HOW DID EUROPEAN COUNTRIES SET PRIORITIES IN RESPONSE TO THE COVID-19 THREAT? A COMPARATIVE DOCUMENT ANALYSIS OF 24 PANDEMIC PREPAREDNESS PLANS

Introduction The COVID-19 pandemic has forced governments across Europe to consider how to prioritise the allocation of scarce resources. Many took decisions to increase funding for health services, and to redirect current fiscal, human and technical resource towards meeting the new threat. Methods We conducted document analysis of pandemic preparedness plans in 24 countries across the regions of Europe, focussing on prioritisation and allocation of health-related resources. To be included, countries needed to have publicly available COVID19 preparedness plans. Where necessary, plans were translated into English before two members of the team conducted data extraction. We adapted the Kapiriri and Martin (2010) framework as our organising data extraction tool. Following validity checks, these data were synthesised numerically and thematically. Results COVID19 has engendered recognition on behalf of government of the scarcity of health care resources. However, many plans still fell short of identifying specific budgetary implications or trade-offs between COVID19 responses and other service priorities. Many plans describe use of evidence, expert involvement and decision making criteria. However, use of formal priority setting tools and frameworks was rare. The plans included very little engagement with citizens and service users, and equity considerations were often underdeveloped. The overall average compliance with quality parameters of priority setting was 29%. Discussion The plans indicate a political commitment to priority setting but underline the relative failure of priority setting methodologies to become embedded in governmental decision making processes. In the balance between 'technocratic' elements of priority setting and 'processual' dimensions, there was an emphasis on the former, reflecting the enforced speed with which plans were drawn up. As difficult priority setting decisions will be required in the post-crisis phase (as care backlogs and unmet need are addressed) it is likely that a rebalancing towards the processual aspects of decision making processes will be required.

PROFILE OF PRIORITY SETTING INCORPORATED TO COVID-19 RESPONSE PLANS IN 86 COUNTRIES IN THE WORLD

Background The COVID-19 pandemic has imposed a burden on all health systems budgets and pushed policymakers to rapidly set priorities for resource allocation. This study aimed to identify quality parameters of priority setting (PS) incorporated in a sample of the national response plans. Methods We reviewed a sample of COVID-19 national response plans from 86 countries across six regions of the WHO to assess the degree to which they included twenty quality indicators of effective PS. A quantitative descriptive analysis was used to explore the profile of PS according to independent variables. Results The countries sampled represent 40% of countries in AFRO, 54,5% of EMRO, 45% of EURO, 46% of PAHO, 64% of SEARO, and 41% of WPRO. They also represent 39% of all HICs in the world, 39% of Upper-Middle, 54% of Lower-Middle, and 48% of LICs. No pattern in attention to PS quality indicators emerged by WHO region or country income levels. As per the quality PS parameters, evidence of political will, stakeholder participation, use of scientific evidence/adoption of WHO recommendations were each found in over 80% of plans. Regarding the frequency of other parameters we found, description of a specific PS process (7%);explicit criteria for PS (36,5%);inclusion of publicity strategies (65%), mention of mechanisms for enforcing decisions, either for appealing decisions or implementing strategies to improve internal accountability and reduce corruption (20%);explicit reference to public values (15%);description of means for enhancing compliance with the decisions (5%). Conclusion We found some emphasis on PS according to contextual factors. For instance, LMICs receiving international donations presented more detailed descriptions of resources required, plans for allocating resources and improving internal accountability. HICs more likely described stakeholder participation, mechanisms for public communication, and explicit PS processes. However, no country included all twenty parameters of PS.

The Competing Influence of Policy Content and Political Cues: Cross-Border Evidence from the United States and Canada

When individuals evaluate policies, they consider both the policy's content and its endorsers. In this study, we investigate the conditions under which these sometimes competing factors guide preferences. In an effort to combat the spread of COVID-19, American President Trump and Canadian Prime Minister Trudeau bilaterally agreed to close their shared border to refugee claimants and asylum seekers. These ideologically opposed leaders endorsing a common policy allows us to test the influence of a well-known foreign neighbor on domestic policy evaluations. With a large cross-national survey experiment, we first find that Canadians and Americans follow ideological positions in evaluating the policy, with right-leaning respondents offering the most support. With an experiment, we reveal how both populations shift their views when told about their neighboring leader's endorsement. Our findings highlight ideologically motivated reasoning across an international border, with broad implications for understanding how individuals weigh a policy's content against its political cues.

