Designing the post-pandemic hospice environment: "The last place"

Where and how people die is a significant concern of human life and society (Worpole, 2009). In these days, people die either in their home or in an end-of-life care facility, such as hospice. Hospice is a place to provide end-of-life care to individuals certified as "terminal." Hospice care or end-of-life care is a multidisciplinary care and support (non-curative) system designed to address the physical, emotional, psychosocial, and spiritual concerns of terminal patients and their families. Thus, the facility design is significantly different in various dimensions. For example, hospice patients are mostly bed-bound, and a patient's family accommodation plays a significant role in the patient's dying experience. Providing a supportive physical environment of hospice has an imperative impact on the patient "quality of life" and the possibility of a "good death." With the COVID-19 challenges, it has become significant to explore the best possible solutions of hospice facility design. This chapter discusses the 11 therapeutic goals of hospice care environment which was developed by Kader and Diaz Moore in 2015 considering dying experiences. The physical settings of hospice along with the carefully designed organizational environment can contribute to the realization of desired therapeutic goals and have a positive effect on the lives of dying patients. This chapter discusses each therapeutic goal and how hospice facility design can support these goals with a few examples and presents six major design-related challenges of post-pandemic (COVID-19) hospice care facilities. Lastly, several prospective design concepts have explored considering pandemic resiliency. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Adolescents' Opinions on COVID-19 Vaccine Hesitancy: Hints toward Enhancing Pandemic Preparedness in the Future.

To understand and assess vaccine reluctance, it is necessary to evaluate people's perceptions and grasp potential reasons for generic apprehension. In our analysis, we focus on adolescents' impressions towards anti-vaxxer behavior. The aim of the study is to figure out students' opinions about vaccine reluctance, connecting possible explanations that motivate anti-vaxxer decisions with common specific personality traits. We further investigate people's forecasts concerning the evolution of the pandemic. Between 2021 and 2022, we conducted a randomized survey experiment on a sample of high school individuals (N=395) living in different Italian regions. At that time, the vaccination campaign had already been promoted for nearly one year. From the analysis, it emerges that vaccinated people (92%), especially males, tend to be more pessimistic and attribute a higher level of generic distrust in science to anti-vaxxers. The results show that family background (mother's education) represents the most influential regressor: individuals coming from less educated families are less prone to attribute generic distrust and distrust of vaccines as principal reasons for vaccine reluctance. Similarly, those who rarely use social media develop a minor tendency to believe in a generic pessimism of anti-vaxxers. However, concerning the future of the pandemic, they are less likely to be optimistic toward vaccines. Overall, our findings shed light on adolescents' perceptions regarding the factors that influence vaccine hesitancy and highlight the need for targeted communication strategies to improve vaccination rates.

Digital Public Health Solutions in Response to the COVID-19 Pandemic: Comparative Analysis of Contact Tracing Solutions Deployed in Japan and Germany.

BACKGROUND: In response to the COVID-19 pandemic, numerous countries, including the likes of Japan and Germany, initiated, developed, and deployed digital contact tracing solutions in an effort to detect and interrupt COVID-19 transmission chains. These initiatives indicated the willingness of both the Japanese and German governments to support eHealth solution development for public health; however, end user acceptance, trust, and willingness to make use of the solutions delivered through these initiatives are critical to their success. Through a case-based analysis of contact tracing solutions deployed in Japan and Germany during the COVID-19 pandemic we may gain valuable perspectives on the transnational role of digital technologies in crises, while also projecting possible directions for future pandemic technologies. OBJECTIVE: In this study, we investigate (1) which types of digital contact tracing solutions were developed and deployed by the Japanese and German governments in response to the COVID-19 pandemic and (2) how many of these solutions are open-source software (OSS) solutions. Our objective is to establish not only the type of applications that may be needed in response to a pandemic from the perspective of 2 geographically diverse, world-leading economies but also how prevalent OSS pandemic technology development has been in this context. METHODS: We analyze the official government websites of Japan and Germany to identify digital solutions that are developed and deployed for contact tracing purposes (for any length of time) during the timeframe January-December 2021, specifically in response to the COVID-19 pandemic. We subsequently perform a case-oriented comparative analysis, also identifying which solutions are published as open-source. RESULTS: In Japan, a proximity tracing tool (COVID-19 Contact-Confirming Application [COCOA]) and an outbreak management tool (Health Center Real-time Information-sharing System on COVID-19 [HER-SYS]) with an integrated symptom tracking tool (My HER-SYS) were developed. In Germany, a proximity tracing tool (Corona-Warn-App) and an outbreak management tool (Surveillance Outbreak Response Management and Analysis System [SORMAS]) were developed. From these identified solutions, COCOA, Corona-Warn-App, and SORMAS were published as open-source, indicating support by both the Japanese and German governments for OSS pandemic technology development in the context of public health. CONCLUSIONS: Japan and Germany showed support for developing and deploying not only digital contact tracing solutions but also OSS digital contact tracing solutions in response to the COVID-19 pandemic. Despite the open nature of such OSS solutions' source code, software solutions (both OSS and non-OSS) are only as transparent as the live or production environment where their processed data is hosted or stored. Software development and live software hosting are thus 2 sides of the same coin. It is nonetheless arguable that OSS pandemic technology solutions for public health are a step in the right direction for enhanced transparency in the interest of the greater public good.

