Financing of Immunization Programs by Local Government Units in Poland as an Element of Health Policy

Introduction: The scope and schedule of immunization in Poland is regulated by the Immunization Programme prepared and announced by the State Sanitary Inspector. There are two kinds of vaccines: compulsory vaccines, financed by the state budget at the disposal of the Minister of Health, and vaccines recommended by the central health authorities but financed by local governments within health policy programmes. Compulsory vaccines cover people up to 19 years of age and individuals at higher risk of infections. The public health programmes organized and financed by local governments play an important role in infectious disease control in the country. Objective: The objective of this study is to analyse health policy programmes including immunization programmes, which were developed, implemented and financed by local government units of all levels in Poland between 2016 and 2019. Material and Methods: This analysis covers data compiled by voivodes and submitted to the Minister of Health as annual information on public health tasks carried out by local government units. From the aggregate information, data on all health policy programmes conducted by individual local government units between 2016 and 2019, including immunization, were extracted and analysed. The data were obtained pursuant to the provisions of the act on access to public information. Results: In the analysed period, local government units implemented a total of 1737 health policy programmes that financed the purchase of vaccines, qualification tests for immunization and carrying out immunization by authorized medical entities. Among the vast majority of programmes, promotional activities were also implemented. Conclusions: In Poland, local governments are deeply engaged in the immunization of their citizens by organizing and financing specific health care programmes. These programmes are an essential addition to the state financial resources in infectious disease control. This engagement expresses local government maturity regarding the health needs of the population and public health measures. Communes are the most engaged units among all levels of local governments. It is probably due to close mutual communication between the people and local governments. The growing awareness of the important role of HPV immunization in the prevention of cervical cancer among local government units is reflected in the increase in the number of girls vaccinated against HPV and the increase in financial resources allocated for primary HPV prevention. The decrease in the number of people vaccinated against pneumococci may result from including pneumococcal vaccines in the compulsory immunization schedule.

Operationalising Regional Cooperation for Infectious Disease Control: A Scoping Review of Regional Disease Control Bodies and Networks

Background: The rapid spread of the COVID-19 pandemic demonstrates the value of regional cooperation in infectious disease prevention and control. We explored the literature on regional infectious disease control bodies, to identify lessons, barriers and enablers to inform operationalisation of a regional infectious disease control body or network in southeast Asia. Methods: We conducted a scoping review to examine existing literature on regional infectious disease control bodies and networks, and to identify lessons that can be learned that will be useful for operationalisation of a regional infectious disease control body such as the ASEAN Center for Public Health Emergency and Emerging Diseases. Results: Of the 57 articles included, 53 (93%) were in English, with two (3%) in Spanish and one (2%) each in Dutch and French. Most were commentaries or review articles describing programme initiatives. Sixteen (28%) publications focused on organisations in the Asian continent, with 14 (25%) focused on Africa, and 14 (24%) primarily focused on the European region. Key lessons focused on organisational factors, diagnosis and detection, human resources, communication, accreditation, funding, and sustainability. Enablers and constraints were consistent across regions/organisations. A clear understanding of the regional context, budgets, cultural or language issues, staffing capacity and governmental priorities, is pivotal. An initial workshop inclusive of the various bodies involved in the design, implementation, monitoring or evaluation of programmes is essential. Clear governance structure, with individual responsibilities clear from the beginning, will reduce friction. Secure, long-term funding is also a key aspect of the success of any programme. Conclusion: Operationalisation of regional infectious disease bodies and networks is complicated, but with extensive groundwork, and focus on organisational factors, diagnosis and detection, human resources, communication, accreditation, funding, and sustainability, it is achievable. Ways to promote success are to include as many stakeholders as possible from the beginning, to ensure that context-specific factors are considered, and to encourage employees through capacity building and mentoring, to ensure they feel valued and reduce staff turnover.

A Report of the Survey on Shelter Management under COVID-19 in Japanese Local Governments

Japan is a disaster-prone country and natural disasters could happen under COVID-19. Shelter management is especially important because many people evacuate there and there’s high risk of spreading infection. In order to establish feasible countermeasures in shelters, we conducted a survey about the current situation of preparation and experience of shelter management in Japanese local governments under COVID-19. From the answer of 346 municipalities, we found that some municipalities took measures against COVID-19 such as adding new shelters and conducting the training, and these proactive measures were very useful. However, due to the addition of infectious disease control work, it became clear that it would take time and difficulty at reception, and that it would be even more difficult to identify evacuees with the recommended distributed evacuation. These results can be useful in proceeding consideration of better shelter management under COVID-19.

