Advancing detection and response capacities for emerging and re-emerging pathogens in Africa.

Recurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa.

Identifying Policy Gaps in a COVID-19 Online Tool Using the Five-Factor Framework

Introduction: Worldwide health systems are being faced with unprecedented COVID-19-related challenges, ranging from the problems of a novel condition and a shortage of personal protective equipment to frequently changing medical guidelines. Many institutions were forced to innovate and many hospitals, as well as telehealth providers, set up online forward triage tools (OFTTs). Using an OFTT before visiting the emergency department or a doctor's practice became common practice. A policy can be defined as what an institution or government chooses to do or not to do. An OFTT, in this case, has become both a policy and a practice. Methods: The study was part of a broader multiphase sequential explanatory design. First, an online survey was carried out using a questionnaire to n = 176 patients who consented during OFTT usage. Descriptive analysis was carried out to identify who used the tool, for what purpose, and if the participant followed the recommendations. The quantitative results shaped the interview guide's development. Second, in-depth interviews were held with a purposeful sample of n = 19, selected from the OFTT users who had consented to a further qualitative study. The qualitative findings were meant to explain the quantitative results. Third, in-depth interviews were held with healthcare providers and authorities (n = 5) that were privy to the tool. Framework analysis was adopted using the five-factor framework as a lens with which to analyze the qualitative data only. Results: The five-factor framework proved useful in identifying gaps that affected the utility of the COVID-19 OFTT. The identified gaps could fit and be represented by five factors: primary, secondary, tertiary, and extraneous factors, along with a lack of systems thinking. Conclusion: A theory or framework provides a road map to systematically identify those factors affecting policy implementation. Knowing how and why policy practice gaps come about in a COVID-19 OFFT context facilitates better future OFTTs. The framework in this study, although developed in a universal health coverage (UHC) context in South Africa, proved useful in a telehealth context in Switzerland, in Europe. The importance of systems thinking in developing digital tools cannot be overemphasized.

Science in One Health: A new journal with a new approach

One Health recognizes the close links and interdependence among human health, animal health and environmental health. With the pandemic of COVID-19 and the risk of many emerging or reemerging infectious diseases of zoonotic nature as well as the spreading antimicrobial resistance, One Health has become one of top concerns globally, as it entails the essential global public health challenges from antimicrobial resistance over zoonoses, to climate change, food security and societal well-being. Research priorities in One Health include the study on interactions of human-animal-plants-nature ecology interface, systems thinking, integrated surveillance and response systems, and the overall One Health governance as part of the global health and sustainability governance. The now launched journal, Science in One Health, aims to be a resource platform that disseminates scientific evidence, knowledge, and tools on the One Health approaches and respective possible socio-ecological interventions. Thus, aims at providing fruitful exchanges of information and experience among researchers, and decision makers as well as public health actors.

The role of children and adolescents in the SARS-CoV-2 pandemic: a rapid review.

BACKGROUND: There has been much discussion about coronavirus disease 2019 (COVID-19) and the virus that causes it, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents, since the pandemic was recognised in early 2020. Understanding their role in this pandemic is important for the development of appropriate prevention measures. OBJECTIVE: To summarise evidence about three aspects of SARS-CoV-2 and COVID-19 in children and adolescents: (1) severity of SARS-CoV-2 presentation, (2) risk of SARS-CoV-2 infection and (3) risk of transmitting SARS-CoV-2.METHODS: We searched PubMed and MedRxiv for studies on SARS-CoV-2 and COVID-19 in children and adolescents from January 2020 to 21 January 2021. The electronic search was supplemented by papers found in a manual search or suggested by experts up to 29 March 2021. We included case reports, cross-sectional studies, cohort studies, narrative reviews or viewpoints, systematic reviews and modelling studies. We synthesised the information descriptively and attempted to report findings separately for: infants and small children (0-5 years) who are mostly pre-school; school children (6-12 years) broadly covering primary school years; and adolescents (13-17 years). RESULTS: Of 2778 screened articles, we included 63 (20 case reports, 18 cross-sectional studies, 8 cohort studies, 6 narrative reviews or viewpoints, 10 systematic reviews and 1 modelling study). Children (≤12 years of age) and adolescents (13-17 years of age) usually present with mild disease, with few requiring intensive care treatment. A minority of children of all ages (<18 years) remains asymptomatic throughout the course of infection. In serological studies, reported symptoms are similar in children with and without SARS-CoV-2 antibodies. Children and adolescents can acquire and transmit SARS-CoV-2. The risks of acquiring and transmitting SARS-CoV-2 seems to increase with age. There was limited information about SARS-CoV-2 variants of concern. Poor reporting of age groups and contextual factors such as levels of community transmission, school closures and other non-pharmaceutical interventions make synthesis of findings across studies difficult. CONCLUSIONS: The clinical presentation and role of children and adolescents in SARS-CoV-2 susceptibility and transmission needs further investigation, particularly with regard to variants of concern. Large, prospective studies that attempt to minimise biases in design, are analysed appropriately and reported comprehensively should be conducted.

What does a pandemic proof health system look like?

