Tuesday, February 7, 2023

“The uptake in vaccination of risk groups should be individualized and adapted to the patients’ health process”

Gaceta Médica has been able to interview the General Director of Public Health of Castilla y León, Sonia Tammes, In office since December 2021, when the Autonomous Community’s Ministry of Health passed into the hands of the Popular Party, he took charge of evaluating a plot in circulation as COVID put its value on the front line. Since his appointment, in the first instance, following an Extraordinary Governing Council, Tomás has remained in the Castilian-Leonian team of directors, who lead Alexander Vazquez, Now for this publication, he analyzes the paradigm this important area of ​​health is headed towards.

Question. What are the main concerns of Castilla y León in the field of public health and what actions are you considering for 2023?

answer. One of our biggest concerns is manpower, availability on the one hand and competency on the other. Like health care, public health faces the demographic challenge of generational turnover with a shortage of professionals in younger generations, in this case exacerbated by two determining factors: the wage competitiveness of some jobs located in general administration as opposed to health Lack of services and absence of regulated and homogeneous training of professionals practicing public health. In this sense, it is important to highlight that the practice of public health functions is multidimensional.

Only in the case of doctors there is a special, intensive and homogeneous health training, but it is not required in most jobs where public health is practiced, resulting in frustration of overqualified personnel when it is not covered by Lack of coverage of untrained workers or unattractive positions. In the case of other qualifications, the situation is even less homogeneous as there is no such specific health training and the knowledge of professionals accessing public health jobs depends on their own interest as well as obtaining the necessary training and qualifications. job access system.

“We must undertake a bold renewal of professional organization in public health to make it competitive and adequate”

Castilla y León, with the Ministry of Health and the rest of the CC. AA working to agree on a series of resources, capacities, qualifications and possibilities for professional development throughout Spain within the framework of the so-called Zaragoza Declaration, which brought together the highest health authorities last March 2022 and where monitoring It was agreed to strengthen Public health at the national level, an aspect which essentially involves strengthening the employment status of the professionals who practice it. We hope that this process does not stop with small temporary patches or minimal compromises, but rather that a bold renewal of professional organization in public health is necessary to make it competitive and adequate, and that confronts the core problems.

Q. The importance of your work has come to the fore due to the pandemic. What is the way forward?

R. One of our concerns is precisely the social recognition and work of those of us within the health professions who work in public health. The advent of the COVID-19 pandemic has undoubtedly focused attention on this task, but there is still a lot of unknown. The population of developed countries take issues such as the health of water, the safety of the food we eat, compliance with quality standards in the provision of health services, availability of vaccines, etc., for granted. All these works, which have an undoubted social value, are deeply unrecognized and one of the objectives of the Junta de Castilla y León is to promote this work as a necessary condition of our lifestyle and even more as a form of economic development. Can be seen in our community.

In addition, the commitments of this legislature include the development and approval of a new public health law with a “one health” approach; That is, under the evidence that humans interact with their environment and other living beings and that this interaction requires that health policies extend to the whole of administration.

P. Castilla y León claims to have the most up-to-date vaccination calendar. What is the roadmap in your community? What challenges do they face?

A. The new schedule of systematic vaccinations in the lives of people for the community of Castilla y León came into force on January 1, 2023. From this moment on, new approved benefits are available, which are numerous and for all ages.

Sonia Tammes, Director General of Public Health of Castilla y León, during the inauguration of her post.

The new vaccination schedule for 2023 for Castilla y León is the most complete nationally as a whole and among many neighboring countries. This is the result of including all nationally agreed services without delay, and we have also chosen to continue our two historical policies in this area, as I said earlier: a selection of vaccine products with additional The cost and introduction of vaccines whose effectiveness has been sufficiently demonstrated and which, if they are not included in the official calendar, generate inequality. The latest example is the rotavirus vaccine, which has proven to be highly effective and was recently classified as cost-effective by the Network of Health Technology Assessment Agencies.

Encouraging vaccination in risk groups is always more complicated. In this area, recruitment must be individualized and adapted to the patient’s health process in order to optimize the timing of vaccination based on the patient’s condition, in order to obtain the greatest benefit. All of these conditioning factors have a negative effect on coverage, which is usually low even in the early stages of an innovation. For this reason, we believe that expanding the herpes zoster vaccination recommendation to the 65-year-old population will facilitate access to this vaccination for at-risk groups, as has previously happened with other vaccines such as the pneumococcal vaccine.

Q. What measures are you going to implement to improve vaccination coverage for healthy adult population and those with at-risk disease?

R. Vaccination in the adult population has several characteristics that differentiate it from childhood vaccination and that make it a challenge for public health policies. First, children do not participate in the decision whether or not to practice certain preventive activities. Authorities and health professionals recommend certain actions and parents usually follow them with exemplary adherence. Adolescents are already participating in decisions about their health and we can see it: coverage of vaccines given at ages 12 and 14 is low.

“The risk of severe flu has a tipping point at age 60; Pneumonia and herpes zoster skyrocket by age 65”

Healthy adults or people with well-controlled chronic disease, especially those under 70 years of age, have a very low risk perception. However, the data make it clear that the risk of severe influenza hits a tipping point at age 60, or pneumonia and herpes skyrocket after age 65. An additional reason to start getting vaccinated when we are still young and healthy is that vaccines train our immune systems to be more receptive when decline has already begun. That’s why we should work on the idea of ​​vaccination as an investment in healthy ageing.

Q. How are you going to improve the epidemiological surveillance system in Castilla y León?

A. Monitoring systems are constantly evolving. Less than twenty years ago, so-called mandatory notification diseases, ODEs, were reported on carbonless forms and digitized in provincial databases that were not online, and later added at the regional and then national level. Lots of CC AA We are increasingly developing automated information systems that provide more information, and more quickly, that may be needed in decision making. The pandemic has put pressure on the entire system and has helped us identify the highest priority improvements in surveillance systems, such as interoperability with different data sources, versatility in reporting, the need to monitor health risks, not just exposures, Etcetera.

Currently, some of these improvements can be thanks to the European Funds for Recovery and Resilience (MRR) facility. We expect that we will be able to make the most of these funds, despite the fact that objectives and timelines have not been agreed with the Spanish Government or the CC. AA Nor with the other agents involved, such as in this case the technological development industry of the health sector, with the difficulties that arise both in management and execution.

Q. Antibiotic resistance is being closely watched as the ‘new pandemic’. What is the action of the regional government in this area?

A. Resistance to antibiotics is not new and could leave humanity in a very compromised position in a short period of time, but luckily all the agents involved have become aware of it. This is a problem that we professionals in human health, animal health and environmental protection must align with, and in fact the fight against antibiotic resistance has been the biggest exponent of “one health” or the application of “one health”, which Promotes comprehensive approaches to major health problems that are the only guarantee of success.

In recent years the Junta de Castilla y León has considered it a priority to establish an organizational structure through which to carry out activities aimed at rationalizing its prescription, optimizing its use and thus preserving its effectiveness. have to be channelized and developed. , For example, PROAs that cover our entire healthcare service, Sacyl, have been established and are working with specific groups for the area of ​​hospital care and others in the area of ​​primary care.

“Antibiotic resistance could leave humanity in a very compromised state in a short time”

There are many actions under development. In the near future, and strictly in the health care setting, efforts are being made to improve information systems so that the shift from empirical prescribing dictated by the changing epidemiological situation is more effective. The next challenge, in the longer term, is to extend the partnership achieved in the human health system to the rest of the interrelated areas: animal care and the environment.

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