The Experience of Testing for Coronavirus Disease (COVID-19) at a Single Diagnostic Center in Paraguay before the Introduction of Vaccination.

Soon after the declaration of the COVID-19 pandemic, the Institute for Health Sciences Research (IICS) of the National University of Asunción, Paraguay became a testing laboratory (COVID-Lab) for SARS-CoV-2. The COVID-Lab testing performance was assessed from 1 April 2020 to 12 May 2021. The effect of the pandemic on the IICS and how the COVID-Lab contributed to the academic and research activities of the institute were also assessed. IICS researchers and staff adjusted their work schedules to support the COVID-Lab. Of the 13,082 nasopharyngeal/oropharyngeal swabs processed, 2704 (20.7%) tested positive for SARS-CoV-2 by RT-PCR. Of the individuals testing positive, 55.4% were female and 48.3% were aged 21-40 years. Challenges faced by the COVID-Lab were unstable reagent access and insufficient staff; shifting obligations regarding research, academic instruction, and grantsmanship; and the continuous demands from the public for information on COVID-19. The IICS provided essential testing and reported on the progress of the pandemic. IICS researchers gained better laboratory equipment and expertise in molecular SARS-CoV-2 testing but struggled to manage their conflicting educational and additional research obligations during the pandemic, which affected their productivity. Therefore, policies protecting the time and resources of the faculty and staff engaged in pandemic-related work or research are necessary components of healthcare emergency preparedness.

30 - Disaster Risk Management

Disaster risk management encompasses a holistic approach to all hazards throughout the disaster cycle of prevention, mitigation, preparedness, response, and recovery. Research during the COVID-19 pandemic highlighted numerous shortfalls globally in disaster preparedness and response within the health care setting. The results of multiple studies suggest that a lack of preparedness and high vulnerability remain significant challenges for health care organizations during disasters. Risk may also need to be reexamined in light of the increasing frequency, duration, and intensity of crisis events. Rather than focusing on an all-hazards approach to disaster risk management, it may be prudent to consider the top hazards an organization may face.

An elephant in the glasshouse? Trade-offs between acceleration and transformation in COVID-19 vaccine innovation policies.

Against the backdrop of a failing vaccine innovation system, innovation policy aimed at creating a COVID-19 vaccine was surprisingly fast and effective. This paper analyzes the influence of the COVID-19 landscape shock and corresponding innovation policy responses on the existing vaccine innovation system. We use document analysis and expert interviews, performed during vaccine development. We find that the sharing of responsibility between public and private actors on various geographical levels, and the focus on accelerating changes in the innovation system were instrumental in achieving fast results. Simultaneously, the acceleration exacerbated existing societal innovation barriers, such as vaccine hesitancy, health inequity, and contested privatization of earnings. Going forward, these innovation barriers may limit the legitimacy of the vaccine innovation system and reduce pandemic preparedness. Next to a focus on acceleration, transformative innovation policies for achieving sustainable pandemic preparedness are still urgently needed. Implications for mission-oriented innovation policy are discussed.

