Unmasking the truth: Experimental evidence of facemask compliance in Bangladesh, Kenya, and Nigeria during the COVID-19 pandemic.

High levels of compliance with public health measures are critical to ensure a successful response to the COVID-19 pandemic and other public health emergencies. However, most data on compliance are self-reported and the tendency to overreport due to social desirability could yield biased estimates of actual compliance. A list experiment is a widely used method to estimate social desirability bias in self-reported estimates of sensitive behaviours. We estimate rates of compliance with facemask mandates in Kenya, Nigeria, and Bangladesh using data from phone surveys conducted in March-April 2021. Data on compliance were collected from two different survey modules: a self-reported compliance module (stated) and a list experiment (elicited). We find large gaps between stated and elicited rates of facemask wearing for different groups depending on specific country contexts and high levels of overreporting of facemask compliance in self-reported surveys: there was an almost 40 percentage point gap in Kenya, 30 percentage points in Nigeria, and 20 percentage points in Bangladesh. We also observe differences in rates of self-reported facemask wearing among key groups but not using the elicited responses from the list experiment, which suggest that social desirability bias may vary by demographics. Data collected from self-reported surveys may not be reliable to monitor ongoing compliance with public health measures. Moreover, elicited compliance rates indicate levels of mask wearing are likely much lower than those estimated using self-reported data.

The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries.

BACKGROUND: The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes. OBJECTIVE: We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses. METHODS: We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker. RESULTS: For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: -5.1%, -1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning. CONCLUSIONS: Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.

The Unintended Consequences of Information Provision: The World Health Organization and Border Restrictions during COVID-19.

Why do some international agreements fail to achieve their goals? Rather than states' engaging in cheap talk, evasion, or shallow commitments, the World Health Organization's (WHO) International Health Regulations (IHR)-the agreement governing states' and WHO's response to global health emergencies-point to the unintended consequences of information provision. The IHR have a dual goal of providing public health protection from health threats while minimizing unnecessary interference in international traffic. As such, during major outbreaks WHO provides information about spread and severity, as well as guidance about how states should respond, primarily regarding border policies. During COVID-19, border restrictions such as entry restrictions, flight suspensions, and border closures have been commonplace even though WHO recommended against such policies when it declared the outbreak a public health emergency in January 2020. Building on findings from the 2014 Ebola outbreak, we argue that without raising the cost of disregarding (or the benefits of following) recommendations against border restrictions, information from WHO about outbreak spread and severity leads states to impose border restrictions inconsistent with WHO's guidance. Using new data from COVID-19, we show that WHO's public health emergency declaration and pandemic announcement are associated with increases in the number of states imposing border restrictions.

Resumen: ¿Por qué motivo algunos acuerdos internacionales no logran alcanzar sus objetivos? El Reglamento Sanitario Internacional (RSI) de la Organización Mundial de la Salud (OMS)­el acuerdo que rige la respuesta de los Estados y la OMS a las emergencias sanitarias mundiales­señala como motivo las consecuencias imprevistas del suministro de información, en lugar del discurso trivial, la evasión o los compromisos superficiales por parte de los Estados. El RSI tiene como doble objetivo proteger la salud pública de las amenazas sanitarias y minimizar las interferencias innecesarias en el tráfico internacional. Como tal, durante brotes importantes, la OMS proporciona información sobre la propagación y la gravedad, así como orientación sobre cómo deben responder los Estados, principalmente en lo que respecta a las políticas fronterizas. Sin embargo, durante la COVID-19, las restricciones fronterizas, tales como las restricciones de entrada, las suspensiones de vuelos y los cierres de fronteras, han sido habituales, a pesar de que la OMS recomendó no aplicar estas políticas cuando declaró el brote epidémico como emergencia de salud pública en enero de 2020. Basándonos en los resultados del brote de ébola de 2014, argumentamos que, sin aumentar el coste de ignorar (o los beneficios de seguir) las recomendaciones contra las restricciones fronterizas, la información de la OMS sobre la propagación y la gravedad del brote lleva a los Estados a imponer restricciones fronterizas que no son coherentes con las orientaciones de la OMS. Utilizando nuevos datos de la COVID-19, mostramos que la declaración de emergencia de salud pública de la OMS y el anuncio de pandemia están asociados con el aumento del número de estados que imponen restricciones fronterizas.

