EVALUATING THE ETHICAL AND SOCIETAL IMPACTS OF MODELLING PANDEMIC CRISES: EXPERIENCES FROM A WORKSHOP

This paper describes a hybrid (virtual and online) workshop held as part of the EU STAMINA project that aimed to engage project partners to explore ethics and simulation modelling in the context of pandemic preparedness and response. The purpose of the workshop was to consider how the model's design and use in specific pandemic decision-making contexts could have broader implications for issues like transparency, explainability, representativeness, bias, trust, equality, and social injustices. Its outputs will be used as evidence to produce a series of measures that could help mitigate ethical harms and support the greater possible benefit from the use of the models. These include recommendations for policy, data-gathering, training, potential protocols to support end-user engagement, as well as guidelines for designing and using simulation models for pandemic decision-making. This paper presents the methodological approaches taken when designing the workshop, practical concerns raised, initial insights gained, and considers future steps. © SW 2023.All rights reserved

COVID-19 and the Indoor Environment - observations from a joint National Academies of Engineering seminar series

The SARS-CoV-2 virus and its variants and COVID-19 disease have affected every aspect of society. The US National Academy of Sciences has been providing scientific insights and advice to aid policymakers and researchers in their quest to respond to the pandemic. Since 2020, it has produced numerous reports and workshop proceedings intended to integrate science into national preparedness and response decision-making, to explore lessons learned and best practices from previous preparedness and response efforts, and to consider strategies for addressing misinformation (NASEM, 2021). Among these was a 2021 symposium series that analyzed engineering's role in catalyzing COVID-19 response, recovery, and resilience, examining topics including the mitigation of exposure in public transit systems, engineering solutions to managing pathogens indoors, and the factors influence the transmission of infectious diseases in cities. Speaker presentations addressing these indoor environment topics are summarized here. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

The European Health Union and the protection of public health in the European Union: Is the European Union prepared for future cross-border health threats?

The Covid 19 pandemic has cast traditional health protection issues in a new light due to their cross-border significance with far-reaching consequences for almost all areas of social life and places health protection in the European Union in a broader context that goes beyond the national consideration of necessary measures at EU Member State level. The pandemic has made it clear that the responsibility for public health remains in principle with the EU Member States and that the competences of the European Union under Article 168 TFEU are – with a few exceptions – generally limited to supporting, coordinating and assisting tasks. This article examines whether the European Union is adequately prepared for future pandemics and other cross-border health threats based on its responsibilities under the current system of competences between the EU and its Member States in the area of health policy under article 168. The article concludes with some suggestions for discussion and consideration. © 2023, The Author(s).

Responding to Future Pandemics: Biosecurity Implications and Defense Considerations

In an evolv ing and expanding biothreat landscape caused by emerging biotechnologies, increases in global infectious disease outbreaks, and geopolitical instability, the Department of Defense now faces challenges that alter its traditional approach to biothreats and prompt the need for modernized, improved preparedness for--and response to--potential biothreat scenarios. These challenges further complicate specif ic weaknesses revealed by the COVID-19 pandemic, including the Department's inability to sustain the military mission while meeting intragovernmental expectations to assist with civilian public health resources and services. [ FROM AUTHOR] Copyright of Parameters: U.S. Army War College is the property of U.S. Army War College 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 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 . (Copyright applies to all s.)

COVID-19 Supply Chain Planning: A Simulation-Optimization Approach

Healthcare providers' preparedness and response plans are crucial to effectively cope with infectious disease outbreaks such as COVID-19. These plans need to provide strategic and operational actionable insights to guarantee the availability of essential resources when needed. This study uses a simulation-optimization approach to (i) determine an optimal replenishment policy to restock personal protective equipment (PPE) items, and (ii) determine proactive demand planning for critical resources such as the number of beds, and ventilators. This model leverages a Simio-MATLAB integration to complete simulation and optimization tasks. © 2022 IEEE.

