Regardless of the results of the president’s attempts, Pedro Sanchez, to open in Spain and “lead” in the EU the debate on the day after Covid ceases to be an epidemic to become a disease more similar to the flu, the first plan for the future that the Government had for the post-pandemic is the creation of a State Public Health Agency that, long before beginning to exist, is already causing suspicions in organs that have been key in the investigation of Covid and their behavior. Specifically, at the National Epidemiology Center and at the Institute of Health Carlos III of which it is a part and which is attached to the Ministry of Science.
The future Public Health Agency aims to be the government “intelligence” service and, within it, the Ministry of Health, which evaluates, monitors and collects information on the possible presence of other infections and other diseases in the future, to try to prevent them from becoming an epidemic and to respond appropriately. The project is one of the few agreements that came out of the reconstruction commission that Congress set up in the summer of 2020, after the first wave. When the Government made it its own and announced a law to create it, the first question arose about its degree of dependence on health, so that the political decisions did not influence those of the technicians, as has happened on several occasions up to now. While waiting for the Government’s proposal, this unknown factor ceased to have weight because the Public Health experts themselves believe that it should be part of the Darias department, as “executive arm”.
However, in recent weeks there has been a different dispute, deeper and runs the risk of confront the Ministries of Health and Science. It opened in mid-December. Christopher Belda, director of the Carlos III Health Institute, attached to the Ministry of Diana Morant. In a few days of the National Epidemiology Center, it limited the scope of the future Public Health Agency, assuring its staff that this body has been and will remain the “reference” in Spain in this matter, reducing weight to the future Agency and disdaining the “news” about the nature it will have, in what the epidemiologists consider a direct message to their proposals, which went in the totally opposite direction.
“The position of the director of the Carlos III Health Institute is that the Institute is the state public center and that is something shared by all. It does not mean that there are not different approaches but they will never cause a rupture or a fragmentation or a dispersion of resources, among other things, because Spain can afford it and because it would be a mistake and no one is going to allow a mistake,” Belda told the epidemiologists at Carlos III, to whom she made a point of directing an organization that manages 100 million euros yearly and which is not going to be overshadowed by a new one that has less funding.
Sources from the Institute clarify that Belda’s words addressed a very specific audience, the staff from the National Epidemiology Center, that it was more of a “message of support” and that if they left that context and were made public -through YouTube, for example- it was because of the imperatives due to Covid and the need to reduce physical capacity. In any case, the forcefulness with which Belda spoke -unusual in political language- did not escape the attention of those who think of a strong Public Health Agency, who fear that if they are shared by the Government it will be reduced to a “centrito”.
“There are approaches that are very good from people who want to design it [la Agencia de Salud Pública] one way or another, but the only reality is that the Carlos III Health Institute is in surveillance service and invests more than 100 million euros every year”. “Can someone consider creating a Public Health Center with 15 [millones]?, wondered Belda. According to the National Reform Plan to receive funds from the EU, the Government plans to invest 9.4 million euros to equip this new Agency.
Belda spoke as director of the Institute, but involved the Ministry of Science by assuring that her new Director General of Research and her predecessor in office, Raquel Yotti, guaranteed a “layer of protection” to the Institute, in the process of creation by Health of the Public Health Agency. “Having her at this time as Secretary General of Research It gives us a very important layer of protection, without forgetting that the public center with the greatest reputation during the pandemic has been the Carlos III Health Institute and that is absolutely untouchable,” he said.
Sources from the Ministry of Science avoid entering the debate and limit themselves to pointing out that “the Institute is a public research organization and, among its functions, it gives Public Health support, from the point of view of Science, of research”. Regarding the allusion to Yotti, they point out that “it is obvious that [su conocimiento del Instituto] is a guarantee of excellent utilization of their capacities in the global environment of the Ministry of Science”.
Bill to fall
At the moment, the Ministry of Health does not reveal when it will submit to the Council of Ministers the Draft Law of the State Public Health Center, but it should not be for a long time if the Government wants to maintain its commitment to have the law approved before the middle of this year. As a preliminary step, Health opened and closed a public consultation in which different associations of epidemiologists, doctors and public health experts were able to present their ideas on how the State Public Health Agency should be.
It is in this process where organizations such as the Spanish Society of Public Health (SESPAS) proposed that the future State Public Health Agency have a “contract own program and budget” and that, although dependent on Health, its governing council is “extremely independent” with members chosen “for merit and ability”.
Regarding its territorial structure, SESPAS proposed a “network configuration”, so that the Agency is as decentralized as the autonomous State is and can draw on research institutes and researchers across the country. In fact, this organization welcomed with real enthusiasm the possibility that the Ministry pointed out months ago that the Agency would be one of the newly created institutions that would have its headquarters somewhere other than Madrid, Barcelona or other large urban centers.
These proposals collide head-on with Belda’s defense from the Carlos III Health Institute, responsible during the pandemic for carrying out seroprevalence studies, for determining that it was safe to mix different vaccines or, more recently, for a study that attempts to gather the characteristics of patients admitted to the ICU for Covid.
In any case, Health finalizes its proposal and SESPAS faces the process with a white glove. “The Carlos III Health Institute does an excellent job but, regarding what is expected from the Government’s proposal [para crear la Agencia de Salud Pública], the logical thing is that it be an independent agency but that it depends on Health because it is the arm and its intelligence to make decisions”, affirms its spokesman, Ildefonso Hernandez, which he believes takes Belda’s words with “absolute respect”, although he does not believe Health shares his point of view.
“It is normal for all the actors to assert their position”, he adds, in the face of a process that involves “reimagining” the management of Public Health and the prevention and action against future epidemics.