Gennady Onishchenko, former chief sanitary doctor of Russia: “Punitive measures in matters of vaccination are not
act"
Russia is a country of cities, rural populationtakes up less than 1/3. The problem of health of the population of megacities is given special attention. We have a national project “Healthcare”, which includes eight federal target programs where priorities are defined - cardiovascular diseases, oncology, children's healthcare, and so on. One of these goals is to increase life expectancy to 74 years by 2021. In Moscow, this figure has already reached 77, according to 2018 data, and by 2024 it should overcome the threshold of 78 years.
Average life expectancy is a multiplicative indicator of everything: medicine with its achievements, the environment and human capabilities for active life.
Moscow is ahead of the curve. For example, infant mortality in our country over the past few years has decreased by 33%, and mortality among people of working age - by 28%. Of course, this is not only the achievement of healthcare, because in health only 20% is the work of medicine, and the remaining 80% is our attitude to our body.
Gennady Onishchenko. Photo: “Healthy Moscow”
Largely increase life expectancyoccurs due to the development of primary health care. The Moscow government allocated 550 billion rubles for the next three years. Of these, 500 billion goes to the reconstruction of the material base in the primary network, that is, to feldsher-obstetric centers, clinics and central district hospitals. The program of the city budget includes reconstruction and equipping with modern equipment of all 140 Moscow clinics.
Respiratory work in progressdiseases, especially with the flu. Even 10 years ago, Moscow vaccinated only 800 thousand inhabitants. Almost 7.5 million people were vaccinated for the 2019-2020 season, or 60.2% - this is the highest indicator of coverage in the country (these data refer to the pre-quarantine period - “High Tech”). Achievement of such successes was made possible by the unity of work of public and private healthcare institutions. I especially note the mobile capabilities that exist in Moscow today, namely, mobile dispensaries. They certainly need to be transferred to all Russian regions. This will allow you to quickly respond to possible outbreaks of various infections.
We are also engaged in improving water quality: infectious (and not only) diseases are also transmitted through it. Suppose water hardness gives us an increased increase in the incidence of urolithiasis, all kinds of skin irritations, and so on. In contrast, the Moscow filter station, which purifies water, ensures its high quality, and this is also a contribution to the health of the city.
Gennady Onishchenko. Photo: Healthy Moscow
We also work with the air condition.The main factor in its pollution in our capital (60%) is emissions from vehicles; we have a lot of cars. But pedestrian zones and entire streets are being created that are comfortable for the movement of people of different ages, for the physical activity of our citizens in a favorable air environment.
Today in Moscow, the program opensreforming the infectious disease service, because last year the president signed a biosafety and chemical safety strategy. We must be aware that the 1972 Convention on Biological and Toxin Weapons is not respected. A draft law “On Biological Safety of the Russian Federation” has been submitted to the State Duma. Literally in the near future it will be read, the president instructed to develop it. This government bill is developing a system of political, economic, state, federal and regional measures to ensure the environmental safety of the country.
The draft law “OnBiosafety of the Russian Federation ”No. 850485-7 was preliminary reviewed in December 2019, discussed by the government from March to April 2020 and is still being disassembled. Possible corrections will be made by a pandemic of a new coronavirus infection.
46 million citizens over 55-60 live in our countryyears old. This is a special cohort of people called the silver economy. For this age group, another health care is needed, not gerontology in our usual sense, when we treat almost hospice patients, but work with people of active age. They need separate standards of treatment and other prophylaxis, their vaccination schedule, including from pneumonia, which today is the scourge of an older age. We need to provide for the involvement of this part of the population in active life. Today, a program of active longevity is working in Moscow, but we must give it a solid medical support.
Mortality of the elderly by COVID-19 alsobig enough. For people from 70 to 80 years old, it is 8%, and over 80 - 14.8%. This is due to diseases of the respiratory and cardiovascular systems concomitant with advanced age.
Life expectancy has increased thanksimplementation of national vaccination calendars. Thanks to this, we eliminated smallpox, eliminated measles, and almost eliminated polymyelitis. We gave an increase in 20 years of life, but this does not mean that all infections are gone. They will be replaced by others. For example, every year we deal with a new strain of influenza. Someday we will create a universal vaccine, but so far we have to make a new one every year.
When in 1997 the law onimmunization in our country, they wrote down the principle of informed consent, and this principle must be adhered to, because punitive measures will not give effect. Doctors should take on enlightening work and persuasion.
Vyacheslav Smolensky, Deputy Head of Rospotrebnadzor: “In Russia, immunization is higher than WHO recommends”
The number of millionaire cities is growing.Over the past 50 years, the number of cities with a population of 5 to 10 million people in the world has grown from 5 to 48, and by 2030, 48 megacities with a population of 10 million are expected, Moscow is one of them.
