What can the UK learn from the EU’s covid plan for winter 2022-23?BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o2331 (Published 27 September 2022) Cite this as: BMJ 2022;378:o2331
- Samantha Field, public health registrar,
- Martin McKee, professor of European public health
This winter is likely to be brutal. The rising cost of living will force many people to choose whether to “heat or eat.” And, despite optimism expressed by several eminent figures,12 it’s clear that the covid-19 pandemic is not over. England continues to record almost 30 000 cases each week despite vastly reduced testing, with almost 4000 people admitted to hospital.3 It would be very surprising if covid proved to be unlike all respiratory viruses and cases didn’t increase further in the winter months.
This will inevitably place an already struggling NHS under even more pressure. In these circumstances it’s perhaps surprising that, beyond the promise of booster vaccinations, covid-19 is largely lacking from Our Plan for Patients,4 published by England’s new secretary of state for health and social care, Thérèse Coffey. This contrasts with the stance taken by the European Union, which has published a comprehensive plan to counter this persistent threat,5 which in turn holds lessons for the UK.
The EU’s covid-19 plan shows that it can adopt a whole system approach, embracing a coordinated strategy for vaccine procurement and distribution, surveillance, and health system strengthening, along with a comprehensive set of recommendations intended to help member states prepare for winter. The UK has documents dealing with aspects of covid-19—for example, from NHS England and the Joint Committee on Vaccination and Immunisation—but, as far as we’re aware, no single unifying plan that brings them all together.
England’s new health secretary also holds the position of deputy prime minister, a role that ought to facilitate cross government planning and open up avenues for greater cross departmental strategic health leadership, but only if Coffey seizes the opportunity.
The EU’s plan highlights the importance of non-pharmaceutical measures for relieving pressure on healthcare systems in winter. It urges member states to use data and epidemiological thresholds to guide the use of non-pharmaceutical measures, and it highlights the importance of political commitment and community engagement. Clear communication on the thresholds at which non-pharmaceutical measures would be introduced can help individuals, businesses, and public bodies (especially schools) to plan, while this demonstration of transparency benefits public trust.
In contrast, the UK’s Living with Covid-19 guidance relies on pharmaceutical measures as the first line of defence against new waves of infection.6 While campaigning to lead her party this summer, the new prime minister, Liz Truss, promised to “never impose a lockdown.”7 However, as the EU plan notes, there’s no guarantee against the emergence of a new covid-19 variant that’s resistant to existing medical countermeasures, placing unsustainable pressure on healthcare systems and society more generally.
By overlooking the part that non-pharmaceutical measures can play in interrupting transmission, the UK has unnecessarily restricted its options.
A key element of the EU plan, inevitably, is the importance of coordinating countries’ responses to cross border threats to health. It emphasises the importance of an integrated surveillance mechanism, both for covid-19 and in preparation for what could be a very severe flu season.8
Although the UK has world leading surveillance systems in place, especially in genomic sequencing capability and advanced wastewater surveillance, coordination of data between different UK regions and with the EU is key for effective monitoring. Steps are being taken to accelerate integration both within the UK and with the European Centre for Disease Prevention and Control (ECDC), with which the UK Health Security Agency signed a memorandum of understanding in 2021.9
Yet it’s difficult to envisage that this could be achieved in time for winter. Meanwhile, the proposed collaboration with the ECDC remains vulnerable to the fallout from the UK prime minister’s rejection of the Northern Ireland protocol in the EU withdrawal agreement.
Vaccination and pharmaceuticals will continue to be the cornerstone of measures to mitigate the impact of covid-19. Although the EU was initially slow off the mark, it can use its vast purchasing power, exerted through its joint procurement measures, to achieve favourable deals with vaccine manufacturers, especially for new versions as they become available.
This is being strengthened by the creation of a new Health Emergency Preparedness and Response Authority, which also covers procurement of therapeutics and tests. The EU’s plan emphasises the need to consider the entire length of the supply chain and to take steps to identify and mitigate blocks and bottlenecks, demonstrating that it has learnt lessons from the initial phases of the pandemic.
While the UK Vaccine Taskforce, then chaired by Kate Bingham, performed strongly in the crisis phase of the pandemic, Bingham has since argued for a “fundamental reset” in how the government engages with industry to better prepare for future pandemics.10 On top of this, simply by virtue of its much smaller size the UK now has much less market power, with additional challenges posed by Brexit. Every stage of its supply chain now involves extra friction—including medicine authorisation by the Medicines and Healthcare Products Regulatory Agency,11 capacity for batch testing, and complex customs procedures.12 Meanwhile, the merger of the UK Vaccine Taskforce with the UK Health Security Agency has the potential to cause further organisational turmoil.13
Coffey’s plan for patients highlights the scale of the challenges facing the NHS, even if we consider only her four “ABCD” priorities: ambulances, backlogs, care, and doctors and dentists. What it lacks is a strategy to optimise defences against the emergence of a new variant of SARS-CoV-2. The EU has shown us what a comprehensive and forward thinking plan would look like. The UK would do well to study it.
Competing interests: MM is a member of Independent SAGE; president of the BMA; a member of the European Commission’s Expert Panel on Effective Ways of Investing in Health; past president of the European Public Health Association and research director of the European Observatory on Health Systems and Policies, both of which receive EU funding; and the recipient of EU funding for research projects and an Erasmus scheme. However, he writes in a personal capacity.
Provenance and peer review: Not commissioned; not externally peer reviewed.
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