5.1. Public health

Public health services remain the responsibility of the MoH under the GeSY, which to some extent signifies the importance of these services to the Ministry and the health of the population. There is no separate directorate or agency for public health. The services are distributed across several entities and settings, and fall within the responsibilities of different health care workers (such as hygiene inspectors, school nurses/health visitors) with no clear structure. The MPHS is the competent department for delivering and monitoring most public health activities. In the majority of cases, various scientific bodies, as well as NGOs, local authorities and other ministries, support and complement the MoH’s efforts for prevention and health promotion activities in Cyprus (see Section 2.5). In this context, the Ministry prepares and implements national strategies related to major public health problems, such as diabetes, cancer, tuberculosis, rheumatic diseases, rare diseases, dementia, etc., as well as strategies against major public health risk factors, such as smoking, road accidents, child accidents and poisonings (Ministry of Health, 2023).

The MPHS is also responsible for delivering a wide range of public health activities including:

• epidemiological surveillance and control of infectious diseases
• immunization services
• school health services
• control of environmental and communicable diseases
• health education and promotion
• control of sexually transmitted diseases.

Public health services are mainly delivered by health professionals in public primary health centres and hospitals, in close cooperation with the State General Laboratory. The State General Laboratory also monitors food and water safety, and controls pharmaceuticals and illegal drugs, cosmetics, children’s toys and other industrial products. It collaborates with the competent authorities for the implementation of official monitoring and control programmes, and conducts applied research to ensure the safety of the above, as well as for the control and prevention of environmental pollution. It plays a pivotal role in disease prevention through controlling public exposures to chemical and biological hazards. It engages with European efforts to develop and apply new risk assessment methodologies, including human biomonitoring. It also supports law enforcement through the provision of forensic and toxicological analytical services to the police. To a lesser extent, some public health services are delivered by the private sector, local authorities, non-profit organizations and other ministries.

Finally, it should be mentioned that a WHO Country Office in Cyprus was officially opened in March 2023. The Office is expected to be active in public health issues, and specifically in strengthening and upgrading preparedness against emerging and epidemic infectious diseases, through the promotion of innovative actions aimed at prevention, as well as collection, dissemination and evaluation of epidemiological data. In addition, the WHO Country Office will support the development of policies in the field of communicable diseases and zoonoses, and promote related actions, response mechanisms and preparation of cooperation tools, including the preparation of a National Strategy for Mental Health in Cyprus.

5.1.1. Epidemiological surveillance and control of infectious diseases

The competent authority in this area is the Epidemiological Surveillance and Control Unit for Infectious Diseases of the MPHS. This unit has responsibility for monitoring, collecting and analysing data as part of the effort to prevent and control infectious diseases, and for providing data to the competent authorities of the EU Member States. For this reason, the Unit cooperates with international organizations such as WHO and the European Centre for Disease Prevention and Control (ECDC). It is also competent for the supervision and coordination of clinical laboratories, the timely identification of new and emerging infectious diseases in the country, and the rapid response to such outbreaks.

During the COVID-19 pandemic, the Unit was at the forefront of identifying and recording new cases, tracing contacts of confirmed cases, and ensuring their isolation to control the spread of the virus in the community. In addition, demographics, epidemiological and other relevant data of SARS-CoV-2 cases were collected and posted to the publicly available electronic platform of the Unit for the better surveillance of the pandemic.

5.1.2. Immunization Services

The child vaccination programme is an important task of the Immunization Services and has been highly successful to date (see Box5.1). It is planned in accordance with the recommendations of WHO, available data on communicable diseases, and relevant international scientific developments. According to the programme, preschool and school-aged children are provided with vaccines against communicable diseases that can pose a serious threat to public health. Vaccination is done either by paediatricians or health visitors at health centres and school premises and is free of charge, with expenses reimbursed by the HIO. Children are required to be vaccinated in order to enrol in school. At the beginning of the school year, health visitors check that all children are vaccinated, thus ensuring universal immunization.

Box5.1

Child vaccination rates in Cyprus are in most cases higher than EU averages. Vaccination coverage in Cyprus in 2021, according to the latest WHO/UNICEF Estimates of National Immunization Coverage, is shown in Table5.1. Vaccination rates have remained stable over the past decade, with small changes of just one or two percentage points. Due to the high vaccination rates, the reported cases of vaccine-preventable diseases up to 2021 in most vaccination categories were zero (WHO, 2023b).

