Public Health Authorities Research Articles

EMSIG: Uncovering Factors Influencing COVID-19 Vaccination Across Different Subgroups Characterized by Embedding-Based Spatial Information Gain

Background/Objectives: COVID-19 and its variants continue to pose significant threats to public health, with considerable uncertainty surrounding their impact. As of September 2024, the total number of deaths reached 8.8 million worldwide. Vaccination remains the most effective strategy for preventing COVID-19. However, vaccination rates in the Deep South, U.S., are notably lower than the national average due to various factors. Methods: To address this challenge, we developed the Embedding-based Spatial Information Gain (EMSIG) method, an innovative tool using machine learning techniques for subgroup modeling. EMSIG helps identify subgroups where participants share similar perceptions but exhibit high variance in COVID-19 vaccine doses. It introduces spatial information gain (SIG) to screen regions of interest (ROI) subgroups and reveals their specific concerns. Results: We analyzed survey data from 1020 participants in Alabama. EMSIG identified 16 factors encompassing COVID-19 hesitancy and trust in medical doctors, pharmacists, and public health authorities and revealed four distinct ROI subgroups. The five factors, including COVID-19 perceived detriment, fear, skepticism, side effects related to COVID-19, and communication with pharmacists, were commonly shared across at least three subgroups. A subgroup primarily composed of Democrats with a high flu-shot rate expressed concerns about pharmacist communication, government fairness, and responsibility. Another subgroup, characterized by older, white Republicans with a relatively low flu-shot rate, expressed concerns about doctor trust and the intelligence of public health authorities. Conclusions: EMSIG enhances our understanding of specific concerns across different demographics, characterizes these demographics, and informs targeted interventions to increase vaccination uptake and ensure equitable prevention strategies.

Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation

BackgroundInfection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown.MethodsWe conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively.ResultsThirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators.ConclusionsEfforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Wastewater Surveillance for Norovirus, California, USA.

Norovirus is a leading cause of acute gastroenteritis and imposes a substantial disease burden. In California, USA, norovirus surveillance is limited. We evaluated correlations between wastewater norovirus concentrations and available public health surveillance data. Wastewater surveillance for norovirus genotype GII in California provided timely, localized, and actionable data for public health authorities.

Securing commitment and control for the supply of plasma derivatives for public health systems. II: A survey of national pathways.

Pressures on the supply of plasma-derived medicinal products (PDMPs) have led to the efforts to increase the level of plasma collected by public health authorities. Public blood collectors were assessed regarding their routes towards domestically sourced plasma and PDMPs. The collectors' operations were specified and analysed. Models were classified according to the type of plasma collection system and contract fractionation arrangements. Commitment and control to a public plasma collection system are the key features that need to underpin plasma collection.

Public perceptions of the health impacts of climate change: a survey study in Greece

Abstract Background Climate change is the biggest global health threat of the 21st century. Despite the tremendous challenges, many people remain unaware of the human health implications of climate change. People perceptions about the health harms of climate change can increase public support for the action needed to reduce climate change. The aim of this study was to examine the public perception of climate change as a human health issue in Greece. Methods A population survey study was conducted from October to December 2023 in the municipalities of Messini and Alexandroupoli, Greece, following proportional quota sampling. A questionnaire was developed and included measures about the socio-demographic background of participants, their understanding of key facts about climate change and their views about climate change thread to human health. Results 406 individuals with a mean age 37.7 (sd = 14.8) participated in the study. Participants understood that climate change is happening (93.6%) and 54% of them think climate change is mostly or entirely caused by human activities, whereas 38% think it is caused equally by human activities and natural causes, and about 8% think climate change is mostly or entirely caused by natural causes. A majority of participants reported that climate change has adversely affected the health of people in various way, either a moderate amount or a great deal, including physical or mental harm from forest fires (90%), physical or mental harm from storms and floods (87%), heat-related illnesses (82%), illness due to reduced outdoor air quality (70%) and loss of housing for residents displaced by extreme weather events (70%). Conclusions Participants viewed climate change as an important cause of health harm, however they partially understood that climate change is caused by humans. Public health authorities should educate the public and policymakers about the climate change and advocate for policies to address the human health challenges of climate change. Key messages • Public health authorities should educate the public and policymakers about the climate change problem and its impact to human health. • Providing people with information about the health harms of climate change can increase public support for the actions needed to reduce emissions.

