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Posts Tagged ‘Covid-19’

For once, an international body has recognized that something has to be done to avoid another COVID-19 disaster. The European Commission is promoting the design and launching of a new agency: the European Health Emergency Preparedness and Response Authority (HERA). The HERA will be tasked with the risk assessment, risk management, and risk communication of future health emergencies.

Five pillars constitute the core of HERA:

  1. Supporting technological innovation.
  2. Fostering coordination among EU and non-EU countries as well as with related international organizations.
  3. Establishing monitoring, preparedness, and response mechanisms.
  4. Instituting a robust EU and WHO surveillance system.
  5. Building specific competence for health and non-health personnel.

All five pillars, together with the promotion of research and innovation for a preparedness agenda and enhancing partnerships with non-EU countries, should put the EU and, by extension, the rest of the world in a better situation than the one it was in a year ago.

We can bet that, if in a few years’ time, no new pandemic has developed, many people will start pointing out how the EU is a machine that wastes money on useless agencies whose only objective is to maintain the good life of many eurocrats. That will be good for two reasons. First, it will mean that we have been spared a new devastating pandemic; second it will probably mean that the mechanisms designed by HERA have worked and we have avoided a new pandemic.

Let’s hope that HERA will have to be faced only with the above kind of criticism, and that its design is as good as we all hope for. Another devastating pandemic like COVID-19 will surely cripple the fabric of the world more than the recent financial and health crises.

Note: this post has been inspired by the paper by Villa, S et al. HERA: a new era for health emergency preparedness in Europe? The Lancet. Published Online May 17, 2021 https://doi.org/10.1016/S0140-6736(21)01107-7

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There is a lot of talk about how to deal with the next pandemic. The consensus is that there is going to be a next pandemic; we do not know when, but we do know there is going to be one. So, are we ready for it?

If we believe the panellists on a recent webinar by The Economist, the answer is an unqualified no. Of all the possible explanations on why we are in such a situation of unpreparedness I subscribe that of Dr. John Nkengasong (Director of African Centres for Disease Control and Prevention): There is a deficit of “trust capital”.

The deficit exists among governments, and between governments and their citizens. Let’s start with lack of trust among governments. No one claims that a pandemic is not a world health problem. But if it is a global problem, why are we still ignoring the obvious fact that if we do not collaborate globally we are not going to solve “our” problem? A pandemic is not going to disappear until it has been eradicated from the most remote country. Trusting other governments means that part of our resources should be directed to other countries so that we can advance in unison.

As for the second aspect, the lack of trust between a government and its citizens, there are plenty of examples. Do we need to be reminded how some people stormed the USA Congress? What about those who refuse to be vaccinated because they believe in weird conspiracy theories? This aspect of lack of trust is as dangerous as the previous. Why? Because citizens are the first responders in a pandemic.

If we want to manage the next pandemic more efficiently, we need to involve first responders. A paper by Ying Yang et al[1] points out that “Epidemics start and end in communities, where citizens are often the first to observe changes in the environment and in animal health, and the first to be exposed to new or re-emerging pathogens”. We should follow the Sendai Framework for Disaster Risk Reduction 2015 – 2030 so as “… to promote a culture of disaster prevention, resilience and responsible citizenship, generate understanding of disaster risk …”. We should invest in educating citizens so that they can identify changes that foreshadow a possible pandemic. They are the cornerstone of a more efficient future preparation and response to the next pandemic.


[1] Ying Yang Chan E, Gobat N, Dubois C, Bedson J, Rangel de Almeida J. Bottom-up citizen engagement for health emergency and disaster risk management: directions since COVID-19. The Lancet Published Online June 4, 2021. https://doi.org/10.1016/S0140-6736(21)01233-2

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After WWII, the ideas of Otto Von Bismarck and William Beveridge came to the fore. In almost every country, citizens demanded that the State should take an active role in helping people in distress: labourers without work, sick people, retirees, etc.