Imagining the next pandemic: Finnish preparedness for chronic transboundary crises before and during COVID-19

Before the COVID-19 pandemic, infectious disease experts had postulated that the next pandemic is only a matter of time, and Finland, among other nations, had prepared for it. Yet the COVID-19 pandemic crossed the customary political, functional, and temporal boundaries of crisis management to a surprising degree. This study analyses pandemic preparedness among Finnish infectious disease experts at the central government level before and during the COVID-19 pandemic (2017–2021). The study is based on interview material, participant observation in the Finnish Institute for Health and Welfare's infectious disease unit in 2017, and health security-related document analysis. By analyzing expert perceptions of preparedness in two points of time, the study provides insights on the challenges that increasingly transboundary crises have posed for preparedness efforts. The experts perceived that pandemic preparedness would benefit from a more generic approach to planning and from more comprehensive risk assessments and policy advice. The analysis shows that Finnish crisis management had overlooked the extent of transboundedness of present-day crises and is lacking consideration of how crises turn into chronic conditions that deplete capacities over time. The crisis man.agement regime needs to develop structures to better analyze systemic risks and to extend its timeframe to cover long-term crises. © 2023 The Authors. Risk, Hazards & Crisis in Public Policy published by Wiley Periodicals LLC on behalf of Policy Studies Organization.

Critical appraisal of the Coronavirus preparedness among countries using the global health security index

Introduction: This critical study was aimed to investigate the utility of the Global Health Security Index in predicting the current COVID-19 responses. Material and Methods: Number of infected patients, deaths, incidence and the death rate per 100,000 populations related to 55 countries per week for 26 weeks were extracted. The relationship of GHSI scores and country preparedness for the pandemic was compared. Results: According to the GHSI, the incidence rate in most prepared countries was higher than the incidence rate in the more prepared countries, and which was higher than the incidence rate in the least prepared countries. However, Prevention, Detection and reporting, Rapid response, Health system, compliance with international norms and Risk environment, as well as Overall, the incidence and death rate per 100,000 people have not been like this. Conclusion: Due to mismatch between the GHSI score and fact about COVID-19 incidence, it seems necessary to investigate the factors involved in this discrepancy. © 2022, Published by Frontiers in Health Informatics.

VACCELERATE Site Network: Real-time definition of clinical study capacity in Europe.

BACKGROUND: The inconsistent European vaccine trial landscape rendered the continent of limited interest for vaccine developers. The VACCELERATE consortium created a network of capable clinical trial sites throughout Europe. VACCELERATE identifies and provides access to state-of-the-art vaccine trial sites to accelerate clinical development of vaccines. METHODS: Login details for the VACCELERATE Site Network (vaccelerate.eu/site-network/) questionnaire can be obtained after sending an email to. Interested sites provide basic information, such as contact details, affiliation with infectious disease networks, main area of expertise, previous vaccine trial experience, site infrastructure and preferred vaccine trial settings. In addition, sites can recommend other clinical researchers for registration in the network. If directly requested by a sponsor or sponsor representative, the VACCELERATE Site Network pre-selects vaccine trial sites and shares basic study characteristics provided by the sponsor. Interested sites provide feedback with short surveys and feasibility questionnaires developed by VACCELERATE and are connected with the sponsor to initiate the site selection process. RESULTS: As of April 2023, 481 sites from 39 European countries have registered in the VACCELERATE Site Network. Of these, 137 (28.5 %) sites have previous experience conducting phase I trials, 259 (53.8 %) with phase II, 340 (70.7 %) with phase III, and 205 (42.6 %) with phase IV trials, respectively. Infectious diseases were reported as main area of expertise by 274 sites (57.0 %), followed by any kind of immunosuppression by 141 (29.3 %) sites. Numbers are super additive as sites may report clinical trial experience in several indications. Two hundred and thirty-one (47.0 %) sites have the expertise and capacity to enrol paediatric populations and 391 (79.6 %) adult populations. Since its launch in October 2020, the VACCELERATE Site Network has been used 21 times for academic and industry trials, mostly interventional studies, focusing on different pathogens such as fungi, monkeypox virus, Orthomyxoviridae/influenza viruses, SARS-CoV-2, or Streptococcus pneumoniae/pneumococcus. CONCLUSIONS: The VACCELERATE Site Network enables a constantly updated Europe-wide mapping of experienced clinical sites interested in executing vaccine trials. The network is already in use as a rapid-turnaround single contact point for the identification of vaccine trials sites in Europe.

A framework for seroepidemiologic investigations in future pandemics: insights from an evaluation of WHO's Unity Studies initiative.