The EU Vaccines Strategy: A Missed Opportunity for EU Public Health?

The response to the COVID-19 crisis implied an unprecedented involvement of the European Union (EU) executive in public health matters. In June 2020, the Member States agreed upon a joint EU Vaccines Strategy, whereby the European Commission was enabled to negotiate, support and allocate vaccine doses on their behalf. Entailing political and redistributive choices, the Commission's centralised procurement presents some innovative patterns when compared to traditional EU executive action. This paper will focus on the institutionalisation of such patterns within the legal framework of the Health Emergency Preparedness and Response Authority (HERA). Did EU administrative law offer appropriate tools for this process? Or did the EU merely formalise the procedural and organisational schemes set up during the crisis? Answers to these questions will contribute to a fuller understanding of the administrative dimension of the new European Health Union and shed light on some recent evolutions of the EU administrative system. © The Author(s), 2023. Published by Cambridge University Press.

SMS-based digital health intervention in Rwanda's home-based care program for remote management of COVID-19 cases and contacts: A qualitative study of sustainability and scalability.

Background: COVID-19 pandemic resulted in unprecedented global health challenges. Rwanda identified its first COVID-19 case on March 14, 2020 and subsequently introduced Home-Base Care (HBC) Program in August 2020 following community transmission of the virus and to alleviate logistical and financial strain on the healthcare system. Cases and contacts eligible for HBC were remotely supported by WelTel, an SMS-based mHealth intervention that was successfully implemented before for HIV epidemic in Rwanda. Enrolled cases and contacts were supported and monitored daily via their cell and/or mobile phones until they complete isolation/quarantine period. This study explored the rationale, perspectives, and experiences of key informants (KIs) during the implementation WelTel's mHealth tool for HBC in Rwanda. Methods: Semi-structured one-on-one virtual interviews were conducted with KIs in this qualitative study. The KIs were classified into 2 major categories: (A) Senior staff including policymakers, directors, and senior managers; (B) Technical teams including case managers, and other staff supporting the implementation of WelTel (e.g., IT staff). Interviews were audio-recorded, transcribed, and analyzed in NVivo. Thematic analysis was conducted using a hybrid approach. A topic guide was developed using the Modified Consolidated Framework for Implementation Research and feedback from local stakeholders. Results: 7 KIs were interviewed. Five themes emerged following thematic analysis including: SMS-Based mHealth for Home-Isolation; Facilitators for Intervention Adoption; Barriers for Intervention Adoption; Infection prevention and control for Home-Isolation; and SMS-Based mHealth for Future Pandemics and Epidemics. Based on interviews, strong political commitment and advanced digital infrastructure were major facilitators for adopting WelTel for HBC. A major barrier to adopting WelTel was identified as technical-based issues. This was followed by local communication culture. All participates agreed on the significance of using WelTel to improve access and adherence to infection prevention and control measures, understand transmission dynamics, and inform public health decision-making regarding HBC. Conclusions: Rwanda successfully adopted WelTel for supporting and monitoring COVID-19 cases and contacts in home-isolation and the implementation was instrumental to the country's effort to manage the pandemic. Experiences and perspectives of cases and contacts enrolled into WelTel must be explored to understand the appropriateness and effectiveness of the intervention.

Developing a Concept of Operations Template to Guide Collaborative Disaster Research Response Between Academic Public Health and Public Health Agencies.

Research conducted in the context of a disaster or public health emergency is essential to improve knowledge about its short- and long-term health consequences, as well as the implementation and effectiveness of response and recovery strategies. Integrated approaches to conducting Disaster Research Response (DR2) can answer scientific questions, while also providing attendant value for operational response and recovery. Here, we propose a Concept of Operations (CONOPS) template to guide the collaborative development and implementation of DR2 among academic public health and public health agencies, informed by previous literature, semi-structured interviews with disaster researchers from academic public health across the United States, and discussion groups with public health practitioners. The proposed CONOPS outlines actionable strategies to address DR2 issues before, during, and after disasters for public health scholars and practitioners who seek to operationalize or enhance their DR2 programs. Additional financial and human resources will be necessary to promote widespread implementation of collaborative DR2 programs.