Needs and opportunities for developing health and well-being profiles in Estonian local governments

Abstract The creation and implementation of health and wellbeing profile, an evidence-based framework for planning health promotion as holistic process, is the responsibility of public health practitioners, who tend work part-time and sometimes lack professional competences. The current study maps the level of awareness, attitudes, needs and possibilities of local government leaders and public health practitioners to develop and implement profiles effectively in Estonian local governments. Semi-structured interviews with leaders in local governments (10) and practitioners (9) were conducted in 2022-2023. Data was analysed using qualitative content analysis. Sample included representatives from all Estonian local governments (79 in total) and were categorized into subgroups based on local governments size, status of the profile, public health specialist employment, and educational background. Preliminary results indicate that leaders find as a supportive factors for enabling and encouraging profile compilation process for example: mandatory requirement; motivated implementors; well organized and effective workplan. Specialists find supportive factors to be cooperation on the national level, good communication practices and joint responsibility. Barriers for health promoters are the lack of time, motivation, financial resources, stakeholders understanding and meaningful action. The first qualitative study on these topics in Estonia highlight that creating a profile is supported by previous positive experience and have per contra an opposite negative effect to start the process. In general, the profile was considered necessary for helping identify problems and support decision-making processes for managing resources, however, assessment whether the profile should be obligatory is needed. In addition, there is a need for further support for the evidence-based decision-making process on the local level in health promotion by offering education and guidance from the national level. Key messages • Knowledge about the importance of public health, barriers and decision-making principles of local government leaders and specialists helps to develop interventions based on actual needs. • Continuously updated health and well-being profile ensures sustainability of health promotion action and is useful knowledge to policymakers, local government leaders and public health practitioners.

1.B. Round table: Artificial Intelligence in Mobile Health Apps: Ethical, Legal, and Regulatory Challenges

Abstract Globally, governments and public health authorities are integrating Artificial Intelligence (AI) techniques in mobile apps to improve public health. For example, during the COVID-19 outbreak, AI-driven chatbots were deployed to provide immediate health information and advice. AI-based mobile apps are also used to support mental health or for preventive healthcare, such as personalized dietary recommendations. Moreover, the use of generative AI for public health purposes is rapidly increasing. In 2024, the WHO launched S.A.R.A.H - a generative AI chatbot designed to provide information on major health topics such as healthy lifestyles and mental health. By integrating AI, public institutions could potentially achieve better health outcomes, improve efficiency, and enhance access to healthcare. However, the rapid adoption of AI public health apps also raises significant ethical, legal, and regulatory challenges. The large amounts of sensitive personal data collected and processed by such apps may create issues for privacy, data protection, and cybersecurity. At the same time, the tendency of AI to exhibit biases may deepen existing health inequities. The new EU ‘digital’ legal framework does not directly address these challenges. This workshop aims to convene leading experts working on AI in health to address these issues. We bring together scholars from different disciplines (health law, health policy, bioethics, biosciences). The workshop objectives are twofold: (1) to critically assess the current landscape of AI in public health apps from a legal, ethical, and regulatory point of view, and (2) to lay the groundwork for policy recommendations on how to ensure the deployment of AI apps for public health in compliance with ethical principles and fundamental rights. First, the panel explores the differences in the data protection regulation of AI public health apps in the EU and the US (speaker: James Hazel). Second, it discusses how these apps are regulated under the new EU Artificial Intelligence Act (speaker: Hannah van Kolfschooten). Third, it investigates the consequences of the European Health Data Space regulation on how health data can be processed through public health apps (speaker: Mahsa Shabani). Finally, as the cross-border use of apps complicates regulatory efforts, it discusses the need for international cooperation in establishing and enforcing guidelines (speaker: Vasiliki Rahimzadeh). The workshop will be conducted as a round table discussion with 4 short presentations of 5 minutes each. Speakers first present a key challenge posed by AI in mobile health apps, and then suggest a potential regulatory solution. This will be followed by a dialogue between panelists and the audience to share best practices on how to regulate AI in mobile public health apps from a legal, ethical, and regulatory perspective. The input will be used to develop a submission for the Call for papers of BMC Bioinformatics. Key messages • As public institutions are increasingly integrating AI technologies into their mobile public health solutions, it is crucial to evaluate the ethical, legal, and regulatory implications. • In light of current gaps in the EU legal framework, we convene scholars from different disciplines and legal systems to design guidelines on the ethical use of AI mobile apps for public health. Speakers/Panelists James Hazel University of Amsterdam, Amsterdam, Netherlands Mahsa Shabani University of Amsterdam, Ghent University, Amsterdam, Netherlands Hannah van Kolfschooten University of Amsterdam, Amsterdam, Netherlands Vasiliki Rahimzadeh Baylor College of Medicine, Houston, USA Pramiti Parwani University of Amsterdam, Amsterdam, Netherlands