BACKGROUND: The WHO Unity Studies initiative supports countries, especially low- and middle-income countries (LMICs), in conducting seroepidemiologic studies for rapidly informing responses to the COVID-19 pandemic. Ten generic study protocols were developed which standardized epidemiologic and laboratory methods. WHO provided technical support, serological assays and funding for study implementation. An external evaluation was conducted to assess (1) the usefulness of study findings in guiding response strategies, (2) management and support to conduct studies and (3) capacity built from engagement with the initiative. METHODS: The evaluation focused on the three most frequently used protocols, namely first few cases, household transmission and population-based serosurvey, 66% of 339 studies tracked by WHO. All 158 principal investigators (PIs) with contact information were invited to complete an online survey. A total of 19 PIs (randomly selected within WHO regions), 14 WHO Unity focal points at the country, regional and global levels, 12 WHO global-level stakeholders and eight external partners were invited to be interviewed. Interviews were coded in MAXQDA™, synthesized into findings and cross-verified by a second reviewer. RESULTS: Among 69 (44%) survey respondents, 61 (88%) were from LMICs. Ninety-five percent gave positive feedback on technical support, 87% reported that findings contributed to COVID-19 understanding, 65% to guiding public health and social measures, and 58% to guiding vaccination policy. Survey and interview group responses showed that the main technical barriers to using study findings were study quality, variations in study methods (challenge for meta-analysis), completeness of reporting study details and clarity of communicating findings. Untimely study findings were another barrier, caused by delays in ethical clearance, receipt of serological assays and approval to share findings. There was strong agreement that the initiative created equitable research opportunities, connected expertise and facilitated study implementation. Around 90% of respondents agreed the initiative should continue in the future. CONCLUSIONS: The Unity Studies initiative created a highly valued community of practice, contributed to study implementation and research equity, and serves as a valuable framework for future pandemics. To strengthen this platform, WHO should establish emergency-mode procedures to facilitate timeliness and continue to build capacity to rapidly conduct high-quality studies and communicate findings in a format friendly to decision-makers.

Influence of SARS-CoV-2 surveillance outputs produced by the UK health security agency (UKHSA) outbreak surveillance team on decision-making by local stakeholders.

BACKGROUND: The UK Health Security Agency (UKHSA) COVID-19 Outbreak Surveillance Team (OST) was established in June 2020 to provide Local Authorities (LAs) in England with surveillance intelligence to aid their response to the SARS-CoV-2 epidemic. Reports were produced using standardised metrics in an automated format. Here we evaluate how the SARS-CoV-2 surveillance reports influenced decision making, how resources evolved and how they could be refined to meet the requirements of stakeholders in the future. METHODS: Public health professionals (n = 2,400) involved in the COVID-19 response from the 316 English LAs were invited to take part in an online survey. The questionnaire covered five themes: (i) report use; (ii) influence of surveillance outputs on local intervention strategies; (iii) timeliness; (iv) current and future data requirements; and (v) content development. RESULTS: Of the 366 respondents to the survey, most worked in public health, data science, epidemiology, or business intelligence. Over 70% of respondents used the LA Report and Regional Situational Awareness Report daily or weekly. The information had been used by 88% to inform decision making within their organisations and 68% considered that intervention strategies had been instituted as a result of these decisions. Examples of changes instigated included targeted communications, pharmaceutical and non-pharmaceutical interventions, and the timing of interventions. Most responders considered that the surveillance content had reacted well to evolving demands. The majority (89%) said that their information requirements would be met if the surveillance reports were incorporated into the COVID-19 Situational Awareness Explorer Portal. Additional information suggested by stakeholders included vaccination and hospitalisation data as well as information on underlying health conditions, infection during pregnancy, school absence and wastewater testing. CONCLUSIONS: The OST surveillance reports were a valuable information resource used by local stakeholders in their response to the SARS-CoV-2 epidemic. Control measures that affect disease epidemiology and monitoring requirements need to be considered in the continuous maintenance of surveillance outputs. We identified areas for further development and, since the evaluation, information on repeat infections and vaccination data have been included in the surveillance reports. Furthermore, timeliness of publications has been improved by updating the data flow pathways.

Narrative Trends over the COVID-19 Pandemic: Digital Social Listening to Inform WHO Infodemic Management.

The COVID-19 infodemic is an overwhelming amount of information that has challenged pandemic communication and epidemic response. WHO has produced weekly infodemic insights reports to identify questions, concerns, information voids expressed and experienced by people online. Publicly available data was collected and categorized to a public health taxonomy to enable thematic analysis. Analysis showed three key periods of narrative volume peaks. Understanding how conversations change over time can help inform future infodemic preparedness and prevention planning.

