Perspectives on COVID-19 13

COVID-19: REFLECTING ON EXPERIENCE AND ANTICIPATING THE NEXT STEPS

A perspective from the WHO Regional Office for Europe

By: Hans Henri P. Kluge, Dorit Nitzan and Natasha Azzopardi-Muscat

Cite this as: Eurohealth 2020; 26(2). Hans Henri P. Kluge is Regional Director, Dorit Nitzan is Regional Emergency Director, Natasha Azzopardi Muscat is Director, Country Health Policies and Systems; World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark.

Nine months into the COVID-19 Health Systems Response Monitor which forced our health systems to adjust with pandemic, devastation and disruption was established at the request of the unprecedented speed. Central to these across much of the European Region WHO Regional Office for Europe in the efforts was our health workforce. We continues unabated. A sharp and sustained early days of the pandemic, has provided must first and foremost prioritise their increase in cases is forcing governments invaluable experience in a timely fashion. well-being including providing adequate to navigate complex response tactics as This has allowed policy considerations mental, physical and financial support, they seek to control disease transmission, and technical /operational guidance to be and continuous training and education. If while also seeking to avoid the negative developed in a rapid response manner. we do not care for them, we will have no consequences associated with lockdowns. health system to depend on. In our view, there are three key lessons At this juncture we are dealing both that should form the foundation of the Health care systems need to operate a with the aftermath of the initial stages evolving COVID-19 response and long- dual track service delivery. Disruption to of the pandemic while grappling with a term recovery efforts: essential health services in the European growing and concerning surge in cases, Region is having a significant impact 1. Even the best health systems were not all the while in the midst of a looming in terms of delayed (missed) preventive sufficiently prepared: building resilient economic recession. The WHO Regional measures, like vaccination and diagnoses health systems Office for Europe has been working on and lack of services provision. The the ground within countries to support 2. There is not a competition between duration of the pandemic is storing up policy makers and health authorities to health and the economy: moving health problems for the future both as increase response effectiveness, save towards an economy of well-being a result of pent up demand as well as lives and protect livelihoods, while also due to increased diseases, e.g. mental 3. We will only get out of this if we work strengthening health systems to improve illness. Primary health care services are together: solidarity, innovation and a their preparedness for the challenges instrumental in enabling this dual track multisectoral response. that lie ahead. At the Regional level, response where routine health services we have tried to synthesise the lessons need to be provided in parallel to services learned and build policy considerations Resilient health systems focused on the pandemic response as well to support countries as they move along as providing aftercare to those persons COVID-19 has ‘unmasked’ critical the various scenarios of the pandemic. who are suffering from the ‘long COVID’ health system gaps and deficiencies. This is in spite of the rapidly evolving syndrome. Public health services need to Health workforce shortages, broken situation and the emergent, incomplete be better equipped and capable of timely supply chains, fragmented services and scientific knowledge, which are both detect, isolate, test, trace and quarantine. silo information systems are a few of hallmarks of navigating in unchartered the problems that hindered the response and uncertain territory. The COVID-19 in the early days. The pandemic has