Résumé: Pourquoi certains accords internationaux n'atteignent-ils pas leurs objectifs? À l'inverse d'États se perdant dans des discussions superficielles, des pirouettes ou des engagements insignifiants, le Règlement sanitaire international (RSI) de l'Organisation mondiale de la santé (OMS), à savoir l'accord encadrant la réponse des États et de l'OMS aux situations d'urgence sanitaire internationales, évoque les conséquences imprévues de la transmission d'informations. Le RSI a un objectif double : protéger les populations contre les menaces pour la santé publique, tout en minimisant les interactions non nécessaires dans le trafic international. Par conséquent, lors des grandes épidémies, l'OMS fournit des informations relatives à la transmission et à la gravité des maladies, ainsi que des conseils quant aux mesures que les États doivent mettre en œuvre, principalement en ce qui concerne les politiques aux frontières. Pourtant, durant la pandémie de COVID-19, les restrictions aux frontières, telles que les limitations des entrées, les suspensions de vols et les fermetures, ont été monnaie courante, et ce bien que l'OMS ait déconseillé de telles pratiques lorsqu'elle a déclaré que l'épidémie constituait une urgence sanitaire, en janvier 2020. S'appuyant sur des travaux portant sur l'épidémie d'Ebola en 2014, nous soutenons, sans exagérer l'impact d'une non-conformité (ou les avantages d'une conformité) aux recommandations de l'OMS en matière de restrictions aux frontières, que les informations transmises par l'organisation en matière de transmission et de gravité de la maladie ont conduit les États à imposer des restrictions aux frontières non conformes auxdites recommandations. Grâce à de nouvelles données relatives au COVID-19, nous montrons que la déclaration d'urgence sanitaire et l'annonce de la pandémie par l'OMS se sont accompagnées d'une augmentation du nombre d'États imposant des restrictions aux frontières.

Reconceptualizing successful pandemic preparedness and response: A feminist perspective.

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.

Understanding the societal factors of vaccine acceptance and hesitancy: evidence from Hong Kong.

OBJECTIVES: Vaccination is considered to be an important public health strategy for controlling the COVID-19 pandemic. Besides subjective evaluations of the vaccine and the health threat, societal factors have been seen as crucial to vaccination decisions. Based on a socioecological perspective, this study examines the role of societal factors in COVID-19 vaccine hesitancy in Hong Kong. STUDY DESIGN AND METHOD: An online survey was fielded between 25 and 28 June 2021, collecting 2753 complete responses. Multinomial logistic regression was conducted to examine how subjective evaluations of the vaccine (summarised by the 5C model - Confidence, Collective responsibility, Constraints, Complacency and Calculation), threat perception, interpersonal influences and institutional trust contribute to explaining three types of decision - acceptant (vaccinated, scheduled or indicated 'Yes'), hesitant (unvaccinated and indicated 'Maybe' on intention) and resistant (unvaccinated and indicated 'No'). RESULTS: A total of 43.2%, 21.7% and 35.1% of respondents were acceptant, hesitant and resistant. Although the 5C model remained useful in explaining vaccination decisions, respondents were heavily influenced by the decisions of their family, although they were less influenced by friends. Second, respondents tended to accept the vaccine when they had a weaker perception that the act is supportive of the government and were less resistant if they had stronger institutional trust. CONCLUSION: Under the low-incidence and low-trust environment such as Hong Kong, vaccination decisions are heavily influenced by family's decision and the perception of vaccination as socially and politically desirable. Our findings highlight the importance of a nuanced conception of interpersonal and political influence towards vaccine acceptance/hesitancy.

#WuhanDiary and #WuhanLockdown: gendered posting patterns and behaviours on Weibo during the COVID-19 pandemic.

Social media can be both a source of information and misinformation during health emergencies. During the COVID-19 pandemic, social media became a ubiquitous tool for people to communicate and represents a rich source of data researchers can use to analyse users' experiences, knowledge and sentiments. Research on social media posts during COVID-19 has identified, to date, the perpetuity of traditional gendered norms and experiences. Yet these studies are mostly based on Western social media platforms. Little is known about gendered experiences of lockdown communicated on non-Western social media platforms. Using data from Weibo, China's leading social media platform, we examine gendered user patterns and sentiment during the first wave of the pandemic between 1 January 2020 and 1 July 2020. We find that Weibo posts by self-identified women and men conformed with some gendered norms identified on other social media platforms during the COVID-19 pandemic (posting patterns and keyword usage) but not all (sentiment). This insight may be important for targeted public health messaging on social media during future health emergencies.

