Search
Search

Poland country snapshot: public health agencies and services in the response to COVID-19

1 March 2022
Case study

Tadeusz Jędrzejczyk, Łukasz Balwicki

Introduction

This snapshot explores the role of public health agencies and services in responding to the COVID-19 pandemic in Poland, using a sub-set of public health functions to serve as ‘tracers’ of how far public health was engaged in different aspects of the response. The report covers the role of public health agencies and services in the following areas: pandemic planning, overall governance of the pandemic response, guidance on non-pharmaceutical interventions, communication, testing and tracing, and vaccination. It draws on interviews with key actors, as well as information contained in the COVID-19 Health System Response Monitor (HSRM), policy documents, government websites, announcements and regulations, and academic and grey literature.

Pandemic planning

Pandemic planning in Poland occurs at the regional (voivodeship) level in line with current legislation, namely the Act of 26 April 2007 on Crisis Management1. Sixteen pandemic preparedness plans that focused on hospital bed management, patient safety issues and hospital procedures were subsequently developed, with the intention of updating them every three years. The Chief Sanitary Inspector (Główny Inspektor Sanitarny) was involved in pandemic planning by setting and supervising standards. 
At the national level, following the Act of 29 October 2010 on Strategic Reserves (amended in December 2020)2, plans which address the storage and distribution of material reserves of basic emergency items (including drugs, medical equipment and medical supplies) in the event of a crisis without direct links to epidemic management were developed. Due to secrecy clauses in these documents, it is unclear whether this central planning addressed issues such as wearing masks, maintaining physical distancing and imposing a lockdown strategy during the COVID-19 pandemic. In any case, these non-pharmaceutical interventions are not included in the publicly available regional plans for pandemic preparedness.
The COVID-19 pandemic demonstrated that the pandemic planning process in Poland did not address all of the areas relevant for crisis management. Shortly before the first outbreak of COVID-19 in Poland in March 2020 and again after the rather mild first wave of infections between June and August 2020, there was a shortage of personal protective equipment and reserve hospital. A new attempt at pandemic planning was announced prior to the fourth wave, in September 2021, but details had not been published at the time of writing this report (January 2022). 
The State Sanitary Inspectorate has the crucial role of preparing strategic plans and supporting government through scientific analyses during epidemics. However, pandemic crisis management extends far beyond health care and public health, ideally involving all public institutions and sectors, including education, social services, transportation and communication. Interventions to help the economy were concentrated on companies and employers, rather than on employees. 
Pandemic planning and preparedness could be strengthened by conducting simulations and providing relevant training at national, regional and local authority levels. There is also a need to bolster crisis planning in health care and involving local authorities, employers and non-governmental organizations. Human resource management and training of the professional and volunteer workforce are also crucial for pandemic planning. 

Overall governance

Regional pandemic response planning is the duty of regional government administrations, in collaboration with the national public health institution, i.e. the State Sanitary Inspectorate (Państwowa Inspekcja Sanitarna). Most of the regions in Poland had not updated their plans prior to 2019.
Emergency state regulations in Poland indicate epidemics as ‘natural disasters’, which are regulated by the Act of 18 April 2002 on the State of Natural Disaster3. The two other types of states of emergency in Poland are martial law and state of emergency. In all three cases, the government can pass laws temporarily without parliament approval.
The Act on the State of Natural Disaster mainly focuses on governance and the constitutional prerogatives of central government, including the possibility of imposing temporary restrictions on civil rights. Although the government did not utilise most of the legal possibilities available during the COVID-19 pandemic and a state of natural disaster was not imposed, the legislative process was very intensive and rapid. Executive regulations about lockdown, the use of masks or the limitation of public transport were at times publicly announced just hours before being enacted. During the pandemic, legal changes in this area were enacted almost two dozen times. Other changes were also evident. Public procurement for government agencies and hospitals became easier and faster. The introduction of new rules about remote working, which included doctors’ consultations through telemedicine, was another important change.
One success story was the deployment of the Territorial Defence Forces, which is a semi-volunteer, newly established section of the Polish army, along with some other army units. Their support in hospitals, for the vaccination programme and other tasks was an important component of overall crisis management. 
On the other hand, one of the failures of pandemic management in Poland was that the potential of occupational medicine clinics and its human resources were not utilized. To some extent, this was also true of school nurses. Due to the lockdown, these health professionals were released from their everyday duties, but without engaging them in the pandemic response.

