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Lee J, Park S, Jang SN, Reyes KA, Garcia F, Canila C, Oraño J, Ballesteros AJ, Muhartini T, Frans S, Marthias T, Putri LP, Mahendradhata Y, De Foo C. Differential impacts of health systems and sociocultural environment on vulnerable populations during the COVID-19 pandemic: lessons from four Asia-Pacific countries. BMC Public Health 2024; 24:1501. [PMID: 38840230 DOI: 10.1186/s12889-024-18949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND This study aims to evaluate healthcare systems and pandemic responses in relation to marginalized and vulnerable groups, identify populations requiring urgent care, and assess the differential impacts on their health during the pandemic. METHODS Data were collected by the Asia-Pacific Observatory on Health Systems and Policies (APO)-National University of Singapore and APO-International Health Policy Program consortium members: Korea, Indonesia, Philippines, and Singapore. Data were collected through a combination of semi-structured interviews, policy document reviews, and analysis of secondary data. RESULTS Our findings reveal that the pandemic exacerbated existing health disparities, particularly affecting older adults, women, and children. Additionally, the study identified LGBTI individuals, healthcare workers, slum dwellers, and migrant workers as groups that faced particularly severe challenges during the pandemic. LGBTI individuals encountered heightened discrimination and limited access to health services tailored to their needs. Healthcare workers suffered from immense stress and risk due to prolonged exposure to the virus and critical working conditions. Slum dwellers struggled with healthcare access and social distancing due to high population density and inadequate sanitation. Migrant workers were particularly hard hit by high risks of virus transmission and stringent, often discriminatory, isolation measures that compounded their vulnerability. The study highlights the variation in the extent and nature of vulnerabilities, which were influenced by each country's specific social environment and healthcare infrastructure. It was observed that public health interventions often lacked the specificity required to effectively address the needs of all vulnerable groups, suggesting a gap in policy and implementation. CONCLUSIONS The study underscores that vulnerabilities vary greatly depending on the social environment and context of each country, affecting the degree and types of vulnerable groups. It is critical that measures to ensure universal health coverage and equal accessibility to healthcare are specifically designed to address the needs of the most vulnerable. Despite commonalities among groups across different societies, these interventions must be adapted to reflect the unique characteristics of each group within their specific social contexts to effectively mitigate the impact of health disparities.
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Affiliation(s)
- Jakyung Lee
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
- Hyo-tree nursing home, Incheon, Republic of Korea
| | - Susan Park
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea
- Seoul National University, Seoul, Republic of Korea
| | - Soong-Nang Jang
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea.
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea.
| | | | - Fernando Garcia
- College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Carmelita Canila
- College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Joseph Oraño
- Alliance for Improving Health Outcomes, Quezon City, Philippines
| | | | - Tri Muhartini
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Depok, Indonesia
| | - Sandra Frans
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Depok, Indonesia
| | - Tiara Marthias
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Depok, Indonesia
| | - Likke Prawidya Putri
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Depok, Indonesia
| | - Yodi Mahendradhata
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Depok, Indonesia
| | - Chuan De Foo
- NUS Saw Swee Hock School of Public Health and National University Health System, Singapore, Singapore
- Duke NUS Graduate Medical School, Singapore, Singapore
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2
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Kim S, Headley TY, Tozan Y. The synergistic impact of Universal Health Coverage and Global Health Security on health service delivery during the Coronavirus Disease-19 pandemic: A difference-in-difference study of childhood immunization coverage from 192 countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003205. [PMID: 38728349 PMCID: PMC11086828 DOI: 10.1371/journal.pgph.0003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 04/12/2024] [Indexed: 05/12/2024]
Abstract
Universal Health Coverage (UHC) and Global Health Security (GHS) are two high-priority global health agendas that seek to foster health system resilience against health emergencies. Many countries have had to prioritize one agenda over the other due to scarce resources and political pressures. To aid policymakers' decision-making, this study investigated the individual and synergistic effects of countries' UHC and GHS capacities in safeguarding essential health service delivery during the COVID-19 pandemic. We used a quasi-experimental difference-in-difference methodology to quantify the relationship between 192 countries' progress towards UHC and GHS and those countries' abilities to provide 12 essential childhood immunization services between 2015 and 2021. We used the 2019 UHC Service Coverage Index (SCI) to divide countries into a "high UHC group" (UHC SCI≥75) and the rest (UHC SCI 75), and similarly used the 2019 GHS Index (GHSI) to divide countries into a "high GHS group" (GHSI≥65) and the rest (GHSI<65). All analyses were adjusted for potential confounders. Countries with high UHC scores prevented a 1.14% (95% CI: 0.39%, 1.90%) reduction in immunization coverage across 2020 and 2021 whereas countries with high GHSI scores prevented a 1.10% (95% CI: 0.57%, 1.63%) reduction in immunization coverage over the same time period. The stratified DiD models showed that across both years, high UHC capacity needed to be augmented with high GHS capacity to prevent a decline in immunization coverage while high GHS alone was able to safeguard immunization coverage. This study found that greater progress towards both UHC and GHS capacities safeguarded essential health service delivery during the pandemic but only progress towards GHS capacity was both a necessary and likely sufficient element for yielding this protective effect. Our results call for strategic investments into both health agendas and future research into possible synergistic effects of the two health agendas.
