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Ramírez Varela A, Touchton M, Miranda JJ, Grueso JM, Laajaj R, Carrasquilla G, Florez MV, Gaviria AMV, Hoyos AMO, Duarte EOV, Morales AV, Velasco N, Restrepo SR. Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future. Front Public Health 2023; 11:1274737. [PMID: 38094236 PMCID: PMC10716458 DOI: 10.3389/fpubh.2023.1274737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths. Methods This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a mixed-methods sequential explanatory study in four South American countries based on structured interviews and focus groups with elite policy makers. Results The results of our study demonstrate that structural and contextual barriers limited PPR activities at political, social, and economic levels in each country, as well as through the structure of the health care system. Respondents believe that top-level government officials had insufficient political will for prioritizing pandemic PPR and post-COVID-19 recovery programs within their countries' health agendas. Discussion We recommend a regional COVID-19 task force, post-pandemic recovery, social and economic protection for vulnerable groups, improved primary health care and surveillance systems, risk communication strategies, and community engagement to place pandemic PPR on Argentina, Brazil, Colombia, and Peru and other South American countries' national public health agendas.
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Affiliation(s)
| | - Michael Touchton
- Faculty Lead for Global Health, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, United States
| | - J. Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Rachid Laajaj
- Department of Economics, Universidad de los Andes, Bogotá, Colombia
| | | | - Martha Vives Florez
- Department of Biological Sciences, Universidad de los Andes, Bogotá, Colombia
| | | | | | | | | | - Nubia Velasco
- School of Business, Universidad de los Andes, Bogotá, Colombia
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Touchton M, Knaul FM, Arreola-Ornelas H, Porteny T, Carniado ÓM, Faganello M, Hummel C, Otero S, Insua J, Patino F, Undurraga E, Pérez-Cruz P, Sanchez-Talanquer M, Velasco Guachalla VX, Nelson-Nuñez J, Boulding C, Calderon-Anyosa R, Garcia PJ, Vargas Enciso V. Author Correction: Non-pharmaceutical interventions to combat COVID-19 in the Americas described through daily sub-national data. Sci Data 2023; 10:751. [PMID: 37907469 PMCID: PMC10618165 DOI: 10.1038/s41597-023-02670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Affiliation(s)
- Michael Touchton
- Department of Political Science, School of Arts and Sciences, University of Miami, Miami, Florida, USA
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- Tómatelo a Pecho, A.C., Mexico City, Mexico
- Fundación Mexicana para la Salud, A.C., Mexico City, Mexico
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA.
- Tómatelo a Pecho, A.C., Mexico City, Mexico.
- Fundación Mexicana para la Salud, A.C., Mexico City, Mexico.
- Institute for Obesity Research, Tecnológico de Monterrey, Monterrey, Mexico.
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico.
| | - Thalia Porteny
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, New York, USA
| | - Óscar Méndez Carniado
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
- Tómatelo a Pecho, A.C., Mexico City, Mexico
- Institute for Obesity Research, Tecnológico de Monterrey, Monterrey, Mexico
| | - Marco Faganello
- MAF dataScience, Universidade Estadual de Campinas, Campinas, Brazil
| | - Calla Hummel
- Department of Political Science, School of Arts and Sciences, University of Miami, Miami, Florida, USA
| | - Silvia Otero
- Facultad de Estudios Internacionales, Políticos y Urbanos, Universidad del Rosario, Bogotá, Colombia
| | - Jorge Insua
- Health Policy and Management, School of Biomedical Sciences, School of Government, School of Health Care Management, Universidad Austral, Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Eduardo Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro Pérez-Cruz
- Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Nucleus for the Study of the Life Course and Vulnerability, Santiago, Chile
| | | | | | - Jami Nelson-Nuñez
- Department of Political Science, University of New Mexico, Albuquerque, New Mexico, USA
| | - Carew Boulding
- Department of Political Science, University of Colorado, Boulder, Colorado, USA
| | - Renzo Calderon-Anyosa
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Patricia J Garcia
- Universidad Peruana Cayetano Heredia, Lima, San Martin de Porres, Peru
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Touchton M, Knaul FM, Arreola-Ornelas H, Porteny T, Carniado ÓM, Faganello M, Hummel C, Otero S, Insua J, Patino F, Undurraga E, Pérez-Cruz P, Sanchez-Talanquer M, Velasco Guachalla VX, Nelson-Nuñez J, Boulding C, Calderon-Anyosa R, Garcia PJ, Vargas Enciso V. Non-pharmaceutical interventions to combat COVID-19 in the Americas described through daily sub-national data. Sci Data 2023; 10:734. [PMID: 37865630 PMCID: PMC10590388 DOI: 10.1038/s41597-023-02638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
