The SARS-CoV-2 pandemic has affected communities, populations, and countries throughout the world. As the SARS-CoV-2 pandemic developed, the extent to which the disease interacted with already existing endemic, non-communicable and infectious diseases became evident, hence deeply influencing health outcomes. Additionally, a synergistic effect has been demonstrated also with socio-economic, cultural, and contextual determinants of health which seem to contribute to poorer health and accumulating social disadvantages. In this essay, using as a starting point the syndemic theory that translates the cumulative and intertwined factors between different epidemics, we argue that the SARS-CoV-2 is a one health issue of a syndemic nature and that the failure to acknowledge this contributes to weakened policy-making processes and public health responses and ineffective health policies and programs.

ResumoEste ensaio tem por objetivo rever os diferentes elementos conceituais de equidade que foram se consolidando ao longo de tempo e a leitura que hoje se faz no Brasil de sua significação, orientada como um caminho para que se possa atingir um nível de garantia real e de fruição plena dos direitos à saúde, tendo-se sempre em mente a preocupação em compreender as diferenças, as necessidades e as particularidades dos distintos grupos sociais. Destaca a necessidade de se pensar a equidade em saúde como um processo em permanente transformação, que vai mudando seu escopo e abrangência à medida que certos resultados são alcançados e que novos desafios vão surgindo. Propõe que se deve avançar na discussão do tema, de modo a se estabelecer balizas seguras que resultem em práticas de promoção da equidade necessária à concretização do direito à saúde, capazes de produzir a melhoria objetiva de indicadores de saúde, bem como da percepção do cidadão com relação à satisfação com seu próprio estado de saúde, o de sua família e o da comunidade a que pertence. Assim sendo, o ideal de um sistema de saúde capaz de garantir o necessário a todos, levando-se em conta suas singularidades e necessidades, poderá ser atingido. Palavras-chave: Equidade; Equidade em Saúde; Sistema Único de Saúde.

Summary Background The COVID‐19 pandemic lead scientists and governmental authorities to issue clinical and public health recommendations based on progressively emerging evidence and expert opinions and many of these fast‐tracked to peer‐reviewed publications. Concerns were raised on scientific quality and generalizability of this emerging evidence. Main argument However, this way acting is not entirely new and often public health decisions are based on flawed and ambiguous evidence. Thus, to better guide decisions in these circumstances, in this article we argue that there is a need to follow fundamental principles in order to guide best public health practices. We purpose the usefulness of the framework of principalism in public which has been proved useful in real life conditions as a guide in the absence of reliable evidence. Conclusions It is recommended the implementation of these principles in an integrated manner adopting an holistic system approach to health policies adapted to specificities of local contexts.

The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries’ progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1‐year‐olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year‐to‐year decrease in new HCV‐ and HBV‐related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.