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

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

Conceptual Framework for Understanding Incident Management Systems During Public Health Emergencies.

OBJECTIVE: Effective incident management is essential for coordinating efforts of multiple disciplines and stakeholders when responding to emergencies, including public health disasters such as the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: Existing research frameworks tend to focus on formal structures and doctrine (eg, ICS-NIMS); however, organizational processes that underlie incident management have not been systematically assessed and synthesized into a coherent conceptual framework. RESULTS: The lack of a framework has hindered the development of measures of performance that could be used to further develop the evidence base and facilitate process improvement. To address this gap, we present a conceptual framework of incident management drawn from expert feedback and a review of literature on incident management and related fields. The framework features 23 measurement constructs grouped into 5 domains: (1) situational awareness and information sharing, (2) incident action and implementation planning, (3) resource management and mobilization, (4) coordination and collaboration, and (5) feedback and continuous quality improvement. CONCLUSIONS: As such, the article provides a first step toward the development of robust measures for assessing the performance and effectiveness of incident management systems.

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

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

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

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

Features and Functionalities of Medical Mobile Applications for the Endemic Phase of COVID‐19: Review and Content Analysis

The study's objective was to assess the features and content of the COVID-19 mobile applications accessible in the Apple AppStore. A content analysis, comparison, and functionality evaluation of a few COVID-19 related mobile applications was performed. The search for COVID-19 related apps in the iOS AppStore took place between February 1 and March 31, 2022. The mobile applications received a maximum of 7 points (basic feature assessment) and 8 points overall (functionality assessment). The requirements were fully met by receiving one point. Frequencies from descriptive statistics were used to allude to the applications' features according to the app's basic purpose. A total of 234 applications were recognized using the keywords to exploreCOVID-19 related mobile applications in Apple AppStore. However, 58 mobile applications (24.8%) relevant to COVID-19 were evaluated. According to the findings of an evaluation of basic aspects of mobile applications, 89.7% require an internet connection, 70.7% have a size of less than 50 MB, 96.6% require no funding, 58.6% include educational content, and 60.3% offer advice from the applications. In terms of score, 41.4% scored three or below, whereas 58.6% scored four or above. Functionality assessment wise, 79.3% included information regarding COVID-19, 12.1% included COVID-19 contact tracing, 17.2% had vaccination status, a health authority maintained 50%, 31.0% included COVID-19 statistics, and 25.8% were able to report ART/PCR test. In terms of score, 91.4% scored three points or less, and 8.6% scored four points or more. This study has discovered several applications that could effectively prevent COVID-19 pandemic spread. Based on the findings, mobile applications that would be recommended are the ones supported by the government health administration of the respective country. App development companies' applications show that competent healthcare personnel was not involved in developing the applications. Online consultation with healthcare professionals might help the public who do not have access to the nearest hospital. © 2022, HH Publisher. All rights reserved.

A COVID-19 Lesson: Better Health Emergency Preparedness Standards Are Needed.

This article reports on an assessment of the value of 4 widely recognized standards of health sector emergency preparedness as predictors of effective preparedness for, and response to, the COVID-19 pandemic in the United States. The standards are sponsored by the National Health Security Preparedness Index (NHSPI), the Trust for America's Health (TFAH), the Emergency Management Accreditation Program (EMAP), and the Public Health Accreditation Board (PHAB). The measure of effectiveness was states' cumulative COVID-19 deaths per 100,000 population, from January 21, 2020, through January 20, 2022. Linear regression analysis found no statistically significant associations when controlling for 3 intervening variables. Cross-tabulation of states' preparedness status with their COVID-19 death rates found that high NHSPI and TFAH preparedness scores were generally, but not uniformly, associated with lower death rates. EMAP and PHAB accreditation had negligible association with low or high death rates. Lack of accreditation was associated with lower death rates. Higher prior state public health spending related to COVID-19 preparedness and higher state household income, an indicator of state economic strength, were associated with lower death rates. States with Democratic control of the legislative and executive branches of government generally had substantially lower death rates than states with Republican control. A science-based, practice-oriented research initiative is recommended to improve the predictive power of health sector preparedness standards and to enhance protection for US residents from large-scale future health threats.