This dataset covers national and subnational non-pharmaceutical interventions (NPI) to combat the COVID-19 pandemic in the Americas. Prior to the development of a vaccine, NPI were governments' primary tools to mitigate the spread of COVID-19. Variation in subnational responses to COVID-19 is high and is salient for health outcomes. This dataset captures governments' dynamic, varied NPI to combat COVID-19 for 80% of Latin America's population from each country's first case through December 2021. These daily data encompass all national and subnational units in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. The dataset includes individual and aggregate indices of nine NPI: school closures, work suspensions, public event cancellations, public transport suspensions, information campaigns, local travel restrictions, international travel controls, stay-at-home orders, and restrictions on the size of gatherings. We also collected data on mask mandates as a separate indicator. Local country-teams drew from multiple data sources, resulting in high-quality, reliable data. The dataset thus allows for consistent, meaningful comparisons of NPI within and across countries during the pandemic.
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Affiliation(s)
- Michael Touchton
- Department of Political Science, School of Arts and Sciences, University of Miami, Miami, Florida, USA
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
- Tómatelo a Pecho, A.C., Mexico City, Mexico
- Fundación Mexicana para la Salud, A.C., Mexico City, Mexico
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA.
- Tómatelo a Pecho, A.C., Mexico City, Mexico.
- Fundación Mexicana para la Salud, A.C., Mexico City, Mexico.
- Institute for Obesity Research, Tecnológico de Monterrey, Monterrey, Mexico.
- School of Government and Public Transformation, Tecnológico de Monterrey, Mexico City, Mexico.
| | - Thalia Porteny
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, New York, USA
| | - Óscar Méndez Carniado
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, USA
- Tómatelo a Pecho, A.C., Mexico City, Mexico
- Institute for Obesity Research, Tecnológico de Monterrey, Monterrey, Mexico
| | - Marco Faganello
- MAF dataScience, Universidade Estadual de Campinas, Campinas, Brazil
| | - Calla Hummel
- Department of Political Science, School of Arts and Sciences, University of Miami, Miami, Florida, USA
| | - Silvia Otero
- Facultad de Estudios Internacionales, Políticos y Urbanos, Universidad del Rosario, Bogotá, Colombia
| | - Jorge Insua
- Health Policy and Management, School of Biomedical Sciences, School of Government, School of Health Care Management, Universidad Austral, Buenos Aires, Argentina
- School of Public Health, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Eduardo Undurraga
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro Pérez-Cruz
- Departamento Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Nucleus for the Study of the Life Course and Vulnerability, Santiago, Chile
| | | | | | - Jami Nelson-Nuñez
- Department of Political Science, University of New Mexico, Albuquerque, New Mexico, USA
| | - Carew Boulding
- Department of Political Science, University of Colorado, Boulder, Colorado, USA
| | - Renzo Calderon-Anyosa
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Patricia J Garcia
- Universidad Peruana Cayetano Heredia, Lima, San Martin de Porres, Peru
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Knaul FM, Arreola-Ornelas H, Touchton M, McDonald T, Blofield M, Avila Burgos L, Gómez-Dantés O, Kuri P, Martinez-Valle A, Méndez-Carniado O, Nargund RS, Porteny T, Sosa-Rubí SG, Serván-Mori E, Symes M, Vargas Enciso V, Frenk J. Setbacks in the quest for universal health coverage in Mexico: polarised politics, policy upheaval, and pandemic disruption. Lancet 2023; 402:731-746. [PMID: 37562419 DOI: 10.1016/s0140-6736(23)00777-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/21/2023] [Accepted: 04/11/2023] [Indexed: 08/12/2023]
Abstract
2023 marks the 20-year anniversary of the creation of Mexico's System of Social Protection for Health and the Seguro Popular, a model for the global quest to achieve universal health coverage through health system reform. We analyse the success and challenges after 2012, the consequences of reform ageing, and the unique coincidence of systemic reorganisation during the COVID-19 pandemic to identify strategies for health system disaster preparedness. We document that population health and financial protection improved as the Seguro Popular aged, despite erosion of the budget and absent needed reforms. The Seguro Popular closed in January, 2020, and Mexico embarked on a complex, extensive health system reorganisation. We posit that dismantling the Seguro Popular while trying to establish a new programme in 2020-21 made the Mexican health system more vulnerable in the worst pandemic period and shows the precariousness of evidence-based policy making to political polarisation and populism. Reforms should be designed to be flexible yet insulated from political volatility and constructed and managed to be structurally permeable and adaptable to new evidence to face changing health needs. Simultaneously, health systems should be grounded to withstand systemic shocks of politics and natural disasters.