Food insecurity and COVID-19 risk in low- and middle-income countries.

The COVID-19 pandemic prompted social distancing, workplace closures, and restrictions on mobility and trade that had cascading effects on economic activity, food prices, and employment in low- and middle-income countries. Using longitudinal data from Bangladesh, Kenya, and Nigeria covering a period from October 2020 to April 2021, the paper assesses whether knowledge of a person infected with COVID-19 is associated with food insecurity, job loss and business closures, and coping strategies to smooth consumption. The likelihood of households to experience food insecurity at the extensive and intensive margins increased among those who knew an infected person in Bangladesh and Kenya.

Using gender analysis matrixes to integrate a gender lens into infectious diseases outbreaks research.

Evidence shows that infectious disease outbreaks are not gender-neutral, meaning that women, men and gender minorities are differentially affected. This evidence affirms the need to better incorporate a gender lens into infectious disease outbreaks. Despite this evidence, there has been a historic neglect of gender-based analysis in health, including during health crises. Recognizing the lack of available evidence on gender and pandemics in early 2020 the Gender and COVID-19 project set out to use a gender analysis matrix to conduct rapid, real-time analyses while the pandemic was unfolding to examine the gendered effects of the coronavirus disease 2019 pandemic. This paper reports on what a gender analysis matrix is, how it can be used to systematically conduct a gender analysis, how it was implemented within the study, ways in which the findings from the matrix were applied and built upon, and challenges encountered when using the matrix methodology.

Strengthening national capacities for pandemic preparedness: a cross-country analysis of COVID-19 cases and deaths.

The International Health Regulations-State Party Annual Reporting (IHR-SPAR) index and the Global Health Security Index (GHSI) have been developed to aid in strengthening national capacities for pandemic preparedness. We examined the relationship between country-level rankings on these two indices, along with two additional indices (the Universal Health Coverage Service Coverage Index and World Bank Worldwide Governance Indicator (n = 195)) and compared them to the country-level reported coronavirus disease (COVID-19) cases and deaths (Johns Hopkins University COVID-19 Dashboard) through 17 June 2020. Ordinary least squares regression models were used to compare weekly reported COVID-19 cases and death rates per million in the first 12 weeks of the pandemic between countries classified as low, middle and high ranking on each index while controlling for country socio-demographic information. Countries with higher GHSI and IHR-SPAR index scores experienced fewer reported COVID-19 cases and deaths but only for the first 8 weeks after the country's first case. For the GHSI, this association was further limited to countries with populations below 69.4 million. For both the GHSI and IHR-SPAR, countries with a higher sub-index score in human resources for pandemic preparedness reported fewer COVID-19 cases and deaths in the first 8 weeks after the country's first reported case. The Universal Health Coverage Service Coverage Index and Worldwide Governance Indicator country-level rankings were not associated with COVID-19 outcomes. The associations between GHSI and IHR-SPAR scores and COVID-19 outcomes observed in this study demonstrate that these two indices, although imperfect, may have value, especially in countries with a population under 69.4 million people for the GHSI. Preparedness indices may have value; however, they should continue to be evaluated as policy makers seek to better prepare for future global public health crises.

A tale of two city-states: A comparison of the state-led vs civil society-led responses to COVID-19 in Singapore and Hong Kong.

The East Asian experience in tackling COVID-19 has been highly praised, but this high-level generalisation neglects variation in pandemic response measures adopted across countries as well as the socio-political factors that shaped them. This paper compares the early pandemic response in Singapore and Hong Kong, two Asian city-states of similar sizes, a shared history of SARS, and advanced medical systems. Although both were able to contain the virus, they did so using two very different approaches. Drawing upon data from a cross-national, probability sample Internet survey conducted in May 2020 as well as media and mobility data, we argue that the different approaches were the result of the relative strength of civil society vs. the state at the outset of the outbreak. In protest-ridden Hong Kong, low governmental trust bolstered civil society, which focused on self-mobilisation and community mutual-help. In Singapore, a state-led response model that marginalised civil society brought early success but failed to stem an outbreak among its segregated migrant population. Our findings show that an active civil society is pivotal to effective outbreak response and that trust in government may not have been as important as a factor in these contexts.