Next-generation public health surveillance: extreme heat event prediction and monitoring system

Abstract Background Extreme Heat Events (EHEs) are a growing threat to public health. The increase in the frequency of occurrence of once rarer EHEs and the rise in their average temperatures are dangerously drastic for public health outcomes. Despite this, existing public health surveillance (PHS) systems fail to leverage IoT and AI technologies to facilitate real-time, continuous monitoring of EHE indicators and its associated health risks. This study closes this gap by proposing a comprehensive PHS system that can, in real-time monitor and predict EHE indicators to provide timely alerts to public health authorities. Methods The EHE PHS system collects EHE detection metrics, including indoor temperature and humidity levels, from IoT sensors and thermostats to map them across Canada, primarily focusing on low-income communities. The system also integrates historical climate data (surface temperature, humidity, wind speed and direction, and air quality indicators) from Environment Canada. The system uses the data to train initial prediction models including CNN, LSTM and GNN. The validated model will be integrated into the system, enabling real-time EHE prediction. The output will be displayed in user-friendly visualizations on the EHE PHS system’s dashboard capabilities. Results The system allows for the analysis of real-time data through dashboards and provides alerts when certain indicators (e.g. excessive or prolonged heat) detrimental to public health outcomes are detected. The alerts enable valuable lead time for public health authorities to implement proactive measures, such as issuing heat advisories and deploying resources to vulnerable areas. Conclusions The EHE PHS system will serve as a blueprint for global public health researchers, utilizing IoT and AI technologies for proactive crisis prevention. This knowledge will inform the development of heat-resilient policies and set a precedent for global public health crisis prevention. Key messages • The proposed EHE PHS system uses AI and IoT technologies, to enhance EHE prediction, risk identification, and real-time monitoring for effective public health interventions. • By integrating advanced predictive models and environmental data, the system facilitates early detection of EHE risk, which can significantly mitigate the health impact on vulnerable populations.