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Affiliation(s)
- Sooyoung Kim
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York, United States of America
| | | | - Yesim Tozan
- Department of Global and Environmental Health, School of Global Public Health, New York University, New York, New York, United States of America
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Kufoof L, Hajjeh R, Al Nsour M, Saad R, Bélorgeot V, Abubakar A, Khader Y, Rawaf S. Learning From COVID-19: What Would It Take to Be Better Prepared in the Eastern Mediterranean Region? JMIR Public Health Surveill 2024; 10:e40491. [PMID: 38359418 PMCID: PMC10871069 DOI: 10.2196/40491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/24/2023] [Accepted: 11/21/2023] [Indexed: 02/17/2024] Open
Abstract
The COVID-19 transmission in the Eastern Mediterranean Region (EMR) was influenced by various factors such as conflict, demographics, travel and social restrictions, migrant workers, weak health systems, and mass gatherings. The countries that responded well to COVID-19 had high-level political commitment, multisectoral coordination, and existing infrastructures that could quickly mobilize. However, some EMR countries faced challenges due to political instability and fragile health systems, which hindered their response strategies. The pandemic highlighted the region's weak health systems and preparedness, fragmented surveillance systems, and lack of trust in information sharing. COVID-19 exposed the disruption of access and delivery of essential health services as a major health system fragility. In 2020, the World Health Organization (WHO) conducted a global pulse survey, which demonstrated that the EMR experienced the highest disruption in health services compared to other WHO regions. However, thanks to prioritization by the WHO and its member states, significant improvement was observed in 2021 during the second round of the WHO's National Pulse Survey. The pandemic underscored the importance of political leadership, community engagement, and trust and emphasized that investing in health security benefits everyone. Increasing vaccine coverage, building regional capacities, strengthening health systems, and working toward universal health coverage and health security are all priorities in the EMR. Emergency public health plays a key role in preparing for and responding to pandemics and biological threats. Integrating public health into primary care and investing in public health workforce capacity building is essential to reshaping public health and health emergency preparedness.
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Affiliation(s)
- Lara Kufoof
- Project Management Office, Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Rana Hajjeh
- Department of Program Management, Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Mohannad Al Nsour
- Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Randa Saad
- Department of Research and Policy, Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Victoria Bélorgeot
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Abdinasir Abubakar
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Yousef Khader
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Salman Rawaf
- Department of Primary Care and Public Health, School of Public Health at Imperial College London, London, United Kingdom
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4
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Boyce MR. State-level public health preparedness indices as predictors of COVID-19 mortality outcomes: results from the United States of America in 2020. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1229718. [PMID: 38455903 PMCID: PMC10910973 DOI: 10.3389/fepid.2023.1229718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/24/2023] [Indexed: 03/09/2024]
Abstract
This study evaluates associations between state-level preparedness indices and reported COVID-19-related mortality outcomes in all 50 states and the District of Columbia in the United States of America during three distinct time periods throughout the first year of the COVID-19 pandemic. State-level preparedness data for the year 2019 were gathered from the National Health Security Preparedness and Trust for America's Health Indices, and COVID-19-related mortality data for March-December 2020 (i.e., excess mortality and reported COVID-19 mortality rates) were collected in May 2022. Linear regression analyses were conducted to examine associations during three distinct time periods. Statistically significant positive associations were observed between both indices and reported COVID-19 mortality rates during the first time period. A statistically significant negative association was observed between one preparedness index and excess mortality during the second time period. No other significant associations existed for the outcomes or time periods considered in this analysis. These results demonstrate that state-level preparedness indices were not well attuned to COVID-19-related mortality outcomes during the first year of the pandemic. This suggests that current measures of state-level preparedness may be underinclusive and require a reconceptualization to improve their utility for public health practice.
