Global financing for health policy and systems research: a review of funding opportunities.

Health policy and systems research (HPSR) is a neglected area in global health financing. Despite repeated calls for greater investment, it seems that there has been little growth. We analysed trends in reported funding and activity between 2015 and 2021 using a novel real-time source of global health data, the Devex.com database, the world's largest source of funding opportunities related to international development. We performed a systematic search of the Devex.com database for HPSR-related terms with a focus on low- and middle-income countries. We included 'programs', 'tenders & grants' and 'contract awards', covering all call statuses (open, closed or forecast). Such funding opportunities were included if they were related specifically to HPSR funding or had an HPSR component; pure biomedical funding was excluded. Our findings reveal a relative neglect of HPSR, as only ∼2% of all global health funding calls included a discernible HPSR component. Despite increases in funding calls until 2019, this situation reversed in 2020, likely reflecting the redirection of resources to rapid assessments of the impacts of the coronavirus disease 2019 (COVID-19) pandemic. Most identified projects represented small-scale opportunities-commonly for consultancies or technical assistance. To the extent that new data were generated, these projects were either tied to a specific large intervention or were narrow in scope to meet a specific challenge-with many examples informing policy responses to the Covid-19 pandemic. Nearly half of advertised funding opportunities were multi-country projects, usually addressing global policy priorities like health systems strengthening or development of coordinated public health policies at a regional level. The Covid-19 pandemic has shown why investing in HPSR is more important than ever to enable the delivery of effective health interventions and avoid costly implementation failures. The evidence presented here highlights the need to scale up efforts to convince global health funders to institutionalize the inclusion of HPSR components in all funding calls.

The far-right and anti-vaccine attitudes: lessons from Spain's mass COVID-19 vaccine roll-out.

BACKGROUND: Far-right politicians in several countries have been vocal opponents of COVID-19 vaccination. But can this threaten vaccine roll-out? METHODS: We take advantage of repeated cross-sectional surveys with samples of around 3800 individuals across Spain conducted monthly from December 2020 to January 2022 (n = 51 294) to examine any association between far-right politics and vaccine hesitancy through the whole vaccine roll-out. RESULTS: Consistent with prior data, we found that far-right supporters were almost twice as likely to be vaccine-hesitant than the overall population in December 2020, before vaccines became available. However, with a successful vaccine roll out, this difference shrank, reaching non-significance by September 2021. From October 2021, however, vaccine hesitancy rebounded among this group at a time when the leadership of the far-right promoted a 'freedom of choice' discourse common among anti-vax supporters. By the latest month analysed (January 2022), far-right voters had returned to being twice as likely to be vaccine-hesitant and 7 percentage points less likely to be vaccinated than the general population. CONCLUSIONS: Our results are consistent with evidence that far-right politicians can encourage vaccine hesitancy. Nonetheless, we show that public attitudes towards vaccination are not immutable. Whereas a rapid and effective vaccine rollout can help to overcome the resistance of far-right voters to get vaccinated, they also seem to be susceptible to their party leader's discourse on vaccines.

Governing and Measuring Health Security: The Global Push for Pandemic Preparedness Indicators.

Providing collective solutions to global pandemics requires the coordination of information that is accurate and accountable. In recent years there has been a global push for reliable pandemic preparedness indicators. This push has come from U.S. foreign policy, the World Health Organization (WHO), NGOs, and private foundations. These actors want control over how data for preparedness indicators is collected, analysed, and promoted. Governments want to influence how they are assessed, using poor performance to attract attention and good performance to deflect blame. In this article we discuss how the push for pandemic preparedness indicators comes from the dual aims of repelling national risk, the spread of disease, while reducing global harm through stronger transnational governance arrangements. We delve into the development of indicators from the WHO and the privately-run Global Health Security Index, and examine how their claims to authority measure-up against standards of transparency, veracity, and accountability. We stress the importance of understanding how these indicators are composed. This is vital given the current drive to include social and governance metrics in revised efforts at data collection, as well as efforts to include pandemic preparedness indicators in how intergovernmental organizations, NGOs, donors, and funders devise health and development policies.

Impact of COVID-19 lockdowns on mental health: Evidence from a quasi-natural experiment in England and Scotland.

The COVID-19 pandemic has been associated with worsening mental health but it is unclear whether this is a direct consequence of containment measures, like "Stay at Home" orders, or due to other considerations, such as fear and uncertainty about becoming infected. It is also unclear how responsive mental health is to a changing situation. Exploiting the different policy responses to COVID-19 in England and Scotland and using a difference-in-difference analysis, we show that easing lockdown measures rapidly improves mental health. The results were driven by individuals with lower socioeconomic position, in terms of education or financial situation, who benefited more from the end of the strict lockdown, whereas they suffered a larger decline in mental health where the lockdown was extended. Overall, mental health appears to be more sensitive to the imposition of containment policies than to the evolution of the pandemic itself. As lockdown measures may continue to be necessary in the future, further efforts (both financial and mental health support) are required to minimize the consequences of COVID-19 containment policies for mental health.

Are we making the same mistakes in fighting COVID­19 as in past pandemics? Lessons from HIV show the urgent need to invest in HPSR.

Are we repeating the mistakes of the human immunodeficiency virus (HIV) epidemic in our approach to combating coronavirus disease 2019 (COVID-19)? Is the world's emphasis on developing vaccines overshadowing investment in the health systems that can deliver them? We analyse a report on the politics of investing in health policy and systems research (HPSR) and conclude by outlining three critical actions, using the Stuckler-McKee model of social change in health. These are: exploiting a political window of opportunity; changing the conversation; and mobilising a campaign to drive the agenda. When implemented together, these actions could help accelerate investment in health systems to combat the immediate COVID-19 pandemic and prepare health systems for the next crisis.

Organising knowledge to prevent global health crises: a comparative analysis of pandemic preparedness indicators.

Preparing for the possibility of a global pandemic presents a transnational organisational challenge: to assemble and coordinate knowledge over institutionally diverse countries with high fidelity. The COVID-19 pandemic has laid these problems bare. This article examines the construction of the three main cross-national indicators of pandemic preparedness: a database with self-reported data by governments, external evaluations organised by the WHO and a global ranking known as the Global Health Security Index. Each of these presents a different model of collecting evidence and organising knowledge: the collation of self-reports by national authorities; the coordination of evaluation by an epistemic community authorised by an intergovernmental organisation and on the basis of a strict template; and the cobbling together of different sources into a common indicator by a transnational multi-stakeholder initiative. We posit that these models represent different ways of creating knowledge to inform policy choices, and each has different forms of potential bias. In turn, this shapes how policymakers understand what is 'best practice' and appropriate policy in pandemic preparedness.

Whatever it takes? The global financial safety net, Covid-19, and developing countries.

Multilateral financial institutions have pledged to do whatever it takes to enable emerging market and developing countries to fill a $2.5 trillion financing gap to combat Covid-19 and subsequent economic crises. In this article, we present new datasets to track the extent to which multilateral financial institutions are meeting these goals, and conduct a preliminary assessment of progress to date. We find that the International Monetary Fund and the principal regional financial arrangements have made relatively trivial amounts of new financing available and have been slow to disburse the financing at their disposal. As of July 31, 2020, these institutions had committed $89.56 billion in loans and $550 million in currency swaps, totaling $90.11 billion-just 12.6% of their current capacity. The new datasets allow scholars, policymakers, and civil society to continue to track these trends, and eventually examine the impact of such financing on health and development outcomes.