Investigation of a Norovirus GII outbreak in a primary school in Portugal,2023

Abstract Background The onset of acute gastroenteritis cases among students in a primary school class on September 19, 2023, prompted an immediate response from the local Public Health unit. A collaborative effort was initiated to investigate and contain the outbreak. Methods Epidemiological questionnaires were distributed to 166 students and 8 staff members, defining cases as individuals exhibiting symptoms including diarrhoea, vomiting, or nausea between September 19th and September 24th, 2023. Additionally, stool samples were collected from three individuals. Results Out of 166 students and 8 staff members, 39 individuals met the case definition, resulting in attack rates of 22% (37/166) and 25% (2/8) among students and staff, respectively. Laboratory analysis confirmed two cases of Norovirus GII among the tested specimens, with five students requiring medical attention. Conclusions Our investigation underscores the significance of continuous epidemiological surveillance and swift implementation of infection control measures in school settings. The detection of Norovirus transmission emphasizes the necessity for rigorous adherence to infection control best practices. Our findings advocate for sustained technical support from public health authorities to prevent and manage similar outbreaks effectively. Key messages • Study on Norovirus outbreak in a primary school highlights the imperative of infection control measures, emphasizing the importance of ongoing support from public health authorities. • The Norovirus outbreak investigation underscores the vital role of surveillance and swift response in containing infectious diseases within educational settings safeguarding all.

10.P. Scientific session: Improving health security and preparedness: are we leaving someone behind?

Abstract Prisons are unique, high-risk, high-security, complex settings; however, the impact of emergencies on prisons is a concern not only to the prison but also to the functioning of, for example, the criminal justice system, policing and courts, as well as to the general public. Prison environments can amplify infectious diseases. In the context of emerging health threats, this risk could be made into an asset through early warning surveillance and epidemiological studies. Many global and public health actors advocated for the inclusion of prisons and custodial settings in a comprehensive response to emerging threats since the early days of the COVID-19 pandemic and again during the Mpox epidemic. The increase in risk in closed environments and the vulnerability of people living in prisons make prisons and other custodial settings potential hotspots for transmission of infectious diseases and for excess morbidity and mortality. Yet, as mentioned above, prisons have been included to only a limited extent in national preparedness and response plans. Similarly, prisons are not always explicitly mentioned in international guidance on the preparation of national plans or in measures taken in the absence of such guidance. Preventing, predicting and responding to threats to the health of prison populations require scientifically valid, evidence-based interventions and assessment of the positive and negative impact of control measures on the population, especially in view of the unequal distribution of harm and disease among people living in prison and unequal access to mitigation or therapeutic interventions. Because of a general lack of timely, good-quality, translatable evidence on prison health, guidance for the management of health threats in prisons is often based on adapting other sources to the prison setting (so-called “prisonification” of guidelines), rather than on evidence specific to prisons. Prisons and custodial settings may also be affected by other biological, chemical, radionuclear and environmental hazards, all of which must be catered for in comprehensive preparedness and response plans. Timely collection of information is essential for national preparedness and response capacity to ensure rapid identification and response to threats. Again, however, the prison population is often excluded from or not explicitly identified in national surveillance systems. As a result, cases or outbreaks may not be identified or not receive an effective response, due to lack of collaborative structures between prison and public health authorities. Inclusion of prisons in local, regional, national and international emergency planning is therefore essential to test plans and revise guidance on the basis of evidence, exercises and/or real events. This workshop aims at exploring the current landscape and deriving implications for preparedness and health security in Europe and beyond. Key messages • Prison authorities should be included as stakeholders in the development of national preparedness and contingency plans according to good governance approach. • Explicit inclusion of prisons and other custodial settings in international and national plans for preparedness and response to emerging health threats is needed.

Impact of AI on public health emergency communication in Europe and Central Asia: A Delphi study

