Building a health protection system fit for today and tomorrow  

07 April 2022

The Government’s recently published ‘Living with COVID-19’ plan marked a shift in strategy, with legal restrictions making way for a scaled-back approach to reflect a new phase in the pandemic.

Finding a way of living as normally as we can while keeping the virus from causing disruption and death is clearly right in principle, however there is no room for complacency when it comes to COVID-19 - especially in light of the current high levels of transmission.

The job at hand has three parts: ensuring the short-term response to COVID-19 is clear and consistent, putting in place plans for the swift deployment of surge capacity if needed and embedding the lessons from the pandemic into the new health protection system.  

The Association of Directors of Public Health (ADPH) has expressed the collective disappointment and concern directors of public health (DsPH) feel about the decision not to provide new money through the Contain Outbreak Management Fund (COMF) – this has supported much of the work local councils have done during the pandemic. Some authorities have money left which they can carry over, but for others, that’s it.

As ADPH recently set out in a briefing, our aim should not simply be ‘living with COVID-19’ but ‘living safely and fairly with COVID-19’. A lack of funding could turn a ‘tale of two pandemics’ into a ‘tale of two recoveries’, with some of the most deprived areas out of COMF funding and less able to support their communities as a result.

The consequence of the funding uncertainty around COMF over the last few months is evident from what DsPH are telling ADPH - experienced and skilled colleagues have moved on. Now the decision has been taken more capacity will be lost. At the same time, expectations on local councils are not insignificant, from supporting outbreak management in high-risk settings to communicating key public health messages to their communities. The core public health grant has been cut by 24% since 2015/16, so the idea that money can be reallocated from public health funding to COVID-19 without serious consequences for other services, and for recovery from the health impacts of the pandemic, is wrong.

Like local authorities overall, DsPH are facing tough decisions in order to balance the books in the midst of rising inflation, rising service pressures and rising national policy ambitions on levelling up and health disparities. The sums just don’t add up.

Living safely and fairly with COVID-19 requires realism about the prospect of further waves and new variants. The virus has proven itself capable of mutating to become more readily transmissible. A future variant could be a much more serious Delta variant rather than the current Omicron family. The disruption to workplace productivity from Omicron is also beginning to be felt. Living with a virus should mean minimising disruption to the economy, jobs and public services.

We need to be prepared to put in place and/or ramp up, during a surge, the basic public health measures we have become familiar with including clear messaging, testing, ventilation and vaccination. The last two years should have taught us that acting promptly is essential when confronted with a highly transmissible infection. And it has shown that local response capabilities were crucial to managing the pandemic. Limits on local capacity will hinder attempts to step up our response to address changing circumstances. We need systems and structures that are on standby, clarity about who is doing what and funding to make it happen. We are not there yet.

A robust health protection system is about more than maintaining adequate plans, processes and support for COVID-19. There is an opportunity, learning from COVID-19, to build a health protection system that is fit for the future based on consensus at all levels of the system. One that embeds strong surveillance, engaged communities, timely data-sharing, comprehensive testing infrastructure where needed, effective diagnostics and treatments and – at its heart – a team of teams approach with every agency funded and supported to fulfil its role, not least local government. The threat from Tuberculosis – still very real in our most vulnerable populations - proved that long before COVID-19 was on the scene. That is what ADPH, working professionally with the Department of Health and Social Care, the UK Health Security Agency, the NHS, the Local Government Association, the Chartered Institute of Environmental Health and many other valued partners are working hard to achieve.

There is a risk that this opportunity passes us by, hindering our medium-term response to COVID-19 and any future public health threat that we may encounter. I, for one, hope we meet the moment and I know DsPH are committed to emerging from the pandemic with a better health protection system.

Professor Jim McManus is president of the Association of Directors of Public Health

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