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Affiliation(s)
- Matthew R. Boyce
- Center for Global Health Science & Security, Georgetown University, Washington, DC, United States
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5
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da Silva RE, Novaes MRCG, de Oliveira C, Guilhem DB. National governance and excess mortality due to COVID-19 in 213 countries: a retrospective analysis and perspectives on future pandemics. Global Health 2023; 19:80. [PMID: 37907968 PMCID: PMC10619274 DOI: 10.1186/s12992-023-00982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND National governance may have influenced the response of institutions to the Covid-19 pandemic, being a key factor in preparing for the next pandemics. The objective was to analyze the association between excess mortality due to COVID-19 (daily and cumulative per 100 thousand people) and national governance indicators in 213 countries. METHOD Multiple linear regression models using secondary data from large international datasets that are in the public domain were performed. Governance indicators corresponded to six dimensions: (i) Voice and Accountability; (ii) Political Stability and Absence of Violence/Terrorism; (iii) Government Effectiveness; (iv) Regulatory Quality; (v) Rule of Law and (vi) Control of Corruption. The statistical analysis consisted of adjusting a multiple linear regression model. Excess mortality due to COVID-19 was adjusted for potential confounding factors (demographic, environmental, health, economic, and ethnic variables). RESULTS The indicators Control of Corruption, Government Effectiveness, Regulatory Quality and Rule of Law had a significant inverse association (p < 0.0001) with the estimated excess mortality in 2020, 2021 and 2022. Furthermore, the governance indicators had a direct significant association (p < 0.0001) with the vaccination variables (People_fully_vaccinated; Delivered population; The total number of vaccination doses administered per 100 people at the country level), except for the variables Vaccination policies and Administration of first dose, which were inversely associated. In countries with better governance, COVID-19 vaccination was initiated earlier. CONCLUSION Better national governance indicators were associated with lower excess mortality due to COVID-19 and faster administration of the first dose of the COVID-19 vaccine.
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Affiliation(s)
- Ricardo Eccard da Silva
- Brazilian Health Regulatory Agency - Anvisa, Setor de Indústrias, Trecho 5, Área Especial 57, Brasília-DF, 71205-050, Brazil
- Faculty of Health Sciences, University of Brasília - UnB, Campos Univ. Darcy Ribeiro, Asa Norte, Brasília-DF, 70910-900, Brazil
| | | | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London (UCL), 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Dirce Bellezi Guilhem
- Faculty of Health Sciences, University of Brasília - UnB, Campos Univ. Darcy Ribeiro, Asa Norte, Brasília-DF, 70910-900, Brazil
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6
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Ledesma JR, Isaac CR, Dowell SF, Blazes DL, Essix GV, Budeski K, Bell J, Nuzzo JB. Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure. BMJ Glob Health 2023; 8:e012203. [PMID: 37414431 PMCID: PMC10335545 DOI: 10.1136/bmjgh-2023-012203] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Previous studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials in surveillance system quality and demographics. Here, we address limitations of previous comparisons by exploring country-level relationships between pandemic preparedness measures and comparative mortality ratios (CMRs), a form of indirect age standardisation, of excess COVID-19 mortality. METHODS We indirectly age standardised excess COVID-19 mortality, from the Institute for Health Metrics and Evaluation modelling database, by comparing observed total excess mortality to an expected age-specific COVID-19 mortality rate from a reference country to derive CMRs. We then linked CMRs with data on country-level measures of pandemic preparedness from the Global Health Security (GHS) Index. These data were used as input into multivariable linear regression analyses that included income as a covariate and adjusted for multiple comparisons. We conducted a sensitivity analysis using excess mortality estimates from WHO and The Economist. RESULTS The GHS Index was negatively associated with excess COVID-19 CMRs (table 2; β= -0.21, 95% CI= -0.35 to -0.08). Greater capacities related to prevention (β= -0.11, 95% CI= -0.22 to -0.00), detection (β= -0.09, 95% CI= -0.19 to -0.00), response (β = -0.19, 95% CI= -0.36 to -0.01), international commitments (β= -0.17, 95% CI= -0.33 to -0.01) and risk environments (β= -0.30, 95% CI= -0.46 to -0.15) were each associated with lower CMRs. Results were not replicated using excess mortality models that rely more heavily on reported COVID-19 deaths (eg, WHO and The Economist). CONCLUSION The first direct comparison of COVID-19 excess mortality rates across countries accounting for under-reporting and age structure confirms that greater levels of preparedness were associated with lower excess COVID-19 mortality. Additional research is needed to confirm these relationships as more robust national-level data on COVID-19 impact become available.
