Speech by Dr Angela Pratt at the Scientific Conference on Infectious Diseases and Public Health Issues in the Post-COVID-19 Era at Pasteur Institute in Ho Chi Minh City

[Please check against the delivery]

Let me start by thanking the Pasteur Institute of Ho Chi Minh City for inviting me to speak at the 2024 PIHCM Scientific Conference. It’s really a pleasure and an honour to be here.  

To prepare for this talk and the topic I was asked to speak about this morning, I have been reflecting a lot on the COVID-19 experience – what it taught me personally, and what I think it teaches all of us about the world we live in, how it is changing, and what this means for public health.  

COVID was a seismic event that re-shaped our world in profound ways. Most of us learned to live and work differently – at least for a while. It generated a renewed understanding among leaders and the public about the centrality of health and wellbeing to communities, societies and economies. The WHO Director General, Dr Tedros (my big boss) is fond of saying, “without health, there is nothing”.  

But while COVID-19 took many people by surprise, in fact, it was an entirely predictable event, and one which public health experts have anticipated – and feared – for some time. This is because it was the result of a changing world, and a changing public health landscape.  

So today I would like to talk with you about my reflections on four major shifts that have been reshaping our health even before COVID-19; and what we at WHO see as the big opportunities for adapting to this evolving public health landscape – and navigating our way towards a more resilient health system, which is better designed to prevent and manage future disease threats.  

Section 1: The 4 shifts that are reshaping our health  

The first significant shift that is having a profound influence on our health – and being felt particularly acutely in Viet Nam – is demographics.  

Around the world, the number and proportion of people aged 60 years and older in the population is increasing. In 2019, there were 1 billion older people. This is predicted to more than double by 2050.  

Viet Nam is one of the most rapidly ageing countries in the world. By 2050, more than one in four people here will be over 60. 

There are several reasons for this. There has been a sharp decline in the birth rate. People now live longer: life expectancy is now 73.6 years, 50% longer than in 1950. And more people survive past their first birthday than at any other time in Viet Nam’s history – thanks to better maternal and child health, childhood vaccination, and dramatic improvements in nutrition, water and sanitation, and grass roots health care. And of course, all of this is great news.  

But a population with a greater proportion of older people will demand different things from the health system than it did in the past.  

For example, as we saw with the COVID-19 pandemic, older adults can face a higher risk of severe illness from an emerging infectious disease. And, when the health system is under strain or restrictions are put in place to control an outbreak, it becomes harder for people to access routine health care, including for the underlying conditions which make them more vulnerable to severe illness from infectious disease.  

So, we need to think about how to prepare health systems for future health emergencies, with the shifting demographics of the population in mind.   

Another example is the growing burden of noncommunicable diseases or NCDs, like heart disease, stroke, cancer, diabetes and chronic lung disease. In Viet Nam, NCDs are now responsible for 80% – or four out of every five – deaths. Many people in Viet Nam live with NCDs, such as hypertension or diabetes, that are undiagnosed and therefore untreated.  

So, the key point here is that many people are living longer, but they are not necessarily living well.  

If we want to continue to see improvements in life expectancy in the future, we will need to ensure our health system is truly designed to meet the needs of the population – and to adapt as those needs continue to change. 

The second big shift that is affecting our health is climate change, which has emerged as one of the biggest threats to human health this century.  

Global temperatures are continuing to increase. Severe weather events and climate-sensitive diseases like dengue are on the rise across the globe, increasing the risk of pandemics, and with a disproportionate impact on disaster-prone countries like Viet Nam. 

Climate change threatens the very essentials for good health – clean air, safe drinking water, nutritious food supply and safe shelter – and have the potential to undermine decades of progress in global health.  

Globally, between 2030 and 2050, climate change is expected to cause 250,000 deaths per year from malnutrition, malaria, diarrhoea and heat stress alone.   

