Equitable Access

The COVID-19 epidemic has once again highlighted the challenges to achieve equitable access to critical antimicrobials and vaccines. The problem is particularly acute for antimicrobials. Despite recent investments improving the pipeline for new treatments, most new treatments are not available to populations most in need, especially in low- and middle-income countries. Once a drug is approved a range of factors may hinder access, from lack incentives to register and commercialize products due to unattractive market potential to unfunded national action plans that can help improve the uptake and appropriate use of new tools to combat antibiotic resistance. Previous studies have shown that the majority of the 18 new antibacterials approved and launched between 2010-2020 were accessible in only 3 out of 14 high-income countries (Sweden, UK, and US). In low- and middle-income countries, the problem is even worse, with only 10 of the 25 new antibiotics that entered the market between 1999 and 2014 registered in more than ten countries. While lack of equitable access to life-saving medicines, diagnostics, and vaccines is not a new problem for infectious diseases, emerging opportunities and innovative approaches can help improve access globally. This talk will review promising recent developments in governance and collaborations, policies, economic models and initiatives that may help correct deadly inequities. For example, the objectives of the Access to COVID-19 Tools Accelerator may serve as model that convenes diverse actors to mount a coordinated access response which may be applied to access to other antimicrobials and vaccines. In addition, novel licensing agreements for access and stewardship to cefiderocol, an antimicrobial that is on the WHO Essential Medicines List can help serve as a pathfinder to accelerate equitable access to novel antimicrobials. The talk will also surface critiques of ongoing initiatives and raise questions for further study and discussion.Copyright © 2023

Impact of COVID-19's supply and demand shocks on the household economy of tilapia smallholder farmer

PurposeThis study aims to verify the impact of the supply shock (fall in harvested output) and demand shock (fall in household income) due to the pandemic on the consumption of necessities and household savings of tilapia's smallholder farmer.Design/methodology/approachThe researchers randomly chose 144 households as research samples using the proportional random sampling technique in Padang Jaya District, North Bengkulu Regency. Researchers collected data on household income, farm losses, household consumption for basic needs, labor demand, use of production inputs, the amount of output sold and saving both during and before the pandemic. The data were collected from the sample using a questionnaire prepared by the researchers. This study used a simultaneous equations system for arranging tilapia's smallholder farmer household economic model.FindingsThis study verified that the demand shock phenomenon makes households more severe than the supply shock phenomenon. The demand shock phenomenon made worse-off tilapia smallholder farmers because it caused their household savings to drop during the pandemic. The fall in savings will disrupt the stability of consumption of household necessities (health, food, education and clothing) in the future.Originality/valueThe main contribution of this study was providing empirical evidence about the impact of the demand and supply shock of COVID-19 on the most vulnerable entities in the Indonesian freshwater aquaculture industry, namely, smallholder farmer households of freshwater aquaculture fish.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-08-2022-0554.

Impact of COVID-19's supply and demand shocks on the household economy of tilapia smallholder farmer

Purpose: This study aims to verify the impact of the supply shock (fall in harvested output) and demand shock (fall in household income) due to the pandemic on the consumption of necessities and household savings of tilapia's smallholder farmer. Design/methodology/approach: The researchers randomly chose 144 households as research samples using the proportional random sampling technique in Padang Jaya District, North Bengkulu Regency. Researchers collected data on household income, farm losses, household consumption for basic needs, labor demand, use of production inputs, the amount of output sold and saving both during and before the pandemic. The data were collected from the sample using a questionnaire prepared by the researchers. This study used a simultaneous equations system for arranging tilapia's smallholder farmer household economic model. Findings: This study verified that the demand shock phenomenon makes households more severe than the supply shock phenomenon. The demand shock phenomenon made worse-off tilapia smallholder farmers because it caused their household savings to drop during the pandemic. The fall in savings will disrupt the stability of consumption of household necessities (health, food, education and clothing) in the future. Originality/value: The main contribution of this study was providing empirical evidence about the impact of the demand and supply shock of COVID-19 on the most vulnerable entities in the Indonesian freshwater aquaculture industry, namely, smallholder farmer households of freshwater aquaculture fish. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-08-2022-0554. © 2022, Emerald Publishing Limited.