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Affiliation(s)
- Jorge Ricardo Ledesma
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Scott F Dowell
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - David L Blazes
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | | | | | - Jennifer B Nuzzo
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Pandemic Center, Brown University School of Public Health, Providence, Rhode Island, USA
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7
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Gallo-Cajiao E, Lieberman S, Dolšak N, Prakash A, Labonté R, Biggs D, Franklin C, Morrison TH, Viens AM, Fuller RA, Aguiar R, Fidelman P, Watson JEM, Aenishaenslin C, Wiktorowicz M. Global governance for pandemic prevention and the wildlife trade. Lancet Planet Health 2023; 7:e336-e345. [PMID: 37019574 PMCID: PMC10069821 DOI: 10.1016/s2542-5196(23)00029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/04/2022] [Accepted: 02/10/2023] [Indexed: 06/19/2023]
Abstract
Although ideas about preventive actions for pandemics have been advanced during the COVID-19 crisis, there has been little consideration for how they can be operationalised through governance structures within the context of the wildlife trade for human consumption. To date, pandemic governance has mostly focused on outbreak surveillance, containment, and response rather than on avoiding zoonotic spillovers in the first place. However, given the acceleration of globalisation, a paradigm shift towards prevention of zoonotic spillovers is warranted as containment of outbreaks becomes unfeasible. Here, we consider the current institutional landscape for pandemic prevention in light of ongoing negotiations of a so-called pandemic treaty and how prevention of zoonotic spillovers from the wildlife trade for human consumption could be incorporated. We argue that such an institutional arrangement should be explicit about zoonotic spillover prevention and focus on improving coordination across four policy domains, namely public health, biodiversity conservation, food security, and trade. We posit that this pandemic treaty should include four interacting goals in relation to prevention of zoonotic spillovers from the wildlife trade for human consumption: risk understanding, risk assessment, risk reduction, and enabling funding. Despite the need to keep political attention on addressing the current pandemic, society cannot afford to miss the opportunity of the current crisis to encourage institution building for preventing future pandemics.
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Affiliation(s)
- Eduardo Gallo-Cajiao
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA, USA.
| | | | - Nives Dolšak
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA, USA
| | - Aseem Prakash
- Center for Environmental Politics, Department of Political Science, Seattle, WA, USA
| | - Ronald Labonté
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Duan Biggs
- School of Earth and Sustainability, Northern Arizona University, Flagstaff, AZ, USA; Resilient Conservation, Centre for Planetary Health and Food Security, School of Environment and Science, Griffith University, Nathan, QLD, Australia; Centre for Complex Systems in Transition, Stellenbosch University, Stellenbosch, South Africa
| | | | - Tiffany H Morrison
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Parkville, VIC, Australia; College of Science and Engineering, James Cook University, Townsville, QLD, Australia
| | - A M Viens
- School of Global Health and Global Strategy Lab, York University, Toronto, ON, Canada
| | - Richard A Fuller
- School of Biological Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Raphael Aguiar
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada
| | - Pedro Fidelman
- Centre for Policy Futures, The University of Queensland, Brisbane, QLD, Australia
| | - James E M Watson
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Cécile Aenishaenslin
- Centre de Recherche en Santé Publique, Université de Montréal et du CIUSSS Centre-Sud de l'Île de Montréal, Montreal, QC, Canada; Research Group on Epidemiology of Zoonoses and Public Health, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Mary Wiktorowicz
- Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada
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8
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Smith J, Davies SE, Grépin KA, Harman S, Herten-Crabb A, Murage A, Morgan R, Wenham C. Reconceptualizing successful pandemic preparedness and response: A feminist perspective. Soc Sci Med 2022; 315:115511. [PMID: 36371930 PMCID: PMC9639384 DOI: 10.1016/j.socscimed.2022.115511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/18/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
Pandemic preparedness and COVID-19 response indicators focus on public health outcomes (such as infections, case fatalities, and vaccination rates), health system capacity, and/or the effects of the pandemic on the economy, yet this avoids more political questions regarding how responses were mobilized. Pandemic preparedness country rankings have been called into question due to their inability to predict COVID-19 response and outcomes, and COVID-19 response indicators have ignored one of the most well documented secondary effects of the pandemic - its disproportionate effects on women. This paper analyzes pandemic preparedness and response indicators from a feminist perspective to understand how indicators might consider the secondary effects of the pandemic on women and other equity deserving groups. Following a discussion of the tensions that exist between feminist methodologies and the reliance on indicators by policymakers in preparing and responding to health emergencies, we assess the strengths and weakness of current pandemic preparedness and COVID-19 response indicators. The risk with existing pandemic preparedness and response indicators is that they give only limited attention to secondary effects of pandemics and inequities in terms of who is disproportionately affected. There is an urgent need to reconceptualize what 'successful' pandemic preparedness and response entails, moving beyond epidemiological and economic measurements. We suggest how efforts to design COVID response indicators on gender inclusion could inform pandemic preparedness and associated indicators.