Federal, state, local, and other public health agency roles in preparedness

Even prior to the September 11, 2001, terrorist attacks and the subsequent mailing of letters and packages contaminated with anthrax spores, public health agencies were focused on the topic of public health emergency preparedness. However, in the last 20 years, based on lessons learned from the public health responses to a number of emergencies, the public health emergency preparedness field has adapted and evolved to changing circumstances. The greatest of these has been changes to funding and funding mechanisms. These include grants and cooperative agreements from the Centers for Disease Control and Prevention that support state, tribal, local, and territorial health departments' ability to detect and respond to public health threats. During public health emergencies, including COVID-19, a mix of supplemental funds, relief packages, and emergency funds are used to support temporary surge capacity, often supporting additional Epidemiology and Laboratory Capacity and an expanded contract-based workforce. In addition to public health emergency preparedness, public health agencies also provide many essential services that are invisible to most when working well, and the need for these essential services continues during an emergency response. In an increasingly connected world, collaborative cross-jurisdictional and global relationships with groups such as the World Health Organization tribal public health agencies, and others are also essential for protecting the public's health. The response to the COVID-19 pandemic has drawn attention to the many gaps in our decentralized public health system in the U.S., including inadequate investment in the public health workforce.

Preventing the Next Pandemic: The Case for Investing in Circulatory Health - A Global Coalition for Circulatory Health Position Paper.

The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments.

Effective Cross-National Respectful Partnerships: A Case Study of Peace Corps' Volunteer Covid-19 Volunteer Evacuation.

Strong, trusted partnerships within a social capital framework are core to Peace Corps' successful international, national, and community interactions and outcomes. The Peace Corps' integrated three level model has thrived since its beginning in 1961. During this time, about 250 000 two-year Volunteers have lived and worked in 142 countries. In March 2020, the Peace Corps had to evacuate all 7 000 currently serving Volunteers because of the world-wide Covid-19 pandemic, a task organized and completed in nine days. The evacuation's success depended on the resiliency of these honored long-term partnerships, and specifically: a partnership model with three intertwining layers of collaboration between national and host country staff and Volunteers;years of respectful integration of Volunteers in local communities building mutual trust;in-country and cross-nation preparedness for health, safety, and security emergencies;transparent communication during the evacuation among all involved parties in every nation with Volunteers; andin-country and host country staff support across countries during the evacuation. This case study illustrates elements of effective and sustainable partnerships that ensure their effectiveness during a crisis and survival beyond the crisis. I write this at the anniversary of one year from my stepping down as the twentieth Director of the Peace Corps. During my tenure, I brought home all 7 000 currently serving Volunteers in nine days as the Covid-19 pandemic spread across countries. This massive - and successful - undertaking was possible because of long-standing and trusted partnerships between the Peace Corps and the communities and countries hosting Peace Corps Volunteers. This is my personal reflection and a reminder to build, honor, and tend relationships with international partners who are collaborators in learning, service, and research in good times and our friends, protectors, and allies in times of crisis.

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

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

Dental safety net providers' experiences with service delivery during the first year of COVID-19 should inform dental pandemic preparedness.

BACKGROUND: COVID-19 disrupted oral health care delivery and revealed gaps in dental public health emergency preparedness and response (PHEPR). Emerging dental PHEPR frameworks can be strengthened by means of understanding the experiences of the discipline's frontline workers-dental safety net providers-during the initial phase of the COVID-19 pandemic. METHODS: Experienced qualitative researchers interviewed dental safety net directors and clinicians (n = 21) in 6 states to understand their experiences delivering care from March 2020 through February 2021. Interview transcriptions were analyzed using iterative codes to identify major and minor themes. Conventional qualitative validity checks were used continuously to ensure impartiality and rigor. RESULTS: Three major themes were identified: unpredictability caused concerns among staff members and patients, while also deepening fulfilling collaborations; care delivery was guided by means of various resources that balanced safety, flexibility, and respect for autonomy; and pandemic-driven changes to oral health care delivery are timely, long-lasting, and can be somewhat fraught. CONCLUSIONS: The human, material, and policy resources that providers used to control infections, serve vulnerable patients, maintain clinic solvency, and address provider burnout during the first year of the COVID-19 pandemic can improve dental PHEPR. PRACTICAL IMPLICATIONS: Dental PHEPR should address concerns beyond infection control within and between practice models, governmental agencies, and professional organizations. Examples of such concerns include, but are not limited to, guideline synchronization, materials exigencies, task shifting, and provider resilience.

