Are Populist Leaders Creating the Conditions for the Spread of COVID-19? Comment on "A Scoping Review of Populist Radical Right Parties' Influence on Welfare Policy and its Implications for Population Health in Europe"

Meeting the challenges of the 21st century: the fundamental importance of trust for transformation

BACKGROUND

This paper is one of a collection on challenges facing health systems in the future. One obvious challenge is how to transform to meet changing health needs and take advantage of emerging treatment opportunities. However, we argue that effective transformations are only possible if there is trust in the health system.

MAIN BODY

We focus on three of the many relationships that require trust in health systems, trust by patients and the public, by health workers, and by politicians. Unfortunately, we are seeing a concerning loss of trust in these relationships and, for too long, the importance of trust to health policymaking and health system functioning has been overlooked and under-valued. We contend that trust must be given the attention, time, and resources it warrants as an indispensable element of any health system and, in this paper, we review why trust is so important in health systems, how trust has been thought about by scholars from different disciplines, what we know about its place in health systems, and how we can give it greater prominence in research and policy.

CONCLUSION

Trust is essential if health systems are to meet the challenges of the 21st century but it is too often overlooked or, in some cases, undermined.

The impact of corona populism: Empirical evidence from Austria and theory

I study the co-evolution between public opinion and party policy in situations of crises by investigating a policy U-turn of a major Austrian right-wing party (FPÖ) during the Covid-19 pandemic. My analysis suggests the existence of both i) a "Downsian" effect, which causes voters to adapt their party preferences based on policy congruence and ii) a "party identification" effect, which causes partisans to realign their policy preferences based on "their" party's platform. Specifically, I use individual-level panel data to show that i) "corona skeptical" voters who did not vote for the FPÖ in the pre-Covid-19 elections of 2019 were more likely to vote for the party after it embraced "corona populism", and ii) beliefs of respondents who declared that they voted for the FPÖ in 2019 diverged from the rest of the population in three out of four health-related dimensions only after the turn, causing them to underestimate the threat posed by Covid-19 compared to the rest of the population. Using aggregate-level panel data, I study whether the turn has produced significant behavioral differences which could be observed in terms of reported cases and deaths per capita. Paradoxically, after the turn the FPÖ vote share is significantly positively correlated with deaths per capita, but not with the reported number of infections. I hypothesize that this can be traced back to a self-selection bias in testing, which causes a correlation between the number of "corona skeptics" and the share of unreported cases after the turn. I find empirical support for this hypothesis in individual-level data from a Covid-19 prevalence study that involves information about participants' true vs. reported infection status. I finally study a simple heterogeneous mixing epidemiological model and show that a testing bias can indeed explain the apparent paradox of an increase in deaths without an increase in reported cases. My results can, among others, be used to enrich formal analyses regarding the co-evolution between voter and party behavior.

"Won't get fooled again": statistical fault detection in COVID-19 Latin American data

BACKGROUND

Claims of inconsistency in epidemiological data have emerged for both developed and developing countries during the COVID-19 pandemic.

METHODS

In this paper, we apply first-digit Newcomb-Benford Law (NBL) and Kullback-Leibler Divergence (KLD) to evaluate COVID-19 records reliability in all 20 Latin American countries. We replicate country-level aggregate information from Our World in Data.

RESULTS

We find that official reports do not follow NBL's theoretical expectations (n = 978; chi-square = 78.95; KS = 4.33, MD = 2.18; mantissa = .54; MAD = .02; DF = 12.75). KLD estimates indicate high divergence among countries, including some outliers.

CONCLUSIONS

This paper provides evidence that recorded COVID-19 cases in Latin America do not conform overall to NBL, which is a useful tool for detecting data manipulation. Our study suggests that further investigations should be made into surveillance systems that exhibit higher deviation from the theoretical distribution and divergence from other similar countries.