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Affiliation(s)
- Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Fundación Mexicana para la Salud, Mexico City, Mexico; Tómatelo a Pecho, Mexico City, Mexico
| | - Hector Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Fundación Mexicana para la Salud, Mexico City, Mexico; Tómatelo a Pecho, Mexico City, Mexico; Institute for Obesity Research and School of Government and Public Transformation, Tecnológico de Monterrey, Nuevo León, México
| | - Michael Touchton
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Department of Political Science, College of Arts, and Sciences, University of Miami, Coral Gables, FL, USA.
| | - Tim McDonald
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; RAND Corporation, Santa Monica, CA, USA
| | - Merike Blofield
- Department of Political Science, University of Hamburg, Hamburg, Germany
| | - Leticia Avila Burgos
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Cuernavaca, México
| | - Octavio Gómez-Dantés
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Cuernavaca, México
| | - Pablo Kuri
- Proyecto OriGen, Instituto Tecnológico y de Estudios Superiores de Monterrey, Nuevo León, México
| | - Adolfo Martinez-Valle
- Centro de Investigación en Políticas Población y Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Renu Sara Nargund
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Vilcek Institute for Biomedical Sciences, New York University, New York, NY, USA
| | - Thalia Porteny
- Department of Health Policy and Management, Columbia University, New York, NY, USA
| | - Sandra Gabriela Sosa-Rubí
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Cuernavaca, México
| | - Edson Serván-Mori
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública de México, Cuernavaca, México
| | - Maya Symes
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Julio Frenk
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Touchton M, Wampler B. Democratizing Public Health: Participatory Policymaking Institutions, Mosquito Control, and Zika in the Americas. Trop Med Infect Dis 2023; 8:tropicalmed8010038. [PMID: 36668945 PMCID: PMC9865320 DOI: 10.3390/tropicalmed8010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
The Zika virus is a mosquito-borne virus spread primarily by Aedes mosquitoes. Zika cases have been detected throughout the mosquito's range, with an epidemic occurring from 2015 to 2017 in Brazil. Many Zika cases are mild or asymptomatic, but infections in pregnant women can cause microcephaly in children, and a small percentage of cases result in Guillan-Barré syndrome. There is currently little systematic information surrounding the municipal spread of the Zika Virus in Brazil. This article uses coarsened exact matching with negative binomial estimation and ordinary least squares estimation to assess the determinants of Zika incidence across the ~280,000 cases confirmed and recorded by Brazil's Ministry of Health in 2016 and 2017. These data come from Freedom of Information Act (FOIA) requests in Brazil and have not been published. We use data on the universe of individual Zika cases in Brazil and Geographic Information Systems (GIS) software to examine the virus at the municipal level across 5570 municipalities and construct a unique, unusually rich dataset covering daily Zika transmission. Additionally, our dataset includes corresponding local data on democratic governance, mosquito control efforts, and environmental conditions to estimate their relationship to Zika transmission. The results demonstrate that the presence of subnational democratic, participatory policymaking institutions and high levels of local state capacity are associated with low rates of Zika contraction. These models control for local healthcare spending and economic conditions, among other factors, that also influence Zika contraction rates. In turn, these findings provide a better understanding of what works for local health governance and mosquito control and makes important data public so that scholars and practitioners can perform their own analyses. Stronger models of Zika transmission will then inform mosquito abatement efforts across the Global South, as well as provide a blueprint for combatting Dengue fever, which is also transmitted by Aedes mosquitoes.
