“I’m not too sure that I want to go back to school because I’ve lost my will to learn. But I’m also not so sure that I want to stay at home; I am just really confused at this time.”

This is the reflection of one young person in the WHO European Region who took part in a survey looking at the experience of being a student during the COVID-19 pandemic.

The survey was run voluntarily by students Emilia, Frida and Malika, and included a total of 927 responses from 10- to 19-year-olds from 16 countries collected over 4 months. Pupils responding to the survey also called attention to problems with online learning and the sacrifices they have made to support the wider community. These are some of their responses.

“[Online learning] … isn’t the same as in-class learning. It feels like some of the teachers and students very rarely have enough energy to give to the lesson, and to let the information be absorbed properly.”

“Our education system is not ready for online learning, and the problems we have now online are the same we had a year ago. Sometimes you don’t even hear the teacher … I know that teachers are also sad about the situation.”

“Of course, we don’t want our grandparents to die or intensive care units (ICUs) to be overburdened. Of course, we want to do our share for our community and protect it. But we also need to see our community do their share for us. How can we justify the closing of schools while shops or hairdressers and restaurants reopen?”

Situation in the WHO European Region

These were just some of the responses shared at the 4th meeting of the Technical Advisory Group (TAG) on Safe Schooling During the COVID-19 Pandemic, held on 9 March 2021. The TAG pointed out that children and adolescents have missed 22 weeks of school on average, due to partial or complete closures caused by COVID-19.

A status report presented at the meeting noted that as of 8 March 2021, 31 countries in the Region have suspended in-person teaching at some levels or for specific age groups. Ten countries have suspended schooling at all levels and have moved entirely to distance education. Eleven countries have in-person teaching but require adaptations such as masks, physical distancing and hand hygiene.

There is also variation across the Region in terms of rapid diagnostic testing, with 16 countries having either a standing recommendation or a requirement for students, teachers, staff or home communities to complete a rapid diagnostic test. Six countries require rapid diagnostic testing for teachers only, 1 country requires students to provide negative COVID-19 tests when travelling to school, and 2 countries require parents to present tests when dropping off or picking up their children.

Thirteen countries in the Region have a standing recommendation or requirement for students, teachers or staff to wear masks when in the school environment.

Recommendations in keeping with emerging evidence

The TAG was set up to provide advice to WHO/Europe on matters relating to schooling in times of COVID-19. This includes advice on the epidemiology of school transmission, infection prevention and control, and public health measures and their effects on the development and well-being of school-aged children.

It aims to identify findings from emerging evidence to inform policy decisions on educational, social, developmental and health outcomes for children and adolescents. Based on their review, the TAG noted that:

• even with the wider spread of more infectious variants, there is no evidence that schools contribute in a major way to community transmission;
• school closures by themselves will not control the pandemic; and
• measures such as physical distancing, masks, hand hygiene and ventilation, applied in an age-appropriate way, should allow schools to stay open even with increasing numbers of infected people in the community.

The TAG also reiterated points raised in earlier meetings, including that:

• closing schools should be a last resort;
• schools should be among the first to reopen; and
• young people in schools need to be part of the decision-making process on prioritizing and implementing interventions that affect them.

“I came to the centre to get my second dose of vaccine – I am happy to get any. I have heard of COVID, how could I not? Everyone is talking about it on the streets, in the centre. I hear about it on the radio, I see it on TV,” says Alexandru, aged 53, from Bucharest. After working for 35 years as an operator in a chemical plant, he is now without work and, following a family break-up, is also homeless.

Alexandru is one of the dozens of people dealing with underlying health conditions and living in difficult circumstances who have been vaccinated against COVID-19, thanks to joined-up health services in Romania’s capital that seek to leave no one behind.

“Romania appreciates the essential contribution of the WHO Regional Office for Europe in these difficult times generated by the COVID-19 pandemic,” says President of Romania Mr Klaus Werner Iohannis. “The cooperation and solidarity of the entire international society is our common response to a challenge of this magnitude, and the World Health Organization is a cornerstone in guiding this process.”

From community outreach to governmental support

This chain of care begins with community outreach undertaken by the nongovernmental organization (NGO) Carusel. Its staff speak to people living and working on Bucharest’s streets, advising them on when and where they can receive health services, including vaccinations, and referring them to social-care centres to register for the COVID-19 vaccination.

Established a decade ago, Carusel focuses on harm reduction and seeks to improve the quality of life for drug and alcohol users, sex workers, people who live on the streets, socially and economically challenged people, and those at risk of illness or facing social exclusion.

Vaccination sessions take place at social-care institutions such as Sfântul Ioan, the largest in the city. Both a day and a night centre, Sfântul Ioan provides health and social services and shelter to up to 450 people. Capacity has now been reduced by half because of COVID-19 restrictions. The centre’s 45 staff, comprising social workers, health-care professionals, a chef, a driver, cleaning staff and security services, are employed by the Bucharest General Directorate for Social Assistance, a specialized institution under Bucharest’s General Mayoralty.

A mobile medical team from Saint Pantelimon Hospital was assigned to Sfântul Ioan, and during 2 sessions it administered COVID-19 vaccines to over 150 people. The team’s activities are managed and financed by the Ministry of Health.

By bringing together a community-level NGO, municipal health services and coordinated support from several national ministries, Bucharest can provide accessible, tailored services to people most in need.

Witnessing joined-up services first-hand

WHO Regional Director for Europe Dr Hans Henri P. Kluge is currently on an official visit to Romania, where he is witnessing this chain of care and the importance of ensuring that health services and support are available to everyone, including during the COVID-19 pandemic.

“Tackling health inequities is at the top of my agenda. It is more important than ever as we rebuild after the pandemic,” Dr Kluge explained at a high-level dialogue on climate change, the human–nature relationship and public health, held today.

“One of the goals of WHO’s European Programme of Work until 2025 is to leave no one behind. That is a centrepiece of the work of the Regional Office as it strives to support Member States in building back better. We do this through technical support, capacity-building, partnerships and alliances – aiming for fairer, healthier recoveries and further investments in what has been coined well-being economies,” he added.

World Health Day focuses on health equity

On this year’s World Health Day – 7 April – WHO’s focus is on promoting health equity. COVID-19 has hit all countries hard, but its impact has been harshest on communities that were already vulnerable. These groups are more exposed to the disease, less likely to have access to quality health-care services, and more likely to experience adverse consequences as a result of measures implemented to contain the pandemic. Yet these inequities – due to living conditions, social and human capital, access to quality health care, and employment and working conditions – are not new.

Alexandru’s greatest wish is to find a job. “It’s very difficult to have no activity and no money of your own. I’ve been working since I was a kid. Sitting around doing nothing is not good,” he concludes.

Today, there is an urgent need to protect, test and treat the whole global population: only when this happens can we end the pandemic. As well as assuring an equitable supply of vaccines, tests and treatments, we must strengthen health systems to deliver them. A strong health workforce and primary health care are key to ensuring people can obtain services when and where they need them, as close to home as possible, without financial hardship.

Through its chain of care, Romania offers a positive example of how vulnerable people can receive appropriate support and health services, and some hope, during the COVID-19 crisis and beyond.