In the Montenegrin health system, it is necessary to supplement the personnel capacities for emergency health situations, said the director of the Institute for Public Health (IJZ), Igor Galić.
He said that Montenegro has taken a big step towards improvement and an adequate response to future emergency situations by establishing a public health emergency operations center (PHEOC), which will enable readiness and a comprehensive public health response.
Galić, in an interview with the MINA agency, stated that the IJZ has enough money for this year to implement all the planned activities.
He said that during the previous two years, financial stabilization of the institution was carried out and a positive financial balance of operations was achieved.
"The IJZ budget for this year is similar to last year's, with the difference that funding for the screening program has been set aside as a separate budget line, outside the Institute's budget," Galić stated.
He said that the IJZ returned 1,634 million euros to the state budget, which were part of the Institute's last year's budget.
"Given that the pandemic recorded a milder form last year and that the need for testing was not the same as in 2021, the planned unused funds for PCR tests, worth about 1,2 million euros, were returned to the state budget," he explained. Galic.
He stated that an additional 430 euros was returned to the state budget, and these are unused funds from other activities.
Galić added that this is the result of savings and household business, first of all, the financial part of the Institute's management.
According to him, this is certainly a rarity in the business of health institutions and the Institute in the earlier period.
Galić said that the allocated funds from the Montenegrin budget for preventive activities - screenings, vaccinations, are not enough, but that they hope that the responsible ministries and institutions, as many times before, will listen to the necessity and seriousness of the aforementioned preventive programs.
"Experiences of cooperation from the previous period of the pandemic indicate that, if necessary, additional funds will be activated when there is a need for it," stated Galić.
Speaking about personnel capacities, he said that the proposed specialization program stipulates that all health centers in Montenegro have at least one epidemiologist, and each hospital with 200 hospital beds has one clinical (hospital) epidemiologist.
As he said, proper supervision of preventive activities and infectious diseases would require at least two epidemiologists in health centers, especially in the southern and central regions, considering population migrations and needs during the summer tourist season.
"In addition, every epidemiologist should be hired with the same number (double the number in hospitals) of middle-level medical personnel trained in a specific public health activity," Galić added.
He said that currently in the health care system of Montenegro, in health centers, special and general hospitals, the Clinical Center, the IJZ, there are approximately 50 specialists working in epidemiology.
"That number mostly meets the needs of the health system outside of emergency situations, but it is necessary to replenish personnel capacities due to the establishment of a response system to future extraordinary public health threats," said Galić.
As he stated, the lack of medical personnel, and therefore of doctors from the preventive branches of medicine, especially epidemiologists, is one of the perceived shortcomings in the response to the emergency situation caused by the coronavirus pandemic.
Galić added that the situation in this regard in Montenegro is somewhat better than in neighboring countries, but that it is certainly not enough for some future public health threats.
He said that three doctors are expected to complete their training and return to the health system as epidemiologists, while three colleagues are still undergoing specialization.
"Certainly, health care institutions should provide for an adequate number of epidemiologists in their systematization, but I would also say specialization in other areas of preventive medicine, given that the situation with the coronavirus pandemic showed us the necessity of this staff," said Galić.
He said that the IJZ will certainly seek to expand its staffing capacities with regard to the development of the PHEOC and the Poisons Laboratory, as well as the development of registers and coordination of screening in their jurisdiction, i.e. the improvement of vital, especially mortality, statistics.
"We hope that this profession will be more attractive for doctors, because it has been noticed that although specializations have been announced for certain institutions, doctors do not respond to the ads," Galić added.
When asked whether the Montenegrin health system is ready in the event of a measles epidemic, he answered in the affirmative.
"We are of the opinion that the health system is ready for a possible smallpox epidemic, but we would not want to fight battles that we don't have to. We have a vaccine that is available to all citizens, free, safe, effective and there is no need to risk the life of any child," Galić pointed out. .
He said that the IJZ launched a series of multisectoral activities in order to immunize unvaccinated children and thereby protect them from serious diseases, such as smallpox, rubella and mumps.
At the proposal of the Institute, as he stated, the Ministry of Health formed the National Commission for Routine Immunization, whose mandate includes numerous systemic interventions in accordance with the Action Plan, and which aim at cooperation at the national and local level of all elements of society.
"Protocols for MMR vaccination have been prepared and updated in case of declaration of a smallpox epidemic (recommendations for health institutions, school and preschool institutions, Guides and other documents have been written"), said Galić.
He added that flyers and other materials were created to deliver quality information.
Galić said that an assessment was made and a sufficient quantity of MMR vaccines was procured for regular and "catch up" vaccination.
"The mandatory vaccination program and calendar have been updated. The Ministry of Health has been recommended to check the accommodation capacity of hospitals for the reception of patients," said Galić.
He said that, unfortunately, all health experts who deal with the topic agree that it is possible to avoid a smallpox epidemic in Montenegro only through a combination of lucky circumstances.
"The reason for this opinion is the low coverage of immunization with the MMR vaccine, which in Montenegro is currently about 62 percent in preschool age, in school age about 92 percent for the first dose, and with the second dose about 85 percent of the population, i.e. in total for all persons up to the age of majority 18 years old, about 84 percent," said Galić.
As he reminded, this is insufficient for 95 percent of what is necessary to achieve collective immunity against the disease.
"In order to reach the necessary coverage, it is necessary that 37.511 thousand be vaccinated in the cohort of preschool children, which numbers 35,6," Galić stated.
So far, he said, 22,9 thousand children of preschool age have been vaccinated, which means that another 12,7 thousand should be vaccinated.
"Given the dynamics of travel, the occurrence of an epidemic in a neighboring country and somewhat larger but insufficient MMR vaccination coverage in neighboring countries, it is realistic to expect the occurrence of a smallpox epidemic in Montenegro as well," Galić said.
