University of Western Australia
A recent rather devastating Lancet editorial: The ethical darkness of global health drew on a Fulbright Lecture by David Miliband. Mr Miliband noted that we live in an age of impunity – and he speaks of “doing nothing as the norm”. The lecture, and in turn the editorial, raised the issue of how globally we often do nothing about horrendous circumstances for people in distant countries.
Global health is not just an important aspect of public health – it is increasingly integral to public health (and public health is integral to global health). Globally, public health continues to face serious challenges with substantial inequities, exacerbated by the current pandemic. An important global threat is the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) virus, the coronavirus causing COVID-19. Outcomes from the pandemic have been extremely poor in many countries, regions and marginalised groups.
Social epidemiology is focused on social factors in epidemiology and draws on many disciplines. Never has epidemiology been so important. However, it has been frustrating at times to observe what was happening and realise what might be looming. This includes missed opportunities for prevention and reduction of disease, particularly ‘wicked’ or seemingly intractable health challenges. Understanding the complexity of such challenges is necessary if solutions are to be found. Hence, when we consider the COVID-19 pandemic, it is important to value the technology providing vaccine options while also recognising the challenges of using vaccines and public health measures optimally with substantial global inequity including poor housing, insecure work and food insecurity.
I was fortunate to be the co-chair (along with Professor Tony LaMontagne from Deakin University) of the World Congress of Epidemiology held virtually in September this year – what an amazing time to co-chair such a congress. The conference bought together epidemiologists from around the world, working in many areas of epidemiology and it was an inspiring and humbling experience to be involved. Being online allowed engagement from many people internationally who may not have been able to attend such a conference face-to-face. There was discussion at the conference of many areas of epidemiology – despite the pandemic there are many other health issues of importance in the program. Of course, many aspects of the COVID-19 pandemic were discussed – genome sequencing, wastewater surveillance, data linkage, modelling, vaccines and communication of science. In fact, ensuring messaging in the community was evidence-based and appropriate was a major concern raised during the conference. Many approaches to COVID-19 have been developed or further developed during the pandemic. While there has been a focus on vaccines, many aspects of public health play an important role.
"Globally we often do nothing about horrendous circumstances for people in distant countries."
Social epidemiologist Professor Linda Slack-Smith
Epidemiologists increasingly need to work with multidisciplinary teams. Often students come into our public health courses almost apologising for having a laboratory science background, but their interdisciplinary perspective is so valuable in public health and epidemiology.
As a social epidemiologist, I am particularly concerned about equity and social justice. We could have a very simple view where everyone is equally vulnerable to an infectious disease and the simple answer for everyone is getting vaccinated. However, it is so much more complex than that.
We need to consider the impact of infectious disease and accessibility of vaccines for marginalised groups. We may have 90 per cent vaccination of adults in the population but a group of teenagers with a disability could still have no vaccine and be extremely vulnerable.
Vaccines, including the new mRNA vaccines, have helped to reduce spread, severity of illness and death in the community during the pandemic.
But while the array of vaccines, including mRNA vaccines used in the COVID-19 pandemic are new in terms of use, vaccine development has been occurring for decades. Accelerating the technology bodes well for vaccine development in the future and mRNA vaccines offer a safe, alternative type of vaccine.
The importance of ongoing research in relevant areas – both the social aspects of epidemiology and technological aspects of vaccines cannot be over-emphasised. Medical science and public health require strong collaborations and universities need to be supported to prosper and support such work.