Governments and health authorities must invest more in primary health care (PHC). This is increasingly urgent to assure service continuity throughout and beyond the pandemic [1, 2]. The pandemic hit hospitals hardest and most visibly in the unprepared health systems of European countries [3, 4]. PHC committed early to new models of working, enforced by lockdowns, accelerating the digital revolution [1].

Mass vaccination in 2021 demanded proactive involvement across sectors, especially PHC, public health (PH), community services and the third sector [2]. Inequalities in vaccine uptake could only be addressed and overcome by community organisations sensitive to local needs and beliefs, alongside trusted PHC professionals. The recent Omicron wave has been characterised by severe service disruption in key areas of the economy, through sickness absence and uncontrolled infection in children.

Governments have not followed a “Vaccine-plus” approach failing to use all preventive measures available [5]. Mandates were removed, replaced by appeals to individual behaviours. Unsurprisingly, infection rates have not declined as hoped, creating new burdens for PHC. The impacts of long-COVID, mental exhaustion and “pandemic fatigue” are clear [6]. Virtually all care occurs in the community and additional gaps in PHC, school nursing, occupational and mental health are evident. There has never been a clearer need to invest in and plan for better integration of primary and community health care, complementing an expanded, resourced and trained multidisciplinary PH workforce [7].

The avalanche of patients with less severe COVID-19 is shifting care progressively from hospitals to PHC, but without plans in place to strengthen investment and reallocate staffing, as happened in hospitals during earlier waves. As society reopens while case rates remain high, PHC and community services remain fragile [8]. The Delta and Omicron waves saw increasing exposure of children and younger adults. PHC provides upwards of 90% of health care and is the main source of assessment and support for people with multimorbidity. PHC has the potential to address health inequalities.

It is essential to learn from experiences in countries such as Canada after the shock of SARS in 2003, which identified the need for better coordination and integration of PH services with health care structures, particularly PHC. PHC services have also recognised opportunities for permanent and beneficial change brought about by the pandemic, especially digital technologies [9].

As we strengthen PHC, public and community health, we must build more sustainable, approaches, increasing protection of our local and global eco-system and environment, following the “One Health” philosophy [10]. We have failed to deliver vaccine equity [11].

ASPHER believes that health administrations, local and national governments should:

(1) Understand and act on the principle that preparedness and response begins with communities, PH, and PHC services.

The Association of Schools of Public Health in the European Region (ASPHER) is the key independent European organisation dedicated to improving and protecting the public health by strengthening education and training of public health professionals for both practice and research. www.aspher.org.

ASPHER is responsible and liable for all contents of ASPHER statements. ASPHER statements are approved by an Editor-in-Chief but not externally peer reviewed.