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Affiliation(s)
- Michael Touchton
- Department of Political Science, University of Miami, Coral Gables, FL 33146, USA
- Faculty Lead for Global Health, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL 33146, USA
- Correspondence:
| | - Brian Wampler
- President’s Office of Public Engagement, Boise State University, Boise, ID 83725, USA
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Knaul FM, Touchton M, Arreola-Ornelas H, Atun R, Anyosa RJCC, Frenk J, Martínez-Valle A, McDonald T, Porteny T, Sánchez-Talanquer M, Victora C. Punt Politics as Failure of Health System Stewardship: Evidence from the COVID-19 Pandemic Response in Brazil and Mexico. Lancet Reg Health Am 2021; 4:100086. [PMID: 34664040 PMCID: PMC8514423 DOI: 10.1016/j.lana.2021.100086] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 12/25/2022]
Abstract
We present a new concept, Punt Politics, and apply it to the COVID-19 non-pharmaceutical interventions (NPI) in two epicenters of the pandemic: Mexico and Brazil. Punt Politics refers to national leaders in federal systems deferring or deflecting responsibility for health systems decision-making to sub-national entities without evidence or coordination. The fragmentation of authority and overlapping functions in federal, decentralized political systems make them more susceptible to coordination problems than centralized, unitary systems. We apply the concept to pandemics, which require national health system stewardship, using sub-national NPI data that we developed and curated through the Observatory for the Containment of COVID-19 in the Americas to illustrate Punt Politics in Mexico and Brazil. Both countries suffer from protracted, high levels of COVID-19 mortality and inadequate pandemic responses, including little testing and disregard for scientific evidence. We illustrate how populist leadership drove Punt Politics and how partisan politics contributed to disabling an evidence-based response in Mexico and Brazil. These cases illustrate the combination of decentralization and populist leadership that is most conducive to punting responsibility. We discuss how Punt Politics reduces health system functionality, providing lessons for other countries and future pandemic responses, including vaccine rollout.
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Affiliation(s)
- Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Fundación Mexicana para la Salud, Mexico City, Mexico,Tómatelo a Pecho, Mexico City, Mexico
| | - Michael Touchton
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Department of Political Science, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL, USA,Corresponding author: Michael Touchton, University of Miami, Coral Gables, FL, USA
| | - Héctor Arreola-Ornelas
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Fundación Mexicana para la Salud, Mexico City, Mexico,Tómatelo a Pecho, Mexico City, Mexico
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Renzo JC Calderon Anyosa
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | | | - Adolfo Martínez-Valle
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,Centro de Investigación en Políticas, Población y Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Tim McDonald
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA,RAND Corporation, Santa Monica, CA, USA
| | - Thalia Porteny
- Departments of Community Health and Occupational Therapy, Tufts University, Medford, MA, USA
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Touchton M, Knaul FM, Arreola-Ornelas H, Porteny T, Sánchez M, Méndez O, Faganello M, Edelson V, Gygi B, Hummel C, Otero S, Insua J, Undurraga E, Rosado JA. A partisan pandemic: state government public health policies to combat COVID-19 in Brazil. BMJ Glob Health 2021; 6:e005223. [PMID: 34083242 PMCID: PMC8182751 DOI: 10.1136/bmjgh-2021-005223] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION To present an analysis of the Brazilian health system and subnational (state) variation in response to the COVID-19 pandemic, based on 10 non-pharmaceutical interventions (NPIs). MATERIALS AND METHODS We collected daily information on implementation of 10 NPI designed to inform the public of health risks and promote distancing and mask use at the national level for eight countries across the Americas. We then analyse the adoption of the 10 policies across Brazil's 27 states over time, individually and using a composite index. We draw on this index to assess the timeliness and rigour of NPI implementation across the country, from the date of the first case, 26 February 2020. We also compile Google data on population mobility by state to describe changes in mobility throughout the COVID-19 pandemic. RESULTS Brazil's national NPI response was the least stringent among countries analysed. In the absence of a unified federal response to the pandemic, Brazilian state policy implementation was neither homogenous nor synchronised. The median NPI was no stay-at-home order, a recommendation to wear masks in public space but not a requirement, a full school closure and partial restrictions on businesses, public transportation, intrastate travel, interstate travel and international travel. These restrictions were implemented 45 days after the first case in each state, on average. Rondônia implemented the earliest and most rigorous policies, with school closures, business closures, information campaigns and restrictions on movement 24 days after the first case; Mato Grosso do Sul had the fewest, least stringent restrictions on movement, business operations and no mask recommendation. CONCLUSIONS The study identifies wide variation in national-level NPI responses to the COVID-19 pandemic. Our focus on Brazil identifies subsequent variability in how and when states implemented NPI to contain COVID-19. States' NPIs and their scores on the composite policy index both align with the governors' political affiliations: opposition governors implemented earlier, more stringent sanitary measures than those supporting the Bolsonaro administration. A strong, unified national response to a pandemic is essential for keeping the population safe and disease-free, both at the outset of an outbreak and as communities begin to reopen. This national response should be aligned with state and municipal implementation of NPI, which we show is not the case in Brazil.