He, speaking about the most important activities during the last year, said that the Institute made a step towards modern European institutions, improved the work of the institution, but also of the entire healthcare system of Montenegro.
Galić said that there are many activities that they have planned for this year.
"We are starting the development of Standard Operating Procedures and the tender process for the procurement of software and hardware within the construction of the PHEOC system. The institute expects to open a microbiological cabinet for the detection of biological safety pathogens 3 (BSL cabinet 3)," said Galić.
He said that they are continuing the process of establishing the National Poison Control Center.
Galić reminded that during the first half of the year, the first national study of the prevalence of hospital infections will be conducted in cooperation with the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).
"We are especially proud of the cooperation with the Robert Koch Institute (RKI) from Berlin, which within the framework of the "Global Health Protection Program" phase 2 and the "Western Balkan Strategic Partnership for Health Protection" chose IJZ as the primary partner in the implementation of activities, as a center for six countries of the Western Balkans, a project worth almost three million euros over the next three years," said Galić.
As he said, together with RKI, with the support of ECDC, they are in the phase of establishing the School of Field Epidemiology, which would be internationally certified after a period of two years.
"During this year, we are also expecting the connection of the information systems of the IJZ and other health institutions, changes to the website and digitization of the entire information system, technical renewal, as well as the expansion of personnel capacities," Galić added.
He said that he will pay special attention to the development of mortality statistics and registries of non-communicable and malignant diseases, a multi-decade problem that has repercussions on the quality of data within public health indicators, which prevent not only quality analysis, but also health management and policy projections.
"We are expecting the organization of international trainings and training within the MediPIET program and cooperation with the WHO, ECDC and RKI, as well as the signing of a Memorandum of Cooperation with the National Institute for Public Health of Greece and continued cooperation with the Pasteur Institute from Paris and the National Institute for Public Health of Italy" , Galić added.
Answering the question of when the end of the pandemic could be expected, he recalled that WHO officials pointed out at the end of September that the continuous, widespread transmission of the coronavirus around the world could cause the emergence of a new variant.
This, as he stated, prevents the WHO from declaring the end of the emergency situation caused by covid-19, although they stated that the end of the pandemic is in sight.
"The pandemic is not over yet, the lesson from last winter with the appearance of the Omikron variant taught us that we must be careful," said Galić.
He said that it is to be expected that in the coming period the disease caused by the infection with the coronavirus will be less serious and the epidemiological situation will be more favorable.
"Until then, we must be on alert and follow the recommendations of the WHO and the experiences of international authorities," said Galić.
When asked how much the future public health emergency operations center will mean for better management of some future, eventual epidemics, he replied that the PHEOC will be the place from which the pandemic will be managed.
"I am extremely honored that the construction of such an important infrastructure project is starting during my mandate, because as an epidemiologist who worked in the field during the coronavirus pandemic, I can best understand the importance and need for the establishment of such an operational center," said Galić.
As he reminded, this important infrastructure project is fully financed from the IPA funds of the European Union and is worth around three million euros.
Galić said that as of February 16 of this year, a total of 685.859 doses of vaccines against the coronavirus had been given, of which 293.814 were the first, 286.026 the second, 102.955 the third, 2.973 the fourth and 91 the fifth doses.
As he stated, 61,2 percent of the adult population received one dose, 59,6 percent received two doses, 21,4 percent received three doses, and 0,6 percent received four doses.
"In relation to the total number of inhabitants, 47,3 percent were vaccinated with the first dose, 46,1 percent with two doses, 16,6 percent with three doses and 0,5 percent with four doses," Galić added.
He said that the activities of the Strengthening capacity program in response to the covid-19 pandemic are currently being carried out, as a donation from the Embassy of the United States of America and WHO implementers, which under the authority of the Ministry of Health are coordinating the IJZ and the Capital City Health Centre.
The goal of the activity, as he stated, is to increase the coverage of immunization with the vaccine against the coronavirus among the most sensitive population of citizens, namely people over 60 years old who often have associated chronic diseases and/or have a weaker immune status.
Galić explained that the strategy is based on calling citizens through a centralized call center and vaccinating them at home.
"One of the important activities is to start the "Health Caravan" which will appear in four municipalities and where it will be possible for citizens to be vaccinated with the vaccine, first of all, against covid-19, and also against the flu, in a specially prepared and equipped bus. ", said Galić.
He added that girls in the nine-year-old age category will be able to be vaccinated against HPV infection, and children who have not been vaccinated so far will also be given the MMR vaccine.
Asked what the general public health of our population is like, Galić said that the main health indicators, such as life expectancy, mortality rate and disease burden on society, indicate that the situation is not much different from that in the countries of Southeast Europe.
"Life expectancy, an indicator, although still lower than the EU average, in Montenegro for 2020 was 75,9 years of life," said Galić.
As he stated, according to the available data on dying in Montenegro, non-communicable diseases are the most common cause, up to 94 percent, of the total number of deaths.
Galić said that almost half of the deaths in the country were caused by diseases of the heart and blood vessels, and almost a quarter by malignant neoplasms.
"Although there are a large number of different non-communicable diseases that require special attention, four groups can be singled out that account for the majority of preventable morbidity and mortality," said Galić.
These are, as he stated, cardiovascular diseases, chronic respiratory diseases, malignant neoplasms and diabetes.
"Most non-communicable diseases and their complications are largely preventable," said Galić.
He pointed out that by promoting healthy lifestyles, 90 percent of type 2 diabetes, 80 percent of coronary heart disease and 70 percent of strokes can be prevented.
According to Galić, the recent coronavirus pandemic reminded and warned that infectious diseases, as well as other causes of emergency situations, can affect the health and well-being of the population unannounced and very quickly.
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