The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems.

For decades, governments and development partners promoted neoliberal policies in the health sector in many LMICs, largely motivated by the belief that governments in these countries were too weak to provide all the health services necessary to meet population needs. Private health markets became the governance and policy solution to improve the delivery of health services which allowed embedded forms of market failure to persist in these countries and which were exposed during the COVID-19 pandemic. In this article, we analyse the manifestations of these market failures using data from an assembled database of COVID-19 related news items sourced from the Global Database of Events, Language, and Tone. Specifically, we identify how pre-existing market failure and failures of redistribution have led to the rise of three urgent crises in LMICs: a financial and liquidity crisis among private providers, a crisis of service provision and pricing, and an attendant crisis in state-provider relations. The COVID-19 pandemic has therfore exposed important failures of the public-private models of health systems and provides an opportunity to rethink the future orientation of national health systems and commitments towards Universal Health Coverage.

Managing borders during public health emergencies of international concern: a proposed typology of cross-border health measures.

BACKGROUND: The near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. RESULTS: Based on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently - policy goal, type of movement (travel and trade), adopted by public or private sector, level of jurisdiction applied, stage of journey, and degree of restrictiveness. These categories are then brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. Addressing the current gaps in evidence about travel measures, including how different jurisdictions apply such measures with varying effects, in turn, enhances the potential for evidence-informed decision-making based on fuller understanding of policy trade-offs and externalities. Finally, through the adoption of standardized terminology and creation of an agreed evidentiary base recognized across jurisdictions, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). CONCLUSIONS: The widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.

FORUM: COVID-19 and IR Scholarship: One Profession, Many Voices

The COVID-19 pandemic has affected virtually every aspect of life, for individuals, communities, nations, regions, and the international system. In this forum, scholars from around the world with diverse areas of expertise consider the contributions of international relations (IR) scholarship in our understanding of the politics and governance challenges surrounding the pandemic. The seven essays that follow together examine how our current state of knowledge speaks to the theme of ISA 2020: "Multiple Identities and Scholarship in a Global IR: One Profession, Many Voices." Each essay features a research area and body of scholarship that both informs our understanding of the COVID-19 pandemic and reflects on how the pandemic challenges us to push our scholarship and intellectual community further. Together, these essays highlight the diversity of our discipline of IR and how its many voices may bring us together in one conversation. La pandemia de COVID-19 ha afectado prácticamente a todos los aspectos de la vida para las personas, las comunidades, las naciones, las regiones y el sistema internacional. En este foro, los académicos de todo el mundo con diversas áreas de experiencia consideran las contribuciones de los estudios de las relaciones internacionales (International Relations, IR) a nuestro entendimiento de la política y los desafíos de gobierno que rodean a la pandemia. Los siete ensayos a continuación analizan en conjunto cómo nuestro estado de conocimiento actual aborda el tema de la Asociación de Estudios Internacionales (International Studies Association, ISA) de 2020: "Múltiples identidades y estudios en una IR global: una profesión, muchas voces." Cada ensayo presenta un área de investigación y un cuerpo de estudios que conforman nuestro entendimiento de la pandemia de COVID-19 y también reflexionan sobre cómo esta nos desafía a impulsar aún más a nuestra comunidad académica e intelectual. En conjunto, estos ensayos destacan la diversidad de nuestra disciplina de relaciones internacionales y cómo sus numerosas voces pueden juntarnos en una conversación. La pandémie de COVID 2019 a affecté pratiquement tous les aspects de la vie, que ce soit les individus, les communautés, les nations, les régions ou le système international. Dans cette tribune, des chercheurs du monde entier spécialisés dans divers domaines d'expertise réfléchissent aux contributions des recherches en relations internationales à notre compréhension des défis politiques et de gouvernance entourant la pandémie. Les sept essais ainsi réunis examinent la manière dont l'état actuel de nos connaissances aborde le thème de la convention 2020 de l'Association d'études internationales : « Identités et recherches multiples dans des relations internationales globales : une profession, de nombreuses voix ». Chaque essai présente un domaine de recherche et un corpus d'études qui éclaire notre compréhension de la pandémie de COVID 2019 tout en amenant une réflexion sur la façon dont la pandémie nous remet en question et nous pousse à aller plus loin dans nos recherches et notre communauté intellectuelle. Ensemble, ces essais mettent en évidence la diversité de notre discipline des relations internationales et la manière dont ses nombreuses voix peuvent nous réunir dans un débat. [ABSTRACT FROM AUTHOR] Copyright of International Studies Review is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