The Economic and Capacity Impact of Time Saved in the Operating Theatre Performing Holmium Laser Enucleation of the Prostate with MosesTM Technology vs Standard Technology

Objectives: Reducing operating theatre time can help hospitals to optimise operational efficiency and effectively allocate scarce resources. Holmium Laser Enucleation of the Prostate (HOLEP) is an established procedure for the treatment of symptoms secondary to Benign Prostatic Hyperplasia (BPH). It can be performed with Standard Technology (standard HOLEP) or MOSESTM Technology (MOLEP, Boston Scientific Corp). A recent meta-analysis demonstrated significantly reduced operative time with MOLEP vs. standard HOLEP. Our objective is to understand the potential economic impact of reducing theatre time with MOLEP vs. standard HOLEP and potential increases in operational capacity in hospitals in major European DRG-system countries, England, France, Germany and Italy. Method(s): We developed a health economic model to extrapolate theatre time savings reported in the meta-analysis to annual procedure volumes of a theoretical small (1 HOLEP/week), medium (3 HOLEP/week), and large (15 HOLEP/week) hospital. The model allows individual proportions of the time saved to feed into either theatre time cost savings or increased procedure throughput. We used national DRG tariffs and theatre cost per minute to estimate the economic impact. Result(s): Assigning all time savings to the performance of new procedures, small, medium, and large hospitals could perform up to 14, 44, and 229 additional procedures per year, respectively, increasing their procedure volume by 28-29%. In this example, potential revenue gains ranged from 32.573 (small French hospital) to 653.866 (large German hospital), for MOLEP vs. standard HOLEP. For every four procedures performed with MOLEP vs. standard HOLEP, sufficient time was saved to perform an additional procedure. Conclusion(s): Use of MOLEP saves time vs. standard HOLEP. Depending on the hospital aims, this efficiency gain can result in higher cost savings and generate additional revenue for the hospital. Aspects of operative efficiency and workflow improvements should be considered when evaluating the adoption of state-of-the-art medical technologies, especially in the post-COVID-19 pandemic era. Copyright © 2022

A simplified economic model and case study for recovery ventilation based on SPECO method

Covid-19 further revealed the significance of ventilation by air conditioning systems. Most common split heaters and resistance heaters recirculate the indoor air without ventilation process. Ventilation wastes energy consumption by the building. However, adding an air-to-air heat recovery unit seems a quick solution to reduce the wasted heat of the ventilation process. Nonetheless, recovery unit means further pumping power (pressure drop through the air-to-air heat exchanger), capital cost, additional fans and their electricity consumption, exergy costs and so on. Hence, the profitability of the recovery unit depends on outdoor temperature, desired indoor temperature, electricity price of the region, exergy loss and also the aforementioned factors. In this research the general standard Specific Exergy Costing theory is employed and simplified as an economic strategy for recovery ventilation. The model not only is able to predict the profitability of the ventilation process using air-to-air heat exchanger, but also it is an optimization tool for air-to-air heat recovery units as provided as a case study in this paper.

Muay Thai: A Suitable Creative Economic Development Model

The research of this paper is based on Muay Thai and it provides value-added and suitable model research for the development of Muay Thai through the principles of creative economics. Therefore, after defining the research scope of Muay Thai, we must clari fy the basic theories related to creative economy, the content that it covers, and the internal and external concepts serving it. In the study of the text, we will concretely consider and study the following theoretical system: the theory of creative economy. UNESCO's concept of creative economy combines creative production and commercialization with intangible cultural connotations to create content-intensive industrial activities.Form and the content is protected by copyright, basically is the product material and non-material services. On the basis of the above-mentioned, the text of the culture and value-added research of Muay Thai adopt the concept of combiningculture, creativity and high-tech in creative economy, as well as related intellectual property rights protection, to study the current situation of Muay Thai. Especially in the COVID-19 epidemic, Muay Thai became the beneficiary of creative economy.

Besides Promising Economic Growth, Will the Italian Nrrp Also Produce Fewer Emissions?

The investment projects funded by the Italian National Recovery and Resilience Plan (NRRP) aim to trigger an increase in GDP, that is in turn expected to drive energy consumption and carbon dioxide emissions up. At the same time, since an important share of the Plan's investments is aimed at facilitating the green transition, we expect favorable effects on emissions. Which one of these two effects will prevail remains to be ascertained. In this study we have used the GEM model by Oxford Economics to build a number of scenarios and generate the relevant simulations. To validate the use of GEM we also considered the macroeconomic impact on GDP and unemployment rate generated by the model and compared the results with those presented by other institutions and obtained using different models. The results show that when the green investments of the NRRP display their effects, there are climatic benefits in terms of reduced emissions. Compared to the implementation of the NRRP in 2021, however, the reduction in emissions by 2030 is modest and equal to 5%. As those investments largely refer to the adoption of dean technologies, the climate benefits are likely to be more substantial only in subsequent years and over longer horizons.

