A review of public health governance structures and addressing “longstanding” IT infrastructure deficits are among four key recommendations made by the Irish Society of Specialists in Public Health Medicine (ISSPHM) in its new position paper on pandemic control.
The document, titled For better pandemic control now and into the future, is the ISSPHM’s first ever position paper and is available on the Society’s website, which is now live (https://issphm.ie).
The ISSPHM was formally launched in December to represent the views of specialists in public health medicine in Ireland. Speaking at the online launch of the ISSPHM, Prof Breda Smyth, Interim Chair of the ISSPHM and Director of Public Health West, said the Society will “provide a strong cohesive voice for public health medicine”.
Last May, an historic agreement was signed between the HSE, Department of Health and IMO to establish 84 consultant in public health medicine posts, over three phases between June 2021 and December 2023.
The ISSPHM’s first position paper makes four recommendations to apply the “lessons learned from our collective experiences with Covid-19”.
Firstly, it recommends a review of “the governance structures for public health, incorporating all health protection functions from surveillance, to case and outbreak management, source identification, and contact tracing, as well as health improvement, health service improvement, and health intelligence”.
Secondly, the ISSPHM calls on the health authorities to “address longstanding and critical IT infrastructure gaps, including the lack of a case and outbreak management system, an integrated surveillance system, an immunisation reporting system”, as well as the development of a “fit for purpose” health information system capable of linking information across all service delivery sites.
Thirdly, the position paper recommends the further strengthening of “the capacities of regional departments of public health” beyond the current investment in health protection to enable the “delivery of the integrated public health service required to support the full implantation of Sláintecare”.
The final of the four key recommendation in the position paper has a global scope. It argues Ireland should be promoted “as a global leader” for health systems recovery and resilience through the promotion of national and global policy that supports “proportionate investment in essential public health functions to promote health security and ensure economic and social prosperity”.
On the general experience of the last two years, the position paper notes that there was “no doubt that we were unprepared for Covid-19”, despite the known risk of a pandemic.
“Ireland is not alone in this, with more than 90 per cent of countries reporting disruptions to essential health services due to the pandemic,” according to the position paper.
“The truth is that Covid-19 has exposed the weaknesses in health systems globally, directly attributable in many cases to the chronic lack of investment in essential public health functions, including emergency planning and response, underpinned by a systems strengthening approach.”
The Society states that “given the likelihood of future and more devastating pandemics, we must learn from these lessons”.
It says the international experience has shown that “critical and longstanding weaknesses” in health systems “hindered the abilities of even well-resourced health systems to respond to this public health emergency”.
The weaknesses concerned information and surveillance systems, laboratory capacities, chronic under-investment and deprioritisation of essential public health functions including emergency preparedness and response, vaccine infrastructure and delivery systems, and an under-development of local response mechanisms and structures.
“As a result, lives and livelihoods were lost.”
The document notes that the Irish health system pre-pandemic was “experiencing significant challenges, many relating to chronic critical weaknesses within the health system”. This included a lack of capacity (including ICUs) within hospitals, “as well as limited capacities to support healthcare workers with infection prevention and control and occupational health services.” There were also “significant infrastructural deficits in IT, including the lack of an integrated health information system, the lack of suitable surveillance infrastructure, and the lack of a case and outbreak management system”.
While the document recognises the “significant and welcome investment in public health functions since the pandemic”, it states this “has come on the back of decades of under-investment, both regionally and nationally”.
“Despite all of this, there is no doubt that Ireland has performed well in many areas of the pandemic response so far,” the ISSPHM states.
The Society highlights such areas as the testing services, contact tracing system, “the tireless efforts of the medical and non-medical staff of regional departments of public health, to provide an un-contracted seven day a week service since the first wave of the pandemic in tandem with the contact management programme,” which resulted in the vast majority of cases being contact traced with the prevention of countless further cases.
In terms of risk communication, public information from the HSE was “rapidly developed, accessible, and available” and communication from the office of the Chief Medical Officer “was frequent, consistent, and clear”.