Public health, perhaps the great forgotten part of healthcare, has a core function to prevent and protect the health of all citizens. The covid pandemic, declared almost four years ago, highlighted the importance of having strong public health. It was not the first epidemic that humanity faced, but it was one of the greatest threats to human health in modern times. With the lessons learned and the stress of managing the health emergency overcome, public health in Spain, and particularly in Catalonia, is better, both in terms of surveillance and response systems. However, there is work to do and resources to contribute.
Diálogos en La Vanguardia, in collaboration with Moderna, addressed the current public health situation and how vaccines, especially the innovation in mRNAs, were, and will continue to be, crucial for the complete protection of the population. The round table was attended by Carmen Cabezas, Secretary of Public Health of Catalonia; Antoni Trilla, epidemiologist at the Hospital Clínic and dean of the Faculty of Medicine of the University of Barcelona; Montserrat Martínez, head of the Preventive Medicine Service of the Public Health Agency of Catalonia; Joan Guanyabens, director of the TIC Salut Social Foundation; and Juan Carlos Gil, general director of Moderna Spain and Portugal, who warned that, despite having managed to combat a significant danger, “the threats are there and we must continue to be alert and take care of” our health.
The pandemic, Cabezas recalled, in addition to putting everyone in check, showed that surveillance and response systems had to be faster and more agile, because in a global world like ours, what is happening in China today is happening all over the planet in a few days. In our country, these systems have improved since the pandemic. The Information System for the Surveillance of Infections in Catalonia (SIVIC) today makes it possible to follow and monitor 20 respiratory viruses practically in real time, with double surveillance. On the one hand, using data from the population's medical records, but also with a sentinel system that covers 34 primary care centers, twelve hospitals and eleven laboratories. “This is a before and after,” he highlighted.
“I don't know if we have reversed the situation, but the trend has been reversed. And the trend was that everything went to assistance and little to prevention,” Guanyabens added. More resources must be dedicated, surveillance must be strengthened and mechanisms must be reinforced, Trilla added, but not before warning that the war in Ukraine and the conflict in the Middle East have once again relegated public health to the background.
Resources are key to the “silent” work of public health which, as Cabezas underlined, goes beyond epidemiology. Less than 2% of the resources allocated to healthcare are dedicated to public health. “A ridiculous amount per person,” in the opinion of Cabezas who, however, highlighted that the items are increasing, although still far from the 5% that would be an optimal figure. “Not long ago we were at 1.2%,” Gil recalled.
However, the top executive of Moderna in Spain and Portugal advocated moving towards well-being, a concept that includes eating well, sleeping well and exercising. In short, lead a healthy lifestyle. The citizen, he continued, has to become aware that he must also participate in this process of prevention and well-being because in the end what it is about is living longer and better. Trilla expressed himself in similar terms, calling for more education on healthy lifestyle habits, starting with children and ending with health professionals.
The other pending challenge is the digital revolution, where data is fundamental. “What you cannot measure you cannot improve, and what you do not know you cannot address,” Guanyabens reasoned. In the field of genetics, he stated, “everything remains to be discovered,” but to answer genetic questions you need genetic code and this is where, he said, “the drama is.” There is data, but it is not very easily accessible. “Europe wants to protect our privacy and our confidentiality, but perhaps by protecting us so much it is protecting us from innovation and development,” she lamented. “One's data is of little use, but everyone's data is of much use. We always say that we are leaders in organ donation. Donating organs saves one, two, three lives; How many lives could we not save with our data?,” she emphasized.
In Gil's opinion, the most important part of the digital revolution is the change in the era of medicine with messenger RNA. Such was his contribution that the Nobel Prize in Medicine this year honored Katalin Karikó and Drew Weissman for their discoveries that allowed the development of messenger RNA vaccines against Covid-19. “It is a disruptive advance,” said the dean of the Faculty of Medicine. And while it is true that the vaccines were developed in one year, a record time, “there were three decades of research” behind them, he stated in line with the opinion of the rest of the speakers. “We had been working with coronaviruses for six years and that allowed us to have the agility to develop the vaccine,” said Gil. Martínez, with the consensus of the rest of the speakers, stressed that the vaccines are safe, because no steps were skipped, and effective. “The messenger RNA companies, and Moderna in particular, from the moment they received the genetic sequence of the first virus, took four days to identify the antigen that could be used to manufacture the vaccine; In two months they had done the tests on mice and then on initial humans, and in nine months we began to vaccinate the population,” said Trilla, who highlighted the public-private collaboration exercise that allowed this result and that should serve as an example. to continue in the future.
The real challenge was production. “We went from producing 10,000 vaccines a year for clinical trials to one billion vaccines in one year. It is a historical event, a miracle that happened thanks to the collaboration of many entities, many people and many regulatory agencies,” Gil stressed.
The mRNA technological platform will allow us to work on future solutions and not only for covid. “When we have a little more historical perspective, we will realize the qualitative leap we are making in terms of treatments and health management, because we are learning the language of life, the language to tell the body how it can fight more effectively.” many of the ailments we currently have,” he highlighted.
Moderna, its representative stated, is obsessed with respiratory vaccines because respiratory conditions are the cause of the greatest number of deaths in hospitals, regardless of the pathology for which the patient is admitted. “Our challenge is to launch 15 products in the next five years and the majority will be vaccines for respiratory diseases,” said Gil, who also assured that Moderna is working on a combined vaccine for flu, covid and respiratory syncytial virus (RSV), which causes of bronchiolitis in children and serious pathology in the elderly, to increase vaccination coverage.
But the versatility of this technological platform allows the development of other solutions that have nothing to do with respiratory viruses. Moderna works on vaccines for personalized cancer treatment. Much of the research, especially on solid tumors, is carried out in Catalonia with clinical trials in several hospitals. We also work on rare diseases with the Hospital Clínic. “This technology will allow us to give hope to many diseases that now have no solution or very suboptimal solutions,” he emphasized.
Due to “pandemic fatigue and vaccine fatigue”, the flu and covid vaccination campaign in Catalonia is not going at the desired pace this year. But Catalonia's vaccination system has already proven exemplary during the pandemic. “We have done a lot of work on information systems related to vaccines, their management, logistics and registration and integration into medical records,” Martínez explained. Now we are working to achieve a more accessible and transparent system for citizens and put an end to the mistaken idea that vaccines are for children. “In the same way that the flu is not an adult disease, and that is why we also vaccinate minors, vaccines are not just things for children,” said Martínez, who recalled that Catalonia's vaccination schedule has been in place for a long time. is for all the life". “We recommend tetanus and diphtheria during adulthood, whooping cough for pregnant women and herpes zoster for people of various ages over 65,” he said as an example. “We must value the effort made; Right now our environment has one of the most advanced calendars globally,” he added.
Along the same lines, Cabezas recalled the importance of vaccines and their effectiveness. The health system covers the entire vaccination schedule free of charge and with access to the best technology vaccines. “Let's use it, we are lucky to have it,” he declared, highlighting that behind it is “the work of many magnificent professionals in the health system, both healthcare and public health.” “Catalonia has one of the pioneering and best vaccination programs not only in Spain, but in the world. Catalans have to be proud, calm and confident,” said Gil.
Since public health is not just epidemiology, Cabezas listed the four challenges of current public health: Equity, population aging, mental health and One health, including the effects derived from climate change, such as drought or heat waves, which last year caused 2,705 excess deaths.
