerge in Europe.

In public health it is important and possible to learn and adapt based on experience to make needed changes. The best example I know of occurred following the SARS episode in Canada. When SARS broke out of China in 2002-03 it reached 27 countries, but Canada was badly hit and poorly managed. The public health system at that time was mainly based on Provincial Health Departments - inadequately staffed with limited resources and poor access to political policy makers. After the epidemic ran its course, Canada appointed a “lessons learned Royal Commission”, which made recommendations for sweeping changes in public health organization in the country.^[5]

This led to a series of reforms, which included establishing a Federal Public Health Agency, developing level 4 (BSL-4) microbiology laboratories across the regions of the country, and the establishment of 15 schools of public health (there were none before the SARS episode).^[6] In short, Canada revolutionized its public health system. As an example of subsequent success, the Federal Health Canada National Microbiology Laboratory lab in Winnipeg (my previous home) played the key role in developing the vitally needed Ebola vaccine recently approved both in Europe and the United States.^[7]

As Europe is now considered the current epicentre of COVID-19, examination is sorely needed of reform in public health organization. ASPHER has taken the initiative at this historic moment to point to a future based on resolving existing deficiencies in infectious disease control - which is a moving target. There are and will be more epidemics and quite probably pandemics, as or more severe than our current challenge on the scale of the 1918 pandemic. There will also be new vaccines for prevention and new treatments for harsh viral illnesses that will save lives.

Martin McKee and colleagues’ BMJ paper on the current COVID-19 pandemic points out weaknesses in infectious disease control in Europe. They call for revision of the mandate of ECDC plus more money.^[8] ASPHER should support this call for a review and modernization of the most basic public health responsibilities in Europe.

ASPHER should continue to be pro-active in addressing relevant authorities on issues that will improve coordination and effectivenessof responses to infectious disease threats to the health and the economies of the populations of all the countries in the WHO Euro Region.

The issues include:

• Appointment of a high level infectious disease regional expert authority including co-leadership by the European Commission and WHO Regional Office for Europe;
• Strengthening the ECDC with a mandate of monitoring, reporting and planning of infectious disease control in close conjunction with WHO Regional Office for Europe;
• Coordination across the entire Region in epidemic and disaster response policies;
• Coordination of public information and guidelines of individual self protection and social responsibility during the COVID-19 pandemic and infectious disease control in general;
• Promotion of epidemic disease control training for PH professionals, health care providers all health workers, and the general public and adequacy of diagnostic and treatment resources, compatibility and supply.
• Harmonization of national routine immunization programs across the Region with robust promotion of political and public awareness of the importance of routine vaccination including for seasonal influenza.

References:

[1] Middleton, J., Martin-Moreno, J.M., Barros, H. et al. ASPHER statement on the novel coronavirus disease (COVID-19) outbreak emergency. Int J Public Health (2020). https://doi.org/10.1007/s00038-020-01362-x (accessed 02.04.20).