More than a public health crisis: A feminist political economic analysis of COVID-19.

Gender norms, roles and relations differentially affect women, men, and non-binary individuals' vulnerability to disease. Outbreak response measures also have immediate and long-term gendered effects. However, gender-based analysis of outbreaks and responses is limited by lack of data and little integration of feminist analysis within global health scholarship. Recognising these barriers, this paper applies a gender matrix methodology, grounded in feminist political economy approaches, to evaluate the gendered effects of the COVID-19 pandemic and response in four case studies: China, Hong Kong, Canada, and the UK. Through a rapid scoping of documentation of the gendered effects of the outbreak, it applies the matrix framework to analyse findings, identifying common themes across the case studies: financial discrimination, crisis in care, and unequal risks and secondary effects. Results point to transnational structural conditions which put women on the front lines of the pandemic at work and at home while denying them health, economic and personal security - effects that are exacerbated where racism and other forms of discrimination intersect with gender inequities. Given that women and people living at the intersections of multiple inequities are made additionally vulnerable by pandemic responses, intersectional feminist responses should be prioritised at the beginning of any crises.

Limited Early Warnings and Public Attention to Coronavirus Disease 2019 in China, January-February, 2020: A Longitudinal Cohort of Randomly Sampled Weibo Users.

OBJECTIVE: Awareness and attentiveness have implications for the acceptance and adoption of disease prevention and control measures. Social media posts provide a record of the public's attention to an outbreak. To measure the attention of Chinese netizens to coronavirus disease 2019 (COVID-19), a pre-established nationally representative cohort of Weibo users was searched for COVID-19-related key words in their posts. METHODS: COVID-19-related posts (N = 1101) were retrieved from a longitudinal cohort of 52 268 randomly sampled Weibo accounts (December 31, 2019-February 12, 2020). RESULTS: Attention to COVID-19 was limited prior to China openly acknowledging human-to-human transmission on January 20. Following this date, attention quickly increased and has remained high over time. Particularly high levels of social media traffic appeared around when Wuhan was first placed in quarantine (January 23-24, 8-9% of the overall posts), when a scandal associated with the Red Cross Society of China occurred (February 1, 8%), and, following the death of Dr Li Wenliang (February 6-7, 11%), one of the whistleblowers who was reprimanded by the Chinese police in early January for discussing this outbreak online. CONCLUSION: Limited early warnings represent missed opportunities to engage citizens earlier in the outbreak. Governments should more proactively communicate early warnings to the public in a transparent manner.

"Women are most affected by pandemics -Lessons from past outbreaks": Correction

Reports an error in "Women are most affected by pandemics -Lessons from past outbreaks" by Clare Wenham, Julia Smith, Sara E. Davies, Huiyun Feng, Karen A. Grepin, Sophie Harman, Asha Herten-Crabb and Rosemary Morgan (Nature, 2020[Jul][9], Vol 583[7815], 194-198). This Comment erroneously stated that 94 countries had reported commitments to support informal workers financially. In fact the number is 29. (The following abstract of the original article appeared in record 2020-51434-001.) The social and economic impacts of COVID-19 fall harder on women than on men. During outbreaks of Ebola and Zika viruses in the past few years women's socio-economic security was upended, and for longer than men's. Here, we call for COVID-19 research, response and recovery efforts that are tailored to support women. The three priorities are to tackle domestic violence;ensure access to sexual- and reproductive-health services;and support women's livelihoods. Governments need to gather data and target policy to keep all citizens equally safe, sheltered and secure. (PsycInfo Database Record (c) 2020 APA, all rights reserved)