Consultation: Statement from #ProtectTheKids
Dear Federal Councillor Baume-Schneider,
Ladies and Gentlemen,
Within the scope of the consultation on the partial revision of the Epidemics Act (EpidA), you have also invited civil society organizations to comment on the preliminary draft (PD-EpidA) of the partial revision. The non-profit association #ProtectTheKids (Switzerland) would like to thank you for this opportunity.
Our statement of March 22, 2024 is based in particular on the experiences of the members of the Association and their families, who repeatedly advocated for an effective and timely protection of their children based on scientific evidence, but who have hardly been heard by the authorities since the successive lifting of protective measures from mid-2021.
Neglecting the protection of children and families represents a violation of Art. 41 para. 1 let. c of the Federal Constitution, according to which the Confederation and the Cantons shall endeavour to ensure that «families are protected and encouraged as communities of adults and children», and of Art. 11 para. 1 of our constitution, which clearly states: «Children and young people have the right to the special protection of their integrity and to the encouragement of their development». We appeal for these constitutional rights to be better respected in the future.
#ProtectTheKids supports the partial revision of the Epidemics Act in principle. However, we consider it necessary to improve protection against transmission and the definition of morbidity as well as to ensure the early and regular involvement of the scientific community, taking into account universal strategic principles for the most important and most likely risk scenarios. The criteria for a change of situation in the three-stage situation model (normal situation, special situation and extraordinary situation) should be objectified. We also see a need to adapt the process of finalizing the containment strategy when a particular danger to public health is identified; this process should incorporate the universal strategic principles of the current risk scenario. In addition, the responsibilities and tasks for the three stages of the situation model should be clarified between the Confederation and the Cantons.
Since fall 2021, school-aged children, young people and their teachers, all of whom work in poorly ventilated classrooms and childcare facilities, have been almost permanently exposed to high COVID-19 infection risks and the associated risks of long-term and late effects (Keiser et al., 2021; Davis et al., 2023; Rao et al., 2024).
Since then, their families have also been affected by increased risks, as children play an important role in the spread of airborne pathogens: As a study in the period Oct. 2019 to Oct. 2022 on the transmission of infections in over 800,000 US households showed, 70.4 % of all transmissions in households originated from a child (Tseng et al., 2023). During school sessions, the proportion of transmissions originating from children was even higher, suggesting that the spread of COVID-19 is associated with school attendance.
Summary of the position on specific articles
#ProtectTheKids considers it urgently necessary that the protection against transmission in accordance with EpidA Art. 2 Purpose, especially for children and adolescents, be effectively implemented in practice, as the spread of pathogens via respiratory aerosols could be significantly reduced by improving indoor air quality through mechanical ventilation and filtration.
At population level, morbidity should be assessed not only based on the severity of the (initial) acute illness but also on the frequency of reinfections and their effects, including known long-term consequences and the absenteeism from work and school caused by reinfections. This expanded definition of morbidity should also be used in PD-EpidA Art. 5a Particular danger to public health. In applying the precautionary principle, the risks of late effects should also be considered, especially when dealing with new pathogens.
In PD-EpidA Art. 2 Purpose para. 3 (new paragraph) concerning the planning and implementation of protective measures, the fundamental principles of controlling communicable diseases, and in particular their scientific basis, should be taken into account. The effectiveness of protective measures should be assessed based on scientific evidence.
In the pandemic years 2020 to 2023, it has become clear that «focused protection», limited to specific age groups and groups of people, does not work if policymakers do not use the available preventive measures to reduce transmission risk overall; moreover, this misguided approach increases health risks for the entire population.
Solidarity should be strengthened in this context, and in PD-EpidA Art. 2 Purpose para. 3, it should be explicitly stated as a principle.
The strategic principles of how to combat communicable diseases, supported by scientific consensus, should take precedence in PD-EpidA Art. 2 Purpose para. 3, whereby the effectiveness of individual and combined protective measures should be taken into account on the basis of scientific evidence.