Table5.1

In 2016, the MoH started the free-of-charge vaccination programme against the human papillomavirus (HPV) for girls aged 12 years. In 2020, the programme was expanded to cover both boys and girls aged 11–12 years through the GeSY. Regarding influenza vaccination in people over 65 years, the uptake was only 26% in 2019, which is well below both the EU average (42%) and the recommended WHO target (75%).

In response to the COVID-19 pandemic, Cyprus initiated a vaccination campaign in late December 2020. Residents and staff in nursing homes and LTC facilities, as well as health professionals, were initially prioritized for vaccination. This was followed by those over 80 years, then those over 75 years; people with a high risk for severe disease; followed by the rest of the population. By October 2023, 74.6% of the adult population had been vaccinated with the first dose and 54.3% with the booster vaccine (compared to EU/EEA averages of 75.6% and 54.8% respectively) (ECDC, 2023). Vaccination is voluntary and free of charge for all, even for those not covered by the GeSY.

5.1.3. Screening programmes

Several screening programmes have been launched in Cyprus in the last 15 years. Since 2003, a national control programme for early detection of breast cancer has been run by the MoH for women aged 50–69 at specialized health centres operating in each of the major cities. Following a recent decision by the Ministerial Council, since 2023, the age limit for women to participate in the programme has been expanded from 45 to 74 years, as opposed to the previous range of 50 to 69. Even though breast cancer is the leading cause of cancer deaths among women in Cyprus, only 31.4% had undergone mammographic screening in public facilities in 2019 (Eurostat, 2022), a rate below the EU average of 59%. However, it is likely that many women chose to have mammography screening in the private sector, for which data are not available. In contrast to the low rate for breast cancer screening, the rate for cervical cancer is quite high: 69% of women aged 20–60 years in 2019 had been screened for cervical cancer in the previous two years, which is higher than the EU average of 58%. It is expected that the introduction of the GeSY will increase the number of screening referrals made by personal doctors or other specialists for both breast and cervical cancer.

In addition to the above, the Ministry is planning to add national screening programmes for prostate, colorectal and cervical cancer. Other available screening programmes include: the National HIV/AIDS programme, antimicrobial resistance and infections screening, hearing tests for all newborns, and the national thalassaemia screening programme.

5.1.4. Control of sexually transmitted diseases

5.1.5. Control of foodstuffs and other activities by the Environmental Health Sector

The MPHS, in collaboration with other interested stakeholders and services, is the responsible authority for the elaboration of relevant policies on foodstuff monitoring and control, which should be based on EU requirements and take into account continual food industry developments. The basic principles of this policy are: i) the best possible control of the whole manufacturing procedure and supply chain; ii) informing consumers about the quality of foodstuffs and possible dangers; and iii) the best possible protection of consumers’ health. In cases of food poisoning, epidemiological investigations are performed to locate the source and prevent new incidences.

Beyond foodstuff control, the Environmental Health Sector of the Public Health Services is also involved in the:

• monitoring and control of the quality of drinking-water for human consumption;
• control of insects of medical importance;
• audit and control of public and private premises, with special attention on hotels and restaurants, etc.;
• inspection of livestock units to avoid any unhealthy conditions;
• audit and control of public swimming pools and the quality of their waters;
• audit and control of the quality of coastal bathing waters;
• audit and control of the quality of the manufacturing and sale of detergents;
• investigation of environmental hygiene related complaints; and
• audit and control of the quality of smoking products and the implementation of smoking related legislation (Ministry of Health, 2017).

5.1.6. Health Monitoring Unit

The Health Monitoring Unit (HMU), which is under the administrative responsibility of the permanent Secretary of the MoH, was established in 2004. Its mission focuses on setting up appropriate mechanisms for collection, storage, analysis and dissemination of health information, which should be valid, available in a timely manner, and compatible with information produced by other European countries for comparison purposes. Among other activities, the Unit is responsible for collecting medical data for births, injuries, accidents and diabetes, keeping and updating the Cancer Registry and coding causes of death.

The knowledge and information generated by the HMU supports the MoH in elaborating the national public health policy and relevant prevention and health promotion activities. In addition, the exchange of information and best practices in public health leads to better cooperation with international organizations, such as the Directorate-General for Health and Food Safety (DG SANTE), Eurostat, WHO and the OECD.