By: Prof. Jean-François Etter, Institute of Global Health (ISG), Faculty of Medicine, University of Geneva
Public health professionals are in the spotlight. Can they be blamed for the country's relative unpreparedness last March? Or, on the contrary, should they be included in the daily applause for health professionals?
Although the epidemic started as early as December 2019 in China and raged in Italy as early as February, other European countries were caught unprepared in early March. China's neighbours (notably Taiwan, Hong Kong, South Korea, Singapore) had already experienced the SARS epidemic in 2003 and were expecting a new epidemic from China, they also knew the unreliability of the information coming from China. As a result, they were better prepared and better able to deal with the epidemic, including the early application of the triad of test-trace-isolate, which involves extensive testing of the population, tracing contacts of infected people and isolating them. The use of masks and other social distancing measures were also applied earlier.
Learning from past experiences
In Europe, several experts and organizations had warned the authorities in time, but their voices were discordant, with some experts underestimating the risks, which delayed political decisions. Let us hope that the lessons of this unpreparedness have been learned and that a new epidemic, or a second wave of the same epidemic, will not surprise us in the same way. A response that maximizes the impact on the epidemic and minimizes damage to the economy and society must be planned now.
"Was containment the best possible response, and were its adverse effects well considered before it was imposed?"
We will undoubtedly learn a lot from comparing the health, economic and social consequences between countries that have applied strict containment measures (e.g. France) and countries that have applied less strict measures and have relied more on the self-discipline of citizens and let the economy work (e.g. Sweden).
Uncertainty now hangs over the medium and long-term consequences of this crisis on the economy, society and health. History teaches us that epidemics have often been followed by wars, and the risk of violence and social unrest cannot be ruled out. The crisis acts as an indicator of the strengths and weaknesses of the societies concerned. In Geneva, for example, the long queues for free food distributions have made visible a population that was not known to be so vulnerable, nor so numerous.
What tomorrow's public health professionals will need to know
Part of preparing for the consequences of the current crisis and future epidemics is the training of public health professionals in sufficient numbers and with the relevant knowledge and skills.
In particular, these professionals will need to have a solid foundation in epidemiology in order to understand the situation and propose effective, evidence-based solutions. They will also need to be able to plan and manage public health projects and programmes, collaborate in the development of health policies and provide leadership in their implementation. Since these measures often involve restrictions on individual freedoms, these professionals will need to have the necessary legal and ethical knowledge to propose responses that respect our fundamental values of human rights and individual freedoms as much as possible.
"Being able to convince the public and decision-makers is a key competence of the public health expert".
These public health experts will also require communication skills to convey key knowledge and messages to the public and policy makers. They will need to learn how to interact with the press and understand that a well-turned phrase will often be picked up by journalists. The best among them will be able to try to compete in this field with Alain Berset and his cult phrase: "As fast as possible, as slow as necessary".
Don't neglect the priorities of the past
More seriously, the concentration of resources on the fight against the epidemic may lead to the neglect of other priorities, such as vaccination against other infectious diseases.
This could lead to an increase in mortality from these diseases, especially if messages about vaccination campaigns are not received by the public. For example, although seasonal influenza kills 10,000 people each year in France (the Covid-19 epidemic has so far killed 28,000 people in France), and although an effective influenza vaccine is available, too large a proportion of the population at risk is not vaccinated against influenza.
Smoking kills 73,000 people in France and 9,500 in Switzerland every year, yet a quarter of the population continues to smoke and thus ignores messages about the risks of smoking.
"The concentration of resources in the fight against the epidemic can lead to the neglect of other priorities".
The current crisis will exacerbate many health problems, in particular because their care has been neglected during the epidemic, but also because of economic difficulties or inadequate social protection systems, malnutrition and domestic violence.
Unexpected consequences of this crisis are to be feared, and public health experts will have to propose innovative solutions to these new problems. They will have to be able to work together in multidisciplinary teams and understand the international dimension of the situation in order to propose solutions that take into account the global challenges.
The public health training courses offered by the University of Geneva enable interested professionals to acquire the above-mentioned knowledge and skills, through theoretical instruction and by carrying out projects enabling them to integrate into public health networks at the local, national and international levels.
Training in public health is currently a priority and needs to be strengthened. They include in particular in continuing education a CAS in health promotion and community health and a MAS in public health, and in initial training a Master of Science in Global Health and a PhD in global health.
Public health is now more than ever a rapidly expanding field with new career opportunities for professionals working in the health field or in related sectors (administration, politics, etc.).