Jeremy Lasek – PHAA
The PHAA’s Australian Public Health Conference 2021, while virtual in nature due to COVID, is being widely acclaimed as having some of the best content in years.
That old saying of ‘saving the best till the last’ may ring true yet again, following the conference’s final keynote presentation from Professor Martin McKee, and his insights into the global fight against COVID.
Martin McKee is Professor of European Public Health at the London School of Hygiene and Tropical Medicine. His presentation, titled ‘Never again: Health and sustainable development in the light of the pandemic’, examined the lessons from the pandemic in Europe and elsewhere.
Staying the course
Professor McKee opened with an analogy, likening a group of countries in the midst of the pandemic to a fleet of ships trying to navigate their way through a storm.
“What went wrong?” he asked.
“And what did we need to do to get to the calm water on the other side?
“Well, you need a captain with the ability to take decisions, to be decisive, and to show leadership. Now, if you look at the countries who’ve done worst in the world, you can see we’ve had serious (leadership) problems.
“The captain of the ship needs to have a crew, in sufficient numbers to be able to raise the sails and to move things around on the deck; who are working together and are adequately trained.
“The ships themselves need to be strong and secure. They need to have robust safety procedures; safety nets, so you don’t have people wandering around the decks and falling into the sea.
“You need to have a means by which the ships can communicate with each other. (In a pandemic) the countries can communicate about what they’re doing, about their cases, and the research their doing.
“You need to have a system of surveillance; so you need a lookout to try to anticipate what’s going to happen; the modellers, the people gathering data on the variants of the virus.
“And crucially, you need to have a map, and you need to have the right map. Countries in the Asia Pacific region had a map labelled ‘coronavirus’ after 2003; while we in Europe were using a map called ‘influenza’.”
Professor McKee’s presentation cited findings of a report he co-authored, ‘Rethinking Policy Priorities in the Light of the Pandemic’, from the Pan-European Commission on Health and Sustainable Development. The report calls for the full implementation of the concept of One Health in all settings where health policies are developed.
The legacy of the pandemic
A major sections of that report refers to the ‘legacy’ of the pandemic.
“These are the things we’re going to have to think about,” Professor McKee said.
“The health consequences of continuing outbreaks of future pandemics, of new variants, the burden of long COVID in those countries that have had a high burden of acute infections, and the legacy of mental illness.”
He discussed innovations in new models of health care, including remote consultations, while recognising the need to have greater surge capacity, and finding new ways to work together in teams.
“We have a huge challenge of a lost generation of school children who’ve missed out on education at a crucial period in their life, and that will live with them throughout their lives. They can expect to face problems all the way through their working lives.”
Professor McKee said while the future of the global economy was uncertain, the built environment will see improved ventilation, more active transport, and home offices, meaning “endless” Zoom meetings.
The case for health
“In the report we are very clear that we need to make the case for health,” Professor McKee said.
“Throughout the pandemic there’s been a debate about whether health even matters. Shouldn’t we just be enjoying ourselves? Why should we be restricting our lives, even though people are getting ill and dying?
“And there are many arguments promoting health is the right thing to do. Health is a human right. We also know that health is a driver of economic growth, as is education. People who are healthier contribute more in terms of participation in the labour force and productivity. And we’re increasingly recognising the role of health and solidarity: countries and communities that experience declining health create fertile ground for populist politicians who want to sow division.”
What comes next?
Professor McKee said as there were many different existential threats to humanity and global health, as set out by the World Economic Forum and others, a comprehensive approach was needed to make sense of it all.
The report he helped write creates a model in which One Health is centred; the health of humans, of animals, and the living environment all superimposed on planetary health.
It lists the determinants of health in the 21st century. These include unwanted things like conflict, pollution, food insecurity, lack of shelter, disinformation and racism. It also includes good things such as digital access, safe environments, housing, education, safe nutritious food, clean air and water, and access to justice.
“Biodiversity is our ultimate insurance policy,” Professor McKee said.
“That’s what we need if we’re going to survive as a species.
:So, what we’re asking for in our report is to place One Health as the basis of our future wellbeing.
“Within countries, we need structures and incentives and a supportive environment for coherent cross-government strategies which build on the well-established principle of health in all policies.
“We need the international organisations to work together. The World Health Organisation, the Food and Agriculture Organisation, the Animal Health Organisation, the United Nations Environment Program. These need to develop a shared understanding of One Health, to agree common terminologies, and to create that international architecture.”
The report emphasises the need to “heal the fractures that weaken our society…by identifying those in society who are leading impoverished or precarious lives…and we need to implement policies that will give them the security that we know underpins good health,” he added.
Innovation is crucial
“We need to have innovation at the heart of our response to COVID,” Professor McKee said.
“That means we have to have research with a purpose. We need to be able to identify the gaps in research, the neglected diseases…the neglected populations; the communities left out of the clinical trials; the communities that we call ‘hard to reach’ when what we really mean is that we haven’t tried hard enough to reach them, and we need to fill these gaps.
“We need to make sure when we do innovate, we make a difference. We need to have learning systems that adopt innovation rapidly. There is no point in having a new piece of information that can save people’s lives published somewhere but never taken up; or where there is no mechanism for a health system to get those ideas into practice.”
Professor McKee said governments needed to invest in strong and resilient health systems, and ensure that money is spent appropriately, particularly in the health workforce.
“We need to work hard to bring health and social care closer together,” he said.
“In many countries we saw the ‘Cinderella’ area of social care just ignored. As a consequence we saw people essentially being left to die with COVID going through care homes and residential facilities looked after by staff who were paid very little, and who had inadequate supplies of personal protection equipment. We need to prioritise prevention because we know that it was those people with complex chronic diseases like diabetes that were most vulnerable when the pandemic came.”
“The first thing we need to do is to create an environment that promotes investment in health,” Professor McKee said.
“We made proposals to create accounting systems to promote investment, to incorporate health and health risks into economic forecasts; to include health when we’re assessing the financial resilience of a country. A country cannot claim to be resilient financially, to have all the systems right, if it is weak in terms of its ability to resist a pandemic.”
He then outlined recommendations for how to improve health governance at the global level.
“We’re proposing a global health board under the auspices of the G20,” he said.
“Why the G20? Because that’s where the money is. We’re basing this idea on what happened after the financial crisis which led to the G20 being created.
“We need a Pandemic Treaty; I think everybody agrees that. But this is one that holds governments to account, at the same time as supporting those in need. It’s the fundamental principle that each should contribute according to their ability and each should be supported according to their needs.
“And we need a Global Pandemic Vaccine Policy that enables availability of vaccines for everyone and also that those vaccines can get from the laboratory into people’s arms, so that they actually make a difference.”
Summarising his report, Professor McKee said its agenda was ambitious, and would not be easy to enact.
“But if it’s going to work, countries will have to accept shared sovereignty for the greater good,” he said.
“So that they come together to protect us all, wherever we live on this planet – the only planet we have – because we will have more and more threats, in particular those that are arising from what we are doing to this planet. We need to be prepared next time, so that we really can come out of this and say to ourselves, never again.”