CHARACTERIZING the SCOPE and DRIVERS of the IMPACT of COVID-19 on LOCAL HIV EPIDEMICS

Background: The potential impact of COVID-19 pandemic on the US HIV epidemic remains unclear. Characterizing the scope and main drivers of the impact of COVID-19 on HIV incidence can inform future HIV policy. Methods: We characterized the impact of COVID-19 pandemic and attendant lockdowns on HIV epidemiology via reductions in sexual transmission (0-50%) from March 1st, 2020 to July 4th, 2021, plus reductions in viral suppression (0-40%), HIV testing (0-50%), and pre-exposure prophylaxis use (0-30%) from March 1st to February 4th, 2022. Using the Johns Hopkins Epidemiologic and Economic Model (JHEEM) of HIV transmission, we projected HIV infections from 2020 to 2025 across 32 high-priority US cities and compared these to projections if COVID-19 had not emerged. Results: Across all 32 cities, 80% of simulations projected a decline in HIV incidence in 2020 (median decrease of 15% from 2019), before rebounding in 2021 (96% of simulations, median increase of 13% from 2020)-see Figure, panel B. Projections of the impact of the COVID-19 pandemic on cumulative HIV incidence from 2020-2025 varied by city, ranging from a median of 3% fewer incident cases in Las Vegas to 9% more incident cases in Boston (Figure, panel A). At the MSA level, reductions in sexual transmission had the strongest impact on incidence, followed by reductions in viral suppression. Among simulations that incorporated large (>25%) reductions in viral suppression due to COVID-19, adverse impacts on HIV incidence were greater where pre-pandemic levels of viral suppression were higher (ranging from a median 1% increase in cumulative incidence 2020-25 in Chicago with 52% pre-pandemic suppression, to a 24% increase in Seattle with 86% pre-pandemic suppression-Figure, panel C). Conclusion: The effects of COVID-19 on HIV transmission remain uncertain and differ substantially at the local level. Disruptions to HIV care and viral suppression due to the COVID-19 pandemic may have greater impact in increasing HIV incidence in settings where pre-existing suppression levels are higher.

THE IMPERATIVE OF TRANSITION TO A NEW MODEL OF SOCIOECONOMIC DEVELOPMENT

The article considers the urgent need to switch to a new model of socio-economic development, which should be based on a radically rethought understanding of progress in all its elements and manifestations. The authors show that in the post-covid world, it will increasingly acquire the character of ecosystem progress, not progress focused on ecology, but a set of processes and characteristics combined within every nation. The ecosystem penetrates all critical spheres of life of the state and the nation and generates a synergy effect. Here ecosystem is understood as a business ecosystem applying to states and societies. Its main feature is the synchronized change of all aspects of human life based on the continuous development, application, and multiplication of new technologies, leading to the exponential growth of all elements of society. The transition from the old type of progress to ecosystemic progress will take time and effort. Due to the results achieved in the process, it will constantly accelerate. Those countries which will timely harness the wave of ecosystemic progress and implement this approach earlier than others will benefit more and become the leaders of this competition. They will become models imitated by others and establish a new set of values for human civilization. It is vital that Russia becomes one of the first among these countries. © 2022

Economic and clinical impact of a novel, light-based, at-home antiviral treatment on mild-to-moderate COVID-19.