Socially Distanced: Have user evaluation methods for Immersive Technologies changed during the COVID-19 pandemic?

Since the emergence of COVID-19 in late 2019, there has been a significant disturbance in human-to-human interaction that has changed the way we conduct user studies in the field of Human-Computer Interaction (HCI), especially for extended (augmented, mixed, and virtual) reality (XR). To uncover how XR research has adapted throughout the pandemic, this paper presents a review of user study methodology adaptations from a corpus of 951 papers. This corpus of papers covers CORE 2021 A* published conference submissions, from Q2 2020 through to Q1 2021 (IEEE ISMAR, ACM CHI, IEEE VR). The review highlights how methodologies were changed and reported;sparking discussions surrounding how methods should be conveyed and to what extent research should be contextualised, by drawing on external topical factors such as COVID-19, to maximise usefulness and perspective for future studies. We provide a set of initial guidelines based on our findings, posing key considerations for researchers when reporting on user studies during uncertain and unprecedented times.

Increased personal protective equipment litter as a result of COVID-19 measures

Use of personal protective equipment (PPE) increased during the COVID-19 pandemic to reduce virus transmission. Here, we quantitatively analyse emergence of PPE and COVID-19-related litter over 14 months for 11 countries using the litter collection application Litterati. The proportion of masks in litter increased by >80-fold as a result of COVID-19 legislation, from <0.01% to >0.8%. Gloves and wipes, more prevalent at similar to 0.2% of litter before the pandemic, doubled to 0.4%, but this has since fallen. Glove litter increased in the initial stages of the pandemic but fell after the introduction of facemask policies, whereupon there was an increase of facemask litter. National COVID-19 policy responses and international World Health Organization announcements and recommendations are a probable driver of PPE litter dynamics, especially the implementation of facemask policies. Waste management should be incorporated in designing future pandemic policies to avoid negative environmental legacies of mismanaged PPE.

Demonstrating the clinical impact of auditing-update from the Australian Clinical Dosimetry Service

Purpose: The Australian Clinical Dosimetry Service (ACDS) has been auditing Australian and New Zealand radiotherapy providers for nearly 10 years building the National Dataset of audit measurements. The audits have uncovered numerous issues with varying significance. This paper will present an update of the ACDS audits including trends within the National Dataset and recent audit findings and will then cover recent audit of more advanced modalities such as SRS, SBRT, VMAT and adaptive radiotherapy. The presentation will conclude with a summary of the COVID-19 impact on the ACDS. The audits demonstrably improve the treatment quality and safety for patients undergoing radiotherapy. Methods and Materials: The ACDS began life in November 2010 and has developed a comprehensive three level auditing service which has expanded beyond Australia's borders. To minimize dosimetric uncertainties the ACDS has been using Computerized Imaging Reference Systems (CIRS)1 plastic water and phantoms across all on-site audits. As phantom complexity increased to meet auditing needs, CIRS was engaged to produce bespoke phantoms for the ACDS. The most recent examples of this are the Stereotactic Radio-Surgery (SRS) head phantom, SBRT, and a thorax customized for stereotactic ablative radiotherapy (SABR) auditing. Results: Audits provide two key outcomes for participating facilities. The first is that independent measurements demonstrate whether the facility's predicted dose is being delivered to the phantom within an acceptable tolerance. For an out-of-tolerance finding the ACDS works with the facility to resolve any discrepancies on the day of audit. Examples include inaccurate data entry in a planning system or inaccurate phantom positioning. Sometimes, however, there may be a systemic issue with calculation algorithms. The National Dataset has enables the ACDS to identify characteristic behavior of certain equipment combinations. As the ACDS perform more audits, the statistical power of the dataset increases and trends can be identified. This is the second key capability which a mature auditor provides to the auditee. Conclusion: The ACDS has development a coherent and successful auditing service which is proactively responding to changing technologies and environment.