Do We Need to Protect the Entire World Population from Health Threats Through One Global Biomedical Surveillance and Response System? A Human Rights-Based Comment on the Proposed WHO Treaty on Pandemic Preparedness and Response

The World Health Organization (WHO) and its member States are currently in the process of negotiating a new multilateral treaty on pandemic preparedness and re-sponse. At the same time, the existing international legal framework regulating global health emergencies – the International Health Regulations (IHR) – are being revised. Overall, substantive proposals made so far for inclusion into the new treaty/revised IHR provide for a further centralisation of control over, and management of, the collectivity of all human bodies through increased digitally-based biomedical surveillance at WHO level to detect potential health threats in order to rapidly adopt, coordinate, and implement global medical and non-medical emergency countermeasures. This contribution shows that this substantive focus is driven by the Global Health Security (GHS) doctrine that has dominated WHO's, its member States', and its public-private partners' response to Covid-19. This is problematic because it will not only entrench the GHS doctrine further into international health law but also endorse and routinise many of the securitised global medical and non-medical coun-termeasures adopted in response to Covid-19 for responses to future health threats. (Emerging) evidence shows, however, that these countermeasures have been ineffective and resulted in far-reaching interferences with people's human rights in virtually every country around the world. By way of example, this is illustrated with an analysis of three GHS-in-formed medical and non-medical Covid-19 countermeasures: lockdowns, constant bio-surveillance, and the fast-track development, global promotion, distribution, and admin-istration of investigational vaccines. The contribution ends with a call on those responsible for the treaty negotiation and IHR revision processes to take due account of WHO's and its member States' human rights duties and responsibilities for human rights in these processes;and to question the exclusive focus on centrally managed, technocratic, biomedical ap-proaches to pandemic preparedness and response. © 2022, Duncker und Humblot GmbH. All rights reserved.

Sustainable strategies for Ebola virus disease outbreak preparedness in Africa: a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo.

BACKGROUND: From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018-2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. MAIN TEXT: Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. CONCLUSIONS: Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.

Examining priority setting in the national COVID-19 pandemic plans: A case study from countries in the WHO- South-East Asia Region (WHO-SEARO).

Background: The World Health Organization- South-East Asia Region (WHO-SEARO) accounted for almost 17% of all the confirmed cases and deaths of COVID-19 worldwide. While the literature has documented a weak COVID-19 response in the WHO-SEARO, there has been no discussion of the degree to which this could have been influenced/ mitigated with the integration of priority setting (PS) in the region's COVID-19 response. The purpose of this paper is to describe the degree to which the COVID-19 plans from a sample of WHO-SEARO countries included priority setting. Methods: The study was based on an analysis of national COVID-19 pandemic response and preparedness planning documents from a sample of seven (of the eleven) countries in WHO-SEARO. We described the degree to which the documented priority setting processes adhered to twenty established quality indicators of effective PS and conducted a cross-country comparison. Results: All of the reviewed plans described the required resources during the COVID-19 pandemic. Most, but not all of the plans demonstrated political will, and described stakeholder involvement. However, none of the plans presented a clear description of the PS process including a formal PS framework, and PS criteria. Overall, most of the plans included only a limited number of quality indicators for effective PS. Discussion and conclusion: There was wide variation in the parameters of effective PS in the reviewed plans. However, there were no systematic variations between the parameters presented in the plans and the country's economic, health system and pandemic and PS context and experiences. The political nature of the pandemic, and its high resource demands could have influenced the inclusion of the parameters that were apparent in all the plans. The finding that the plans did not include most of the evidence-based parameters of effective PS highlights the need for further research on how countries operationalize priority setting in their respective contexts as well as deeper understanding of the parameters that are deemed relevant. Further research should explore and describe the experiences of implementing defined priorities and the impact of this decision-making on the pandemic outcomes in each country.