OBJECTIVES: Antiviral treatments for early intervention in patients with mild-to-moderate COVID-19 are needed as a complement to vaccination. We sought to estimate the impact on COVID-19 cases, deaths, and direct healthcare costs over 12 months following introduction of a novel, antiviral treatment, RD-X19, a light-based, at-home intervention designed for the treatment of mild-to-moderate COVID-19 infection. METHODS: A time-dependent, state transition (semi-Markov) cohort model was developed to simulate infection progression in individuals with COVID-19 in 3 US states with varying levels of vaccine uptake (Alabama, North Carolina, and Massachusetts) and at the national level between 1 June 2020 and 31 May 2021. The hypothetical cohort of patients entering the model progressed through subsequent health states after infection. Costs were assigned to each health state. Number of infections/vaccinations per day were incorporated into the model. Simulations were run to estimate outcomes (cases by severity, deaths, and direct healthcare costs) at various levels of adoption of RD-X19 (5%, 10%, 25%) in eligible infected individuals at the state and national levels and across three levels of clinical benefit based on the results from an early feasibility study of RD-X19. The clinical benefit reflects a decline in the duration of symptomatic disease by 1.2, 2.4 (base case), and 3.6 days. RESULTS: In the base case analysis with 10% adoption, simulated infections/deaths/direct healthcare costs were reduced by 10,059/275/$69 million in Alabama, 21,092/545/$135 million in North Carolina, and 16,670/415/$102 million in Massachusetts over 12 months. At the national level, 10% adoption reduced total infections/deaths/direct healthcare costs by 686,722/17,748/$4.41 billion. CONCLUSION: At-home, antiviral treatment with RD-X19 or other interventions with similar efficacy that decrease both symptomatic days and transmission probabilities can be used in concert with vaccines to reduce COVID-19 cases, deaths, and direct healthcare costs.

Telemedicine and hemostasis-thrombosis centres

Nowadays, telemedicine has different clinical applications since it is used in almost all medical specialties. The COVID-19 pandemic has created not only major economic and social upheavals but also has an important impact on public health. In this emergency situation, the use of telemedicine has been rise aiming to mitigate the effects of COVID-19 on human health (1). In Italy, the Hemostasis-Thrombosis Centres (HTCs) belong to the Federation of Centres for the diagnosis of thromboembolic disease and the Surveillance of Anticoagulant therapy (FCSA) and they offer the highest possible quality of assistance to patients treated with Vitamin K Antagonists (VKAs) or Direct Oral Anticoagulants (DOACs). Unlike DOACs, VKAs need a close monitoring through the Prothrombin Time (PT) expressed as International Normalized Ratio (INR). The test result allows doctors at HTCs to prescribe the correct dosage of VKAs to maintain the INR in the therapeutic range. This means that patients have to go to their HTC more often than patients treated with DOACs. Telemedicine has been implemented in the routine clinical practice at HTC many years ago (2) and actually, during the COVID-19 pandemic, this system is of significant aid in the management of this therapy allowing patients to perform the test at home or to self-manage their own therapy. The system is organised as a centralised net-supported program with a server and PC stations in the HTC and workstations in the peripheral districts. Points-of-Care INR allow patients to easy perform the test on capillary blood and to quickly gain the INR result thus reducing the number of controls that patients would perform at the HCT (3). This aspect is of important value during COVID- 19 pandemic since overcrowding should be avoided. In general, self-management and self-testing have similar safety (RR=1.08, 95% CI 0.81-1.45, RR=0.99, 95% CI 0.8-1.23, respectively) than traditional monitoring as reported by the metanalysis of Sharma et al (4). As regard the efficacy, the authors showed a less incidence of thromboembolism when self-management was used (RR=0.51, 95% CI 0.37-0.69) with a trend versus a significant reduction in all-cause mortality (RR=0.68, 95% CI 0.46-1.01) while self-testing allowed to reach a 4.4% (95% CI 1.7-7.18) increase in time in therapeutic range. In accordance with other economic models, the metanalysis also showed that self-monitoring is costeffective. Another advantage of the use of telemedicine in HCT is the patients' satisfaction. In our experience (5) 85% of the patients are satisfied with self-testing at home and the quality of life is improved in 87% of them. The cost of test strips was medium-high for 89% of the patients, and 75% of them stated that it was worth improving their quality of life. Telemedicine is usefull in managing patients on VKAs and, as suggested by the FCSA (6), it is a safe and efficacy system to guarantee an adequate medical assistance not only routinely but especially during pandemic. Finally, telemedicine could be used also for DOACs patients putting in place a system that may allow patients to attach the PDF file of their laboratory tests and to video-call the doctors at HTC.