By 2050, 70% of the world's population will live insuch metropolitan areas. But from the point of view of sanitary and epidemiological well-being, we cannot say that the time of infections has passed and humanity has got rid of them. The epidemiological risks in cities, including Moscow, have become much more diverse. For example, in 2000-2007, WHO monitored two emergency situations for sanitary and epidemiological welfare in the world: SARS and bird flu, the so-called H1N1, and in 2007-2012 there were about seven situations - in particular, polio in Tajikistan. There are three reasons: the risks of known and new recurring infections, communicatively related and technogenic associated risks.
But immunization in Moscow and in Russia as a wholeis at a high level. The country's immunization rate for measles and other vaccine-preventable infections is over 97%, which is higher than the WHO recommendation.
Vyacheslav Smolensky. Photo: Healthy Moscow
Passenger flow of Moscow airports - 100 millionpeople per year. Therefore, Moscow and similar large cities are vulnerable to the risks of importation and fulminant spread of infectious diseases (which happened in the case of the high-tech coronavirus). To prevent this, first of all, a sanitary-epidemiological control system is needed that timely detects an infection and reacts with the healthcare system. Second, compliance with all international health rules is necessary. And the third, fundamentally important condition is to help neighboring countries fight infections.
The first cases of coronavirus infection in Russiaregistered on January 31, 2020: one was detected in the Trans-Baikal Territory, the second in the Tyumen Region. The patients are residents of China, where the new virus began its development.
According to some reports, patient zero was a man who flew in from Milan. He was hospitalized in Kommunarka by the head physician Denis Protsenko. There are currently more than 262 thousand cases in Russia.
The most terribleepidemicsin history
- Plague. Its very first epidemic broke out in 540 in the Byzantine Empire and spread throughout Europe. It lasted 200 years, as a result of which about 125 million people died. Although today there is already evidence that the plague of the times of Justinian was not a pandemic. A second pandemic raged in Europe, India and China between 1346-1354 and killed 60 million people. The third began in 1855 in China and lasted until the middle of the 20th century, 12 million people died.
- Cholera. Pandemics erupted in 1816 in Bangladesh, in 1860 in Russia and Europe, the latter in 1962. From 1 to 10 million people died from it.
- Smallpox. For the first time, an epidemic was recorded in Asia from the 4th to the 8th centuries of our era. 25% of the population of China and Korea, 40% of the Japanese died from it. The second outbreak was observed in the XVII – XVIII centuries, up to 1.5 million people per year died in Russia and Europe, 20 million became disabled - they were blinded, not to mention the fact that they still had ulcer scars.
- Spanish flu, or Spanish flu. The outbreak occurred in Spain, and then the virus spread throughout the world in 1918-1919. From him died from 60 to 100 million people.
Currently, these infections are practicallydefeated. Plague is treated with antibiotics, sulfonamides and special serum. Antibiotics help against cholera. Smallpox was defeated by the vaccine; as a result of mass vaccinations of the population, this disease was eliminated. Spaniard (strain H1N1) is treated with antiviral agents.
H1N1 strain- serotype of virus A. Today is the most common type of influenza. Highlighted in 1931. This serotype was the cause of the pandemics of 1918 (Spanish flu) and 2009 (swine flu).
Alexey Khripun, head of the Moscow Department of Health: “We remind parents of the need for vaccinations with push notifications”
12 million people live in Moscow permanently, andThey are located in the city of about 20 million. If we take into account that there is the so-called Moscow agglomeration (communication between the region and the city of Moscow itself is very developed), it turns out 30 million or more. A high population density, an abundance of public transport, a huge number of organized groups increase the risks of epidemics.
Infectious disease incidence rate inMoscow has been stable for the last three years (before the COVID-19 pandemic - High Tech), despite the fact that all these factors exist. Over the past 10 years, the prevention of infectious diseases has been in the zone of special attention of the Moscow government. First, the spread of infections is hindered by the vaccine policy strategy. Secondly, when the rise in seasonal incidence of, for example, influenza begins, the Moscow government, in particular the health department and the Rospotrebnadzor department in Moscow take control of daily information on the number of cases by age category, threshold of incidence and the number of hospitalized. Our outpatient forces are actively responding to the situation, including the outpatient sector and the reserve bed fund. Ambulance works well. The brigade arrives to the emergency call in 12 minutes. We see online in which area which car is located and react very quickly. Therefore, it is possible to keep a low incidence rate.
Alexey Khripun. Photo: “Healthy Moscow”
Thanks to vaccination, two seasons (2018–2020) inMoscow dispensed with epidemics of influenza. We advertise vaccinations: for example, an ambulance team is standing at the metro station and vaccinating everyone. The effect is not only that a certain number of people entered this car and got vaccinated. People see such teams, begin to think about vaccinations and are looking for the opportunity to get vaccinated in a clinic or in some other place.
