Expert Speak Health Express
Published on Mar 11, 2021
2021 recovery plan: Moving beyond herd immunity and vaccines

This article is part of the series — 2021: The Year of Vaccines.

Even though the vaccination process will decrease pressure on healthcare systems, this will not be an easy year for the health sector as well as the educational, economic, and other sectors that have been hit by the pandemic.

Firstly, there are the difficulties related to the vaccination process itself, such as logistics, costs, political pressures, low trust in institutions and authorities, fear of health outcomes, and large groups of the population who are influenced by fake news.

Secondly, there will be the surge in demand for diagnosis and treatment of health issues postponed due to the pandemic. Evidence indicates that vaccination, consultations, and hospitalisations for non-COVID-19 illnesses have decreased. A considerable portion of this new surge will be due to mental health conditions. Data does not lie about the duration and magnitude of the effects these catastrophic events can have on people´s mental health, especially children, women, and families with preschool children. This demand will collide with an exhausted medical staff and with already poorly resourced health systems, at least for most non-rich countries (even for some of the rich ones as well).

But the impact of the pandemic does not end there. Thirdly, there are the effects on the economy and education systems with the consequences being acutely felt by those with lower economic and personal resources, thus, inequalities will increase.

Hence, the challenges are huge, but there are opportunities for governments and communities to develop public policies and settings for improving life conditions in different areas.

On the one hand, until ‘herd immunity’ is achieved, we will still need to apply the basic pandemic response recipe, which involves measures on all aspects that literature has shown relevant: (i) mitigation and containment, (ii) economic, (iii) pandemic management, (iv) and health.

Regarding the mitigation and containment measures (i.e., frontiers, commerce, and schools closures, and quarantines), they vary according to each country`s capacity to cope with the disease (i.e., number of beds and doctors available) and its consequences on health and the economy. The economic initiatives should help people to comply, as well as to keep the country producing and balancing the impact of the mitigation and containment measures. This aspect also depends on different countries’ characteristics, such as levels of work formality, development, and income, amongst others. Pandemic management involves communication and coordination from those in charge of the response. Compliance and prevention of the most dreadful consequences of the pandemic rely on the capacity of governments to communicate risks, being empathetic, and to appeal to all (i.e., civil society, youth, elderly, and migrants). It also depends on the vertical (i.e., from central to local governments) and horizontal (i.e., public and private sector) coordination of the measures adopted. Furthermore, for vaccination, a clear and trustful communication strategy is key to achieve expected goals.

Last, but not least, is the health response. This aspect depends heavily on the capacities of each health system to test and track those infected and their contacts, as well as to treat the sick (i.e., number of beds, doctors, ventilators). The latter includes not only those infected with the novel coronavirus, but also the lagged demand for diagnosis and treatment of other illnesses. As health workers and the necessary infrastructure cannot be trained at short notice, this surge is defying traditional ways of providing healthcare and opening chances for innovation and collaboration between public and private sector. Telemedicine has been shown to work well on general medicine and many specialties, along with electronic prescriptions, integral home and selfcare, internet-based rehab, and delivery of treatments (i. e., medicines) to workplaces and homes, just to mention a few. These new methods can be an important tool to counteract the increase in healthcare inequality, since they allow access to a population that otherwise cannot receive a consultation or treatment for their diseases or would have to wait for a long time to receive them.

Overall, it is likely that the magnitude and stringency of the measures adopted for 2021 will decrease in relation to those used in the most critical moments of the pandemic in 2020, but countries must be prepared to apply them if the situation requires it. Therefore, each nation should develop a solid plan, with clear tasks for every person and institution involved, as well as the criteria to unleash the different actions and resources associated, among others. The plan should include levels of priorities concerning population welfare and economic development.

On the other hand, there are challenges for the other sectors affected by the pandemic. Besides the economic area, three other relevant ones are education, gender, and mental health. Regarding education, the good news is that teachers (as well as a great proportion of labour) were immersed in information technologies (IT), such as online platforms and aids to work and teach. IT can be a good tool for improving teaching and learning, to reach remote students and to tackle school drop-out issues, since they are more attractive and familiar to the youth. But in-person contact is irreplaceable, especially in pre and primary school levels. Thus, nurseries and schools need to stay open (adopting appropriate measures), and efforts should concentrate on implementing conditions for this to happen. Lastly, the lag in learnings will need an extra effort from teachers, students, and families, especially for the most vulnerable children and households. Adaptative and cooperative learning strategies together with the promotion of motivation and autonomy in learning can help teachers cope with differences in learnings and to level children’s knowledge. This will require special training for educators and school staff in general, to get parents and students on board, as it will demand more dynamic and proactive educational leaders and institutions in charge.

Regarding gender, evidence shows a drawback of 10 or more years. Women are back home. This is partly due to the lower opportunity cost for them to assume household chores (i.e., lower salaries) compared to men, the lack of policies that ease work life balance, as well as cultural and other influences. Therefore, more flexibility is welcomed. First, regarding the distribution of working hours, it would be more feasible with telework but also for in-person jobs. And second, regarding child care, provisions of other modalities of care, such as home and community care would also be of help in easing the pressure on women.

Finally, although mental health can be associated to the health sector, it encompasses much more, since it affects job performance and personal relations (i.e., children’s mental health is closely related to parents’ mental health). Thus, it must be addressed from different angles and in a coordinated and innovative way. That means that education, labour, and health policies will need to converge. An adequate space for them to converge is primary health at the local government level, which work more closely with the population and can coordinate with local communities, enterprises, and schools by engaging with public and private institutions. Indicators for mental health in schools and workplaces are needed to diagnose and treat people in a timely manner, and policies should include mental health diagnostics and treatments coverage in an integral way. This approach can be applied to other problems, such as child abuse and domestic violence. Among others, reducing the stress that households are experiencing by increasing job opportunities and financial help, and as aforementioned, opening schools and day-care centres, and funding mental health treatments seem to be urgent concerns.

This only covers some of the challenges that 2021 will bring, but the moral of the story is that we need to be open to new ways of organising health and education systems, jobs, intersectoral relations, and, in general, to a better link between the public and private sector. Let’s give it a try.

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