2021 IANPHI Annual Meeting: Integrating Health Equity in COVID-19 Responses

On December 2, 2021, IANPHI held a session of the 2021 Annual Meeting dedicated to the experiences of national public health institutes (NPHIs) responding to COVID-19 and the issue of health equity.

Dr. Natalie Mayet of South Africa, Yujin Jeong of Korea, Prof. Geneviève Chêne of France, and Dr. Natia Skhvitaridze of Georgia discussed the challenges their countries faced in terms of disparities and the solutions put in place to include more equity in their strategies. 

Speakers all pointed out the need to base their actions on evidence and data, coming from the ground and the concerned groups. They explained that a cross-level and multisectoral approach involving different stakeholders was necessary, in order to better support vulnerable populations. In the end, it appears that NPHIs need to develop and build capacities to be more present and influence the political sphere.

The session was moderated by Dr. Claudia Perandones, director of the Executive Unit for Higher Education and Training at Argentina's Administración Nacional de Laboratorios e Institutos de Salud and offered interpretation in French, Spanish and Portuguese thanks to support from Fiocruz, Brazil's public health agency and host of the 2021 IANPHI Annual Meeting.

According to Dr. Perandones, health inequities have been highlighted by the COVID-19 pandemic. There are many definitions of the term "inequity", she said, but it is particularly relevant here to talk about "unfair inequities". The impact of the virus has been very unequal for different groups and populations, and especially for the extremely vulnerable. Extremely vulnerable people can be defined as individuals that depend on informal economy, and are mostly women, refugees, or dislocated people. In Latin America for instance, 50% of workers depend on the informal economy and therefore do not have social protection.

Presentation by Natalie Mayet, Deputy Director,National Institute for Communicable Diseases, South Africa (download slides)

South Africa has a history of deep inequity. For a long time, the access to medical care and services was based on racial segregation. Now, the country is moving towards universal medical coverage, following the principle of “no one left behind”. To do so, Dr. Mayet explained, NPHIs need to focus on social determinants of health rather than focus more on the determinants of disease. This is why South Africa’s National Plan for COVID-19 makes efforts to address equity issues. First, it aims to institutionalize health equity. Then, it recognizes the special needs of vulnerable people. That is where NPHIs have a role to play, because they can provide evidence of these facts. Finally, the national plan promotes an intergovernmental and cross-sectoral approach. Collecting data is, most of the time, a scientific matter. Involving stakeholders and vulnerable groups is an opportunity to act in favor of equity.

However, at the level of health services, there are barriers to equity. South Africa has a federal system. In practice, each region has developed a surveillance system that meets their needs according to their capacities. There is no equity and there is no standardization in surveillance system between those regions. To try to balance the supply of services, the government set up mobile laboratories at strategic locations (e.g. borders). Because in the end, equity finds its roots in the availability of resources and the allocation of those resources.

Presentation by Yujin Jeong, Director, Korea Disease Control and Prevention Agency, Republic of Korea (download slides)

Korea developed a response system to sanitary emergency years ago. The WHO-ROK Joint Mission on the MERS outbreak in 2015 allowed the country to learn lessons of the outbreak and better react to the COVID-19 pandemic. Currently, Korea faces its fourth wave of COVID-19 and had to set up new restriction measures, called “3T measure”: testing, tracing, and treatment.

COVID-19 has also affected vulnerable groups in Korea, such as temporary employees, small business owners, and low-income families. To address inequities, Yujin Jeong said that the government has initiated prevention measures such as frequent testing for vulnerable groups, focusing on illegal migrants. Korea also tries to share its knowledge, experiences and resources to help reduce inequalities between countries. Low and middle-income countries often lack experience for COVID-19 responses. Korea also supports international initiatives such as Covax.

Presentation by Prof. Geneviève Chêne, Chief Executive, Santé publique France  (download slides)

In France, analyses of data from the national COVID-19 surveillance system show a clear positive social gradient in prevalence and positivity rates, and a negative social gradient for screening rates. Specifically, people in the most deprived quintile had the highest COVID-19 prevalence rates and the least access to screening. Across France, in regions with high rates of viral circulation, people living in deprived areas had the greatest excess mortality rates. Further analyses by country of birth showed that the "healthy immigrant" mortality advantage was reversed in 2020, particularly among people born in sub-Saharan Africa. Santé publique France helped researchers contribute to a survey evaluating children's experiences during the first lockdown. This study revealed a clear social divide and highlighted the increased risks of distress amongst children from deprived families. The survey was used to advocate for the re-opening of schools and new prevention measures.

Different actions can be taken to generate an equitable public health response, said Prof. Chêne. Collaboration with key stakeholders, and taking into account the knowledge of vulnerable populations, facilitates the development of tools adapted to their needs. For example, the regional health authorities of Nouvelle Aquitaine developed a COVID-19 Action Plan for Travellers adapted to their needs. The action plan helped guide the implementation of COVID-19 contact tracing, screening, and prevention for Travellers. Moreover, the government has adapted its communications to a community-centered approach.

Presentation by Dr. Natia Skhvitaridze, Advisor of Director General for Global and Public Health, National Center for Disease Control and Public Health (NCDC), Georgia (download slides)

Georgia is a middle-income country, which has made progress in public health as it follows the will to develop a universal, affordable and curative health system. Georgia took early actions when the first cases of COVID-19 were detected. But despite the efforts, the country is now recovering from its fifth wave, and COVID-19 has become the fifth leading cause of death in the country.

NCDC is widely implicated in the country's vaccination and immunization strategies. The institute participated in the development of the national strategy against COVID-19. This strategy integrates health equity and is based on the principle of “no one left behind”. Georgia’s government initiated multisectoral work, enhancing capacities of real-time surveillance, publishing daily statistics, or adapting communications to special groups. Regarding access to vaccination, Georgia made sure to guarantee equity by translating informational and educations material, setting up vaccination buses for remote areas, and offering the vaccine free of charge.

Learn more about the 2021 IANPHI Annual Meeting

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