The editorial by Werneck ¹1. Werneck GL. The COVID-19 pandemic: challenges in assessing the impact of complex and multidimensional problems on the health of populations. Cad Saúde Pública 2022; 38:e00045322. highlighted the weaknesses of health systems in relation to the COVID-19 pandemic. We wanted to draw attention to a very topical problem which, in our opinion, is directly related to damages to health systems caused by the COVID-19 pandemic.

In 2021, it became clear that a major problem of the COVID-19 pandemic was the progressive and uncontrolled decrease of children’s routine vaccinations ²2. Causey K, Fullman N, Sorensen RJD, Galles NC, Zheng P, Aravkin A, et al. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet 2021; 398:522-34.. In particular, a worrying reduction in vaccination coverage has been recorded in developing countries ³3. Shet A, Carr K, Danovaro-Holliday MC, Sodha SV, Prosperi C, Wunderlich J, et al. Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories. Lancet Glob Health 2022; 10:e186-94.. In addition to having been disadvantaged in the vaccination campaign against SARS-CoV-2 ⁴4. Cioffi A, Cioffi F. COVID-19 vaccine: risk of inequality and failure of public health strategies. Ethics Med Public Health 2021; 17:100653., these countries have been more affected by public health issues related to the decrease in vaccination coverage for other infectious diseases.

This decrease in vaccination coverage for common diseases has, predictably, led to a recent increase in measles cases worldwide ⁵5. World Health Organization. UNICEF and WHO warn of perfect storm of conditions for measles outbreaks, affecting children. https://www.who.int/news/item/27-04-2022-unicef-and-who-warn-of--perfect-storm--of-conditions-for-measles-outbreaks--affecting-children (accessed on 24/May/2022).
https://www.who.int/news/item/27-04-2022... . In fact, in the first two months of 2022, measles cases increased about 79% compared to the cases recorded in 2021. This situation is particularly worrying and, in view of its considerable contagiousness, this epidemiological situation will probably worsen further.

Moreover, we should highlight that measles is a disease which can cause serious health consequences in children. The possible complications of this pathology are ear infection, diarrhea, pneumonia, brain damage, and death.

Especially in the event of permanent damage or death, potential medico-legal issues could be significant. In fact, as already attested in the diagnostic delays of other pathologies, we can say that these public health consequences were foreseeable and avoidable. The inadequate management of vaccination campaigns for diseases other than COVID-19 is a clear breach of national health systems. Health policies have been totally ineffective in this instance. The medium- and long-term effects of this noncompliance could be devastating from both an economic and health point of view. Relatives of children who have died or been permanently injured by measles may take legal action against health facilities. Moreover, they might start class actions against health ministries which have been unable, in various countries around the world, to ensure adequate vaccination coverage for certain diseases, such as measles.

The COVID-19 pandemic has caused massive social, economic, legal, and health damage ⁶6. Charlier P. The consequences of Covid-19 in terms of public health for the year 2022: new challenges. Ethics Med Public Health 2022; 21:100757.^,77. Cioffi A, Lugi C, Cecannecchia C. Apps for COVID-19 contact-tracing: too many questions and few answers. Ethics Med Public Health 2020; 15:100575.^,88. Scopetti M, Santurro A, Tartaglia R, Frati P, Fineschi V. Expanding frontiers of risk management: care safety in nursing home during COVID-19 pandemic. Int J Qual Health Care 2021; 33:mzaa085.. Unfortunately, although some consequences were unforeseeable, the pandemic has had effects which were totally predictable and avoidable. This exposes national health systems to a high risk of litigation and judicial failure. Moreover, the inadequacy and unpreparedness of some national health systems are the product of years of carelessness by the government bodies responsible for managing public health policies ⁹9. Cioffi A. Public and private health services: wait times for health services and the risk of inequality from the Italian perspective. Popul Health Manag 2021; 24:314-5.. In some countries, the pandemic has opened a Pandora’s box, exposing all the gaps in weak health systems. In these realities, insufficient economic investments in health have, in fact, entailed, in earlier stages of the pandemic, the total directing of the few available resources to patients with COVID-19, preventing the execution of controls and screening for chronic and oncological diseases. Some countries have even limited compulsory pediatric vaccinations. In the second phase of the pandemic, access to public health facilities for such preventive measures was restricted and thus delayed due to a foreseeable overcrowding of requests. Consequently, the end of the emergency phase will predictably open the way to an increased incidence of deaths from chronic, oncological, and infectious diseases. This will increase claims for compensation because, in the case of chronic diseases, diagnostic-therapeutic delays are a fundamental causal element in the determinism of death.

In our opinion, these gaps must be filled as soon as possible with appropriate policies and investments aimed at strengthening health systems. We cannot overlook the inadequacies highlighted by the COVID-19 pandemic; it will be crucial to learn from this pandemic to avoid that all the damage caused and all the human and economic sacrifices made are totally in vain.

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