In PD-EpidA Art. 6b Special Situation: Ascertaining the situation, the strategic principles and risk assessment of a newly established interdisciplinary Federal Commission for Infection Protection and Pandemic Control (FCPC) 1. should be considered. Further considerations from the Federal Office of Public Health (FOPH) and other departments may be taken into account, leading thus to the strategy of the Federal Council. Based on the the principle of transparency anchored in the Freedom of Information Act (FoIA), the decision-making foundations of the Federal Council’s resulting strategy should be communicated in a timely manner.
1. or a Federal Commission for Infection Control (FCIC)
EpidA Art. 8 Preparatory measures is particularly suited to outline important and universally applicable strategic principles on the Confederation’s preparatory measures for the most likely risk scenarios. For example, the superiority of a multilayered «vaccines plus» combat strategy (Open letter in BMJ, 2022; Lazarus et al., 2022; Markov et al., 2022) in the scenario «virus variant with high morbidity».
According to Art. 164 para. 1 let. e of the Federal Constitution, such important and universally applicable principles concerning the tasks of the Confederation are to be enacted in the form of federal law.
However, the preliminary draft of the consultation lacks both the universally applicable strategic principles and the most likely hazard scenarios. While PD-EpidA Art. 8 para. 1–3 specifies that the federal government and Cantons must develop, publish, and update «preparation and coping plans», it does not indicate on what basis these plans should be developed. The involvement of science is a necessity not only in the development of the strategic principles of preparatory measures, but also in the implementation of the three-tiered situation model. For early and regular involvement of science in dialogue with political actors, the creation of the aforementioned interdisciplinary Federal Commission for Infection Protection and Pandemic Control (FCPC) is recommended.
In EpidA Art. 8 Preparatory measures, the state of science regarding the main transmission routes should also be considered (Wang et al., 2021; Pöhlker et al., 2021; Peng et al., 2022; Sachs et al., 2022; Smieszek et al., 2022), both at federal level and in implementation at cantonal level. Regardless of the epidemiological situation, reducing transmission risk by improving indoor air quality in public spaces is an essential principle in preparing for risk scenarios and provides universal protection against airborne pathogens (Minguillón et al. 2020; Keiser et al., 2021; Buonanno et al., 2022; Villers et al., 2022; WHO, 2024; WHO partners platform, 2024).
Furthermore, there is a need for adaptation regarding the topic of «epidemiological surveillance», specifically in PD-EpidA Art. 12 Reporting Persons and Entities and in PD-EpidA Art. 60 National Information System «Reports on Communicable Diseases»: Firstly, for estimating the actual incidence; secondly, to obtain reliable data on breakthrough infections and to analyze vaccine effectiveness.
An analysis conducted in August 2021 on Swiss case numbers determined the expected number of breakthrough infections by age group, taking into account the initial British studies on vaccine effectiveness (VE) of mRNA vaccines. This analysis was submitted to the Federal Office of Public Health (FOPH) (epi@bag.admin.ch) and also published on Twitter (Thread 1 on VE, 21.08.2021; Thread 2 on VE and breakthrough infections, 30.08.2021). The analysis found that the numbers of breakthrough infections published by the FOPH were significantly underestimated due to insufficient data collection in PCR tests (lack of vaccination status). The report submitted to the FOPH in August 2021 also contained a solution to this problem based on improved data collection. This solution would have allowed for a precise determination of vaccine protection against infection by age group and over time since the last vaccination. However, the recommended improvements in data collection outlined in the report have not been implemented thus far.
We thank you for kindly considering the concerns of families who uphold the precautionary principle, orient themselves on the consensus of science and are convinced that only an approach based on solidarity can be successful in fighting pandemics.
Yours sincerely,
#ProtectTheKids (Switzerland)
Fredy Neeser
Scientific Advisor
Andrea Hadorn
Board Member
Full consultation response by #ProtectTheKids
References
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