Abstract Background Artificial Intelligence (AI) holds the potential to fundamentally transform public health communication - presenting promising opportunities alongside profound challenges and risks. This two-wave Delphi study therefore invited practitioners and scholars to assess the potential impact of AI on the risk communication, community engagement, and infodemic management (RCCE-IM) of public health authorities in European and Central Asian countries. Methods In two successive online surveys, 54 experts - both RCCE-IM practitioners and scholars with expertise in (digital) health communication, risk communication, and AI - from 28 countries provided their assessment of the following analytical dimensions: (1) opportunities, challenges, and risks of AI, (2) conditions for the responsible use of AI, (3) potential future scenarios, and (4) prioritized actions. The first Delphi wave followed an open and exploratory approach, while the second wave sought to prioritize and rank key findings from the previous round. The survey instruments included open-ended and closed-ended questions that were analyzed through statistical analysis, inductive and deductive coding. Results Results showed that AI holds various opportunities for the RCCE-IM of public health communicators. Challenges and risks, such as algorithmic bias or concerns about inclusivity, equally affect RCCE-IM efforts. Experts identified seven principles for the responsible use of AI (e.g., fair, human-centered) and predicted optimistic (e.g., optimized workflows) and pessimistic (e.g., flood of (mis)information) scenarios for the future impact of AI. Prioritized actions range from regulation, resource allocation, and feedback to capacity building, public trust, and education. Conclusions To responsibly navigate the opportunities, challenges, and risks of AI for public health emergency communication, clear guiding principles, ongoing critical evaluation, and multi-sectoral collaboration are needed. Key messages • AI is likely to transform public health emergency communication. • A set of agreed-upon principles will support public health authorities in the responsible management of the opportunities, challenges, and risks of AI.

Tackling Pertussis in Schools: A Public Health Unit’s Approach

Abstract Issue Pertussis is a highly infectious bacterial respiratory disease, easily transmitted in closed settings, such as schools. In Portugal, 2019 was the last year with a significant number of cases (83). As pertussis usually follows epidemic cycles from 3 to 5 years, another wave is expected in 2024. Children aged 1-5 years are particularly vulnerable as they no longer benefit from maternal vaccination and have not yet received the 5-year boost recommended in the national schedule. Description of the problem In April 2024, the Cascais Public Health Unit (PHU) addressed two possible pertussis cases in preschools. A streamlined response protocol was drafted, including an online contact tracing form and task distribution among response team members, along with templates and a scripted guide for standardized communication. Results We were provided a list of close contacts for the children and staff and shared an online form. In the first case, 34 in 35 identified contacts responded to the form, while in the second case, 38 in 55. When comparing both scenarios, the average scripted call duration decreased from 10 to 6 minutes. The PHU response to the first index case took 6 hours, involving 4 physicians and 5 nurses, whereas to the second took 4 hours, involving 3 physicians and 3 nurses. However, implementation requires at least one team member with basic information technology skills to set up the system. Lessons Clear communication channels between schools and public health authorities are vital for effective outbreak management. Streamlining communication processes with online forms and scripted conversation guides improved efficiency. Centralised data collection reduced response time and resource requirements in each outbreak. Key messages • Established communication channel, standardized data collection, and streamlined protocol allow more effective outbreak management. • Centralized data collection via digital tools is particularly useful in limited human resources settings.

Innovation in border regions: from inequality to equity! Starting with acknowledgment in policy

Abstract Living in a border area can create health inequalities due to limited access to healthcare compared to people in central regions. In centrally located areas, citizens can choose healthcare providers 360 degrees around them, benefiting from full prevention and health promotion coverage. In contrast, border residents have only 180 degrees of access, leading to partial inclusion in health services. National systems typically prioritize health equality but not necessarily equity, especially for those living in border regions. To address this gap, innovative policies that account for cross-border interactions are needed, benefiting over 35% of the EU population living in border areas. A key question is how to ensure health equity in border regions. To explore this, cross-border case studies, like air pollution, food purchases, antibiotic availability and q fever were looked at to identify the situation, the public health challenges it entails and existing solutions. The Essential Public Health Functions (EPHF) framework, developed by the World Health Organization and the International Association of National Public Health Institutes, was used to evaluate public health functions with a focus on achieving greater equity and inclusiveness. Currently in cross-border health key EPHF functions such as health promotion and disease prevention are emphasized, while others like public health governance and community participation need improvement. To better implement health equity in border regions, for use of the EPHF framework an additional and short guideline was developed on how border regions should be considered in national, regional, and local public health policies. This approach offers a pathway to addressing health inequalities in these unique environments: a crucial step towards creating health equity. Key messages • The EPHF framework as an innovative tool to strengthen public health in border regions. • Take the geographical living space of citizens in a border region into account to achieve health equity.

