Pandemic, Conflicts, Climate Change: What Have We Learned from the Past Three Years?

On December 1, 2022, IANPHI held a session of the 2022 Annual Meeting dedicated to sharing lessons learned from National Public Health Institutes (NPHIs) and the World Health Organization (WHO) that have been working to address the pandemic, conflicts, and climate change during the past three years. The session was moderated by Karin Tegmark Wisell, director general of the Public Health Agency of Sweden. 

The speakers included Dr. Scott Pendergast, director of Health Emergencies at WHO, Dr. Annika Veimer, director of Estonia's National Institute for Health Development, Prof. Hervé Hien, director of Burkina Faso's Institut National de Santé Publique, Dr. Oleksandr Mastkov, deputy director of the Public Health Centre of Ukraine, Dr. Abdifatah Ahmed, executive director of the Somalia National Institute of Health, and Dr. Mariken Leurs, head of the Centre for Health and Society at the National Institute for Public Health and the Environment (RIVM) in the Netherlands. 

Dr. Wisell opened the session by referring to the UN’s Sustainable Development Goals (SDGs) Report 2022 which describes how the converging global crises of COVID-19, the conflict in Ukraine, and the climate crisis are jeopardizing SDGs’ ambitions and impacting food supplies, education, health, and security across countries worldwide. With this backdrop, the first two speakers discussed lessons learned from global and regional perspectives while the remaining four speakers presented country case studies. 

Dr. Karin Tegmark Wisell, director general of the Public Health Agency of Sweden

Strengthening the Global Architecture for Health Emergency, Preparedness, Response, and Resilience

by Dr. Scott Pendergast, WHO Health Emergencies Programme

Dr. Scott Pendergast, director of Health Emergencies at the World Health Organization

  According to Dr. Pendergast, one lesson that emerged from the COVID-19 pandemic is the extent of spillover effects on the economy, education, climate, poverty and health. The interconnectedness of health systems with the environment, animal health, and agriculture thus demands multisectoral solutions engaging community, national, regional, and global levels. “The integration between primary health care, health promotion, and health security need to go hand in hand,” he said. “We have come quite a long way in our ability to structure and obtain resources for response, but what we haven’t been as effective with is having investments in preparedness.” Thus, making an investment case, not only in terms of money but leveraging existing resources, continues to be both a priority and a challenge. 

Due to the overwhelming volume of COVID-19 information, member states requested WHO to provide a summary of this knowledge. In response, WHO synthesized more than 300 recommendations and distilled the findings into a strategic framework highlighting governance (leadership, International Health Regulations, accountability), systems (capacity, coordination, and collaboration) and financing (finance, pandemic fund, response financing). Dr. Pendergast concluded his presentation by remarking on the potential for collaboration, opportunity, and leveraging the new partnership between WHO and IANPHI 

Preparing for and Responding to Crisis: Report from IANPHI’s European Regional Network Meeting in Tallinn

by Dr. Annika Veimer, Director, National Institute for Health Development, Estonia

Dr. Veimer presented a brief overview of the European Regional Network meeting in Tallinn that focused on the health impacts of the war in Ukraine and what COVID-19 taught NPHIs on how to prepare for future crises. The ongoing war in Ukraine has had a devastating impact on health, infrastructure, medical supplies, and health personnel. In addition, other indirect effects from the war including housing displaced populations, malnutrition, addressing the needs of the disabled, family separation, mental illness, unaccompanied minors, and refugees. The primary takeaway was the need to focus more on cooperation between the social and health systems and scaling up assistance for medical supplies and medical staff. 

The European Regional Network participants also discussed lessons learned from the COVID-19 pandemic. On this topic, the two takeaways were that impacts from COVID-19 go beyond disease and that communication is an essential component of public health. Finally, the importance of collaboration between countries and a dedication to the understanding of not only what has gone right, but what has done wrong should be discussed openly and honestly.  

Case Study: INSP’s Contribution to the Management of the COVID-19 Pandemic in Burkina Faso

by Prof. Hervé Hien, Institut National de Santé Publique, Burkina Faso

Burkina Faso’s INSP was at the heart of the COVID-19 response. Among Burkina Faso’s population of 22 million, 21, 886 cases and 395 deaths were counted. Immunization coverage hovers around 12% so there is still ample room for progress. In terms of best practices, INSP was successful in mobilizing the health research, devolving COVID-19 management in the routine system, establishing a mechanism to fight rumors and creating a call center for detection and advice. 

In terms of challenges, Prof. Hien believes that INSP needs to continue to collect facts to contribute to evidence-based decision making by policy makers. He recognized the need to strengthen the integration of a One Health perspective in epidemic management and noted that “the health system needs to use integrated instruments for monitoring public health and we need to take into account the national context, internally displaced people and populations facing security and climate challenges.” He concluded by noting that it was important to showcase the role of the institute in facing COVID-19 and a range of epidemics.