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For us to enable health systems to respond pandemic has shown us once again that It is vital that we continue to explore in the way we need, we must also take investing in health and preparedness yield all possible response mechanisms, advantage of alternative service delivery above and beyond the input. Investing in particularly ones that bring together platforms. The new frontier of digital the economy of well-being would help sectors and technical expertise to and remote services should be scaled up reduce lives lost, morbidity and stress help us move beyond the biomedical to reduce barriers to seeking care and among the population as well as promote (including through behavioural insights) complement the efforts of the scarce economic growth. The COVID-19 to build health system resilience while human resources for health. pandemic has also illustrated the impact also tackling persistent inequalities in of political decision-making on health our communities. As we explore new frontiers, we must also services in a way that is immediate and double down on responding to persistent highly visible. Frameworks for the future challenges that have been exacerbated by the crisis. We need greater investment It is patently clear that keeping COVID-19 To facilitate the utilisation of lessons in mental health care, care for older under control is necessary for a solid and learned so far from COVID-19, WHO people, and a renewed commitment to sustained economic recovery. The mantra, Europe has developed several frameworks immunisation programmes including there is no wealth without health, has been and tools: efforts to tackle vaccine hesitancy. amply demonstrated in a harsh way. 1. An evolving lessons learned catalogue: 1 Although it is too soon for Here it is important to learn lessons a comprehensive and critical evaluation from the financial and economic crisis this document provides a starting point of the previous decade. In order to avoid for regional discussions on how to accentuating catastrophic expenditure on improve preparedness for and response health, it will be necessary to find ways to investing in to future events, and “build back better.” sustain health spending within a situation health and where fiscal space is limited. Cognisant 2. Transition Framework: 2 key of the necessity to think up solutions that considerations for Member States to preparedness may be well outside of the tried and tested help them to decide on the modulation ground, WHO Regional Office for Europe of large-scale restrictive public health yield above and has set up the Pan European Commission measures, while at the same time on Health and Sustainable development strengthening core public health service beyond the input chaired by Mario Monti. This Commission capacities together with personal has the remit to: protective measures. Overall, the pandemic has only • Rethink policy priorities in the light 3. Framework for the reopening of strengthened for us what we already ‘‘ of pandemics drawing lessons from schools: 3 guidance to ensure the knew, which is that health systems are the ways in which different countries’ safety and well-being of children, their central to the well-being of people and health systems have responded to the families and communities as schools their communities. For these systems COVID-19 pandemic are reopened. The framework is guided to be resilient to shocks they must have by the best interests of the child and strong governance structures driven by • Make recommendations on overall public health considerations, adequate and effective leadership that investments and reforms to improve informed by cross-sectoral and context- engages with the communities, listens and the resilience and further integration specific evidence. adjusts to their needs. These structures of health and social care systems will support health system preparedness in 4. A framework for responding to • Build consensus on these the face of rapidly changing scenarios and pandemic fatigue: 4 key considerations recommendations and bringing them population needs. for the planning and implementation to the attention of the highest political of national and subnational strategies level within the government The need for an economy of to maintain and reinvigorate public well-being • Make health and social care as political support to prevent COVID-19. priorities in governments’ political The COVID-19 pandemic has illustrated and fiscal agendas. We are at a pivotal point in the biggest the futility of the debate between life public health crisis of our lifetimes and livelihood; without health, there New approaches to persistent and can be no economy or social cohesion. growing challenges There is an opportunity to take the set Health is an important determinant for of lessons that had to be learned with development, and yet investment decisions COVID-19 has shown us that we need an unprecedented speed and reduce the that are concerned with health system integrated, cross-sectoral approach if we burden this pandemic continues to have on strengthening have been considered as a are going to achieve the structural change communities. Responses must be nuanced cost and a burden on society. However, the needed to protect communities. to meet the specific needs of every

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population group from older people in 4 WHO/EURO. Pandemic fatigue – Reinvigorating care homes to young people at universities the public to prevent COVID-19, September 2020. and in schools. Targeted responses must Available at: https://www.euro.who.int/en/health- topics/health-emergencies/coronavirus-covid-19/ also be designed to cope with the new publications-and-technical-guidance/2020/ challenges brought by the winter months. pandemic-fatigue-reinvigorating-the-public-to- Policy considerations to prepare for an prevent-covid-19,-september-2020-produced-by- autumn /winter season where COVID-19, whoeurope influenza and influenza-like respiratory 5 WHO/EURO. Health system considerations: when illnesses coincide have been prepared. 5 influenza meets COVID-19. Preparedness and response measures when COVID-19, influenza and acute Going forward we must examine the respiratory infections coincide in the WHO European Region, October 2020. Available at: https://www. impact of COVID-19 on our ability to euro.who.int/en/health-topics/health-emergencies/ make significant progress towards the coronavirus-covid-19/publications-and-technical- Sustainable Development Goals. Whilst it guidance/2020/health-system-considerations-when- is clear that progress will be hindered as influenza-meets-covid-19,-october-2020-produced- a result of this pandemic, setbacks should by-whoeurope only serve to sharpen our appetites to achieve our ambitions.

A multi-sectoral approach is paramount, but the true way through this crisis is through bridging the divide between policy makers and the public. Solutions need to be created together, the input of communities needs to rapidly be elevated.

Despite its hardships, COVID-19 is offering an opportunity to rapidly create societal and policy changes on scale that has not been done before. Necessity, courage, innovation and collaboration are the attributes needed to see us through.

References

1 WHO/Europe. The COVID-19 pandemic: lessons learned for the WHO Europe Region, 2020. Available at: https://www.euro.who.int/en/health-topics/ health-emergencies/coronavirus-covid-19/ publications-and-technical-guidance/strategic- documents/the-covid-19-pandemic-lessons-learned- for-the-who-european-region

2 WHO/Europe. Strengthening and adjusting public health measures throughout the COVID-19 transition phases, 24 April 2020. Available at: https://www. euro.who.int/__data/assets/pdf_file/0018/440037/ Strength-AdjustingMeasuresCOVID19-transition- phases.pdf?ua=1

3 WHO. Schooling in the time of COVID-19, 2020. Available at: https://www.euro.who.int/__data/ assets/pdf_file/0011/463817/COVID-19-schooling- virtual-folder.pdf

Eurohealth — Vol.26 | No.2 | 2020