Unintended consequences of communicating rapid COVID-19 vaccine policy changes- a qualitative study of health policy communication in Ontario, Canada.

BACKGROUND: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. METHODS: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. RESULTS: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. CONCLUSIONS: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

Critical junctures as complex processes: examining mechanisms of policy change and path dependence in the Canadian pandemic response to homelessness

Policy change is not an instantaneous or linear process. In fact, change includes several mechanisms working in tandem and even against one another. This article examines the impacts of the COVID-19 pandemic on homelessness policy in Canada. In a sector that is already plagued with emergency responses - rather than long-term solutions - the pandemic has initiated a critical juncture where policy change is possible, but not guaranteed. Although the existing failures to alleviate homelessness in Canada make policy failings even more obvious, aspects of the pre-existing Canadian response to homelessness negate change. The pandemic, however, has led to temporary solutions and created a setting where long-term change is possible. Using over 150 primary sources, this article analyses mechanisms of change and path dependence in the pandemic response to homelessness. The presence of such mechanisms is tested in three major Canadian cities.

Effect of the UNOS policy change on rates of rejection, infection and hospital readmission following heart transplantation.

BACKGROUND: The 2018 adult heart allocation policy sought to improve waitlist risk stratification, reduce waitlist mortality and increase organ access. This system prioritized patients at greatest risk for waitlist mortality, especially individuals requiring temporary mechanical circulatory support (tMCS). Post-transplant complications are significantly higher in patients on tMCS before transplantation, and early post-transplant complications impact long-term mortality. We sought to determine if policy change affected early post-transplant complication rates of rejection, infection and hospitalization. METHODS: We included all adult, heart-only, single-organ heart transplant recipients from the UNOS registry with pre-policy (PRE) individuals transplanted between 11/1/2016 to 10/31/2017 and post-policy (POST) between 11/1/2018 to 10/31/2019. We used a multivariable logistic regression analysis to assess the effect of policy change on post-transplant rejection, infection, and hospitalization. Two COVID-19 eras (2019-2020, 2020-2021) were included in our analysis. RESULTS: The majority of baseline characteristics were comparable between PRE and POST era recipients. The odds of treated rejection (p=0.8), hospitalization (p=0.69), and hospitalization due to rejection (p=0.76) and infection (p=0.66) were similar between PRE and POST eras; there was a trend towards reduced odds of rejection (p=0.08). In both COVID eras, there was a clear reduction in rejection and treated rejection with no effect on hospitalization for rejection or infection. Odds of all-cause hospitalization was increased in both COVID eras. CONCLUSION: The UNOS policy change improves access to heart transplantation for higher acuity patients without increasing early post-transplant rates of treated rejection or hospitalization for rejection or infection, factors which portend risk for long-term post-transplant mortality.

Beyond path dependency: Analysing Indonesia's social policy responses to two crises

This article sets out a coherent framework for debates and discussions on social policy changes during crisis periods. Using Indonesia as a case, this article compares its social policy responses to the 1997–1998 economic crisis and the current COVID-19 pandemic crisis. Both two crises and their responses, once analysed, lead to an argument that path dependence does not always dominate policy processes, as most literature claims, but rather it operates alongside other path-creation-related processes, such as path-clearing policy accelerators and path-creation policy accelerators. This article also presents that ‘old player' penetration in policy processes does not necessarily preclude alternatives and, in some examined cases, it, instead, strengthens impulses toward substantial reforms. Therefore, revised policies must be viewed as political vehicles for seeking popular support and power reconsolidation as democracy allows. Furthermore, this current analysis contributes to enhancing our understanding of crises, often seen as issues in public policy literature, yet less explored in terms of their importance as unique critical junctures and their implications for social policy changes in multiple paths. © 2023 John Wiley & Sons Ltd.

COVID-19 as an opportunity window for policy change, insights from electronic authentication case study in Iran

Public emergencies are focal events that present possibilities for policy changes. This study aims to explain policy insights on policy change in Iran through analyzing how the Iranian government's policy toward the long-awaited e-authentication finally changed in the wake of the outbreak of COVID-19. Due to the policy context of Iran, it uses the Multiple Stream Model, in which three streams were identified: problem, policy, and political dynamics. The paper contends that while the second stream existed prior to the pandemic, the first one had not yet been appropriately recognized by the government. Furthermore, it identifies the political stream as the third missing link for policy change. With the spread of coronavirus, these three streams converged, thus opening a window of opportunity for enacting this policy change. Two main reasons behind the emergence of this opening are identified: first, arising a new complex problem (COVID-19) that necessitated new initiatives, and second, growing public anxiety about the pandemic. Iran's desperate circumstances, which included an already severely depressed economy as the result of sanctions, were further exacerbated through the socio-economic repercussions of the pandemic. Furthermore, the growing demand from prospective traders to register for the stock exchange during the lockdown prompted officials to make a realistic decision. As a result, barriers to e-authentication were overcome and policy change happened. The paper highlights the security perspective as a necessary condition for policy change in Iran. Finally, it discusses the likelihood of permanency of the change. © 2023 Policy Studies Organization.

