What should the agency that manages the next pandemic be like?

When on December 27, 2019, the technicians of the Center for the Coordination of Health Alerts and Emergencies (CCAES) received the first unofficial news that a strange pneumonia seemed to be spreading through China, this department numbered no more than half a dozen officials. In a meager office on the fourth floor of the Ministry of Health, this small group, with reinforcements in the worst times of the covid, has been in charge of gathering and standardizing all the data that has been made public since the beginning of the epidemic , in addition to leading the response to the health crisis and being its voice: specifically, that of Fernando Simón, its director. The clamor for a national public health center with more means and resources, which until then was restricted to professionals in this world,it then became evident to the entire population. A year and a half later, there is still no news about how this body will be, beyond the five million euros consigned in the General State Budgets to start it this year.

This lack did not take anyone by surprise. The General Law of Public Health of 2011 already contemplated the creation of a body that would centralize public health competencies, which would give this discipline a muscle that it lacked (and still does not). José Martínez Olmos, Secretary General of Health when the law was drafted, explains that the idea was “to create a center, or an agency, with the maximum possible autonomy”. “It would be a sum of what today is the CCAES and all the public health centers of the communities, a connection with the World Health Organization and other international organizations that can analyze important diseases and policies that may be valid. ”, He details. It is a project that, according to this expert, "slept the dream of the just with the PP governments."

Not only was the agency not created, but the Ministry of Health lost more and more muscle in the years after the financial crisis.

According to Martínez Olmos, since then the department has had 1,500 fewer employees.

The competitions to cover the body of State doctors leave empty places in each call.

And it is these professionals, among others, who should manage crises such as the pandemic we are experiencing or those to come.

More information

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For the next crisis, in theory, that agency or state center should already exist. Health does not provide details of how her pregnancy is progressing. In interviews with EL PAÍS, the Minister, Carolina Darias, and the Secretary of State, Silvia Calzón, assured that their department is working on it. “It was a legal mandate. Unfortunately it had not yet come true. In the Budgets project there is already an item for the start-up of the state center and from the ministry we are designing the participatory strategy to help us create it. We have to listen to everyone: professionals, communities, scientific societies… ”Calzón said in November 2020, when Salvador Illa was still minister. His replacement, Darias, added in March: “We are working to have it as soon as possible.We have to strengthen everything that affects the improvement of public health, make a national health system that is stronger, more resilient and more proactive, and contribute to that EU of health ".

A group of experts is preparing a document of proposals that they will present to the ministry and that will be published in the School of Public Health of Menorca, which is being held this week. One of its members is Ildefonso Hernández, Professor of Public Health at the Miguel Hernández University, who tells EL PAÍS some of the characteristics that this report draws: “There is a lot of consensus that it has the legal form of agency. It must coordinate all the intelligence in public health provided by the CCAES, the National Epidemiology Center and have flexibility and capacity to bring together the best capacities of the autonomous communities, but also of scientific or technical centers. For example, if we have a great flu center, we could establish networks with them ”.

What all those consulted agree on is that it should be an independent agency. “It would not make sense that it was a kind of general direction that depends on the ministry. It must be able to give recommendations and then the rulers decide whether to follow them or not. But the most important thing is that he knows how to speak to power, ”says Rafael Bengoa, co-director of the Institute of Health and Strategy and former Minister of Health of the Basque Government, who proposes that he not necessarily be physically in Madrid, something that Hernández shares.

In the reconstruction commission of Congress, in the summer of 2020, one of the conclusions was that an agency had to be created with characteristics similar to those described. Ana Pastor, member of the PP in this commission and Minister of Health in the Governments of Aznar, explains that what has to be created is something different from what the 2011 law proposed, “which was limited to coordinating what the CCAES does with other national centers ”. "It must be independent from the Government, elected by Parliament and it must take care of all issues that have to do with the health of citizens, not only infectious diseases: it must carry out all national prevention and

screening

plans

, from rare diseases, neurological, mental health, cancer, based on a large information center.

It would be a comprehensive health and quality care agency, ”he explains.

In the world there are models that can serve as examples and in which some of the proposals are inspired.

But officially it is not even known what legal form it will have.

Institutes such as Robert Koch in Germany or the Centers for Disease Control and Prevention in Atlanta, in the United States, are independent bodies that give recommendations to governments in a similar way to what experts ask in Spain.

One of the problems that many analysts have pointed out during the pandemic is the Government's lack of agility, partly due to its own structures, to have the best professionals at all times to advise or work directly to resolve the crisis. The Executive was forming groups of experts who did these tasks, but without a clear structure or functions. A public health agency should have more capacities to join forces, beyond the fact that, in itself, it should have a data collection system that would avoid one of the great problems of Spain during the health crisis: the lack of capacity to collect and unify figures in time and form that could lead to quick decisions based on reality.

The creation of this agency was one of the topics of conversation at the annual meeting of the Spanish Epidemiology Society, which met earlier this month in León. In the opening talk, Miguel Hernán, Professor of Epidemiology at Harvard University, called for a “leading institution led by respected scientists” that can make recommendations. "If a government does not follow them, fine, but it will have to explain why."