Priority setting for pandemic preparedness and response: A comparative analysis of COVID-19 pandemic plans in 12 countries in the Eastern Mediterranean Region.

Background: The COVID-19 pandemic has significantly disrupted health systems and exacerbated pre-existing resource gaps in the Eastern Mediterranean Region (WHO-EMRO). Active humanitarian and refugee crises have led to mass population displacement and increased health system fragility, which has implication for equitable priority setting (PS). We examine whether and how PS was included in national COVID-19 pandemic plans within EMRO. Methods: An analysis of COVID-19 pandemic response and preparedness planning documents from a sample of 12/22 countries in WHO-EMRO. We assessed the degree to which documented PS processes adhere to twenty established quality parameters of effective PS. Results: While all reviewed plans addressed some aspect of PS, none included all quality parameters. Yemen's plan included the highest number (9) of quality parameters, while Egypt's addressed the lowest (3). Most plans used evidence in their planning processes. While no plans explicitly identify equity as a criterion to guide PS; many identified vulnerable populations - a key component of equitable PS. Despite high concentrations of refugees, migrants, and IDPs in EMRO, only a quarter of the plans identified them as vulnerable. Conclusion: PS setting challenges are exacerbated by conflict and the resulting health system fragmentation. Systematic and quality PS is essential to tackle long-term health implications of COVID-19 for vulnerable populations in this region, and to support effective PS and equitable resource allocation.

Integrated disease surveillance and response in humanitarian context: South Sudan experience.

Introduction: decades of instability continue to impact the implementation of the Integrated Disease Surveillance and Response (IDSR) strategy. The study reviewed the progress and outcomes of rolling out IDSR in South Sudan. Methods: this descriptive cross-sectional study used epidemiological data for 2019, 2020, and other program data to assess indicators for the five surveillance components including surveillance priorities, core and support functions, and surveillance system structure and quality. Results: South Sudan expanded the priority disease scope from 26 to 59 to align with national and regional epidemiological trends and the International Health Regulations (IHR) 2005. Completing the countrywide rollout of electronic Early Warning Alert and Response (EWARS) reporting has improved both the timeliness and completeness of weekly reporting to 78% and 90%, respectively, by week 39 of 2020 in comparison to a baseline of 54% on both timeliness and completeness of reporting in 2019. The National Public Health Laboratory confirmatory testing capacities have been expanded to include cholera, measles, HIV, tuberculosis (TB), influenza, Ebola, yellow fever, and Severe Acute Respiratory Syndrome 2 (SARS-COV-2). Rapid response teams have been established to respond to epidemics and pandemics. Conclusion: since 2006, South Sudan has registered progress towards using indicator and event-based surveillance and continues to strengthen IHR (2005) capacities. Following the adoption of third edition IDSR guidelines, the current emphasis entails maintaining earlier gains and strengthening community and event-based surveillance, formalizing cross-sectoral one-health engagement, optimal EWARS and District Health Information Systems (DHIS2) use, and strengthening cross-border surveillance. It is also critical that optimal government, and donors' resources are dedicated to supporting health system strengthening and disease surveillance.

Improving the Pharmacists' Response to Public Health Emergencies-Documentary Research on Online Resources Provided by National Pharmacists' Associations.

