In the epidemiology of infectious diseases, we are frequently monitoring cases of illness and death caused by microorganisms that can threaten our health.
With the emergence of new diseases, such as Covid-19, there is an international and national health legislation that makes it possible to establish a legal framework to facilitate actions to face the event.
At the moment, internationally, we have the decree of three Public Health Emergencies of International Importance (ESPII) in force: the Poliomyelitis, instituted in 2014; Covid-19, instituted in 2020 and, since July 23, the global health emergency due to monkeypox (Monkeypox). It is the first time that we have three simultaneous decrees of ESPII for diseases caused by viruses.
These decrees, in addition to being seen as something negative, must be seen from their main objectives, which are: coordinating the response to disease control with integrated and internationally agreed actions, facilitating access to medicines, vaccines and other supplies and generate scientific evidence to guide actions at national and subnational levels.
Science is the backbone that allows us to review lessons learned, re-evaluate approaches and build on its methods a framework to accelerate progress towards controlling a disease.
In Brazil, in order to organize actions to combat these emergencies, Decree 7,616 of November 17, 2011 was created, which provides for the declaration of a Public Health Emergency of National Importance (ESPIN) and institutes the National Force of the Health Service (FN-SUS). ESPIN can be enacted in situations that demand the urgent use of measures to prevent, control and contain risks, damages and harm to public health. It is declared due to the occurrence of the following situations: epidemiological; of disasters; or lack of assistance to the population.
We are still in a Covid-19 pandemic, even though the Ministry of Health has decreed the end of ESPIN for Covid-19 and we have not had the ESPIN decree for Poliomyelitis in Brazil. Therefore, there is a question of the epidemiology of diseases, such as their distribution, severity and lethality; and there are operational issues that serve to organize responses to these diseases, such as purchasing inputs, hiring people and services. For the latter, ESPIN has been very effective and should be used whenever necessary. What must support these decisions must always be science. Without it, we run the risk of misusing the decree or failing to use it when it is urgently needed.
Science is the central axis that allows us to review the lessons learned, reassess approaches and develop, based on its methods, a structure that allows municipalities, states, the Federal District and the Union to accelerate progress to control the disease, as it is as important as instituting a decree is to establish the criteria for its completion.
Thus, it is appropriate to discuss and agree on objective parameters for changing administrative actions (standards) based on scientific (epidemiological) evidence. ESPIN must be reassessed periodically, so that legacies are permanently incorporated into the services and so that we are prepared to maintain emergency status or even, if the emergency eventually ends, we can rationally agree a new declaration if the virus so imposes. , always based on the evidence generated.
Finally, the greatest legacy of coping with emergencies in public health is the understanding that science, in the face of its uncertainties, can generate some disagreement in the fight against diseases, but without it it would be impossible to reach the stage of disease control that we reached in the past. 21st century.
It is necessary that our governments recognize that science must be the beacon of public health actions and the good use of our tax money. After all, a government should only be considered good when it uses the effective means at its disposal to protect its citizens. In public health, this effective means is called scientific evidence.
This article was written for the #scienceinelections campaign, which celebrates Science Month.
Ethel Macielan epidemiologist and professor at Ufes, is president of the Brazilian Tuberculosis Research Network and the coordination of the Abrasco Epidemiology Commission and the Brazilian Network of Women Scientists.