Restricting access to antibiotics: The effectiveness of a 'no repeats' government policy intervention.

BACKGROUND: Australia has a high rate of antibiotic use. Government policy interventions are one strategy to optimise the use of antibiotics. On 1 April 2020, the Australian Government Department of Health introduced a policy intervention to increase the quality use of four antibiotics. OBJECTIVES: To assess if the government policy intervention improved the appropriate supply of the four antibiotics amoxicillin, amoxicillin-clavulanic acid, cefalexin and roxithromycin. METHOD: This study employed a retrospective cohort study design comparing a 10% sample (n = 345,018) of four antibiotics prescribed and dispensed in Australia during a three-month period (May, June, July) in 2019, and again in 2020 (after the policy intervention). The 10% sample of PBS data was obtained from the Australian Government Department of Health. Descriptive statistics, bivariate and multivariable logistic regression analysis were carried out. RESULTS: The results suggest the policy change improved the appropriate supply of original prescriptions in 2020 compared to 2019 OR = 1.75 (95% CI = 1.68-1.82, p < 0.001), and appropriate supply of repeat prescriptions OR = 1.56 (95% CI = 1.25-1.96, p < 0.001). In 2020, the proportion of appropriate supply of original prescriptions increased by an absolute difference of 1.8% (95% CI = 1.6-1.9%; P < 0.001), and appropriate supply of repeat prescriptions increased by 3.9% (95% CI = 2.2-5.5%; P < 0.001). The total number of antibiotic prescriptions prescribed and dispensed in 2019 (N = 219,960) reduced in 2020 (N = 125,058) after the policy intervention. CONCLUSION: The study provides evidence for the impact of a government policy intervention to improve the appropriate supply of antibiotics, although some of the reduction in antibiotic use was likely due to the concomitant COVID-19 pandemic. Further research is required to assess the impact of the intervention outside a pandemic.

Policy learning from crises: lessons learned from the Italian food stamp programme

Advancing learning is a central tenet for improving public action. Recent calls for agility, robustness, prototyping and other strategies for coping with crises imply continual learning and improvement. This article contributes to challenging this ideal interpretation of the learning process. It provides conceptual and methodological tools to investigate the relationship between policy learning and policy change and sheds light on the diverse dynamics and types of learning that can emerge from crises. At the conceptual level, the article presents a learning matrix that classifies the possible outcomes in the relationship between learning and change. On methods, our research design includes process tracing, binary comparisons, and an innovative real-time approach to the study of learning. The article investigates three municipal case studies from the Italian food stamp programme implemented during the COVID-19 lockdowns. The repetition of the programme over a short period of time offers the opportunity to investigate inter-crisis learning, the process by which lessons from the first wave of implementation contributed to reforms in the second delivery. The coronavirus crisis magnified the acquisition of knowledge and provided radical inter-programme lessons – long-term, non-incremental learning beyond the management of the emergency. Yet, the findings also highlight how this window of opportunity for learning quickly closed and how certain lessons learned may be lost in the process of reform, hard to implement or are unlikely to be extrapolated across contexts.

COVID‐19 as an opportunity window for policy change, insights from electronic authentication case study in Iran

Public emergencies are focal events that present possibilities for policy changes. This study aims to explain policy insights on policy change in Iran through analyzing how the Iranian government's policy toward the long‐awaited e‐authentication finally changed in the wake of the outbreak of COVID‐19. Due to the policy context of Iran, it uses the Multiple Stream Model, in which three streams were identified: problem, policy, and political dynamics. The paper contends that while the second stream existed prior to the pandemic, the first one had not yet been appropriately recognized by the government. Furthermore, it identifies the political stream as the third missing link for policy change. With the spread of coronavirus, these three streams converged, thus opening a window of opportunity for enacting this policy change. Two main reasons behind the emergence of this opening are identified: first, arising a new complex problem (COVID‐19) that necessitated new initiatives, and second, growing public anxiety about the pandemic. Iran's desperate circumstances, which included an already severely depressed economy as the result of sanctions, were further exacerbated through the socio‐economic repercussions of the pandemic. Furthermore, the growing demand from prospective traders to register for the stock exchange during the lockdown prompted officials to make a realistic decision. As a result, barriers to e‐authentication were overcome and policy change happened. The paper highlights the security perspective as a necessary condition for policy change in Iran. Finally, it discusses the likelihood of permanency of the change. (English) [ FROM AUTHOR]