Objectives: Given the expanding role of pharmacists during COVID-19 pandemic, we aimed to investigate the approach of professional associations to supporting their practice and to find ways to improve their response to public health emergencies. Methods: We conducted documentary research on websites of seven national pharmacists' associations, submitted the findings to a comparative thematic analysis, and made proposals of specific good practices. Results: Many great resources were provided by pharmacists' associations in Australia, France, Spain, and the US. The similarities include scientific information on COVID-19 tests, treatments and vaccines, legal issues, and wellbeing management. The main differences were in developing medication management programs, supporting hospital pharmacists, helping families, or advocating for an equitable vaccination. In Finland, Hungary and Romania, the focus was on updating emerging information. Considering the need for better managing public health emergencies at organizational level, we suggested good practices regarding training and communication. Conclusion: Professional associations should develop preparedness and response plans for public health emergencies. Practical training and effective communication could improve the resilience of pharmacists and patients during pandemics, which could save lives.

One Health and Pathogen Sharing: Filling the Gap in the International Health Regulations to Strengthen Global Pandemic Preparedness and Response

The c Owl)-19 pandemic and other major public health emergencies of international concern occurred in the last zo years remind us of the close interconnections between human, animal, and environmental health and the need for collaborative and multisectoral approaches to address complex health threats. These outbreaks also serve to highlight the importance of timely sharing of pathogens, which are used to characterise the causative agent of an outbreak, understand its spread, and develop diagnostics, antiviral treatments, and vaccines. Despite their relevance to preparedness and response, neither One Health nor pathogen sharing are grounded within the International Health Regulations (IHR). This paper analyses the existing institutional and normative gaps within the IHR, including examining how other regimes within the international legal landscape have sought to 'fill the gaps'. We explore possible solutions and make proposals to strengthen interinstitutional cooperation and coordination through mechanisms alternative to IHR reform or a global pandemic treaty.

An Incentive Based Road Traffic Control Mechanism for Covid-19 Pandemic Alike Emergency Preparedness and Response

The Covid-19 pandemic has hit hard on the highly-organised yet risk-vulnerable modern societies, and has introduced new characteristics to large-scale emergencies, which feature long persistence in duration, high frequency in occurrence, large sensitivity to individual behaviours, and extreme high hazard propagation rate owing to the highly-efficient transport networks. This has raised new challenges on long-term emergency preparedness of urban transportation systems in terms of safety, efficiency, robustness and sustainability. Non-cooperative behaviours of transport participants could result in severe performance degradation in emergency preparedness, and mandatory restrictions in human activities can be economical costly and difficult in operation. In addition, current arrangement models for the disaster financial assistance have not been elaborately designed for civilian behaviour optimisation although with great potential as an economical instrument. Hence, in this paper, we propose a reward based traffic control mechanism to generate cooperative behaviours and optimise resource allocation in an urban transportation system for emergency preparedness via distributing credit coins, which can also be treated as a financial assistance approach during long-term disasters. A queueing theory based analytic model is employed to mimic the behaviours of civilians in the transportation system under the emergency preparedness state and a probability choice model is utilised to optimise the emergency preparedness strategies of the system. The experimental results show that the introduction of the incentive based traffic control mechanism can significantly reduce hazard response time, travel delay as well as the energy usage of the urban transportation system at the expense of monetary rewards.

Challenges and Opportunities for Mental Health and Psychosocial Support in the COVID-19 Response in Africa: A Mixed-Methods Study.

This research aimed to (1) assess the extent to which mental health and psycho-social support (MHPSS) was included in the national response to the COVID-19 pandemic in African countries, and (2) explore barriers and enablers to MHPSS integration into the COVID-19 response. A mixed-methods study, using an online survey and in-depth interviews, was conducted. Participants included Mental Health Focal Points at the Ministries of Health, the World Health Organization (WHO) country and regional offices, and civil society representatives. Responses were received from 28 countries out of 55 contacted. The implementation level, based on standard guidelines, of MHPSS activities was below 50% in most countries. The most implemented MHPSS activities were establishing coordination groups (57%) and developing MHPSS strategy (45%), while the least implemented activities included implementing the developed MHPSS strategy (32%) and establishing monitoring and evaluation mechanisms (21%). Key factors that hindered implementing MHPSS activities included lack of political commitment and low prioritisation of mental health during emergencies, as it was seen as a "less important" issue during the COVID-19 pandemic, when more importance was given to infection prevention and control (IPC). However, there are signs of optimism, as mental health gained some attention during COVID-19. It is imperative to build on the attention gained by integrating MHPSS in emergency preparedness and response and strengthening mental health systems in the longer term.

