Tuesday, February 27

An Agency to face future health crises

A few days ago, the Council of Ministers approved the Draft Law proposing to create the State Public Health Agency (AESAP). An organization provided for in the General Law of Public Health of 2011, and that we would surely continue to wait, perhaps another decade if we had not suffered from the pandemic. One more example of the secular backwardness of our country in terms of public health, since neighboring countries already have institutions of this type, some of which are benchmarks, such as those that have existed in the United Kingdom or Germany for decades. Moreover, many of these agencies, including the European one (ECDC), are in a period of reconfiguration as a result of the lessons learned and considering the credible threats that we may face. An opportunity that we must take advantage of to build our Agency anew.

Honestly, after what we have experienced, we can affirm that, possibly, if AESAP had been available before the pandemic, some mistakes could have been avoided. For example, we would have possibly had more reliable, immediate and comparable information from the beginning of the crisis to guide decision-making. The steps established in the previously designed surveillance, preparation and response plans would have been followed, which would also have considered having strategic reserves of essential materials. Communication with the media and society could also have been structured with greater transparency and better capabilities, and with a diversity of actors adjusting to the information needs at all times and for each target population.

But there will be time to know the conclusions of the evaluations that are being carried out, and to know the successes and errors that have occurred during the pandemic. We are not so different either, there have been errors in all countries, as the North American agency (CDC) has just recognized, pointing out communication failures with the population. But we can advance as a hypothesis that the cost of not having an Agency has been higher than the cost of having one.

However, as recently recommended by the Spanish Society of Public Health and Health Administration (SESPAS), the creation of the Agency cannot wait any longer. Health problems happen and it is urgent to have it working as soon as possible. The monkeypox epidemic, declared by the WHO as an international emergency, or the cases of poliomyelitis detected in New York, which seem to push its global eradication away, are some examples. But so are the humanitarian crises resulting from migratory movements that do not stop. Syria, Afghanistan and now Ukraine, all of them generate health demands, in addition to housing, employment and education, that were not expected, and that must be addressed urgently.

But these crises are not comparable to the one we are beginning to glimpse related to the climate and energy crisis. More in an environment of the end of abundance, as it is announced to us, and we see that it is coming. In fact, it is already affecting us. The increase in mortality due to heat waves is a fact, and we fear that it will be followed by those that will occur this winter due to cold waves, and again in the most vulnerable people. These crises will also affect the economy and politics, which will end up affecting health. Without forgetting, of course, the health challenges that we have to face continuously, such as, for example, the unequal distribution of diseases due to gender, social class or ethnic group, and which affect all health problems in a transversal way. health, including chronic diseases that increase as the population ages.

Preparing ourselves for the challenges, present and future, must be the essential mission of AESAP. There is no National Security Strategy if there is no health security. The preparation of hospitals and primary care must also include their responses to these crises. The chaotic situations that were experienced in the first weeks and months of the COVID-19 pandemic must not be repeated.

To do this, AESAP must have autonomy and sufficient resources to lead the responses to these challenges based on its technical and professional competence. This requires timely, reliable and comparable information to share with the other actors involved: economy, interior, work, social security, education, etc. Having an Agency specialized in public health in operation, which looks at problems collectively and gives priority to prevention, will help in the search for solutions that are up to the complexity of the problems we face. This is good news that should be celebrated, hopefully soon, by way of urgency and with the unanimous support of the parliamentary groups. The signatories of this article are available to contribute with our scientific knowledge and experience in everything that ensures the configuration of an Agency that truly contributes to improving the protection of the health of our population.