Every Tool in the Toolbox: Pursuing Multilevel Institutional Change in the DeLTA Project

For decades, educators and policy makers have called for reform in higher education, yet now the urgency is palpable. The COVID-19 pandemic and heightened attention to systemic racism have highlighted the fact that outdated teaching practices can stunt student learning and trust of science, maintain systemic biases, and prevent equitable education. Promoting change to outdated teaching practices requires fundamental shifts at each level of a university--among faculty, departments, and the institution as a whole. The Departmental and Leadership Teams for Action (DeLTA) project at the University of Georgia pursues transformative shifts in policies and practices related to undergraduate science, technology, engineering, and math (STEM) education. This article provides examples of how DeLTA applies various change perspectives to shift thinking, practices, and policies related to evaluating teaching.

Ideas and Policy Response to the COVID-19 Crisis: Evidence from Jakarta, Indonesia

Coronaviruses have emerged as a potential disruptive force in policymaking. Using a comparative case study method, we examine two social policy responses in Jakarta, Indonesia: the Social Safety Nets (SSN) programme and the health policy. Such examples demonstrate an aggressive change in policy direction from means-tested systems and government-centred approaches to a total relaxation of conditions with the involvement of non-state actors in the provision of services. Our study analyses the ideational dimensions of the policy process that produces abrupt and radical change. From our analysis, the policy change may be explained by the emergence of a new policy paradigm created through the emulation-contextual process - an alternative model of policy learning. The theoretical implication of our research is that policy response in this study cannot be viewed in a completely path-dependent process. Instead, we propose a 'path-creation accelerator,' which represents an infrequent instance of policy change.

Crisis management: personal financial well-being and public attitudes toward government intervention

Purpose Crises precipitate strong fiscal responses by government - sometimes toward austerity, other times toward renewed social spending. This variation in approaches to crisis handling has the potential to highlight factors that drive public opinion toward government interventions that may be quite different from those in non-crisis times. This study aims to discuss the aforementioned issues. Design/methodology/approach This article brings together theories of government policymaking in crises, policy responsiveness and economic voting to assess how personal financial (egocentric) concerns and/or national financial (sociotropic) concerns may influence opinions toward government handling of direct financial supports in a crisis and, more generally, opinions toward social policy interventions. The authors assess this dynamic in the Canadian context using original national survey data collected in the initial stage of the pandemic-based crisis in June and July of 2020 (N = 1290). Findings The authors find strong evidence in support of sociotropic concerns shaping government approval and support for greater social policy interventions, but limited evidence to support egocentric concerns, suggesting that social policy attitudes may be more insulated from personal factors than anticipated. Research limitations/implications The authors' findings suggest that crises may prompt enhanced support for interventionist social policy measures that may lack broad-based support in non-crisis times. Originality/value The authors' findings speak to the ongoing discussion around the possibility for crises to function as policy windows for enhanced social spending and for entrenching targeted financial supports for vulnerable individuals.

Policy learning and change during crisis: COVID-19 policy responses across six states.

Whereas policy change is often characterized as a gradual and incremental process, effective crisis response necessitates that organizations adapt to evolving problems in near real time. Nowhere is this dynamic more evident than in the case of COVID-19, which forced subnational governments to constantly adjust and recalibrate public health and disease mitigation measures in the face of changing patterns of viral transmission and the emergence of new information. This study assesses (a) the extent to which subnational policies changed over the course of the pandemic; (b) whether these changes are emblematic of policy learning; and (c) the drivers of these changes, namely changing political and public health conditions. Using a novel dataset analyzing each policy's content, including its timing of enactment, substantive focus, stringency, and similar variables, results indicate the pandemic response varied significantly across states. The states examined were responsive to both changing public health and political conditions. This study identifies patterns of preemptive policy learning, which denotes learning in anticipation of an emerging hazard. In doing so, the study provides important insights into the dynamics of policy learning and change during disaster.