The impact of air pollution, fuelled by the same factors which are driving climate change, is particularly concerning in Viet Nam. Both outdoor and indoor air pollution is estimated to cause at least 70,000 deaths each year in Viet Nam, shortening the average lifespan by 1.4 years.  

Climate change also affects people’s health and well-being indirectly, by threatening the capacity of health systems to protect the health of their populations – for instance, health care facilities which are often not built to cope with extreme climate events including storms, floods and droughts.   

We experienced this first-hand in Viet Nam less than 3 months ago, when Typhoon Yagi, Viet Nam’s strongest storm in 30 years, struck the northern part of the country – damaging more than 800 health care facilities.   

The experience of Yagi illustrates how health care facilities in low- and middle-income countries are particularly vulnerable, as they often lack stable infrastructure, adequate sanitation, and reliable supplies of water and energy.  

But around the world, as well as feeling its effects, health systems are also contributing to climate change, making up nearly 5% of net climate emissions globally – through energy consumption, health care supply chains, and poor management of health care waste.   

The third shift I want to briefly address is the ever-present and increasing risk of zoonoses. 

Diseases that jump from animals to people make up a large percentage of all newly identified infectious diseases, as well as many now established ones, including COVID-19, Ebola, rabies, mpox, and avian influenza. As we have seen in the last few years, some have the potential to cause global pandemics.  

So, why are zoonoses on the rise? 

Simply put, in Viet Nam, as in many other countries, agriculture, urbanization and deforestation mean that people and domesticated animals are now more likely to have contact with wildlife. These encounters increase the possibility of disease transmission. 

At the same time, the speed and volume of human movement means that should a zoonotic outbreak occur, it can spread from one country to another in a matter of hours.  

This is why we should not look at COVID-19 as an isolated or unexpected event. Rather, it is a sign of things to come – especially if we do not do more to prevent the risk of zoonotic diseases, as well as the health sector’s readiness and preparedness to respond when they do.   

The fourth important shift in the health landscape is advances in science and technology, especially digital technology – which has huge potential to improve health and human development.  

However, advances in science and tech also carry the risk of serious social and health consequences if they are not managed well. For example, gaps or inequities in access which exacerbate inequality and exclusion.  

Social media, for example, is great for connection, but has also contributed to polarization and politicization, as well as the spread of disinformation and misinformation. The rapidly expanding application of artificial intelligence highlights the need for coordinated governance to harness its potential, while ensuring necessary protections. 

So, our challenge in this exciting and evolving space is to harness the promise of technology for better health, while at the same time guarding against some of the perils.  

Section 2: What these shifts mean for our health 

Each of these shifts, by themselves, is profoundly affecting our health. And the interconnectedness between these shifts, even more so.    

For example, as you’re aware, COVID-19 took a particularly deadly toll on older people. This group also suffered from being unable to access routine care, such as for NCDs. There is evidence that climate change and environmental degradation amplified the impact of COVID-19 in some places. For example, higher rates of transmission were reported when air quality was poor. And, of course, the coronavirus was a zoonosis that was quickly spread around the world because of travel.  

Climate change and environmental degradation amplify the risk of NCDs. For instance, heat waves, air pollution and wildfires can exacerbate cardiovascular diseases, such as stroke, heart disease and COPD. Storms, floods and droughts can displace people and bring shortages of safe water. All can disrupt health services. And when a health system is overwhelmed with a zoonotic disease, then NCD care suffers. But, on a more optimistic note, the digital technology revolution has the potential to unleash a health revolution in NCD care.  

So, what does all of this mean for public health professionals, and for the health services and systems we aim to build for the future?  

Here, I would like to suggest 5 important ways that I believe we need to adapt. 

First, we need to transform health services from a sick system, to a health system. That is, to move from a system designed to respond to acute episodes of ill health, to a system that actually focuses on keeping people in good health.  

