Emergency Preparedness: A Shared Effort

The COVID-19 pandemic has exposed gaps and weaknesses in health care systems worldwide, but it has also highlighted countries’ capacity to respond and provided valuable lessons for the future. The pandemic has highlighted the need for countries to work together on scientific evidence production and vaccine development and elucidated the commonality of pandemic-related challenges, such as personal protective equipment unavailability and supply chain disruptions. International cooperation has been key to tackling COVID-19 and continues to be a fundamental pillar of emergency preparedness and response in circumstances when synergy among countries is more important than individual efforts.

In a context of cooperation, the American Public Health Association (APHA) and the Pan American Health Organization (PAHO) have collaborated for more than 100 years to promote health and address emerging public health threats. This year, APHA celebrates its 150th anniversary, and PAHO its 120th. This joint special issue produced by AJPH and the Pan American Journal of Public Health (PAJPH) commemorates the achievements of our partnership.

A JOINT SPECIAL ISSUE

The supplement focuses on Latin America (i.e., the cultural region of the Americas in which Romance languages are spoken, generally comprising South America, Central America, and the Caribbean islands). Although it is not possible to present research from all countries in the region, the articles offer a representative perspective of emergency preparedness from different parts of Latin America. The articles cover three main topics: the pandemic’s impact on countries, the essential public health function response, and the digital transformations needed to improve the resilience of health care systems. To facilitate access to the information in the supplement, all articles are published in English in AJPH and in Spanish in PAJPH.

Impact of the Pandemic

Health insurance scheme in Colombia

To quantify socioeconomic disparities in COVID-19 mortality, Garzón-Orjuela et al. (p. S586) analyzed factors in a Colombian cohort in relative and absolute terms and found that type of health insurance is by far the main contributor to inequalities among both genders and especially among young adults. Urgent structural changes are required in the Colombian health care system to confront future public health challenges and inequality.

Cancer care access in Chile

Although directly affecting millions around the world, COVID-19 also has had an enormous indirect impact, particularly on health care. Cuadrado et al. (p. S591) evaluated the impact of the pandemic on cancer care access in Chile. Oncology services suffered a sharp drop in March 2020, when Chile was most affected. After March, oncology services utilization improved slowly but did not completely recover in 2020. The pandemic has put health care systems under pressure and has had a profound impact on cancer and overall care, especially among women and state-insured populations. Cancer care programs should secure financial mechanisms to compensate for the impact of the pandemic and to prepare for future disruptions.

Guatemalan health care workers’ mental health

In a groundbreaking study named HEROES (COVID-19 Health Care Workers Study), Paniagua-Avila et al. (p. S602) describe the prevalence of mental health conditions and associated exposures during the COVID-19 pandemic in a Guatemalan cohort of health workers. Among participants, mental distress (59%) and moderate or severe depressive symptoms (23%) were highly prevalent. Additional surveillance and attention are warranted to preserve the mental health of these essential workers.

Response

The role of essential public health functions in addressing the challenges of the COVID-19 pandemic are also considered in this issue. Through the lens of the renewed essential public health functions framework, Báscolo et al. (p. S615) reviewed the institutional capacities of several health authorities in Latin American countries to respond to the needs of their populations during the COVID-19 pandemic before vaccination programs started. Responses were grouped into prevention, prioritization, and mitigation strategies, and challenges were identified to propose an agenda to strengthen the stewardship function of the health authorities.

Strengthening the System

Digital transformation is essential for more equitable and sustainable public health in the age of digital interdependence. In their article, García Saisó et al. (p. S621) emphasize the importance of digital connectivity as a tool to improve health care access and coverage and to better prepare for future health crises. They consider eight guiding principles for the digital transformation of the health care sector, identifying their relationship with the COVID-19 pandemic in Latin America, where 30% of the population has no access to the Internet.

NEW EVIDENCE FOR DECISION-MAKING

The COVID-19 pandemic will not be the last. Latin America’s health systems will face future health emergencies, including the reemergence of infectious diseases, the effects of climate change on health, and the spread of health misinformation. To address these threats, public health decision-makers require appropriate, relevant, and timely information to devise measures that can influence tangible changes at the population level.

This new scientific evidence will guide public health preparedness for future emergencies, which will affect health care systems and population health in an increasingly interconnected and interdependent world.