Mientras que el cambio de política a menudo se caracteriza como un proceso gradual e incremental, la respuesta efectiva a la crisis requiere que las organizaciones se adapten a los problemas en evolución casi en tiempo real. En ninguna parte esta dinámica es más evidente que en el caso de COVID­19, que obligó a los gobiernos subnacionales a ajustar y recalibrar constantemente las medidas de salud pública y mitigación de enfermedades ante los patrones cambiantes de transmisión viral y la aparición de nueva información. Este estudio evalúa (a) la medida en que las políticas subnacionales cambiaron en el transcurso de la pandemia; (b) si estos cambios son emblemáticos del aprendizaje de políticas; y (c) los impulsores de estos cambios, a saber, las cambiantes condiciones políticas y de salud pública. Usando un nuevo conjunto de datos que analiza el contenido de cada política, incluido el momento de la promulgación, el enfoque sustantivo, el rigor y variables similares, los resultados indican que la respuesta a la pandemia varió significativamente entre los estados. Los estados examinados respondieron a cambios tanto en la salud pública como en las condiciones políticas. Este estudio identifica patrones de aprendizaje de políticas preventivas, lo que denota aprendizaje en previsión de un peligro emergente. Al hacerlo, el estudio proporciona información importante sobre la dinámica del aprendizaje y el cambio de políticas durante un desastre.

Public policy changes in public funding of family doctors in Slovenia

In Slovenia, patients report difficulties registering with a family doctor (FD), even in dense urban areas, since the patient-to-FD ratio is well below the EU average and not improving. Moreover, public primary healthcare providers (PCP) report difficulties with the financial liquidity that endangers the regular payment of employed FDs' salaries and constantly call for additional budget funding in the healthcare sector, especially after the COVID-19 pandemic crisis. It is therefore questionable, whether or not the PCP, which perform economic activity under the EU standards, respect human rights of all the stakeholders in the healthcare sector. Therefore, in this paper, I analyse the existing regulations on the public financing of FDs in Slovenia that seems to pose significant problems to patients' timely access to health care and does not facilitate the FDs' goal of delivering the patients' constitutional right to healthcare services. I discuss some better alternative solutions that would promote the patients' right to effective primary healthcare, attract more medical students to specialise in family medicine and consolidate the fiscal sustainability of the primary healthcare sector, which is at grave risk of collapse due to a dysfunctional healthcare payment and delivery system. Copyright © 2022 Inderscience Enterprises Ltd.

Legitimizing Postcrisis Policy Change: Crisis-Framing Strategies by Public Leaders in China

Research shows that postcrisis policy change in democracies is shaped by how crises are framed. Given structural political differences, the role that such framing plays in postcrisis policy change in other types of political systems is unclear. Therefore, this study adjusts the concept of crisis framing to authoritarian China and subsequently identifies framing strategies used by national leaders in response to the severe acute respiratory syndrome (SARS), the Sichuan earthquake, and the 2009 H1N1 influenza pandemic. Based on qualitative thematic analysis of statements made by national leaders, this paper shows that although no framing contests existed between them, these individuals used different framing strategies in response to different crises, and each strategy corresponds with different degrees of crisis-induced policy change. We observed major policy changes when national leaders simultaneously acknowledged the crisis, admitted a malfunctioning status quo, and put forward explicit proposals for postcrisis policy changes. Conversely, we observed minor policy change when national leaders denied the significance of the crisis, blamed the crisis on external forces, or put forward no or only proposals for policy change. We argue that national leaders in China use the former strategies if they want to legitimize major policy changes and use the latter if they want to defend the status quo and restrict policy change.

What will it take to achieve the sexual and reproductive health and rights of women living with HIV?

This article outlines progress in realizing the sexual and reproductive health and rights of women and girls living with HIV over the last 30 years from the perspective of women living with HIV. It argues that the HIV response needs to go beyond the bio-medical aspects of HIV to achieve our sexual and reproductive health and rights, and considers relevant Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization, United States President's Emergency Plan for AIDS Relief (PEPFAR), Global Fund and other guidelines, what engagement there has been with women living with HIV and whether guidelines/strategies have been adopted. It has been written by women living with HIV from around the world and a few key supporters. Co-authors have sought to collate and cite materials produced by women living with HIV from around the world, in the first known effort to date to do this, as a convergence of evidence to substantiate the points made in the article. However, as the article also argues, research led by women living with HIV is seldom funded and rarely accepted as evidence. Combined with a lack of meaningful involvement of women living with HIV in others' research on us, this means that formally recognized evidence from women's own perspectives is patchy at best. The article argues that this research gap, combined with the ongoing primacy of conventional research methods and topics that exclude those most affected by issues, and the lack of political will (and sometimes outright opposition) in relation to gender equality and human rights, adversely affect policies and programmes in relation to women's rights. Thus, efforts to achieve an ethical, effective and sustainable response to the pandemic are hindered. The article concludes with a call to action to all key stakeholders.