We will never meet the demands of an ageing population, a rising tide of NCDs and an increasing risk of vulnerability to communicable diseases by focusing on tertiary health care to treat illness.  

We need to try to reduce demand – by keeping people healthier, longer. And we can only do this by addressing all of the factors that determine a person’s risk of contracting a communicable disease or developing an NCD. 

This is not something the health sector can do alone. We need to work across sectors to change the social and commercial determinants of health – including socioeconomic status, access to credible health information, exposure to climate hazards, exposure to marketing from food companies, and the easy availability of tobacco and acceptance of smoking. 

We also need stronger and more integrated primary – or grassroots – health-care services, to help meet people’s essential health needs.  

Let me give you an example. 

For several years, WHO has collaborated with health authorities on a pilot project to bring care closer to people, here in Ho Chi Minh City. 

Our aim was to increase the number of people receiving treatment for their NCDs at commune heath stations, closer to where people live. To achieve this, commune health stations received support from district health centres and higher levels to manage mild, moderate or stable NCDs using standardized and simplified protocols and tools. Through this work, we have shown that up to 80% of people with NCDs – people like Mrs Hien, the lady in the photo on the screen – can be managed at the commune level, without a substantial investment in staff or equipment. 

It is models like these – that not only treat people when they are sick, but help them to live well – that need more investment and support, as we build the health system we need for the future.  

The second opportunity to adapt to our changing landscape is to ensure health services are more climate resilient and environmentally sustainable. 

WHO is proud to support work on this in Viet Nam, under VIHEMA and the MOH’s leadership. And to demonstrate the importance of this work, I want to tell you a very brief story.  

A couple of months ago I was privileged to visit Yen Thanh District General Hospital, in the Nghe An province.  

In the past, there was not enough clean water at the hospital for patients to brush their teeth, wash their faces, shower, do laundry or flush the toilet. This was because the hospital was effectively competing for its water with the local agricultural sector: twice a year during harvest season, the hospital’s water supply was completely cut off.  

Not surprisingly, people avoided the hospital – understandably. And bacterial and other infections were common.   

Working together with the Government, we helped address the water shortage – by supporting a modest investment in infrastructure which enabled a different supply of raw water to be piped to the hospital year-round. As part of this work, the hospital also improved waste management and installed solar panels to enhance energy efficiency.   

With these improvements, the hospital has been able to significantly increase the number of medical procedures it carries out. And I know from my visit there, both the staff – and the patients – are happier, as well as healthier.   

Climate resilience and environmental sustainability are not just buzz-words: they make people’s health and lives better.  

A third important adaption is in strengthening pandemic preparedness and response.  

The importance of this is self-explanatory after COVID-19, especially for this audience. The evidence from the last few years is clear: those countries that had good pandemic preparedness and response systems in place fared much better during the pandemic than those which did not. Indeed, Viet Nam is a great example of this. 

We need to take the lessons from COVID-19 and apply them to building health systems which are better equipped to deal with shocks from a range of health hazards – including disasters and infectious disease risks – by emphasizing prevention, preparedness and resilience.   

Focussing on resilience includes recognizing the important role that communities play, as primary responders on the frontline of emergencies. So as part of pandemic preparedness efforts, we must work to ensure that communities have the knowledge, resources and skills to protect themselves, their families and their livelihoods.  

My fourth proposed adaptation is in levering opportunities from science and digital technology – while also managing the risks. 

As I have already mentioned, technology brings huge potential for advancing health. But we need to guard against risks – including that of exacerbating inequality.  

For example, during the pandemic, we saw the rapid development of mRNA vaccine technology. But its rollout around the world was grossly inequitable – putting the health and lives of many tens of millions of people at risk. So my question for all of us is, how do we ensure we don’t repeat this mistake as we think about how to deploy technology within public health in the future?  

In Viet Nam, the Government has recognized and promoted digital transformation in all areas of society and the economy, including in the health system. This is a very exciting agenda.