As I write, I am conscious that we are approaching the two-year anniversary of COVID-19’s arrival in Europe. My last in-person meeting was an EPHA Board meeting in early March 2020, and I recall us all wondering around the table quite what the future would hold.

In 2022 much of the answer to that question has been made clear: we understand far more about COVID-19, and have a number of valuable tools available to us now that we could only dream of as 2020 unfolded. However, there still remains much we do not know (particularly around the long-term effects of the virus, as well as, and separate from, Long-COVID) and much to be done. COVID-19 has highlighted the health inequalities that are familiar to all of us; but also created new ones.

In a small way I found myself caught up in this over Christmas. Health tourism was something I never thought I would do, but as the UK government removed all COVID-19 mitigations from primary schools whilst failing to open up vaccination to children aged 5-11, I took the decision to drive from the UK to Italy to enable my daughter (aged 9) to be vaccinated. Both she and I have dual citizenship, making this a possibility for us. This straightforward decision on my behalf was picked up by both UK and Italian press: in the UK I was advocating for parental choice, given the lack of other protective measures, whereas in Italy my story was presented as a ‘call to vaccination’ in a country with a previously high level of vaccine hesitancy. EPHA has long recognised the value of vaccination, and the threat to public health of vaccine hesitancy, and in my view: better the known risks of vaccination than the potential unknown effects of COVID infection over time. As things stand, children will be able to be vaccinated in the UK but only from April. Latest data estimates that 71.2% of 8-11 year olds have COVID antibodies acquired through infection: a potential huge problem for the future if the virus does cause long-term health effects.  

Italy’s response to the pandemic has been clear: messaging has focused on protections being necessary to safeguard the most vulnerable in society, rather than presenting them as restrictions being imposed which remove civil liberties. However, I feel that COVID-19 is not being viewed holistically: the global health community seems to be relying heavily on a pharmaceutical response to the pandemic (vaccines and antivirals) and ignoring the bigger picture: air quality. In the mid 1800s John Snow tracked the spread of cholera in London to one water pump in Broad Street and from this the recognition of the importance of sanitation and clean drinking water grew. COVID-19 is as yet unlike the airbourne diseases we have learnt to live with: highly transmissible, and with high mortality rates.

We are also starting to understand the negative impact that existing air pollution has: potentially making humans more vulnerable to viruses causing respiratory infections, such as COVID-19. Surely than this is our John Snow moment: we need to be able to guarantee the quality of the air we all breathe, particularly that of our indoor air. In the same way that Snow’s discovery led to collaboration between health and engineering to construct sewers and safe means of supplying water; we should be collaborating to create healthy-air environments for living, and working, and breathing. Air filtration in enclosed spaces, including in homes, and air hygiene ratings on public spaces should surely become the new norm.

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