The Ethics of Infectious Disease Control: Lessons from the Ebola outbreak and an ethical framework

<p>Ebola virus disease (EVD) devastated its way into news headlines in 2014, destroying communities across three West African countries and costing the lives of over 11,000 people. The global health response was widely scrutinised and criticised, and though the outbreak is now over, there are still many lessons that can be learned from the 2014 EVD outbreak. This thesis will use the EVD outbreak in two ways. Firstly, I will use the EVD outbreak as a case study through which I will strive to address the ethical concerns for using experimental treatment during the outbreak, and I will address ethical concerns of the use of quarantine during the outbreak. Second, I will use the EVD outbreak as a launch pad to examine broader and more abstract ethical principles of the ethics of infectious disease control, such as the principles of reciprocity, transparency, proportionality, and the harm principle. This discussion will highlight how physical, biological features of a disease very much impact the application of the above principles when it comes to controlling the disease in an ethical manner. Finally, from this observation, I have created a ‘disease taxonomy’ that categorises infectious diseases based upon, what I argue, are the most ethically relevant biological features of infectious diseases. The taxonomy can aid in preparing for, understanding, and responding to the most pertinent ethical issues that surround various infectious diseases. The thesis should leave the reader with not only a greater understanding of some of the ethical issues raised by the 2014 EVD outbreak, but also a solid framework to utilise in discussing the most pertinent ethical issues of any future outbreak of any infectious disease.</p>

The Ethics of Infectious Disease Control: Lessons from the Ebola outbreak and an ethical framework

<p>Ebola virus disease (EVD) devastated its way into news headlines in 2014, destroying communities across three West African countries and costing the lives of over 11,000 people. The global health response was widely scrutinised and criticised, and though the outbreak is now over, there are still many lessons that can be learned from the 2014 EVD outbreak. This thesis will use the EVD outbreak in two ways. Firstly, I will use the EVD outbreak as a case study through which I will strive to address the ethical concerns for using experimental treatment during the outbreak, and I will address ethical concerns of the use of quarantine during the outbreak. Second, I will use the EVD outbreak as a launch pad to examine broader and more abstract ethical principles of the ethics of infectious disease control, such as the principles of reciprocity, transparency, proportionality, and the harm principle. This discussion will highlight how physical, biological features of a disease very much impact the application of the above principles when it comes to controlling the disease in an ethical manner. Finally, from this observation, I have created a ‘disease taxonomy’ that categorises infectious diseases based upon, what I argue, are the most ethically relevant biological features of infectious diseases. The taxonomy can aid in preparing for, understanding, and responding to the most pertinent ethical issues that surround various infectious diseases. The thesis should leave the reader with not only a greater understanding of some of the ethical issues raised by the 2014 EVD outbreak, but also a solid framework to utilise in discussing the most pertinent ethical issues of any future outbreak of any infectious disease.</p>

Principles of infectious disease control

Infectious diseases remain a leading cause of morbidity, disability, and mortality worldwide. Lower respiratory infections are the third leading causes of death worldwide and their control is a constant challenge that faces health workers and public health officials in both industrialized and developing countries. This chapter provides a global and comprehensive view of the principles of infectious disease control through examination of the magnitude of disease burden, the chain of infection (agent, transmission, and host) of infectious diseases, the varied approaches to their prevention and control (measures applied to the host, vectors, infected humans, animals, environment, and agents), and the factors conducive to their eradication as well as emergence and re-emergence.

The One-Health Approach to Infectious Disease Outbreaks Control

Close contact between people, animals, plants, and their shared environment provides more disease transmission opportunities. Host characteristics, environmental conditions, and habitat disruption can provide new opportunities for disease to occur. These changes may lead to the spread of existing and new diseases. Bacteria, viruses, fungi, protozoans, sporozoans, worms, and others cause infectious diseases. Some of these diseases may be prone to explosive outbreaks and may constitute deadly epidemic threats that could rapidly reach pandemic proportions. Drugs and vaccines can successfully control many infectious diseases; however, this is challenged by the lack of facilities and resources. In all parts of the world, infectious disease is an essential constraint to increased human, animal, and environmental interactions. Identifying hot-spot and interventions for prevention while considering the heterogeneity of target diseases to places, population time, or situation is essential. Therefore, successful infectious disease control measures must be based on understanding disease transmission pathways, strengthening surveillance systems, and intervention. Application of the One Health method is a responsive approach to infectious disease control. Much of the One-Health based approach to managing an infectious disease has been utilized with a promising effect on controlling current outbreaks. More deliberate efforts should encourage understanding of disease determinants to analyze infectious disease issues through a One-Health lens. Only through the extensive participation of all related field stakeholders can One-Health truly reach its potential to mitigate infectious disease outbreaks. This chapter reviews utilization of the One Health approach to infectious disease outbreak control.

Commentary: Making pre-school children wear masks is bad public health

Children are not small adults. This is a critical point that many pediatricians and other child health professionals get bored of saying, yet it does seem to need repeating. While children have the lowest risk from COVID-19 directly, they risk suffering the indirect impacts of policy decisions, many of which appear to have been made with next to no explicit consideration of their interests. Public health interventions should not only be about infectious disease control, they should consider a broad set of outcomes. In addition, they ought to consider vulnerability, including that in early childhood - a time when young children’s brains are developing rapidly and are most susceptible to adversity. We believe that mandating masking of pre-school children is not in line with public health principles, and needs to be urgently re-considered.