An Adaptive Digital Intelligence System to Support Infodemic Management: The WHO EARS Platform.

The WHO Early AI-Supported Response with Social Listening (EARS) platform was developed to help inform infodemic response during the COVID-19 pandemic. There was continual monitoring and evaluation of the platform and feedback from end-users was sought on a continual basis. Iterations were made to the platform in response to user needs, including the introduction of new languages and countries, and additional features to better enable more fine-grained and rapid analysis and reporting. The platform demonstrates how a scalable, adaptable system can be iterated upon to continue to support those working in emergency preparedness and response.

Lessons Not (Yet) Learned: What African Countries Could Teach the Global North about One Health during the Pandemics

The COVID-19 pandemic revealed the extraordinary importance of pandemic preparedness for public policy. The article argues that the cases of entrepreneurial and exemplary implementation of the intersectoral and bottom-up One Health policy in Africa can be a chance for the Global North to enhance pandemic preparedness under a changing climate. Using document analysis and participatory observation, the article draws on two case studies illustrating the multisectoral and bottom-up approaches, respectively. The cases demonstrate how the bottom-up community inclusiveness developed during the Ebola outbreak enhanced pandemic preparedness, and how community resilience was improved through sustainable entrepreneurs implementing One Health policies. The article draws important policy lessons for more resilient health systems in the Global North. [ FROM AUTHOR] Copyright of Journal of Comparative Policy Analysis is the property of Routledge 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.)

Global Veterinary Diagnostic Laboratory Equipment Management and Sustainability and Implications for Pandemic Preparedness Priorities1.

Substantial investments into laboratories, notably sophisticated equipment, have been made over time to detect emerging diseases close to their source. Diagnostic capacity has expanded as a result, but challenges have emerged. The Equipment Management and Sustainability Survey was sent to the Veterinary Services of 182 countries in mid-2019. We measured the status of forty types of laboratory equipment used in veterinary diagnostic laboratories. Of the 68,455 items reported from 227 laboratories in 136 countries, 22% (14,894/68,455) were improperly maintained, and 46% (29,957/65,490) were improperly calibrated. Notable differences were observed across World Bank income levels and regions, raising concerns about equipment reliability and the results they produce. Our results will advise partners and donors on how best to support low-resource veterinary laboratories to improve sustainability and fulfill their mandate toward pandemic prevention and preparedness, as well as encourage equipment manufacturers to spur innovation and develop more sustainable products that meet end-users' needs.

Combining epidemiological data and whole genome sequencing to understand SARS-CoV-2 transmission dynamics in a large tertiary care hospital during the first COVID-19 wave in The Netherlands focusing on healthcare workers.

BACKGROUND: Healthcare facilities have been challenged by the risk of SARS-CoV-2 transmission between healthcare workers (HCW) and patients. During the first wave of the COVID-19 pandemic, infections among HCW were observed, questioning infection prevention and control (IPC) measures implemented at that time. AIM: This study aimed to identify nosocomial transmission routes of SARS-CoV-2 between HCW and patients in a tertiary care hospital. METHODS: All SARS-CoV-2 PCR positive HCW and patients identified between 1 March and 19 May 2020, were included in the analysis. Epidemiological data were collected from patient files and HCW contact tracing interviews. Whole genome sequences of SARS-CoV-2 were generated using Nanopore sequencing (WGS). Epidemiological clusters were identified, whereafter WGS and epidemiological data were combined for re-evaluation of epidemiological clusters and identification of potential transmission clusters. HCW infections were further classified into categories based on the likelihood that the infection was acquired via nosocomial transmission. Secondary cases were defined as COVID-19 cases in our hospital, part of a transmission cluster, of which the index case was either a patient or HCW from our hospital. FINDINGS: The study population consisted of 293 HCW and 245 patients. Epidemiological data revealed 36 potential epidemiological clusters, with an estimated 222 (75.7%) HCW as secondary cases. WGS results were available for 195 HCW (88.2%) and 20 patients (12.8%) who belonged to an epidemiological cluster. Re-evaluation of the epidemiological clusters, with the available WGS data identified 31 transmission clusters with 65 (29.4%) HCW as secondary cases. Transmission clusters were all part of 18 (50.0%) previously determined epidemiological clusters, demonstrating that several larger outbreaks actually consisted, of several smaller transmission clusters. A total of 21 (7.2%) HCW infections were classified as from confirmed nosocomial, of which 18 were acquired from another HCW and 3 from a patient. CONCLUSION: The majority of SARS-CoV-2 infections among HCW could be attributed to community-acquired infection. Infections among HCW that could be classified as due to nosocomial transmission, were mainly caused by HCW-to-HCW transmission rather than patient-to-HCW transmission. It is important to recognize the uncertainties of cluster analyses based solely on epidemiological data.