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Affiliation(s)
- Michael Touchton
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
| | - Felicia Marie Knaul
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Dept of Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Héctor Arreola-Ornelas
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundacion Mexicana para la Salud AC, Mexico City, Mexico
| | - Thalia Porteny
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Mariano Sánchez
- Department of Politics, Colegio de Mexico, Mexico City, Mexico
| | - Oscar Méndez
- Department of Political Science, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, USA
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundacion Mexicana para la Salud AC, Mexico City, Mexico
| | - Marco Faganello
- MAF dataScience, Universidade Estadual de Campinas, Campinas, Brazil
| | - Vaugh Edelson
- Dept of Public Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Benjamin Gygi
- Department of Political Science, University of Miami College of Arts and Sciences, Coral Gables, Florida, USA
| | - Calla Hummel
- Department of Political Science, University of Miami College of Arts and Sciences, Coral Gables, Florida, USA
| | - Silvia Otero
- Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Jorge Insua
- Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Eduardo Undurraga
- Department of Government, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Julio Antonio Rosado
- Department of Social Sciences and Politics (currently listed in Spanish), Universidad Iberoamericana, Mexico City, Mexico
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Knaul F, Arreola-Ornelas H, Porteny T, Touchton M, Sánchez-Talanquer M, Méndez Ó, Chertorivski S, Ortega S, Chudnovsky M, Kuri P. Not far enough: Public health policies to combat COVID-19 in Mexico's states. PLoS One 2021; 16:e0251722. [PMID: 34061864 PMCID: PMC8168889 DOI: 10.1371/journal.pone.0251722] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/30/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mexican state governments' actions are essential to control the COVID-19 pandemic within the country. However, the type, rigor and pace of implementation of public policies have varied considerably between states. Little is known about the subnational (state) variation policy response to the COVID-19 pandemic in Mexico. MATERIAL AND METHODS We collected daily information on public policies designed to inform the public, as well as to promote distancing, and mask use. The policies analyzed were: School Closure, Workplace Closure, Cancellation of Public Events, Restrictions on Gatherings, Stay at Home Order, Public Transit Suspensions, Information Campaigns, Internal Travel Controls, International Travel Controls, Use of Face Masks We use these data to create a composite index to evaluate the adoption of these policies in the 32 states. We then assess the timeliness and rigor of the policies across the country, from the date of the first case, February 27, 2020. RESULTS The national average in the index during the 143 days of the pandemic was 41.1 out of a possible 100 points on our index. Nuevo León achieved the highest performance (50.4); San Luis Potosí the lowest (34.1). The differential between the highest versus the lowest performance was 47.4%. CONCLUSIONS The study identifies variability and heterogeneity in how and when Mexican states implemented policies to contain COVID-19. We demonstrate the absence of a uniform national response and widely varying stringency of state responses. We also show how these responses are not based on testing and do not reflect the local burden of disease. National health system stewardship and a coordinated, timely, rigorous response to the pandemic did not occur in Mexico but is desirable to contain COVID-19.
