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With COVID-19 still a Public Health Emergency of International Concern, some timely advice on prevention

Introduction by Croakey: The World Health Organization’s International Health Regulations Emergency Committee has advised Director-General Dr Tedros Adhanom Ghebreyesus that the COVID-19 pandemic remains a Public Health Emergency of International Concern.

In a statement dated 30 January, the committee noted that while the pandemic is likely at a “transition point”, the coronavirus still poses a threat with a high number of global deaths, uncertainty on emerging variants and insufficient vaccine uptake in low- and middle-income countries as well as in high-risk people across the globe.

See Twitter thread here

The Committee provided seven recommendations to WHO member states – to focus on vaccination, improve reporting on data surveillance to WHO, increase uptake and long-term availability of vaccines, diagnostics and therapeutics, prepare for future events (such as new pathogens or emerging variants), work with communities to address misinformation and effective implementation of public health and social measures, adjust travel-related measures based on risk, and continue to support research for vaccines and post-acute COVID-19 conditions.

Committee members said pandemic fatigue and reduced public perception of risk have led to drastically reduced use of public health and social measures, such as masks and social distancing. Vaccine hesitancy and the continuing spread of misinformation continue to be extra hurdles to the implementation of crucial public health interventions, they said.

“At the same time, the long-term systemic sequelae of post-COVID condition and the elevated risk of post-infection cardiovascular and metabolic disease will likely have serious negative on-going impact on population, and care pathways for such patients are limited or not available in many countries,” said their statement.

Meanwhile, ahead of the National Cabinet meeting this Friday, Australian health leaders are urging governments to revise COVID-19 management strategies, as reported at Croakey last week.

In the article below, Professor Andrew Wilson, Co-Director of The Australian Prevention Partnership Centre and Co-Director of the Menzies Centre for Health Policy and Economics at the University of Sydney, discusses what can be learnt from some key strategies used in chronic disease prevention. Wilson has previously held senior leadership positions in NSW and Queensland departments of health.


Andrew Wilson writes:

Our focus [at the Prevention Centre] is on chronic disease; however, there are many commonalities when it comes to prevention and human and community behaviour (i.e. beyond vaccines and anti-viral treatments).

It is interesting how little of this evidence was picked up on, likely because we saw COVID as an acute, relatively short-term problem and not one that would drag on and continue after three years.

A particular element that stands out for me during the peak periods was not fully appreciating what we know about the social determinants of health.

From the studies in chronic disease prevention [that could be applied to infectious disease prevention]:

  1. Communication about risks and protective behaviours has to be clear, consistent, ongoing, multi-pronged and refreshed at regular intervals.
  2. Understanding health literacy (and digital literacy in this age) is critical to messaging.
  3. Messaging needs to reflect the full range of the intended audience – in population-wide issues like COVID, what might be influential for young people may be different to the needs of those more at risk, similarly, in multicultural communities.
  4. There are always detractors – whether it is deliberate for gain (for example, the tobacco industry), political or lack of understanding – you need to have specific tailored responses to this.
  5. When evidence is new and incomplete, there are always going to be differing expert views and in our digital world there is always avenues for those views to be public – and people hear and act on ‘expert’ advice that is consistent with their biases. Most tobacco smokers, for example, have a couple of misinformed views that justify their persistent behaviour.
  6. Maintaining human behaviour change is difficult without environmental change including enabling regulation where appropriate.
  7. The community does not automatically accept what experts might think are best for them – think seats belts, alcohol restrictions, even fluoridation – particularly where this can be presented as loss of choice by opponents. This includes vaccination. So while you can impose substantial restrictions for short periods when the presence of threat to individual/family is real, doing it longer term requires efforts to get a social licence to do so.
  8. We have to think extra carefully about how imposed measures may impact socially and economically differentially – and proactively put measures in place to address such impacts.
  9. Population-wide prevention involves acceptance that the benefits of measures (for example restrictions) imposed on all are not equally experienced. Just as many smokers don’t develop lung cancer, most people under 50 without other health problems will not experience severe COVID (even with the more severe variants we have seen so far). So depending on how imposed restrictions impact, there will be different views on the benefits versus ‘harms’.
  10. When you are out of the acute threat phase, all options are unlikely to be seen as equally effective, cost effective, acceptable or implementable. You are unlikely to get all you think is optimal. So you need to be clear on your priorities – for example, (and I am not a content expert here, so this is illustrative only), what are the likely benefits of pushing better ventilation in schools (which has other non-COVID benefits) versus other strategies?

Professor Andrew Wilson is Co-Director of The Australian Prevention Partnership Centre and Co-Director of the Menzies Centre for Health Policy and Economics at the University of Sydney.


See Croakey’s extensive archive of articles about COVID-19.