COVID-19 pandemic response in the Meuse-Rhine Euroregion: methods, participation and recommendations of a longitudinal cross-border study.

BACKGROUND: Comparative data collection in transborder areas can contribute to informed decision making processes when dealing with borderless health threats such as pandemics, and thus help minimize the negative health effects for its citizens. To examine the pandemic response over time and the impact of infectious disease control in a cross-border setting, a prospective longitudinal study was conducted in the border area between Germany, Belgium and the Netherlands. In the spring of 2021, a random sample of 26,925 adult citizens selected from governmental registries was invited to collect a blood sample at home for SARS-CoV-2 antibody testing and to fill in an online questionnaire on attitudes and behaviour towards infection prevention measures, cross-border mobility, social network and support, COVID-19 self-reported infection(s) and symptoms, vaccination, general self-reported health and socio-demographics. In autumn 2021, participants were invited for a follow-up round. An online tool was developed to coordinate fieldwork procedures, real-time monitoring of participation and consultation of antibody test results. Furthermore, a helpdesk in all three languages for participants' support was set up. RESULTS: In the first round, 6,006 citizens in the Meuse-Rhine Euroregion participated. 15.3% of the invited citizens on the Belgian side of the border participated. In the Netherlands and Germany this was respectively 27% and 23.7%. In the follow-up round 4,286 (71.4%) citizens participated for the second time. The participation rate was highest in the age group 50-69 years and lowest in > 80 in all sub regions of the Meuse-Rhine Euroregion. More women participated than men. Overall, more blood samples were returned than completed questionnaires. In total, 3,344 citizens in the Meuse-Rhine Euroregion completed all components of participation in both rounds. CONCLUSIONS: The collection of comparative data can help better assess the pandemic response and the impact of infectious disease control in a cross-border area. Recommendations for a longitudinal cross-border study include a centralized online environment, mapping out potential challenges related to national regulations in the preparation phase and organizing regional coordination centres to create more familiarity and trust towards the involved organisations.

Improved healthcare disaster decision-making utilizing information extraction from complementary social media data during the COVID-19 pandemic.

Managing an extreme event like a healthcare disaster requires accurate information about the event's circumstances to comprehend the full consequences of acting. However, information quality is rarely optimal since it takes time to determine the information of relevance. The COVID-19 pandemic showed that even official data sources are far from optimal since they suffer from reporting delays that slow decision-making. To support decision-makers with timely information, we utilize data from online social networks to propose an adaptable information extraction solution to create indices helping to forecast COVID-19 case numbers and hospitalization rates. We show that combining heterogeneous data sources like Twitter and Reddit can leverage these sources' inherent complementarity and yield better predictions than those using a single data source alone. We further show that the predictions run ahead of the official COVID-19 incidences by up to 14 days. Additionally, we highlight the importance of model adjustments whenever new information becomes available or the underlying data changes by observing distinct changes in the presence of specific symptoms on Reddit.

Ethical Failures of the COVID-19 Pandemic Response

This book draws attention to the non-biological—political, economic, societal and cultural—variables shaping both the emergence and persistence of the COVID-19 pandemic and the global response to it, with a particular focus on political decisionmakers' role in the domestic and international politics surrounding the process of the pandemic. The book identifies the strategic and underlying ethical failures of decision making, using a process-tracing approach to reconstruct considerations, decisions and actions by key leaders—interested in thus weaving a global narrative of the response. The author highlights key speech acts, and interprets the causal implications embedded in a chronological and contextualised appraisal of events, statements and public health measures. The book further discusses the normative ethics of pandemic response, and presents lessons drawn from the present experience. It also offers a normative analysis taking into consideration pre-pandemic guidelines for response, including in the literature of public health ethics and pandemic preparedness plans. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022.