Prospects for chinese-russian cooperation in the dairy sector

Relevance. The COVID-19 pandemic is a new challenge facing humanity, which has already caused serious damage to the global economy. In particular, international cooperation has faced somewhat unprecedented challenges. In the post-pandemic era, it is extremely important to study the state of the dairy sector in China in order to find a way to develop cooperation between the People’s Republic of China and the Russian Federation in this field. Research objective. To analyse the state of China’s dairy sector in the post-pandemic period, taking into account the trend of recovery, as well as to identify the priority areas and interaction directions in the dairy sector between China and the Russian Federa-tion. Data and Methods. The research was conducted using the methods of comparative analysis, focusing mainly on quantitative and qualitative indicators. The conditions for the interaction of the dairy sector between China and the Russian Federation were analysed. Results. It is shown that, at present, the Chinese-Rus-sian interaction in the dairy sector includes four aspects: trade in dairy products, experience exchange, investment cooperation and interaction at the governmen-tal level. Trade in dairy products and the exchange of experience and technologies in the dairy sector are developing steadily, supported by increased interaction at the state level. Conclusions. The Chinese-Russian cooperation in the dairy sector is experiencing some difficulties;however, the common interest of both countries in dairy production and the strong support of both governments ensure excellent prospects for achieving mutual benefits and high performance. © 2021, Ural University Press. All rights reserved.

The European Green Deal: More than an Exit Strategy to the Pandemic Crisis, a Building Block of a Sustainable European Economic Model*

This article puts forward that the European Green Deal (EGD) is more than just another initiative for green growth. Instead, it adds a building block to the European economic model, alongside the single market and economic and monetary union. The pandemic crisis would therefore need to be addressed also through the EGD framework. We find that the Covid-19 crisis provided a missing link between the EGD's long-term objectives and conducive short-term policies. We discuss to what extent economic governance changes reinforce the role of the EGD as a pillar of the European Union economic model, contributing also to creating strong (political, institutional and society) dynamics in favour of sustainability and promoting integration.

Cost-benefit analysis of vaccination against four preventable diseases in older adults: Impact of an aging population.

OBJECTIVE: This exploratory study estimates the economic value of the current vaccination program and increased coverage against four preventable diseases in older adults in the United States (US). METHODS: A population-based, age-structured economic model was used to conduct a cost-benefit analysis of vaccination against influenza, pertussis, herpes zoster, and pneumococcal disease among US adults aged 50 years and older, accounting for aging of the population. The model used separate decision trees for each disease to project the discounted number of vaccinated individuals, number of disease cases, and direct medical and indirect costs (2018 US$) over a 30-year period. Benefit-cost ratios (BCRs) and net present values were calculated for two primary analyses comparing current vaccination coverage versus no vaccination and comparing increased coverage versus current coverage. Key parameter values were varied in deterministic sensitivity analyses. RESULTS: Current adult vaccination coverage (vs. no vaccination) is estimated to result in nearly 65 million averted disease cases, $185 billion averted costs of cases, and $136 billion in incremental vaccination costs over a 30-year period from a societal perspective (BCR = 1.4). Increased vaccination coverage (vs. current coverage) is associated with over 33 million additional averted disease cases, $96 billion additional averted costs of cases, and nearly $83 billion in incremental vaccination costs, resulting in a societal BCR of 1.2 over 30 years. Deterministic sensitivity analyses demonstrated that results were most sensitive to disease incidence, vaccine efficacy, and productivity costs for time required for vaccination. CONCLUSIONS: Study results highlight the economic value of vaccination programs for older adults in the US and indicate that efforts to further increase vaccination coverage may be warranted and economically justifiable.

Long-term pathways to deep decarbonization of the transport sector in the post-COVID world.

The novel coronavirus disease 2019 (COVID-19) crisis has influenced economies and societies across the globe and will thoroughly reshape our world as it continues to unfold. The pandemic is likely to trigger permanent long-term impacts on the transport sector in the post-COVID world. While a post-COVID "new normal" will be likely to incur negative consequences, it may provide an opportunity to move toward a more sustainable transport sector. This paper is aimed at developing an urban economic model with an energy focus to depict the dynamics of travel demand, energy consumption, and emissions in the post-COVID world. A set of scenarios was created according to model assumptions regarding lifestyle changes and policy interventions accompanied by the expected post-COVID new normal, to explore long-term pathways toward a deep decarbonization of the transport sector. Scenario simulations demonstrated that working from home, online shopping, and a bike-friendly infrastructure will contribute to a reduction in energy consumption and CO2 emissions, whereas a significant shift from bus to car transport and the decreasing use of car-sharing services will adversely affect CO2 emission reductions. The arrival of the post-COVID world may contribute to an 11% reduction in CO2 emissions by 2060, while the maximum reduction potential could be as high as 44%. Supporting policies and strategies for encouraging remote work and online shopping as well as for promoting safe public transport, active transport, and carpooling services are needed to strongly decarbonize the transport sector in the post-COVID world. Moreover, population distribution and urban structure may also be influenced by the arrival of the post-COVID new normal, which warrant further attention for urban planning.