Switzerland is currently in a lockdown and other lockdowns are looming world-wide. Many countries in the West are now experiencing a third COVID-19 wave. While some scientists are aiming for Zero Covid, calls to learn to live with the virus are becoming prominent as anti-lockdown protests spread across Europe. A health system is defined as all organizations, institutions and resources that produce actions whose primary purpose is to improve health. A health care system on the other hand, is defined as institutions, people and resources involved in delivering health care to individuals. Many countries that have health systems previously thought to be world class, have also been tested, pushed to the edge and in some ways found wanting. The pandemic took all countries by some surprise and the discussion on appropriate national and global strategies is very diverse. Lessons from similar earlier outbreaks seem to suggest, that living and learning to live with the virus could be the way forward. Others argue that the virus is new, not like any other we have fought before, calling for novel ways of containing the virus. Irrespective of standpoint, being a high-, middle- or low-income country, pandemic fatigue is setting in, while new variants are being discovered. It is urgent and unprecedented. The pandemic is here and more pandemics are expected to follow. What does, 'living with the virus,' mean in practical terms? The purpose of this viewpoint is to stimulate debate on how we can move towards pandemic proof health care systems.

Health Technology Assessment in High, Middle, and Low-income Countries: New Systematic and Interdisciplinary Approach For Sound Informed-policy Making: Research Protocole.

Technological innovation has a significant role in improving health systems (HSs) and achieving universal health coverage (UHC). The World Health Organization (WHO) has declared resolutions on Health Technology Assessment (HTA) and other global organizations emphasized on HTA systems to achieve the Sustainable Development Goals (SDGs). HTA is a modern multidisciplinary decision-making framework linking knowledge and policymaking by assessing the medical, social, economic, organizational, and ethical effects, and/or impacts within health and social systems. The research significance lies in the growing need for HTA at these moments than ever as it is seen as an essential development approach to tackle the current global challenges and pandemics, particularly in developing countries. The research aims to comprehensively evaluate and understand HTA systems concerning the level of knowledge about HTA, current HTA structure, practices, application, capacity, gaps, and solutions. The project starts in January 2021 and ends in January 2022 and will be carried out in seven countries: Canada, Switzerland, Brazil, Lebanon, Jordan, Palestine, and Tanzania. A mixed-methods, quantitative and qualitative, along with a literature review will be applied. In each country, ten HTA-associated institutions will complete an adapted electronic survey, developed by the WHO, and ten key-informants selected purposively from the government, academia, NGOs, and private sectors to participate in ten individual in-depth interviews. One government representative from each country will participate in one expanded inter-country workshop. Excel, IBM Statistical Package for the Social Sciences (SPSS), and MAXQDA software programs will be used for data management and analysis. The research will form cutting-edge evidence not only for the seven countries, but also for the global, regional, and national endeavors with regards to opening a room for HTA best application and optimization. It will reveal lessons learned, determine gaps, and build a well-enabled and institutionalized HTA for better UHC, health systems, and multi-sectoral development.

Rethinking and strengthening the Global Health Diplomacy through triangulated nexus between policy makers, scientists and the community in light of COVID-19 global crisis.

The COVID-19 pandemic is considerably the biggest global health challenge of this modern era. Spreading across all regions of the world, this corona virus disease has disrupted even some of the most advanced economies and healthcare systems. With an increasing global death toll and no near end in sight, questions on the efficacy of global response mechanisms, including the role and relevancy of global health institutions, have emerged. Using a reflexive content analytic approach, this study sheds light on some of these questions, underscoring the disconnect between science, policymaking, and society. Global health funding approaches; politicization of the pandemic, including political blame gaming; mistrust of government and other institutions; and a lack of robust accountability measures are some of the pandemic response obstacles. However, COVID-19 has also presented an opportunity for a collaboration that may potentially solidify global solidarity. A pandemic response built on strategic global health diplomacy, vaccine diplomacy, and science diplomacy can spur both political and economic benefits, advancing development, health security, and justice. The virus thrives and flourishes in face of political divisions and lack of cooperation. While the current global crisis has exacerbated the existing social injustices in societies, national unity and global solidarity is essential to winning the fight against the COVID-19 pandemic.

Strategies supporting the prevention and control of neglected tropical diseases during and beyond the COVID-19 pandemic.

Emerging and re-emerging zoonotic diseases represent a public health challenge of international concern. They include a large group of neglected tropical diseases (NTDs), many of which are of zoonotic nature. Coronavirus disease 2019 (COVID-19), another emerging zoonotic disease, has just increased the stakes exponentially. Most NTDs are subject to the impact of some of the very same human-related activities triggering other emerging and re-emerging diseases, including COVID-19, severe acute respiratory syndrome (SARS), bird flu and swine flu. It is conceivable that COVID-19 will exacerbate the NTDs, as it will divert much needed financial and human resources. There is considerable concern that recent progress achieved with control and elimination efforts will be reverted. Future potential strategies will need to reconsider the determinants of health in NTDs in order to galvanize efforts and come up with a comprehensive, well defined programme that will set the stage for an effective multi-sectorial approach. In this Commentary, we propose areas of potential synergies between the COVID-19 pandemic control efforts, other health and non-health sector initiatives and NTD control and elimination programmes.