Vulnerability and antimicrobial resistance

It is now well-recognised that antimicrobial resistance (AMR), or the ability of organisms to resist currently available antibiotics and other antimicrobial drugs, represents one of the greatest dangers to human health in the 21st Century. As of 2022, AMR is a top-10 global public health threat. Various national and transnational initiatives have been implemented to address accelerating AMR, and the pressure to find local and global solutions is increasing. Despite this urgency, surprisingly limited progress is being made in rolling back or even slowing resistance. A multitude of perspectives exist regarding why this is the case. Key concerns include an enduring dependency on market-driven drug development, the lacklustre governance and habitual over-prescribing of remaining antimicrobial resources, and rampant short-termism across societies. While rarely presented in such terms, these disparate issues all speak to the social production of vulnerability. Yet vulnerability is rarely discussed in the AMR literature, except in terms of 'disproportionate effects' of AMR. In this paper, we offer a reconceptualisation of vulnerability as manifest in the AMR scene, showing that vulnerability is both a predictable consequence of AMR and, critically, productive of AMR to begin with. We underline why comprehending vulnerability as embodied, assembled, multivalent and reproduced through surveillance matters for international efforts to combat resistance.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

How has COVID-19 affected migrant workers vulnerability to human trafficking for forced labour in Southeast Asia?-a narrative review

Background and Objective: This paper seeks to assess the impact of the COVID-19 pandemic on migrant workers' vulnerability to human trafficking for forced labour in Southeast Asia. Migrant workers already make up a large proportion of those most vulnerable to the coercion and exploitation that define human trafficking, yet few are officially identified as such. While migrants have been working in the very occupations and sectors essential to keeping societies and economies running during the pandemic, they have oftentimes been the least protected. The authors argue that to avoid further increases in human trafficking for labour exploitation as a result of the pandemic, the vulnerabilities of migrant workers should be addressed from policy to operational levels. Methods: Review of ASEAN-Australia Counter Trafficking (ASEAN-ACT) monitoring data and reports, supplemented by a review of relevant publications on the impact of COVID-19 on the vulnerability of migrant workers to abuse and exploitation. Key Content and Findings: Human trafficking for forced labour in Southeast Asia is a largely under-addressed and under documented phenomenon affecting the basic rights of exploited workers, many of these being migrants. The data indicates that vulnerability to human trafficking is likely to have increased among migrant workers in precarious occupations and sectors in Southeast Asia through the COVID-19 pandemic. As the region looks to recover from COVID-19, there is an opportunity to integrate migrant workers and promote more inclusive policy frameworks and workplace cultures that respect and value their important social and economic contributions. A transformation is required in response to the unsustainable practices that contribute to vulnerability in Southeast Asia and the Sustainable Development Goals (SDGs) provides the highest-level elaboration of these required standards. Acceleration towards the relevant SDG targets will contribute to more resilient workplaces, economies and societies in the region. Conclusions: The greater vulnerability of migrant workers to human trafficking as a result of COVID-19 will require greater initiative and political will to address. Governments and the private sector in Southeast Asia are critical in addressing these vulnerabilities and the SDGs provide a valuable framework to do so through an integrated approach to development. © 2022 Journal of Innovation Management. All rights reserved.

Experiences of the SARS-CoV-2 pandemic amongst Australian healthcare workers: from stressors to protective factors.

BACKGROUND: The SARS-CoV-2 pandemic has critically challenged healthcare systems globally. Examining the experiences of healthcare workers (HCWs) is important for optimizing ongoing and future pandemic responses. OBJECTIVES: In-depth exploration of Australian HCWs' experiences of the SARS-CoV-2 pandemic, with a focus on reported stressors vis-à-vis protective factors. METHODS: Individual interviews were performed with 63 HCWs in Australia. A range of professional streams and operational staff were included. Thematic analysis was performed. RESULTS: Thematic analysis identified stressors centred on paucity of, or changing, evidence, leading to absence of, or mistrust in, guidelines; unprecedented alterations to the autonomy and sense of control of clinicians; and deficiencies in communication and support. Key protective factors included: the development of clear guidance from respected clinical leaders or recognized clinical bodies, interpersonal support, and strong teamwork, leadership, and a sense of organizational preparedness. CONCLUSIONS: This study provides insights into the key organizational sources of emotional stress for HCWs within pandemic responses and describes experiences of protective factors. HCWs experiencing unprecedented uncertainty, fear, and rapid change, rely on clear communication, strong leadership, guidelines endorsed by recognized expert groups or individuals, and have increased reliance on interpersonal support. Structured strategies for leadership and communication at team, service group and organizational levels, provision of psychological support, and consideration of the potential negative effects of centralizing control, would assist in ameliorating the extreme pressures of working within a pandemic environment.

Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence.

The transmission behaviour of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still being defined. It is likely that it is transmitted predominantly by droplets and direct contact and it is possible that there is at least opportunistic airborne transmission. In order to protect healthcare staff adequately it is necessary that we establish whether aerosol-generating procedures (AGPs) increase the risk of transmission of SARS-CoV-2. Where we do not have evidence relating to SARS-CoV-2, guidelines for safely conducting these procedures should consider the risk of transmitting related pathogens. Currently there is very little evidence detailing the transmission of SARS-CoV-2 associated with any specific procedures. Regarding AGPs and respiratory pathogens in general, there is still a large knowledge gap that will leave clinicians unsure of the risk to themselves when offering these procedures. This review aimed to summarize the evidence (and gaps in evidence) around AGPs and SARS-CoV-2.