The Lancet recently published an editorial commentary on how COVID-19 cannot be defeated by vaccination alone. A neologism was introduced to explain this position. The corona crisis is not a pandemic but a “syndemic”. It is about networking and mutual reinforcement of biological-medical and social factors that negatively affect human health. Pandemics of a number of noncommunicable diseases and health-related conditions, such as obesity, diabetes, thyroid disease, tumors and various chronic diseases, make the population more susceptible to the most severe consequences of corona infection. They are influenced not only by overall health policy, but by a whole range of social factors that determine the existence of vulnerable social groups. The long-term solution to the corona crisis is therefore not exclusively bio-medical, concludes The Lancet editor Richard Horton.
I am writing this comment to strongly advocate for vaccination. In addition to the many shortcomings of Western medicine, preventive vaccination measures for various diseases and protection of the population by the so-called collective immunity are one of the greatest achievements of this science. Given the disappointing results of voluntary vaccination in Croatia, compulsory vaccination seems to me to be the only solution. There are no legal obstacles to this. In addition to the fact that there is already a practice of compulsory vaccination in Croatia, the European Court of Human Rights in April this year confirmed that countries have the right to introduce compulsory vaccination, which can be applied in the case of COVID. The freedoms and rights of individuals in communities, even when it comes to deciding on their own body and health, must be restricted in order to protect the freedom, health and safety of others. Figuratively, the same can be said in the following way – the freedom to wave your hands is limited by the position of someone else’s head. The lack of vaccination hits other people’s heads.
There are not so many opponents of vaccination in general (so-called antivaxxers) and opponents of wearing masks and other epidemiological measures in Croatia. The research by the Institute for Social Research in Zagreb, based on a survey of citizens, shows that about 13% of the so-called antimaskers, i.e. citizens who oppose epidemiological measures because they believe that the corona either does not exist or is not so dangerous. Compulsory vaccination would target a large group of indecisive citizens who are justifiably confused and concerned in the cacophony of information on coronavirus. They should be systematically informed as part of the vaccination program. The advantage of compulsory vaccination is not only in the potentially higher final vaccination, but also in the equal treatment of all citizens. COVID certificates and the combinations of their application, in addition to very complicated implementation mechanisms, divide citizens into unequal groups, the so-called citizens of the first, second, third order, etc.
Although vaccination carries with it a certain risk, it seems to be the only solution to an acute corona crisis. And the compulsory vaccination against the COVID-19 is the only way to implement it effectively in Croatia, in addition to having additional positive consequences, which I pointed out. But even if there was a government with enough political courage to prescribe mandatory vaccination of all citizens, with this comment, as the title suggests, I want to point out that even that will not be enough to solve the corona crisis problem. Is it really the only option available to us that the entire population is vaccinated against the corona every year? Vaccination is the solution to the acute phase of the crisis, but it is not its complete and long-term solution.
What I want to emphasize, following the editors of The Lancet, is that the corona crisis can only be resolved by a radical transformation of health policy, and then a series of other public policies. Currently in Croatia, the basis of health policy is the health system, not health itself. The basic issues of our health policy are the organization of hospitals, debts to drugs wholesalers, the number of respirators and the share that the salaries of health workers occupy in the state budget. For the current health policy, citizens are patients who need to be treated, who need to be diagnosed with something and who need diagnoses and medications. Croatian health policy deals primarily with the treatment of disease, not with health.
In Croatia, two thirds of adults are overweight. The European Health Survey, based on indicators for 2019, additionally shows that in Croatia only 50% of the population drinks alcohol rarely or never, that about 25% of the population smokes tobacco, and about 35% of our citizens spend seven or more hours a day sitting or lying down (not while they are asleep). These are all health risks, probably much greater than vaccination. In order to defeat the COVID-19, we must reduce the number of vulnerable groups and/or their sensitivity to the coronavirus, or increase the general level of health of the entire population, not just patients. For that, it is necessary that the health policy deals with the protection and improvement of health through health prevention and health promotion, i.e. by reducing the presence of risk factors that negatively affect health and advocating healthier habits among all citizens.
If instead of treating disease the basic goal of health policy would be the quality of health of the entire population, our health policy and resolving the corona crisis would look completely different. Information-based policy instruments, those that raise awareness, educate and persuade citizens, should become incomparably more numerous and important in health policy. This includes, for example, broad-based advocacy campaigns, which combat obesity, smoking or alcohol consumption and that help prevent the development of diabetes, addiction or chronic diseases. Next, this policy approach should include instruments to make citizens aware of the importance of self-examination, for example in the cases of early detection of the development of breast or testicular tumors. Both frequent and comprehensive preventive screenings of particularly vulnerable social groups could help. Campaigns to encourage the regular physical activity of all age groups, and to shift the focus from professional sports to recreational sports, seem especially important to me.
General health education, the development of healthy habits and the promotion of healthy lifestyles should certainly include mental health issues on which the overall health picture of both individuals and nations depends. Even the corona crisis, which is a source of extreme stress for all sections of the population, due to fear of disease or disease consequences, stigma, isolation, economic and financial problems it has caused, which is a great mental burden, has not prompted the adoption of a new strategy of mental health. And along with the missing strategy, we should have also received budget investments in systematic and extensive programs of preventive protection and promotion of mental health.
In the next step, for real change, a broader, more comprehensive health policy needs to be coordinated with a whole range of other public policies. Awareness of health care goes through schools, so efforts must be made through education policy. Then, in matters of food quality, agricultural policy and regulation of the food industry, food distribution and trade are important, in addition to raising awareness and educating citizens about healthy eating. It is important to add new priorities to sports policy, but also environmental protection, urban planning policy and tourism policy, which should to a greater extent provide spaces and programs for physical activity and recreation of citizens. The policy of social welfare and the fight against poverty are certainly worth mentioning, because a lower standard of living is unquestionably associated with lower quality of health.
These are just some of the examples of what we should do in the struggle against the coronavirus, in order to improve the health of citizens. I did not even touch on the other social, educational, and economic consequences of the corona crisis. Altogether, in Croatia these recommendations sound like a science fiction movie script, don’t they? We are caught in a web of a highly short-term political decision-making. Constraints seem insurmountable, and long-term plans and visions look unnecessary, useless, unattainable, and even a little insane. Who would mention public campaigns for more recreation at a time when the health care system is falling apart? However, deep social crises, when the status quo can no longer be sustained, are sources of social change and new values. It was the corona crisis that clearly demonstrated the importance of collective efforts to preserve health, both within and outside the health system, which strengthens the argument for radical changes in health policy. But maybe this crisis isn’t deep enough either and the old ways of functioning will remain stable? Or are we simply a society without the ability to imagine and realize long-term visions?