From a scientific point of view, the most important thing is the lack of organisation, the lack of data, of coordination, of what is nowadays called surveillance and monitoring. This means that because we do not have a public health agency, we will not have a system for collecting data and possibly analysing data that will help us as a country to understand what is happening and make decisions.

Public health is based on data analysis and decision-making in terms of interventions for the promotion and protection of health. The lack of understanding that we need this organisation at a national level is tremendous, because what it does is curtail the knowledge that is needed to advance health and well-being. The agency planned not only to have this monitoring function, but also to evaluate policies and interventions, not only in alerts, but also in the protection against infectious diseases and chronic non-communicable diseases, which are the most important in any European country, at least.

On the other hand, there are two fundamental things and that is that a State Public Health Agency would reinforce the role we have, not only at the local, regional and national level, but also the role that Spain has in Europe and in the world. And that is increasingly important in public health, as we saw in the pandemic: many of the decisions that were made were made at the European level and they are decisions based on data, on what is happening with the disease or data on what materials, what medicines, what organisation is needed to protect health.

And finally, I think we also make a mistake in terms of communication. This country lacks an organisation that speaks to the nation about health and public health, and that doesn't exist.

It's also worth saying that other European countries have solved it very quickly. Germany is a country that, for historical reasons, didn't even have a general directorate for public health in its government, it didn't have an agency and it didn't have an international global vision. During the pandemic, Germany created a general directorate for public health within its government, it has created a State Public Health Agency and it now has a WHO centre in Berlin.

These are decisions that have been made today not to make progress on something that has an impact on the health and well-being of our population and I find it incomprehensible.

The failure to pass the law creating the State Public Health Agency is very bad news. We were already very late because the General Public Health Law, which dates from 2011, already provided for the creation of a state public health centre, which was another of the things that should have been approved today, the modification precisely to refer to an agency. One of the aspects that was seen in the evaluation of the pandemic, which was published at the end of 2023, was the need for a body, an agency, a centre that from the state point of view could coordinate in an effective way and with operational autonomy the public health competences that all the autonomous communities have. Although the latter are exclusive, the General State Administration is responsible for the general foundations of healthcare and, therefore, the State is responsible for this coordination.

This agency, therefore, was very necessary, is very necessary. It brings us into line with what is happening in other European countries and, therefore, its absence and, above all, the absence of consensus to push forward the creation of this agency is, as I say, very bad news. Let's consider the possibility of a new public health emergency, and we have several on the horizon, not necessarily as serious as the Covid-19 pandemic, but some that could be very worrying. We are also in a context in which international coordination on public health matters could be greatly diminished by the departure of the United States from the World Health Organisation, as well as other countries such as Argentina. This contributes to the discrediting of this type of institution. With all this, the lack of a state organisation in good condition is going to make it more difficult for us to operate in the event of an emergency.

But this agency was not only created for emergencies. This agency was also created to coordinate all information on public health, to coordinate actions in the field of health promotion, to coordinate communication on public health issues. In other words, there were many other things that did not necessarily have to do with emergencies and it would have been time to start already, with a delay, as I say, to get all this up and running. Bearing in mind that, in addition, the approval of the law is only the starting signal for the creation; afterwards, it will take quite some time until the agency is fully operational, integrated with all the units.

In other words, all the time that is being lost now is time that we will have difficulty making up later in a way that does not cause harm to the health of all Spaniards.

The Spanish Society of Public Health and Health Administration regrets that the agency's approval has not been granted today. However, we understand that its refusal was more a question of timing than substance. The work that has been done by all the parliamentary groups has resulted in a text on which practically everyone was in agreement. Therefore, we cannot waste the work that has been done, we must try again. The agency is more necessary than ever, I think we are all aware of that, and we are confident that it can come out in 2025.

The fact that Congress has today ‘knocked down’ the bill that would have created the State Public Health Agency is not good news because of the delay in the implementation of a necessary institution for the protection of health in Spain.

From a public health perspective, the world is becoming very complicated. Climate change, desertification, migration, international mobility, increasing inequalities, technological deregulation, industrialisation of animal production are, among others, important risks for the increase of communicable and non-communicable diseases. War risks are also increasing and public health structures are essential in defence. The withdrawal of the USA from international health protection organisations, the dismantling of its scientific and public health structures, and the denial of science-based strategies in the USA increase these risks. Especially in the USA, but in a global world the problems in the USA will affect us all.

A complicated world in which, today more than ever, we need, among other things, a State Public Health Agency. Bad for everyone.