Comorbidities, sociodemographic factors, and determinants of health on COVID-19 fatalities in the United States

Previous studies have evaluated comorbidities and sociodemographic factors individually or by type but not comprehensively. This study aims to analyze the influence of a wide variety of factors in a single study to better understand the big picture of their effects on case-fatalities. This cross-sectional study used county-level comorbidities, social determinants of health such as income and race, measures of preventive healthcare, age, education level, average household size, population density, and political voting patterns were all evaluated on a national and regional basis. Analysis was performed through Generalized Additive Models and adjusted by the COVID-19 Community Vulnerability Index (CCVI). Effect estimates of COVID-19 fatality rates for risk factors such as comorbidities, sociodemographic factors and determinant of health. Factors associated with reducing COVID-19 fatality rates were mostly sociodemographic factors such as age, education and income, and preventive health measures. Obesity, minimal leisurely activity, binge drinking, and higher rates of individuals taking high blood pressure medication were associated with increased case fatality rate in a county. Political leaning influenced case case-fatality rates. Regional trends showed contrasting effects where larger household size was protective in the Midwest, yet harmful in Northeast. Notably, higher rates of respiratory comorbidities such as asthma and chronic obstructive pulmonary disease (COPD) diagnosis were associated with reduced case-fatality rates in the Northeast. Increased rates of chronic kidney disease (CKD) within counties were often the strongest predictor of increased case-fatality rates for several regions. Our findings highlight the importance of considering the full context when evaluating contributing factors to case-fatality rates. The spectrum of factors identified in this study must be analyzed in the context of one another and not in isolation.

The Fallout of Catastrophic Technogenic Emissions of Toxic Gases Can Negatively Affect Covid-19 Clinical Course

The coronavirus D-19 (Covid-19) pandemic has shaken almost every country in the world: as we stand, 6,3 million deaths from the infection have already been recorded, 167,000 and 380,000 of which are in Italy and the Russian Federation, respectively. In the first wave of the pandemic, Italy suffered an abnormally high death toll. A detailed analysis of available epidemiological data suggests that that rate was shockingly high in the Northern regions and in Lombardy, in particular, whilst in the southern region the situation was less dire. This inexplicably high mortality rate in conditions of a very well-developed health care system such as the one in Lombardy - recognized as one of the best in Italy - certainly cries for a convincing explanation. In 1976, the small city of Seveso, Lombardy, experienced a release of dioxin into the atmosphere after a massive technogenic accident. The immediate effects of the industrial disaster did not become apparent until a surge in the number of tumors in the affected population in the subsequent years. In this paper, we endeavor to prove our hypothesis that the release of dioxin was a negative cofactor that contributed to a worsening of the clinical course of COVID-19 in Lombardy.

Experts vs. policymakers in the COVID-19 policy response

We build an evolutionary game-theoretic model of the interaction between policymakers and experts in shaping the policy response to the COVID-19 pandemic. Players' decisions concern two alternative strategies of pandemic management: a "hard" approach, enforcing potentially unpopular measures such as strict confinement orders, and a "soft" approach, based upon voluntary and short-lived social distancing. Policymakers' decisions may also rely upon expert advice. Unlike experts, policymakers are sensitive to a public consensus incentive that makes lifting restrictions as soon as possible especially desirable. This incentive may conflict with the overall goal of mitigating the effects of the pandemic, leading to a typical policy dilemma. We show that the selection of strategies may be path-dependent, as their initial distribution is a crucial driver of players' choices. Contingent on cultural factors and the epidemiological conditions, steady states in which both types of players unanimously endorse the strict strategy can coexist with others where experts and policymakers agree on the soft strategy, depending on the initial conditions. The model can also lead to attractive asymmetric equilibria where experts and policymakers endorse different strategies, or to cyclical dynamics where the shares of adoption of strategies oscillate indefinitely around a mixed strategy equilibrium. This multiplicity of equilibria can explain the coexistence of contrasting pandemic countermeasures observed across countries in the first wave of the outbreak. Our results suggest that cross-country differences in the COVID-19 policy response need not be the effect of poor decision making. Instead, they can endogenously result from the interplay between policymakers and experts incentives under the local social, cultural and epidemiological conditions.

Right-Wing Populism, Social Identity Theory, and Resistance to Public Health Measures During the COVID-19 Pandemic

Many western democracies experienced significant resistance to public health measures designed to curb the spread of the COVID-19 virus. Although there were complex reasons for this resistance, right-wing populist forces seem to have played a significant role in fueling it. Studies show a strong correlation between right-wing populist support and resistance to COVID-19-mitigating measures including vaccination, and those who supported these populist movements were more likely to suffer and die from the virus. The question thus arises: why do people support these movements which openly undermine their own health interests? This paper addresses this question from a social-psychological perspective. Specifically, it draws on social identity theory to explain the considerable success of right-wing populism’s radical anti-health agenda and to offer some suggestions about how this negative influence may be countered.

