Primary health care: a cornerstone of pandemic prevention, preparedness, response, and recovery.

The COVID-19 crisis highlighted the devastating consequences of neglecting primary health care (PHC) before, during, and after a pandemic. The diversion of health workers to surge response efforts disrupted health systems; clinics were closed and access to essential health products declined. As a result, over 90% of countries reported widespread backsliding of health services, and routine immunisations plummeted to their lowest point in three decades.1WHOThird round of the global pulse survey on continuity of essential health services during the COVID-19 pandemic.https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-EHS_continuity-survey-2022.1Date: Feb 7, 2022Date accessed: May 2, 2023Google Scholar This regression created a vicious cycle of vulnerability, especially for groups at high risk of disease. Therefore, PHC should not be an afterthought—it must be core to pandemic prevention, preparedness, response, and recovery (PPR). Before a pandemic, PHC promotes health and prevents underlying conditions that increase the risk of severe disease and death, such as hypertension and diabetes. Ultimately, when people are healthier, they are better prepared to fight off infections.2Schwalbe N Lehtimaki S Gutiérrez JP COVID-19: rethinking risk.Lancet Glob Health. 2020; 8: e974-e975Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar Continuous access to PHC also builds trust in local health workers and facilities, which helps combat misinformation and disinformation and strengthens community resilience. During a pandemic, health workers made available via PHC provide the first line of defence to identify new cases and support surveillance, deliver continuous care and context-specific risk communication, and monitor stockouts and assist with supply chain management.3Frieden TR Lee CT Lamorde M Nielsen M McClelland A Tangcharoensathien V The road to achieving epidemic-ready primary health care.Lancet Public Health. 2023; 8: e383-e390Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar Comprehensive PHC systems can also be rapidly repurposed to distribute emergency countermeasures alongside essential health services and treatments, thereby maximising resources and averting health system collapse. After a pandemic, PHC can help deliver catch-up care, particularly to individuals affected by disruptions to preventive services, such as reduced cancer screenings. Furthermore, PHC can hasten social and economic recovery by connecting communities to nutritional, housing, and financial support programmes.4Schwalbe N Crowley S Lehtimaki S Allotey P British Medical JournalDeaths from COVID-19 could be the tip of the iceberg.https://blogs.bmj.com/bmj/2020/05/20/deaths-from-covid-19-could-be-the-tip-of-the-iceberg/Date: May 20, 2020Date accessed: May 2, 2023Google Scholar Integrating emergency surveillance with routine health data at the PHC level can also help rapidly identify disease hotspots and inform future research and development efforts so that pandemic countermeasures are appropriate for the communities they intend to serve. Paradoxically, proposed reforms to the PPR architecture remain nearly silent on PHC, including negotiations for a pandemic accord, amendments to the International Health Regulations, and the development of the Pandemic Fund and a medical countermeasures platform.5Lal A Abdalla SM Chattu VK et al.Pandemic preparedness and response: exploring the role of universal health coverage within the global health security architecture.Lancet Glob Health. 2022; 10: e1675-e1683Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar Addressing this gap is straightforward. First, invest in PHC to keep people healthy. Second, establish community-driven contingency plans to deliver PHC at all stages of a crisis, ensuring health workers and essential health services remain accessible and affordable and can be used for catch-up care. Finally, leverage PHC as a coordination point for integrating PPR and universal health coverage.6Lal A Erondu NA Heymann DL Gitahi G Yates R Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage.Lancet. 2021; 397: 61-67Summary Full Text Full Text PDF PubMed Scopus (192) Google Scholar PHC can be the linchpin for equity in PPR. Therefore, emergency response should not be made at the expense of routine service delivery; both are required to maintain functioning health systems. Just as every government has a crisis management plan for data and computer systems when electricity fails, they should ensure that PHC has a contingency plan too. Policy makers should develop these failsafe plans for PHC to help communities better prepare for, respond to, and recover from infectious disease threats, starting with its prioritisation in all national and international PPR negotiations and investments. We declare no competing interests.