The politics of medical expertise and substance control: WHO consultants for addiction rehabilitation and pharmacy education in Thailand and India during the Cold War.

This paper explores the role of World Health Organization (WHO) medical experts in ambitious projects for substance control during the Cold War in Thailand and India. The circumstances surrounding opium production in these two nations were very different, as were the reasons for requesting expert assistance from the United Nations. Whereas the Thai military regime was concerned with controlling illicit traffic to secure its borders, the Indian government wanted to direct its opium raw materials towards domestic pharmaceutical production. Overlapping and sometimes competing agendas of country governments and international agencies converged upon each project, complicating the consultants' work and requiring careful navigation. In both cases, medicine as a science concerned with human health and well-being was subordinated to more pressing agendas. At the same time, the article argues that WHO consultants left an important impact, though not necessarily due to their skills and training in medicine. Instead, they provided exemplars of sound governance and delivery of public health in a politically stable and economically developed country.

7.I. Skills building seminar: Beyond the jargon: an interactive workshop for effective risk communication

Abstract Risk communication plays a central role in epidemiology to provide information for disease surveillance and outbreak control. It is one of the of the eight core functions that WHO Member States must comply with as part of the International Health Regulations (2005) ensuring national and global preparedness for health threats. It refers to the timely and accurate exchange of information between public health experts or authorities and individuals who are confronted with a threat to their survival, health, economic or social well-being. At its core, risk communication is about empowering people exposed to a risk to make well-informed decisions in order to mitigate potential risks and adopt preventive actions and measures. Risk communication considers political, social, and economic factors; it analyses risk and risk perception; and it places a great emphasis on dialogue with impacted and targeted populations to help them make the best decisions they can. Therefore, it requires an understanding of stakeholders’ perceptions, concerns, and beliefs, as well as their knowledge and practices. In the context of the COVID-19 pandemic, the need for effective and efficient risk communication has become even more evident than before. Risk communication should be able to recognise and deal with rumours and disinformation, and reach the most vulnerable groups, who have a higher risk of contracting the virus and suffering from COVID-related consequences. Lately, increasing attention has been given to this topic. The WHO set-up, in April 2023, a technical Advisory Group for Risk Communication, Community Engagement and Infodemic management (TAG-RCCE-IM) to provide independent review and technical advice in the context of emergency preparedness and response in Europe. The Joint Action PreventNCD aims to also build a framework for country-specific communication strategies for non-communicable diseases (NCD) patients in health crises in one of the Work Packages, by collecting and analysing health communication strategies in different European countries targeting NCDs. In this interactive skills-building seminar, we will share with the participants the knowledge, skills, and process of effective risk communication by using case studies from experts in the field. The session will start with a presentation on the core elements of risk communication followed by examples from the field. This workshop will foster an inclusive interactive environment where participants will hear from panellists sharing their experiences from different settings such as international organisations and national public health institutes. Participants will be split into groups and will be provided with a piece of scientific output, such as a research study or epidemiological report and encouraged to translate this technical message into a clear, concise message that can effectively communicate the key points to the general public. Key messages • Risk communication is essential to fight disinformation while empowering the public to make informed decisions related to their health and well-being. • Epidemiologists and researchers should be encouraged to employ efficient and targeted communication strategies when disseminating their findings. Speakers/Panelists Stefan Schaub Bundeszentrale für gesundheitliche Aufklärung (BZgA, Cologne, Germany Federica Rossetti Sciensano, Brussels, Belgium Stefan Adrian Voinea WHO/Europe, Copenhagen, Denmark