Inequalities in the disruption of paid work during the Covid-19 pandemic: A world systems analysis of core, semi-periphery, and periphery states

This article reveals the extent of international inequalities in the immediate impact of the COVID-19 pandemic on participation in paid work. Drawing on World Systems Theory (WST) and a novel quasi-experimental analysis of nationally representative household panel surveys across 20 countries, the study finds a much sharper increase in the likelihood of dropping out of paid work in semi-periphery and periphery states relative to core states. We establish a causal link between such international disparities and the early trajectories of state interventions in the labor market. Further analysis demonstrates that within all three world systems delayed, less stringent interventions in the labor market were enabled by right-wing populism but mitigated by the strength of active labor market policies and collective bargaining.

Political Populism, Institutional Distrust and Vaccination Uptake: A Mediation Analysis

Politics is ubiquitous in public health, but vaccines had never been weaponized to instill distrust to gain political advantage. In pandemic and post-pandemic scenarios, populist political parties could use vaccine-related issues to generate distrust in evidence-based knowledge. Therefore, some questions arise. What impact could populist political parties impinge on vaccination uptake rates through sowing political discontent? What could the medical institutions do to avoid the adverse effects that these political strategies could infringe? For answering these research questions, we first hypothesized that vaccine uptake was negatively associated with distrust in the institutions. Furthermore, we analyzed whether populism mediates this relationship. In doing so, we hypothesized a positive association between distrust and populism, because populists, mainly fueled by politically discontent citizens, offer hope of a better future, blaming their misfortune on the actions of the elite. Additionally, we hypothesized that those citizens with a higher level of political dissatisfaction, following the claims of the populist political parties, will have lower vaccine uptake results, because they will be discouraged from making the efforts to counter the pandemic. Based on a survey carried out by the European Commission that covered 27 E.U. + U.K. countries (totaling 27,524 respondents), this paper proves that an individual’s political discontent fully mediates the relationship between distrust in institutions and vaccine uptake. Targeting the vaccine-hesitant population is quite convenient for populists because they only need to convince a minority of citizens not to be vaccinated to achieve their destabilizing goals. New outbreaks will appear if the minimum herd immunity coverage is not reached, reinforcing a vicious circle of distrust in elites, in consequence. For tackling this matter, recommendations are given to institutional managers from a social marketing standpoint.

Miasmas, mental models and preventive public health: some philosophical reflections on science in the COVID-19 pandemic

When the history of the COVID-19 pandemic is written, it is likely to show that the mental models held by scientists sometimes facilitated their thinking, thereby leading to lives saved, and at other times constrained their thinking, thereby leading to lives lost. This paper explores some competing mental models of how infectious diseases spread and shows how these models influenced the scientific process and the kinds of facts that were generated, legitimized and used to support policy. A central theme in the paper is the relative weight given by dominant scientific voices to probabilistic arguments based on experimental measurements versus mechanistic arguments based on theory. Two examples are explored: the cholera epidemic in nineteenth century London-in which the story of John Snow and the Broad Street pump is retold-and the unfolding of the COVID-19 pandemic in 2020 and early 2021-in which the evidence-based medicine movement and its hierarchy of evidence features prominently. In each case, it is shown that prevailing mental models-which were assumed by some to transcend theory but were actually heavily theory-laden-powerfully shaped both science and policy, with fatal consequences for some.

When Covid-19 first struck: Analysis of the influence of structural characteristics of countries - technocracy is strengthened by open democracy

Context

The Covid-19 pandemic hit the developed world differentially due to accidental factors, and countries had to respond rapidly within existing resources, structures, and processes to manage totally new health challenges. This study aimed to identify which pre-existing structural factors facilitated better outcomes despite different starting points, as understanding of the relative impact of structural aspects should facilitate achieving optimal forward progress.

Methods

Desk study, based on selecting and collecting a range of measures for 48 representative characteristics of 42 countries’ demography, society, health system, and policy-making profiles, matched to three pandemic time points. Different analytic approaches were employed including correlation, multiple regression, and cluster analysis in order to seek triangulation.

Findings

Population structure (except country size), and volume and nature of health resources, had only minor links to Covid impact. Depth of social inequality, poverty, population age structure, and strength of preventive health measures unexpectedly had no moderating effect. Strongest measured influences were population current enrolment in tertiary education, and country leaders’ strength of seeking scientific evidence. The representativeness, and by interpretation the empathy, of government leadership also had positive effects.

