The government has just released “Living with COVID-19” The plan marked a shift in strategy, with legal restrictions giving way to a scaled-back approach to reflect a new phase of the pandemic.
Finding a way to live as normally as possible while preventing the virus from causing disruption and death is clearly right in principle, but there is no room for complacency when it comes to COVID-19 – especially in light from the current high levels of transmission.
The task ahead is threefold: ensuring that the short-term response to COVID-19 is clear and coherent, putting plans in place for the rapid deployment of surge capacity if needed, and incorporating lessons from the pandemic in the new health protection system.
The Association of Directors of Public Health (ADPH) has expressed the collective disappointment and concern of Directors of Public Health (DsPH) over the decision not to provide new funds through the Management Fund Containment Epidemics (COMF) – this has supported much of the work local councils have been doing during the pandemic. Some communities have money they can carry forward, but for others, that’s it.
As the ADPH recently stated in a Report, our goal must not simply be to “live with COVID-19”, but to “live safely and fairly with COVID-19”. A lack of funding could turn a “story of two pandemics” into a “story of two recoveries”, with some of the most deprived areas not receiving COMF funding and therefore being less able to support their communities.
The consequence of the funding uncertainty around COMF over the past few months is evident from what DsPH tells ADPH – experienced and knowledgeable colleagues have moved on. Now that the decision has been made, more capacity will be lost. At the same time, expectations of local councils are not insignificant, from supporting outbreak management in high-risk settings to communicating key public health messages to their communities. . The base grant for public health has been reduced 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 false.
Like local authorities as a whole, the DsPH faces tough decisions in order to balance its books amid rising inflation, growing pressures on services and growing national political ambitions for leveling and disparities health matter. The sums simply do not add up.
Living safely and fairly with COVID-19 requires realism about the prospect of new waves and new variants. The virus was found to be able to mutate to become more easily transmissible. A future variant could be a much more serious Delta variant rather than the current Omicron family. The disruption to productivity in Omicron’s workplace is also beginning to be felt. Living with a virus should mean minimizing disruption to the economy, jobs and public services.
We must be prepared to put in place and/or intensify, during an outbreak, the basic public health measures with which we have become familiar, including clear messaging, testing, ventilation and vaccination. The last two years should have taught us that it is essential to act quickly in the face of a highly transmissible infection. And it showed that local response capabilities were crucial to managing the pandemic. Limits in local capacity will hamper attempts to scale up our response to deal with changing circumstances. We need standby systems and structures, clarity on 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 COVID-19 plans, processes and support. There is an opportunity, learning from the lessons of COVID-19, to build a future-proof health protection system based on consensus at all levels of the system. One that incorporates robust surveillance, engaged communities, timely data sharing, comprehensive testing infrastructure where needed, effective diagnostics and treatments, and – at its core – a team-of-teams approach with each agency funded and supported to fulfill its role, including local government . The threat of tuberculosis – still very real in our most vulnerable populations – proved this long before COVID-19 entered the scene. This is what the ADPH, in professional collaboration 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 partners valuable, strives to achieve.
There is a risk that this opportunity will pass us by, hampering our medium-term response to COVID-19 and any future public health threats we may encounter. For my part, I hope we will meet the moment and I know that DsPH is committed to emerging from the pandemic with a better health protection system.
Professor Jim McManus is President of the Association of Chief Public Health Officers