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Affiliation(s)
- Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Simon Fraser University, Blusson Hall 8888 University, Burnaby, BC, Canada.
| | - Sara E Davies
- School of Government and International Relations, Griffith University, 170 Kessels Rd, Nathan, 4111, QLD, Australia
| | - Karen A Grépin
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sophie Harman
- Queen Mary University of London, Mile End Rd, Bethnal Green, London E1 4NS, United Kingdom
| | - Asha Herten-Crabb
- Department of Health Policy, London School of Economics and Political Science, Houghton St, London WC2A 2AE, United Kingdom
| | - Alice Murage
- Faculty of Health Sciences, Simon Fraser University, Simon Fraser University, Blusson Hall 8888 University, Burnaby, BC, Canada
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, Houghton St, London WC2A 2AE, United Kingdom
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9
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Zhao HQ, Fei SW, Yin JX, Li Q, Jiang TG, Guo ZY, Xue JB, Han LF, Zhang XX, Xia S, Zhang Y, Guo XK, Kassegne K. Assessment of performance for a key indicator of One Health: evidence based on One Health index for zoonoses in Sub-Saharan Africa. Infect Dis Poverty 2022; 11:109. [PMID: 36273213 PMCID: PMC9588233 DOI: 10.1186/s40249-022-01020-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/26/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Zoonoses are public health threats that cause severe damage worldwide. Zoonoses constitute a key indicator of One Health (OH) and the OH approach is being applied for zoonosis control programmes of zoonotic diseases. In a very recent study, we developed an evaluation system for OH performance through the global OH index (GOHI). This study applied the GOHI to evaluate OH performance for zoonoses in sub-Saharan Africa. METHODS The framework for the OH index on zoonoses (OHIZ) was constructed including five indicators, 15 subindicators and 28 datasets. Publicly available data were referenced to generate the OHIZ database which included both qualitative and quantitative indicators for all sub-Sahara African countries (n = 48). The GOHI algorithm was used to estimate scores for OHIZ. Indicator weights were calculated by adopting the fuzzy analytical hierarchy process. RESULTS Overall, five indicators associated with weights were generated as follows: source of infection (23.70%), route of transmission (25.31%), targeted population (19.09%), capacity building (16.77%), and outcomes/case studies (15.13%). Following the indicators, a total of 37 sub-Sahara African countries aligned with OHIZ validation, while 11 territories were excluded for unfit or missing data. The OHIZ average score of sub-Saharan Africa was estimated at 53.67/100. The highest score was 71.99 from South Africa, while the lowest score was 40.51 from Benin. It is also worth mentioning that Sub-Sahara African countries had high performance in many subindicators associated with zoonoses, e.g., surveillance and response, vector and reservoir interventions, and natural protected areas, which suggests that this region had a certain capacity in control and prevention or responses to zoonotic events. CONCLUSIONS This study reveals that it is possible to perform OH evaluation for zoonoses in sub-Saharan Africa by OHIZ. Findings from this study provide preliminary research information in advancing knowledge of the evidenced risks to strengthen strategies for effective control of zoonoses and to support the prevention of zoonotic events.