Testing and tracing

Prior to the outbreak of COVID-19, hospitals, outpatient clinics and several laboratories belonging to the State Sanitary Inspectorate conducted relatively few diagnostic tests for viruses, leading to organisational problems in some regions as demand increased. Delays in testing were common, which in turn led to public concern. When additional resources were allocated, commercial laboratories started to offer testing and this can be viewed as a relative success. However, contact tracing and testing stopped at the beginning of the second wave in September 2020, due to a lack of employees dedicated to this task. 
The test and trace system was not reviewed and updated before the fourth wave of COVID-19 in August/September 2021. To date, the effectiveness and quality of testing and tracing in Poland has not been analysed by any public health authority.

In an attempt to innovate in this area, mobile applications were introduced with the intention to help reach a decision about quarantine (Kwarantanna Domowa4) and to inform individuals about possible contacts with an infected person (STOP COVID - ProteGO Safe5). It is difficult to assess whether these applications were effective.

Non-pharmaceutical interventions

At the beginning of the pandemic, WHO did not recommend the use of face masks in public places, and therefore initial official recommendations and regulations in Poland did not refer to wearing face masks, but only recommended physical distancing and increased use of disinfection. The shift in policy around the use of face masks was quite radical, since, at the peak of the pandemic, wearing a face mask became obligatory (including outdoors), irrespective of physical distancing. Not adhering to the regulation could be penalised by a fine, although enforcement was generally inadequate and inconsistent. The easing of restrictions around wearing masks outdoors was announced as late as May 2021, after international data around effectiveness were published and following political pressure. Thus far, no evaluation or research around the effectiveness of wearing face masks in Poland has been conducted.
General health promotion is an important component of organised pandemic management. Public awareness about the importance of maintaining one’s general health seemed to increase in Poland during the pandemic, as the vulnerability of chronically ill people, smokers, overweight individuals and people exposed to air pollution to severe COVID-19 outcomes was realised. However, although official communication outlined these concerns, overall efforts to address these underlying health issues were very limited. At the beginning of July 2021, the Ministry of Health’s ‘Prevention 40 Plus’ programme for diagnosing risks of chronic diseases for those aged 40 years or older was announced6, but it is too early to assess its impact on population health.

Changes in the functions of public health institutions

The decision to test, trace, isolate and quarantine a person exposed to a virus is taken by the State Sanitary Inspectorate. These competences were not changed during the COVID-19 pandemic, even though substantial decision-making capability had been centralised before the pandemic. However, the previous co-dependency of the State Sanitary Inspectorate with self-governing county authorities was not altered because of the pandemic, but in accordance with a process of centralisation of public institutions being carried out by government. Coincidentally, the Act of 14 March 1985 on State Sanitary Inspection (Amendment of 2006) came into effect on 1 April 2020, at the very beginning of the pandemic.

The Ministry of Health, with the help of the National Health Fund (Narodowy Fundusz Zdrowia), was responsible for the management of hospitals, outpatient clinics and other health facilities. One notable exception was the development of testing capacity for COVID-19, which at the beginning of the pandemic was rather inefficient, since not all regional sanitary inspectorates were equipped with laboratories capable of detecting viruses. Therefore, more than a hundred laboratories, the majority private, were included in the testing system and were financed by the National Health Fund. The development of laboratory infrastructure during the first months of the pandemic can be considered a success, since pandemic planning did not originally address laboratory equipment, technology and staff.