"No Regrets" Purchasing in a pandemic: making the most of advance purchase agreements.

"No regrets" buying - using Advance Purchase Agreements (APAs) - has characterized the response to recent pandemics such as Avian flu, Zika Virus, and now COVID-19. APAs are used to reduce demand uncertainty for product developers and manufacturers; to hedge against R&D and manufacturing risks; and to secure availability of products in the face of spiking demand. Evidence on the use of APAs to buy vaccines, medicines, diagnostics, and personal protective equipment during recent pandemics illustrates how these contracts can achieve their intended objectives for buyers. But, transferring risk from suppliers to buyers - as APAs do - can have consequences, including overbuying and overpaying. Furthermore, the widespread use of APAs by high-income countries has contributed to the striking inequities that have characterized the Swine flu and COVID-19 responses, delaying access to vaccines and other supplies for low- and middle-income countries (L&MICs).We identify seven ways to address some of the risks and disadvantages of APAs, including adoption of a global framework governing how countries enter into APAs and share any resulting supplies; voluntary pooling through joint or coordinated APAs; a concessional-capital-backed facility to allow international buyers and L&MICs to place options on products as an alternative to full purchase commitments; greater collection and sharing of market information to help buyers place smarter APAs; support for a resale market; building in mechanisms for donation from the outset; and transitioning away from APAs as markets mature. While a binding global framework could in theory prevent the competitive buying and hoarding that have characterized country/state responses to pandemics, it will be very challenging to put in place. The other solutions, while less sweeping, can nonetheless mitigate both the inequities associated with the current uncoordinated use of APAs and also some of the risks to individual buyers.Analysis of recent experiences can provide useful lessons on APAs for the next pandemic. It will be important to keep in mind, however, that these contractual instruments work by transferring risk to the buyer, and that buyers must therefore accept the consequences. In the spirit of "no regrets" purchasing, having bought what hindsight suggests was too much is generally preferable to having bought not enough.

Public health emergencies: Case studies, competencies, and essential services of public health

Public Health Emergencies provides a current overview of public health emergency preparedness and response principles with case studies highlighting lessons learned from recent natural and man-made disasters and emergencies. Designed for graduate and advanced undergraduate public health students, this book utilizes the 10 essential services of public health as performance standards and foundational competencies from the Council on Education for Public Health to assess public health systems. It emphasizes the roles and responsibilities of public health careers in state and local health departments as well as other institutions and clarifies their importance during health-related emergencies in the community. Written by prominent experts, including health professionals and leaders on the frontlines, this textbook provides the framework and lessons for understanding the public health implications of disasters, emergencies, and other catastrophic events, stressing applied understanding for students interested in pursuing public health preparedness roles. Practical in its approach, Part One begins with an introduction to the fundamentals of public health emergency preparedness with chapters on community readiness, all-hazards preparedness design, disaster risk assessments, and emergency operation plans. Part Two covers a range of public health emergency events, including hurricanes, tornadoes, earthquakes, disease outbreaks and pandemics, accidents and chemical contamination, nuclear and radiological hazards, extreme heat events, and water supply hazards. The final part addresses special considerations, such as how the law serves as a foundation to public health actions;preparedness considerations for persons with disabilities, access, and functional needs;children and disasters;and a chapter evaluating emerging and evolving threats. Throughout, chapters convey the roles of front-line, supervisory, and leadership personnel of the many stakeholders involved in preparedness, response, and recovery efforts to demonstrate decision-making in action. © 2022 Springer Publishing Company, LLC.