Case Study: Public Health System in Ukraine in Wartime: New Challenges and New Lessons Learned

by Dr. Oleksandr Mastkov, Deputy Director, Public Health Center of Ukraine

Dr. Mastkov provided a sobering overview of public health challenges facing Ukraine since the Russian invasion on February 24, 2022. Challenges due to the invasion include mass displacement of the population (including medical workers), interruption of logistics for the delivery of vaccines and medical supplies, understaffing, and depletion of medical supplies. Shelling and occupation have also resulted in limited access to medical care for the population, restricted laboratory services, overcrowding in temporary locations, an increase of infectious and noncommunicable diseases, and difficulties in data collection due to unreliable internet connection and security considerations. Changing priorities have resulted in re-allocation of health funds to the war effort. Destruction of the health infrastructure includes damage to 1,153 medical facilities, 29 civilian doctor deaths, and more than 100 injured. On a positive note, 98 medical facilities have been completely restored and 204 partially restored. 

The most urgent public health risks according to a WHO public situation analysis are mental health, injury/trauma, and radio/nuclear hazards. In response to the current situation, several new initiatives have been introduced, including mobile clinics for hard-to-reach areas, mobile vaccination teams, new logistics and transportation procedures, and hotlines/chat bots. Despite ongoing challenges, Ukraine also managed to adopt a law on Public Health Systems in September 2022 that was established to provide a framework for building a public health system in Ukraine. Looking ahead, a recovery plan with recovery stages is designed to restore the health system’s infrastructure and technical, professional, and staffing areas.  

Dr. Abdifatah Ahmed, executive director of the Somalia National Institute of Health

Case Study: Impact of COVID-19 and Climate Change and Conflict in Somalia

by Dr. Abdifatah Ahmed, Executive Director, Somalia National Institute of Health

Somalia has experienced one of the longest standing humanitarian crises in the world. Climate shocks displaced 919,000 people due to flooding in 2020 and destroyed 144,000 hectares of farmland. Fifty percent of the population has been affected by drought; 300,000 people face famine, and 1.8 million children are acutely malnourished. Climate change has also resulted in famines, recurring flooding, locust swarms, sea level rise, air temperature rise, and failed rainfall seasons. Future climate projections entail frequent and intense weather events, a resurgence of disease, crop and livestock loss, internal displacements, and extreme food hunger and malnutrition.  

The onset of the COVID-19 pandemic further threatened Somali’s fragile health system. However, “despite the pandemic overwhelming an already weak health system, the Ministry of Health, together with its partners, has been able to respond,” said Dr. Ahmed. With WHO’s assistance, Somalia improved their laboratory capacity, training, provision of medicines, and life-saving equipment. 

Somalia is off track with respect to the SDGs. Sixty-nine percent of people live below the poverty line and 79% experience moderate or severe food insecurity. Health systems suffer if food systems are not working, which is the current state in Somalia. Drought conditions, for example, have resulted in a four-to-five-fold increase in childhood diseases, and a two-fold increase in severe acute malnutrition, extreme hunger, and water shortages. The essential ingredients for a ‘Build Back Better’ approach include multisectoral efforts to combat the effects of climate change, the promotion of durable displacement solutions, scaling up social protection programs, and inclusivity of women and children in the system.

Case Study: Added Value of Behavioral Sciences

by Dr. Mariken Leurs, Centre for Health and Society, National Institute for Public Health and the Environment (RIVM), The Netherlands

Recognizing the behavior component of COVID-19, the Netherland’s RIVM mobilized a behavioral science team designed to address and understand population behavior. A team of behavioral scientists designed and implemented a survey that was conducted 20 times over two years with 60,000 respondents. The survey investigated behavior, beliefs, affect, vaccine uptake, well-being, trust, and justice and was complemented by focus groups, interviews, field work, and scenario studies. Based on the findings, a model encompassing communication, context and control was developed to capture motivations, environments, and enforcement issues. Contrary to the general belief that people will do what you tell them, it became obvious that context and control issues needed to be considered. 

One lesson learned was to give voice to the ‘silent majority’ since many in society are willing to cooperate even though they are less vocal than some minorities. “Behavior is key to the spread of infections,” said Dr. Leurs, so behavioral scientists should be included in outbreak response efforts. “Investing in behavioral trials, qualitative research, and monitoring is key in preparing for pandemics and other crisis where (structural) behavioral change could prevent major negative impact on health and society,” she concluded. 

Dr. Mariken Leurs, head of the Centre for Health and Society at the National Institute for Public Health and the Environment (RIVM) in the Netherlands

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