The future of public health in Europe

Abstract EuroHealthNet - in collaboration with the Copenhagen Institute for Futures Studies - has conducted a Foresight study to collect insights and identify risks and opportunities. The study investigates the role of public health by 2035 in achieving health equity through health promotion and prevention, in the context of the digital and green transition. The multi-round study ran from June to November 2023. It consisted of a workshop, a kick-off meeting, two rounds of surveys using the Delphi method, and a final back-casting expert panel. The Foresight exercise involved 35 experts across Europe and covered six themes: public health policy and governance; public health financing and spending; sustainability and the green transition; health promotion and disease prevention; equity and society; digitalisation in public health. The presentation will highlight some of the outcomes, recommendations as well as experiences from this Foresight exercise and how it can be applied in practice.

Large scale public health system transformation: Ireland

Abstract Ireland has coped comparatively well with the COVID-19 pandemic when considering excess mortality. The reasons are likely complex and multifaceted, but it may be, in part, attributable to a comparatively young population and progress on indicators related to premature mortality and preventable mortality on chronic diseases and lifestyle risk factors. “Healthy Ireland” is a national framework in place since 2013 and utilizes a settings based approach to promote health and wellbeing in communities. It aims to improve collaboration between government, institutions, local communities, and individuals. Sláintecare is an all’party long-term health reform initiative developed in 2017 aimed at delivering the right care, at the right time, in the right place by the right team. In addition, in 2018 Ireland embarked on an ambitious public health reform programme with the implementation of the recommendations of the Crowe Horwath review of Public Health. While challenges exist, including access to services and waiting times, the governments has put in place initiatives to address these and is committed to, amongst other things, promo ting the continued integration of services across a variety of domains including primary to quaternary prevention. As Ireland began to emerge from the COVID-19 pandemic it established “The Public Health Reform Expert Advisory Group” to identify learnings from the public health components of the response, with a view towards strengthening public health and health protection generally and, specifically, future public health pandemic preparedness. The group, made up of national and international public health experts, submitted its final report in September 2023 which outlined a series of recommendations focused on potential improvements to public health policy, structures and governance. The WHO analysis of the Essential Public Health Functions provided complementary results. More work is now ahead to consider and implement these recommendations and foster institutional reforms including at the Health Services Executive, the Department of Health, and at the Health Protection Surveillance Centre.

9.L. Round table: “What” and “How” for building competencies for effective policy making in and for public health

Abstract Policymakers operating within the field of public health must regularly draw on their skills or competencies to facilitate engagement in and between policy sectors and with the public, to navigate the larger landscape of public health institutions and governance levels across the policy cycle, to generate, understand, and apply evidence for decision making, as well as to negotiate the demands of diverse stakeholders. What exactly are the competencies needed and how can they be cultivated to enhance the collective capacity of policymaking institutions? The increasing strain placed on public health systems worldwide, owing specially to challenges in population ageing, the burden of non-communicable diseases, and the exigencies introduced by pandemics, environmental disasters, and geo-political instabilities push us to expand the scope of public health. A look to the policy environs and outcomes seen within and across countries demonstrates that the quality of policy is both highly variable and exceedingly subject to the quality of public health leadership itself. These developments shed light on the need for greater investment in the development of competencies needed by policymakers to engage in effective decision making on key issues impacting population health and the resilience of public health systems. This includes efforts to strengthen the abilities of policymakers to identify problems, recognize opportunities, and put forth solutions in line with robust data and evidence, principles of public health ethics, gaps and priorities in public health needs, and in accordance with financial and political realities. The proposed roundtable will examine the state-of-the-art on policymaking competencies in public health, and how to build them by examining the barriers and opportunities. The panel will convene leading experts in the field of public health research and practice to explore: 1) the conceptual definition of competencies for policymaking at different levels of governance and across the policy cycle; 2) the strengths and limits of competency frameworks and their utility in guiding assessment and training tools, as well as policy practice; 3) the challenges associated with developing, maintaining and transferring competencies in fast-changing, multi-level policy making environments; 4) the challenges for public health experts and institutions to be trusted advisors both by policy makers and other stakeholders and the population; and 5) the opportunities to harness the unexploited power of professional networks in some countries of Europe. Key messages • An enhanced research agenda and investment are needed for the development of competencies - individual and collective - for effective public health policy-making and stronger governance. • Innovative approaches to policy-making are needed, and this requires building competencies, including leadership, for addressing the complex nature of public health.