That thinking dominated the world till the Reagan-Thatcher liberal revolution. Helped by an ageing population in almost every country, the current thinking of the last decades of the previous century and first two decades of the twenty first  have centred around the  possible unsustainability of the social umbrella designed after WWII.

Then came SARS-CoV-2 and the COVID-19 pandemic. It changed everything. If the post-WWII design was meant to care for people in distress, citizens are demanding that the new social-welfare policies now include the whole population. From worrying that the social-welfare system was about to collapse, to demanding a bigger role for it, only a pandemic has sufficed. As an example, according to a recent editorial by The Economist (March 6th, 2021), today two-thirds of Europeans are asking for a universal basic income. How we are going to finance those new demands is not clear, but the old rule of lower taxes and no interference by the State in our personal socio-health has been broken into pieces.

We are demanding a social system in which help moves quickly and seamlessly to the entire population, and not only during crises, but always. Governments will need to find ways in which to finance that demand, and not only through borrowing, as is the case today, but permanently. The chunk of social services in the overall government budget will increase and, accordingly, the chunk of taxation in respect to GDP will increase. There will be a movement away from the Anglo-Saxon model towards a more comprehensive model, something more similar to what the Scandinavian countries have in place.

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During the pandemic, care-homes have been rat-traps for old people. In Canada more than 80% of deaths attributed to Covid-19 have been in care-homes; in places like England or Germany, the ratio was almost 40%. In Spain, the ratio is 68.67% according to estimates published by RTVE. I would say that something must be done.

I have written before about care-homes (see Services and conveniences) and the need for trained carers. But beyond that, what is needed is a complete overhaul of the way we care for old people. In most countries the system pivots on care-homes instead of caring at home.

Very few people argue that staying at home is the preferred choice of old people. It gives autonomy and independence, as well as familiar surroundings. Those characteristics are invaluable comforts as age advances. And not only that: according to a study, in Alabama those receiving care at home saved the State $4,500 a year, compared with those in care-homes.

As I see it, the only barrier to change the system is the system itself. Care at home implies a complete disruption of the care system logistics. It is easier to hire and control a care person in an institution. In the institution, the system can control comings and goings as well as productivity through close supervision. When you have people going from house to house, you have to give the person autonomy and trust that the work will be well done.

It is easy to see that the professional doing one institutionalized job, and the one doing the home care job have to have quite different training. They do basically the same work, namely helping with basic daily activities, so the difference is not in the acts to be performed. The basic difference is in trust, and trust comes with professionalism to be learned through proper training of attitudes more than aptitudes, even if the latter are also important. Unfortunately, I think the system is not ready for training real care professionals when it is relying on mostly immigrants, untrained and underpaid, who do the best they can with very little preparation.

Note: all the figures cited are taken from The Economist July 25th 2020 “The pandemic shows the urgency of reforming care for the elderly

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I can understand that what happens today is more pressing than what will happen tomorrow, but that does not mean that today is more important. I think we should start looking at tomorrow and start planning what we will need for a world beyond Covid-19.

As of today, one of the few things we know for sure is that SARS-CoV-2, which produces the Covid-19, infects more old people and mainly those with previous chronicity. That means that it is old people who need more care.

Care that, we have also learned, would be better given at home than in nursing homes. Gathering vulnerable people in close quarters has proved not to be the best solution if we want to avoid the spread of a communicable disease.

Only if we are capable of building an army of caregivers will we be able to give home care in the EU to that 19% of the population aged 65 and older.

With a total population of almost 513 million people, we will need to take care of 97 million old people (all figures from Eurostat). Just for the sake of discussion, let us assume that we need one hour per day of care per old person. With an estimated 1.540 productive yearly hours per person, we will need almost 23 million caregivers. The fact that many of those 23 million will be informal caregivers does not make the hours and the people less essential.

Who will take care of that army of caregivers? Who will be providing training, moral and physical support for them? Very little is done today in that domain and almost nothing if we focus on informal caregivers. I think we must start getting ready to tackle caregivers’ needs, formal and informal, so that we will be able to provide our old people with the best possible care by the healthiest and most motivated caregivers.

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