Vaccination

The National Vaccination Programme started on 28 December 2020, with the White Paper about the programme having been released just two weeks earlier. Participation is voluntary and free of charge. Vaccination of medical staff was prioritized initially, followed by vaccination of chronic disease patients and residents of long-term care institutions, nursing homes and social centres. Vaccines were mostly administered in bigger hospitals, called “population centres”, predominantly in bigger cities, and to a lesser degree in primary care and in homes when patients were otherwise unable to get vaccinated. Starting in September 2021 pharmacists were also allowed to administer vaccinations. When the programme was already underway, the Polish government allowed additional qualified health professionals (i.e. nurses, paramedics, final-year medical students and pharmacists) to administer vaccines. Pharmacies were also permitted to organize vaccination points.  After achieving vaccination of the initial target groups, the age of people invited for vaccination quickly decreased, because willingness to get vaccinated was much lower among the younger population. As early as the beginning of July 2021, the number of people seeking vaccination had decreased significantly, since almost all those who had intended to get vaccinated had already done so. Until January 2022, no compulsory vaccination had been introduced, although obligations for healthcare workers to become vaccinated were envisaged to come into force in March 2022. The Digital COVID Certificate (commonly known as the COVID-19 Passport) was adopted in Poland shortly after its introduction by the EU, no additional incentives (or restrictions for unvaccinated citizens) were imposed.

Before the pandemic, the State Sanitary Inspectorate was responsible for administering national vaccination programmes and supervising clinical activity in this area. The COVID-19 National Vaccination Programme, however, was organised directly by the Office of the Prime Minister. It was mostly successful, despite some logistical and organisational problems and an inadequate communication campaign. Anti-vaccine sentiments had been present in Poland long before COVID-19, but incoherent communication practices and populist actions by some politicians worsened the situation, particularly in rural areas, where a need for an entirely different approach to communication was evident.

In a bid to encourage vaccine uptake, a lottery for people who took the vaccine was announced in June 2021, along with relevant media campaigns. Additional financial resources were allocated to local authorities that had low vaccination prevalence in July 2021. However, as of mid-August 2021, no additional incentives for vaccinated individuals had been announced, and the anti-vaccination movement not only spread misinformation effectively, but also managed to organise large public protests in which several thousand people participated.

In conclusion, there is the need to strengthen national vaccination programmes for adults that includes reimbursement, organisation, promotion and communication for the most important vaccines available for contagious diseases. The use of e-health solutions and tools for reporting and disseminating relevant data, especially about potential adverse effects of COVID-19 vaccines, could be considered as a moderate success. While it helped the work of vaccination teams across the country, e-health solutions were not sufficiently developed to cover all vaccination programme needs.

Communications strategy and communicating with the public

The Government’s pattern of communication with the public changed over the course of the pandemic. We can distinguish the following stages:

  1. December 2019 – February 2020. Two messages were simultaneously communicated to the public: a refusal to acknowledge the risk of a potential crisis and reassurance that the best possible preparation was underway. Some announcements about gatherings of authorities’ crisis commissions at central and regional levels were reported to the public along with involvement of the State Sanitary Inspectorate. The severity of the COVID-19 outbreak in Tuscany, Italy, forced the Polish government to radically alter its message, as societal anxiety about the pandemic increased. The most important official message in this stage was that ‘all the required preparation is being carried out’.

     

  2. March 2020 – May 2020. Real anxiety and insufficient data on the SARS-CoV-2 virus and the characteristics of the COVID-19 disease led to the establishment of a comparatively strict lockdown. The core message released by the authorities was to ‘stay at home’, which was accompanied by increasingly strict lockdown regulations. The involvement of the State Sanitary Inspectorate, epidemiologists and virologists was limited, since the Ministry of Health took up the bulk of the communication process. Some restrictions, such as a prohibition on entering forests or the compulsory wearing of masks in empty public spaces, were introduced, despite a lack of scientific evidence to support them. Initially, official information was prepared and distributed via county, regional and central offices of the State Sanitary Inspectorate. However, local and regional channels of communication were subsequently stopped and central communication was imposed. At the end of this period, a decision to hold presidential national elections in June/July 2021 was taken.