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Affiliation(s)
- Felicia Knaul
- Institute for the Advances Study of the Americas, University of Miami, Miami, Florida, United States of America
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Tómatelo a Pecho, A.C., Ciudad de México, México
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundación Mexicana para la Salud, A.C., Ciudad de México, México
| | - Héctor Arreola-Ornelas
- Institute for the Advances Study of the Americas, University of Miami, Miami, Florida, United States of America
- Tómatelo a Pecho, A.C., Ciudad de México, México
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundación Mexicana para la Salud, A.C., Ciudad de México, México
- Research Center for Health Sciences, Anahuac University North Campus, Mexico City, Mexico
| | - Thalia Porteny
- Institute for the Advances Study of the Americas, University of Miami, Miami, Florida, United States of America
- Department of Community Health, Tufts University, Medford, MA, United States of America
| | - Michael Touchton
- Institute for the Advances Study of the Americas, University of Miami, Miami, Florida, United States of America
- Department of Political Science, School of Arts and Sciences, University of Miami, Miami, Florida, United States of America
| | | | - Óscar Méndez
- Institute for the Advances Study of the Americas, University of Miami, Miami, Florida, United States of America
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundación Mexicana para la Salud, A.C., Ciudad de México, México
| | - Salomón Chertorivski
- Division of Public Administration, Center for Economic Research and Teaching (CIDE), Mexico City, Mexico
| | - Sonia Ortega
- Tómatelo a Pecho, A.C., Ciudad de México, México
- Consejo Promotor de Universalidad y Competitividad en Salud, Fundación Mexicana para la Salud, A.C., Ciudad de México, México
| | - Mariana Chudnovsky
- Division of Public Administration, Center for Economic Research and Teaching (CIDE), Mexico City, Mexico
| | - Pablo Kuri
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Hummel C, Knaul FM, Touchton M, Guachalla VXV, Nelson-Nuñez J, Boulding C. Poverty, precarious work, and the COVID-19 pandemic: lessons from Bolivia. The Lancet Global Health 2021; 9:e579-e581. [PMID: 33508245 PMCID: PMC8648071 DOI: 10.1016/s2214-109x(21)00001-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Calla Hummel
- Department of Political Science, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL 33146, USA
| | - Felicia Marie Knaul
- Department of Political Science, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL 33146, USA; Miller School of Medicine, University of Miami, Coral Gables, FL 33146, USA; Fundación Mexicana para la Salud, Mexico City, Mexico; Tómatelo a Pecho AC México, Mexico City, Mexico
| | - Michael Touchton
- Department of Political Science, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL 33146, USA.
| | | | | | - Carew Boulding
- Department of Political Science, University of Colorado Boulder, Boulder, CO, USA
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10
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Rodriguez NM, Casanova F, Pages G, Claure L, Pedreira M, Touchton M, Knaul F. Community-based participatory design of a community health worker breast cancer training intervention for South Florida Latinx farmworkers. PLoS One 2020; 15:e0240827. [PMID: 33075111 PMCID: PMC7571710 DOI: 10.1371/journal.pone.0240827] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Community health worker (CHW)-led education is an important strategy to increase awareness and access to breast cancer screening in medically-underserved communities. This study aimed to develop a context-specific, culturally-appropriate training intervention for South Florida CHWs to educate Latinx immigrant farmworkers on breast cancer and early detection. METHODS A community-based participatory research (CBPR) study, conducted 2017-2019, informed the design of a training curriculum for CHWs and educational dissemination materials. Twenty-two CHWs were trained and knowledge gains were measuring using a one-group pre-and post-test design. Triangulated evaluation consisted of field observations of CHW-client interactions, CHW self-reports, and rapid assessment surveys of community members. RESULTS A community stakeholder-informed breast cancer training curriculum resulted in significant, sustained breast cancer knowledge gains among CHWs when comparing pre-, post-, and 4-6 month post-training follow-up test scores. Field observations of educational material dissemination, CHW self-reported evaluations, and community rapid assessment surveys at three health fairs demonstrated this was an effective strategy to engage female Latinx farmworkers in breast cancer education. CONCLUSIONS Community and key stakeholder participation in the development of a breast cancer educational intervention allowed for tailored design priorities around knowledge-based content, comprehensiveness, relevance, appropriateness, and ease of dissemination to community members. This model of participatory CHW training intervention design can enable future train-the-trainer approaches to disseminate and scale-up evidence-based health education interventions.
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Affiliation(s)
- Natalia M. Rodriguez
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Felicia Casanova
- Department of Sociology, College of Arts and Sciences, University of Miami, Miami, Florida, United States of America
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, United States of America
| | - Gabriela Pages
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, United States of America
| | - Layla Claure
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, United States of America
| | - Marian Pedreira
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, United States of America
| | - Michael Touchton
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, United States of America
| | - Felicia Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, Florida, United States of America
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