Measles cluster in Northern Portugal: enhancing surveillance strengths

Abstract Although measles was declared eliminated in Portugal in 2015, outbreaks persist, despite high vaccination coverage. The last outbreak in the northern region was in 2017. Portugal has a Surveillance System implemented for mandatory communicable diseases (SINAVE) integrating clinical, epidemiological and laboratory data. In 2021, WHO expressed concern about the low sensitivity of measles surveillance and urged Portugal to strengthen its surveillance practices. Our study aims to describe a measles cluster in northern Portugal during the first trimester of 2024. Data from measles cases from the first trimester of 2024 were collected from SINAVE. Contact tracing and Public Health (PH) intervention data was sent by Local Public Health Authorities through a survey designed for that purpose. A total of 70 suspected cases were reported and investigated: 6 cases were laboratory confirmed and 64 were discarded. The confirmed cases had a mean age of 28 years (all adults), with 50% female. The mean notification time was 0,3 days. The index case was imported (Mauritania) and unvaccinated, leading to 2 secondary cases. Five cases had 2 doses of a measles vaccine, with 1 case being a health professional. Additionally, 1 case was imported from France. For 2 cases the source of infection could not be unequivocally identified and no travel history during incubation period. A total of 851 contacts of confirmed cases were identified. Although sustainable transmission is not evident in our region, measles is being introduced through migration and tourism. Despite clinical awareness, strengthening early case detection is essential to enforce effective control measures. PH teams have been working tirelessly to trace clusters origins, gathering large number of contacts and adapting strategies for sustained control. In a globalized world, ensuring surveillance sensitivity is paramount. Integrating other data sources in surveillance routine is crucial for upholding Measles-Free Status compliance. Key messages • Measles must take centre stage on our agenda. • Reinforcing surveillance, integrating additional data sources, is crucial for heightened sensitivity and prompt response.

Adverse Reaction Reports for Skincare: Zero

Abstract Introduction Suspicions of Adverse Drug Reactions (sADRs) facilitate public health authorities in making decisions regarding the safety of various drugs in the market, thus it is important to be acquainted with these data in our population. Objectives To identify suspicions of adverse reactions due to skincare product use among adults in Veracruz, Mexico. Methods A cross-sectional, prospective, and descriptive study was conducted, including subjects over 18 years old residing in the metropolitan area of Veracruz, Mexico. A self-administered questionnaire was utilized to identify suspicions of adverse reactions due to skincare product use and their notifications. Results 607 subjects participated, with a mean age of 24.61 (±9.85), comprising 78.25% females and 21.75% males. The prevalence of sADRs identified by patients was 37.2%; however, 44.3% reported experiencing skin redness, 42.7% reported burning sensation, and 31.6% noted changes in their skin becoming oilier. 70.20% claimed awareness of potential adverse effects of the products they use, and 37.2% reported experiencing some adverse reactions, with 76.6% indicating that adverse reactions noticed on their skin disappeared upon discontinuing the product. None of the participants notified sADRs upon identifying them. Conclusions Not all participants in this study recognize sADRs as adverse effects, indicating the possibility that patients may have experienced adverse reactions without being aware of them, as they may not relate the product to the reaction Key messages • The notification of sADRs is a regulated activity in Mexico, so we must promote its implementation at all levels, since they are fundamental for public health decisions. • We must carry out educational activities on skin care in order to prevent SADRs or so that the doctor provides care in a timely manner, since the patient does not recognize them.