Conclusion

Strength of therapeutic health system, and indeed of preventive health services, surprisingly had little correlation with impact of the pandemic in the first nine months measured in death- or case-rates. However, specific political system features, including proportional representation electoral systems, and absence of a strong single party majority, were consistent features of the most successful national responses, as was being of a small or moderate population size, and with tertiary education facilitated. It can be interpreted that the way a country was lead, and whether leadership sought evidence and shared the reasoning behind resultant policies, had notable effects. This has significant implications within health system development and in promoting the population’s health.

Macro level influences on strategic responses to the COVID-19 pandemic - an international survey and tool for national assessments

BACKGROUND

Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning.

METHODS

A cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains - Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks.

RESULTS

928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains.

CONCLUSIONS

The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.

The politics of Covid-19 vaccine confidence

In the context of emerging COVID-19 virus variants, trends of vaccine nationalism, and multiple vaccine supply challenges, COVID-19 vaccine related uncertainties and challenges continue. Additionally, confidence in new COVID-19 vaccines is highly variable, with minority communities generally less trusting of not only the new vaccines, but also those who produce them and the governments buying and recommending them. How governments handle the COVID-19 response will be a key influencer of public confidence in and acceptance of COVID vaccination.

Our Postpandemic World: What Will It Take to Build a Better Future for People and Planet?

Policy Points Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will work to ensure that the future aligns with their interests. A flourishing world needs strong and equitable structures and systems, including strengthened democratic, research, and educational institutions, supported by ideas and discourses that are free of opaque and conflicted influence and that challenge the status quo and inequitable distribution of power.

Explaining covid-19 performance: what factors might predict national responses?

Correspondence to: F Baum fran.baum@flinders.edu.au Fran Baum and colleagues discuss the factors that affected prediction of the success of national responses to covid-19 and will influence future pandemic preparedness

What can we learn from Israel's rapid roll out of COVID 19 vaccination?

Israel has led the world in rolling out its COVID-19 vaccination program. This experience provides lessons that others can learn from. It is, however, necessary to consider some national specificities, including the small size of the country, its young population, and the political imperative to drive this program forward. Israel also has a number of other advantages, including a strong public health infrastructure. The lessons that can be learnt include the importance of coordinating delivery mechanisms with the inevitable prioritisation of groups within the population, timely deployment of a skilled cadre of health workers, a recognition that not everyone in the population shares in the benefits of digital connectedness, the need to reach out to disadvantaged groups, based on an understanding of the barriers that they face, and the importance of placing COVID-19 vaccination within a comprehensive response to the pandemic.

Learning from past pandemic governance: Early response and Public-Private Partnerships in testing of COVID-19 in South Korea

How can political elites learn from the past to enhance sustainability of their leadership in a pandemic situation? In this article, we develop a theoretical framework of policy implementation that combines collaboration from public and private sectors ("Public-Private Partnership," or PPP) to efficiently deal with urgent crises such as COVID-19. We explain the role of new institutions prompted by policy failure precedence (Time 1) that at a later time period (Time 2) allow for the activation of PPPs with the aim to extend the political life of incumbent leaderships. Specifically, we examine the case of South Korea, a country in which a prior case of MERS in 2015 (Time 1) had established new policies for pandemic governance. In 2020, such policies were activated by the incumbent leadership in order to contain COVID-19 (Time 2). In particular, for swift and effective management of the pandemic, the South Korean government utilized partnerships with the private sector to exponentially increase the amount of Real-Time Polymerase Chain Reaction (RT-PCR) testing. We apply Policy Feedback Theory to demonstrate the political effects of failed policy precedents and how the political outcomes again shape new policies in a dynamic and cyclical manner. Empirically, we conduct a content analysis of South Korea's pharmaceutical sector in government procurement and exports of test-kits during the COVID-19 pandemic. We show that as the pandemic situation progressed, South Korea's leader, who had been in danger of plummeting support to the extent that impeachment was discussed as a viable option, drastically shifted public opinion to achieve a landslide victory in general elections in April 2020. Our findings suggest that democratic governments, aware of precedents and wary of their fate in elections, are pressured to perform well in crisis management, and thus turn to rapidly mobilizing public and private means for survival. Such means are evidenced by the case of emergency use authorization (EUA) process for test-kits, in which "leapfrogging players" - up-and-coming innovators - that contribute to turning a pandemic crisis into an opportunity for sustainable leadership and for themselves.