Long-term policy impacts of the coronavirus: normalization, adaptation, and acceleration in the post-COVID state

This paper offers an analysis of the theoretical and empirical challenges the coronavirus pandemic poses for theories of policy change. Critical events like coronavirus disease are potentially powerful destabilizers that can trigger discontinuity in policy trajectories and thus are an opportunity for accentuating path shifts. In this paper, we argue that three dynamic pathways of change are possible and must be considered when analysing post-COVID policymaking: normalization, adaptation, and acceleration. These different pathways need to be explored in order to understand the mid- and long-term policy effects of the pandemic. This introduction contextualizes the articles in this special issue, situating them broadly within two broad categories: (a) assessment of how the coronavirus disease pandemic should be understood as a crisis event, and its role in relationship to mechanisms of policy change;and (b) mapping the future contours of the pandemic's impact on substantive policy areas, including education, health care, public finance, social protection, population ageing, the future of work, and violence against women.

Digitalization and beyond: the effects of Covid-19 on post-pandemic educational policy and delivery in Europe

Education has been extremely affected by the coronavirus disease crisis, with almost all countries temporarily closing their schools in 2020. After the first stage of the pandemic, in which national governments focused on guaranteeing the academic year's continuity, key international organizations emphasized the need to adopt structural policy reforms to face the challenges posed by the crisis. Based on international and European countries' policy documents, this paper analyzes long-term responses articulated in the education sector. The analysis has allowed us to identify three preponderant areas of response: the digitalization of the educational system, educational inequalities, and teachers' development. The agendas and policy instruments that international organizations have so far pushed for in relation to each of these areas do not differ substantially from the agendas and instruments they promoted in the pre-pandemic era. It is still early to assess the deepness of the transformations in course, but in most cases, prevailing responses represent the intensification of change processes initiated before the pandemic. Nonetheless, the type and intensity of country responses vary among the European Union member states. Although the pandemic represents a common thread, countries have experienced the crisis differently according to the characteristics of their educational systems and the main problems the crisis has revealed.

Health policy and COVID-19: path dependency and trajectory

The coronavirus disease (COVID-19) pandemic has tested the mettle of governments across the globe and has thrown entrenched fault lines within health systems into sharper relief. In response to the outbreak of the pandemic, governments introduced a range of measures to meet the growth in demand and bridge gaps in health systems. The objective of this paper is to understand the nature and extent of the changes in health systems triggered by the COVID-19 crisis. The paper examines changes in the role of governments in (1) sector coordination, (2) service provision, (3) financing, (4) payment, and (5) regulations. It outlines broad trends and reforms underway prior to the pandemic and highlights likely trajectories in these aspects in the future. The paper argues that while the pandemic has accelerated changes already underway before the crisis, it has made little headway in clearing the path for other or deeper health policy reforms. The reform window that COVID-19 opened has not been wide enough to overcome the entrenched path dependency and structural interests that characterize the sector.

What has happened and what has not happened due to the coronavirus disease pandemic: a systemic perspective on policy change

The societal and policy transformations associated with the coronavirus disease pandemic are currently subject of intense academic debate. In this paper, we contribute to this debate by adopting a systemic perspective on policy change, shedding light on the hidden and indirect crisis effects. Based on a comprehensive analysis of policy agenda developments in Germany, we find that the pandemic led to profound shifts in political attention across policy areas. We demonstrate that these agenda gains and losses per policy area vary by the extent to which the respective areas can be presented as relevant in managing the coronavirus disease crisis and its repercussions. Moreover, relying on the analysis of past four economic crises, we also find that there is limited potential for catching up dynamics after the crisis is over. Policy areas that lost agenda share during crisis are unlikely to make up for these losses by strong attention gains once the crisis is over. Crises have hence substantial, long-term and so far, neglected effects on policymaking in modern democracies.

From crisis to reform? Exploring three post-COVID pathways

Crises are often viewed as catalysts for change. The coronavirus disease crisis is no exception. In many policy sectors, proponents of reform see this global crisis both as a justification and an enabler of necessary change. Policy scholars have paid ample attention to this crisis-reform thesis. Empirical research suggests that these proponents of crisis-induced change should not be too optimistic. The question remains why some crises give rise to reform whereas so many others do not. This paper focuses on one particular factor that crisis researchers have identified as important. Crisis research suggests that the outcome of the meaning-making process-the efforts to impose a dominant frame on a population-shapes the prospects of postcrisis change. The paper offers three ideal-typical framing scripts, which researchers can use to study postcrisis trajectories.