     

  3. June 2020 – August 2020. The official message being disseminated during this period was that ‘the epidemic is over’. The decline in the numbers of SARS-CoV-2-related infections, hospitalisations and deaths during May and June 2020, following around 6 weeks of very strict lockdown, were recognised by the public as positive developments. However, in contrast to the first two phases of the pandemic, the public was not fully compliant with the stepwise easing of regulations. This period was also marked by a switch in the source of information from the Ministry of Health to the Office of the Prime Minister. In August 2020, when negotiations about the new government took place after the national elections, almost no official narrative about pandemic was released. By the end of this period, official channels of communication were dismantled in practice until a new Minister of Health was appointed.  

     

  4. September 2020 – mid-December 2020. During this period, the death toll related to COVID-19 was the highest recorded thus far. Hospitals were overwhelmed and access to health services, especially planned hospitalisations and consultations, was severely disrupted. The main message being disseminated in this stage was that ’Restrictions [are] for rescue’, which justified a new wave of restrictions. However, the message was disputed, since a State of Natural Disaster was not declared, even though civil rights are directly derived from constitutional regulations.

     

  5. Mid-December 2020 – January 2021. The fist vaccines arrived in Poland when the second wave of COVID-19 infections was on the decline. At this point, the message being communicated was ‘Vaccination – a new hope’. However, there was an imbalance between the demand for vaccines and initially very limited access. Although organisational and logistical challenges of the vaccination programme were generally minor, unauthorised access to vaccination became a public issue and eventually negatively impacted the general public’s view of the process.

     

  6. February – May 2021. The third wave of the pandemic started between January and February 2021, as a new variant of SARS-CoV-2 spread within the population. The leading narrative at the time was similar to that of September 2020 – mid-December 2020. A second message being disseminated was that ‘the vaccination programme is well-organised’. Support for restrictions was comparatively modest, since law enforcement was marginal during this period.

     

  7. June 2021 – January 2022. The overarching message in this period was that ‘vaccination will give us safety against another wave of the pandemic’. Efforts were concentrated on increasing vaccination coverage and providing a third dose of the vaccine.

Overall lessons

  1. The transmission of airborne diseases which can cause a pandemic has long been presented in risk analyses, well before the outbreak of COVID-19. Planning efforts should be extended to new areas, such as exploring the pandemic’s economic and social impact, its effect on support structures and the behaviours and mental wellbeing of the public. At the same time, there is a need to demonstrate skilled leadership.
  2. Special attention should be paid to the planning and organisation of human resources in anticipation of the next crisis. This should involve both medical and para-medical professionals, support staff, volunteers, and trained leaders from all kinds of organisations.
  3. Efforts at health education aimed at the general public are needed to counter anti-vaccine sentiments and similar movements.
  4. More experts and professional bodies, rather than politicians, should be engaged in communicating with the general public to foster trust in measures such as vaccinations.

References

  1. Government of Poland. Act of 26 April 2007 on Crisis Management. Journal of Laws (2007).
  1. Government of Poland. Act of 29 October 2010 on Strategic Reserves. Journal of Laws (2010).
  1. Government of Poland. Act of 18 April 2002 on the State of Natural Disaster. Journal of Laws (2002).
  1. Aplikacja Kwarantanna domowa - Koronawirus: informacje i zalecenia - Portal Gov.pl. https://www.gov.pl/web/koronawirus/kwarantanna-domowa.
  1. Ministry of Digitization, GovTech Polska & Chief Sanitary Inspectorate. STOP COVID - STOP COVID EN - Gov.pl website. https://www.gov.pl/web/stopcovid-en.
  1. Ministry of Health. Prevention 40 Plus Program. https://pacjent.gov.pl/aktualnosc/wystaw-sobie-e-skierowanie-na-badania (2021).
  1. Government of Poland. Act of 14 March 1985 on State Sanitary Inspection (Amendment of 2006). Journal of Laws (2006).
  1. European Commission. EU Digital COVID Certificate | European Commission. https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/safe-covid-19-vaccines-europeans/eu-digital-covid-certificate_en (2021).
  1. Polska Agencja Prasowa SA. Poland launches lottery to promote Covid-19 vaccinations. https://www.pap.pl/en/news/news%2C902316%2Cpoland-launches-lottery-promote-covid-19-vaccinations.html.

 

 

Subscribe to our newsletter

Sign Up