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Affiliation(s)
- Han-Qing Zhao
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China
| | - Si-Wei Fei
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China
| | - Jing-Xian Yin
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China
| | - Qin Li
- National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission of the People's Republic of China (NHC) Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, People's Republic of China
| | - Tian-Ge Jiang
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China
| | - Zhao-Yu Guo
- National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission of the People's Republic of China (NHC) Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, People's Republic of China
| | - Jing-Bo Xue
- National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission of the People's Republic of China (NHC) Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, People's Republic of China
| | - Le-Fei Han
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China
| | - Xiao-Xi Zhang
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China
| | - Shang Xia
- National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission of the People's Republic of China (NHC) Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, People's Republic of China
| | - Yi Zhang
- National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), National Health Commission of the People's Republic of China (NHC) Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, People's Republic of China
| | - Xiao-Kui Guo
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China
| | - Kokouvi Kassegne
- Department of Infectious and Tropical Diseases, School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China. .,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, 200025, People's Republic of China.
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10
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Markovic S, Salom I, Rodic A, Djordjevic M. Analyzing the GHSI puzzle of whether highly developed countries fared worse in COVID-19. Sci Rep 2022; 12:17711. [PMID: 36271249 PMCID: PMC9587258 DOI: 10.1038/s41598-022-22578-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
Global Health Security Index (GHSI) categories are formulated to assess the capacity of world countries to deal with infectious disease risks. Thus, higher values of these indices were expected to translate to lower COVID-19 severity. However, it turned out to be the opposite, surprisingly suggesting that higher estimated country preparedness to epidemics may lead to higher disease mortality. To address this puzzle, we: (i) use a model-derived measure of COVID-19 severity; (ii) employ a range of statistical learning approaches, including non-parametric machine learning methods; (iii) consider the overall excess mortality, in addition to official COVID-19 fatality counts. Our results suggest that the puzzle is, to a large extent, an artifact of oversimplified data analysis and a consequence of misclassified COVID-19 deaths, combined with the higher median age of the population and earlier epidemics onset in countries with high GHSI scores.
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Affiliation(s)
- Sofija Markovic
- grid.7149.b0000 0001 2166 9385Quantitative Biology Group, Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Igor Salom
- grid.7149.b0000 0001 2166 9385Institute of Physics Belgrade, National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Andjela Rodic
- grid.7149.b0000 0001 2166 9385Quantitative Biology Group, Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Marko Djordjevic
- grid.7149.b0000 0001 2166 9385Quantitative Biology Group, Faculty of Biology, University of Belgrade, Belgrade, Serbia
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11
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Dowell SF, Wang H, Blazes D. Better pandemic preparedness does correlate with lower COVID-19 mortality. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13649.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Paradoxically, many countries with strong pandemic preparedness have reported high coronavirus disease 2019 (COVID-19) mortality. After adjusting for country under-reporting by using total excess mortality estimates, and age distributions by using indirect standardization, we find the resulting comparative mortality ratios are predicted by pandemic preparedness. Countries with higher scores on the Global Health Security Index had significantly lower COVID-19 mortality (r(192) = -.32, p<.001). These findings can help inform and prioritize future pandemic preparedness work.
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12
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Lekagul A, Chattong A, Rueangsom P, Waleewong O, Tangcharoensathien V. Multi-dimensional impacts of Coronavirus disease 2019 pandemic on Sustainable Development Goal achievement. Global Health 2022; 18:65. [PMID: 35761400 PMCID: PMC9235167 DOI: 10.1186/s12992-022-00861-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health, social and economic crises triggered by the Coronavirus disease pandemic (COVID-19) can derail progress and achievement of the Sustainable Development Goals. This commentary analyses the complex nexus of multi-dimensional impacts of the pandemic on people, prosperity, planet, partnership and peace. From our analysis, we generate a causal loop diagram explaining these complex pathways and proposed policy recommendations. MAIN TEXT Health systems, health and wellbeing of people are directly affected by the pandemic, while impacts on prosperity, education, food security and environment are indirect consequences from pandemic containment, notably social measures, business and school closures and international travel restrictions. The magnitude of impacts is determined by the level of prior vulnerability and inequity in the society, and the effectiveness and timeliness of comprehensive pandemic responses. CONCLUSIONS To exit the acute phase of the pandemic, equitable access to COVID-19 vaccines by all countries and continued high coverage of face masks and hand hygiene are critical entry points. During recovery, governments should strengthen preparedness based on the One Health approach, rebuild resilient health systems and an equitable society, ensure universal health coverage and social protection mechanisms for all. Governments should review progress and challenges from the pandemic and sustain a commitment to implementing the Sustainable Development Goals.
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Affiliation(s)
- Angkana Lekagul
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand.
| | - Anamika Chattong
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Putthipanya Rueangsom
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Orratai Waleewong
- International Health Policy Program, Ministry of Public Health, Nonthaburi, 11000, Thailand
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