When Politics Meets Pandemic: How Prime Minister Netanyahu and a Small Team Communicated Health and Risk Information to the Israeli Public During the Early Stages of COVID-19

BACKGROUND

The coronavirus brought the world's leaders to the center of the media stage, where they not only managed the COVID-19 pandemic but also communicated it to the public. The means they used to communicate the global pandemic reveal their strategies and the narratives they chose to create in their nation's social consciousness. In Israel, the crisis broke out after three election cycles, such that the government in charge of the crisis was an interim government under the leadership of Prime Minister Benjamin Netanyahu, who was operating under three criminal indictments. This study sought to examine the ways in which Prime Minister Netanyahu and two senior Israel Ministry of Health officials-Director General Moshe Bar Siman Tov and Prof. Sigal Sadetsky, Head of Public Health Services-communicated information about the health crisis in Israel during what has been termed the first wave and the beginning of the second wave.

METHODS AND SAMPLE

The research adopted qualitative methods (discourse, content and thematic analysis) to analyze the communication strategies and compare them to health and risk communication. Triangulated data collection from different data sources was used to increase the credibility and validity of the results. The research sample comprised the following sources from March 3 through June 21, 2020: transcripts of 19 press conferences and 12 press interviews, 95 emergency regulations signed by Prime Minister Netanyahu, and 52 articles in major Israeli newspapers.

RESULTS

Netanyahu and the Health Ministry Director General used an apocalyptic narrative to communicate COVID-19 to the public. The main strategies used in constructing this narrative were intimidation, lack of information transparency, giving the public conflicting instructions contrary to the health and risk communicating approach, and using a health crisis to promote political intentions and actions.

CONCLUSION

Communicating health crises to the public, particularly ongoing crises like COVID-19, requires that leaders implement the health and risk communication approach and create a cooperative narrative that does not rely on a strategy of intimidation, but rather on empathy and on fact-based and transparent information.

Comparison of Deaths Rates for COVID-19 across Europe During the First Wave of the COVID-19 Pandemic

Background: Europe overall suffered greatly in the early stages of the COVID-19 pandemic but the impact of different countries varied. Italy was in the forefront, but there too there were differences, with the Lombardy region the epicentre of the pandemic. Methods: We report Crude Mortality Rates (CMRs) from deaths reported as due to COVID-19 and, in five countries where age-specific data are available, Standardized Mortality Rates (SMRs) in the European Union and United Kingdom. Results: As of 30th August 2020, Belgium was the country with the highest cumulative CMR (86.3/100,000), but the Lombardy region reached almost double this figure (167.6/100,000), far ahead of the corresponding figure for the rest of Italy at 37.0/100,000. SMRs could be calculated for five countries (Italy, Portugal, Sweden, Germany, and Netherlands). Among them, Sweden had the highest SMR (61.6/100,000). The corresponding figures for Italy, Netherlands, Portugal and Germany were 50.2, 41.4, 15.9, and 10.1 per 100,000, respectively. Conclusion: It is clear that countries within Europe have performed very differently in their responses to the COVID-19 pandemic, but the many limitations in the available data must be addressed before a definitive assessment of the reasons for these differences can be made.

Science unites a troubled world: Lessons from the pandemic

European Journal of Pharmacology has published a special issue entitled Therapeutic targets and pharmacological treatment of COVID-19 that contains more than 30 manuscripts. Scientists from around the world contributed both review articles and original manuscripts that are remarkable in their diversity. Each contribution offers a unique perspective on the current approaches of the discipline called pharmacology. Yet the contributions share an enthusiasm to put forward a fresh viewpoint and make a positive difference by the exchange of ideas during the troubled times of this pandemic. What other enterprise but science can unite so many diverse cultures and nationalities in global uncertainty and discord, and mobilize an effective response against a common enemy. The efforts of science are in stark contrast to those of populism that has introduced division and a self-serving attitude that are not simply ill-matched to tackle the pandemic, but foster its spread and severity. We trust that the readers of European Journal of Pharmacology will discover new ideas and concepts in our special COVID-19 series as members of the scientific community and shared world.