The COVID-19 pandemic has raged for more than two years now. With the succession of new variants, it appears that it will remain pandemic for the foreseeable future. Many European countries are gradually relaxing pandemic restrictions, but we need to remain vigilant. The impact of the pandemic in terms of the cost to human lives, health, and socioeconomic stability of society has been very big [1]. This Viewpoint focuses on how Occupational Safety and Health (OSH) can leverage optimal impact on public health (PH) through closer collaboration, based on our experience in Europe. We advocate stronger links between public and occupational health with a clear structure to define this cooperation to achieve better synergies and outcomes.

Before the pandemic, European countries paid little attention to employers as critical actors in prevention to protect the health of the population. At the turn of the nineteenth century, PH and OSH emerged from common origins in Europe, but the role of public health in this region has been more limited than in the United States (US), which are partly due to differences in level of unionization and collective bargaining culture. Hence, European OSH policy operates in a tripartite framework involving employers, workers, and, in most countries, ministries of labour or labour inspection (OSHA). Labour unions in many European countries have been mainly focussing on work-related diseases and injuries keeping out of the OSH and tripartite framework lifestyle related PH outcomes that may have a workplace attribution like obesity, cardiovascular diseases, and diabetes.

Europeans have treated workplace health promotion and infection control as mostly within the domain of public health, with, at best, the involvement of the tripartite framework. For example effective tuberculosis control and prevention is done in an integrated program with all general health care providers and stakeholders—including government health facilities, nongovernmental organizations, private and OSH practitioners, community groups, and workplace actors. The pandemic has thrust infection control and perhaps also health promotion (home office, sitting, and screen time) into the workplace domain. Thus, it is likely employers will become more involved in PH prevention along with the employees and labour inspectors and ministries.

COVID-19 has highlighted the employer's role in preventing occupational and other PH risks in the workplace in close collaboration with the OSH practitioners. OSH practitioners participated in the PH pandemic response in various ways and degrees of efficiency and effectiveness. A first, OSH providers undertook actions at an individual level: testing, tracking, isolating, and vaccinating workers in occupational settings. They also performed workplace risk assessments and advised employers about implementing exposure controls such as source elimination, containment, segregation, pathway controls (effective ventilation and filtration) and receptor controls (effective personal protective equipment (PPE)) [2, 3].

OSH practitioners also played important roles in prevention and mitigation of physical and mental health problems at collective and individual levels [4, 5]. OSH provided advice on ergonomic and psychosocial issues for healthcare workers and people working from home [6]. These activities demonstrate importance of OSH important input with employers and for policy to ensure that working people could be appropriately protected and critical services and economic activity could continue uninterrupted [7].

Workplaces afford contact of staff with the general public, customers, suppliers, visitors, and patients. Because employees interact, cohabit, commute to work together, they are potential carriers, vectors, or targets of the virus. Effective workplace prevention can reduce excess occupational risk for workers, their families, community contacts, and patients in healthcare [8,9,10,11]. Workplaces also serve as settings for education about prevention and vaccination, knowledge that workers can transfer to their communities. Thus, OSH contributes to effective prevention of community-acquired infection.

Conceivably the lack of integration between OSH and PH pandemic early response lead initially to the neglection of necessary precautions (e.g. provision of appropriate Respiratory Protective Equipment) and occupational risk assessments to protect both staff and business, which facilitated wider transmission driving natural selection of SARS-CoV-2. Effects include increased transmissibility (seen with alpha, delta, and omicron variant), increased immune escape (beta and omicron variant), or greater pathogenicity (alpha and delta variants). This continues with variants BQ.1.1, BF.7, BA.2.75.2, BA.2.3.20 and XBB amongst others. Countries that permitted high transmission have had higher COVID-specific and all-cause mortality, healthcare worker shortages, and repeated lockdowns to control surges in cases [12]. Countries that suppressed transmission early reduced mortality and have, to date, suffered less economic damage. European responses to COVID-19 have highlighted the value of an integrated approach, also called the Swiss Cheese Model.

This model is also central to management of other crises affecting communities. A ‘vaccines-plus' strategy exemplifies the sort of integration of OSH and PH that we advocate. As depicted in Fig. 1, this strategy combines vaccination, exposure control, and financial support. For exposure control, intervening at the source control is most effective; receptor control is the least effective measure [13]. If countries worldwide were to integrate and apply all these measures, they could reduce the evolution of new variants by ensuring low transmission. Effective PH measures can contain outbreaks, while ensuring that everyone (including the clinically vulnerable) can live and work freely.

Paradigm of integrated control measures

To be more effective in controlling the pandemic, we argue that PH and OSH must work together in a complementary fashion. Several EU policies, documents, debates, and research programs highlight movement in this direction since inception of the pandemic [14]. This alliance is critical to increase the preparedness for potential future health crises, as outlined in the EU Strategic Framework on Health and Safety at Work 2021–2027 [15]. The European Commission advocates that “synergies between OSH and PH should be further developed”. An in-depth assessment of the effects of the pandemic and the efficiency of the European Union (EU) and national OSH frameworks will be necessary to develop emergency procedures and guidance for the rapid deployment, implementation, and monitoring of effective measures in potential future health crises, in close cooperation with PH actors. The Commission should move rapidly to determine how to achieve such ‘synergies’ and to promote them across Europe. Only recently EU has taken action and put the building blocks of the European Health Union officially in place. This not only includes stronger EU rules on serious cross-border threats to health, but also a stronger mandate of the European Centre for Disease Prevention and Control (ECDC) and a new Emergency Framework for medical countermeasures.