In 2019, the Moscow government allocated 2billion rubles more for vaccination. There is a struggle not only with the flu. We vaccinate against meningococcal infection and human papillomavirus. Soon we will be able to prevent some types of cancer - the cervix and the anogenital area in men. Rotavirus infection has been added to the vaccination calendar. In 2019, we retrospectively digitized all vaccinations that Moscow children received, entered these data into an electronic medical record, and now we know which child is vaccinated against, from which there is no and for what reasons. Now we remind parents of the need for vaccinations using push notifications, SMS and electronic messages.
While there is some urban laginfectious services from other profiles, mainly due to infrastructure. It is clear that the overhaul of existing buildings and putting them in order is impossible, because modern epidemiological requirements have changed. Therefore, the Moscow government last year made a strategic decision to build two large infectious diseases clinics, an adult and a children's. A hospital complex with a capacity of 600 beds will be built in the first infectious diseases hospital; there will only be boxed wards. All the services will work in the buildings: diagnostic, medical, and operating. An infectious diseases hospital for 350 beds will be built on the territory of the St. Vladimir Children's Hospital. Construction financing is provided for five years in the targeted investment program.
Source: base.garant.ru
Robb Butler, Senior Advisor to the Director, WHO Regional Office for Europe: “People get information from Google and don't trust doctors”
We are opening a new unit at WHO, whichwill work with people's behavior: fight against smoking, alcohol consumption and antimicrobial resistance decrease due to alcohol. It is important to educate people, to tell them about the dangers of infectious diseases. We need a culture of health, and problems with it. If you look at Northern Europe today, one of the groups with the highest risk of getting sick is educated people, those who receive information from Google and do not trust doctors. This is the situation in Copenhagen, London, Paris and Berlin.
Robb Butler. Photo: “Healthy Moscow”
We with UNICEF and WHO developed a new guide: how can we stimulate the demand for vaccination in various population groups, diagnose the barriers that people face and overcome them correctly. This can be both an information campaign and changes in the provision of services. UNICEF demands to find out what are the problems with the behavior of the population, and with the help of information, as well as training to solve them. Now WHO in Europe is developing a second document - on tools for influencing behavior.
Common noncommunicable diseases in large cities
- Disorders of the nervous system. The reasons are a long way to work and home, high noise levels, traffic jams, stress at work.
- Allergy. The reasons are the abundance of exhaust gases, the presence of allergens in the urban flora, food with synthetic products, and the wearing of synthetic clothing.
- Gastrointestinal diseases and obesity due to snacking instead of full meals, frequent eating of fast food.
- Diseases of the spine and musculoskeletal system due to prolonged work at the computer and low physical activity.
- Vision problems. Reasons - a long sitting at the computer, the active use of gadgets.
Oksana Drapkina, Center for Preventive Medicine Ministry of Health of Russia: “We need to constantly monitor risk factors”
Chronic noncommunicable diseases arethe main cause of death, and the path to them lies through risk factors, such as overweight and smoking. We need to constantly monitor these factors. This can be done if epidemiological studies are properly planned, and together with the medical community, under the leadership of the Russian Ministry of Health, we are doing this in dynamics. After analyzing a huge amount of data and choosing a Markov mathematical model, we propose a certain indicator that can be followed - this is a commitment to a healthy lifestyle.
Markov decision process- tasks consistently solving someproblems. The name was given in honor of the Russian mathematician Andrei Markov, who made a significant contribution to the development of probability theory. It serves to model decision making in situations where the results are random and are controlled by certain individuals. The peculiarity of the Markov model is that it allows you to solve unknown parameters that affect the dynamics of the development of the disease, based on the observed parameters. Moreover, it is believed that the COVID-19 pandemic is a Markov process, that is, its further development does not depend on the previous growth rate, but on the factors operating in the present.
From the large data array, the mainfive factors that reduce the risk of getting sick. The first is quitting smoking. Next, you need the consumption of fruits and vegetables daily at least 400 g, 30 minutes or an hour of walking in an intensive mode, less salt and, finally, moderate alcohol consumption.
Oksana Drapkina. Photo: “Healthy Moscow”
After analyzing the seven megacities of theseindicators, we see that Moscow has made a leap in reducing mortality. Half of Muscovites from 35 to 64 years old never smoked. They began to drink much less, and in 2019 only 7.6% of those who drank alcohol showed up, and those who never drank more, almost 90% of women and 82% of men show low alcohol consumption. But there are problems: low physical activity, insufficient consumption of fruits and vegetables and a love of salt. On the whole, the situation with chronic noncommunicable diseases and with risk factors in Moscow is favorable. We must not forget that our health is a very multicomponent problem, it is affected not only by these risk factors, but also our emotional background, what books we read, how much we sleep, whether we have a vacation or not, how we eat, what people we are surround. It is no coincidence that we can already talk about the concept of planetary prevention.
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