On the Legitimacy and Effectivity of the World Bank and Its Pandenic Emergency Financing Facility ('PEF') at the Time of the Covid-19 Outbreak

Pandemic financing has in the current climate of disruption and turmoil of an ongoing global pandemic become the most highly debated and controversial issue within the field of international public health law and policy. From the perspective of international public health law and policy, a precondition for success is that financial resources and funds are employed in an effective manner. Whether the International Bank for Reconstruction and Development ('World Bank' or 'WB') and the Pandemic Emergency Financing Facility ('PEF') - a financing mechanism housed at the WB - may be perceived as effective public health players shall be established by referring to their mandates, their inherent capacity for enhancing accepted global legal standards and rules on public health and their funding methods and practices. After the affirmation and consolidation of its role in the public health sector in the early 1990s, the WB has rapidly accredited itself as the most active intergovernmental institution dealing with pandemic and epidemic financing. Its direct involvement in public health trust funds, such as the Avian Flu Trust Fund Facility and the Health Emergency Preparedness and Response Multi-Donor Fund (the HEPRF), and its lending practices and internal policies and procedures were of crucial significance in this respect. Considering that acceptance of international institutions, including international financial institutions, has always been conditioned by their acknowledgment as legally legitimate, legitimacy is regarded as closely connected to effectiveness. The criteria for establishing legitimacy in relation to international financial institutions are increasingly, amongst others, the respect and promotion of rule of law standards in the recipient states. From this perspective, the WB's functional and management structures, but not the PEF's structures and management, have made noteworthy progress, and notwithstanding some deficiencies and peculiarities they present several elements of legitimate decision-making. © KONINKLIJKE BRILL NV, LEIDEN, 2021

Uncertain future of privacy protection under the Korean public health emergency preparedness governance amid the COVID-19 pandemic

This article explores the implications of South Korea's assertions that it has successfully controlled the transmission of coronavirus disease (COVID-19). South Korea has consistently pursued two underlying policies since the COVID-19 outbreak, namely, securing maximum transparency and undertaking seemingly extreme preemptive measures. However, these measures have resulted in privacy concerns. Public health authorities are allowed to collect comprehensive personal details for contract tracings. Although the system of divulging infected persons' routes has been praised by the public, the contact tracing system carries blatant privacy risks. Politicians are easily tempted to reveal more information than is necessary or perhaps more than is legal to alleviate public anxiety. Until now, professional groups' autonomous authority has withstood the populist call for further intrusive measures against privacy rights. Nonetheless, it remains unclear how far the current public health emergency preparedness governance will go to strike a balance between privacy protection and efficient disease control, given the nebulous future of the current pandemic.

Flexibility and partnerships perceived as supportive of dual hazard response: COVID-19 and heat related illness, Summer 2020.

OBJECTIVES: To understand how health departments implemented the response to the dual hazards of Heat Related Illness (HRI) and COVID-19 in Summer 2020. METHODS: We interviewed five health jurisdictions with a Building Resilience Against Climate Effects (BRACE) Framework HRI project to understand impacts to organizational roles and preparedness activities, capacity to respond to the heat season, challenges experienced with resources and personnel, and how partners influenced their capacity to respond to dual hazards. RESULTS: Health jurisdictions working in both heat preparedness and on the COVID-19 response highlighted three components as integral to maintaining public health capacity throughout the pandemic: 1) adapting to changing roles and responsibilities, 2) building and strengthening inter-organizational partnerships, and 3) maintaining flexibility through cross-training as themes to maintain the public health capacity throughout the pandemic. CONCLUSIONS: With impacts of the changing climate, including resultant extreme events with subsequent public health impacts, simultaneous responses are likely to arise again in the future. Developing cross-training programs, fostering flexibility and adaptability within the workforce, and building and sustaining external partnerships can support health departments anticipating the need to respond to simultaneous public health hazards in the future.

Extreme heat at outdoor COVID-19 vaccination sites.

Extreme heat is an increasing climate risk due to climate change and the urban heat island (UHI) effect and can jeopardize points of dispensing (PODs) for COVID-19 vaccination distribution and broader public health emergency preparedness (PHEP) response operations. These PODs were often located on large parking lot sites with high heat severity and did not take heat mitigation or management strategies into account for unacclimated workers and volunteers. To investigate the personal heat exposure of workers, volunteers, and clients at three PODs in Tucson, Arizona, we collected ambient air temperatures, wet bulb globe temperatures (WBGT), surface temperatures, and thermal images. We also made qualitative observations and compared data against daily meteorological records. Ambient air temperatures at all three PODs exceeded the meteorological recorded high. WBGT on average were 8°F (4.4 °C) higher in full sun locations than shaded locations such as tents. Evaporative cooling decreased ambient air temperatures by 2°F (1.2 °C) when placed one per tent, but decreased ambient air temperatures by 7°F (3.9 °C) when placed en masse in a larger tent. Vehicle surface temperatures exceeded recommended safe limits of 140°F (60 °C) at all three sites, with a maximum temperature recorded at 170.9°F (77.2 °C). Public health professionals should consider heat resilience, including heat mitigation and management measures, in POD and PHEP response operations to reduce exposure. This includes considering the UHI effect in the siting of PODs, applying heat mitigation strategies in the design of PODs such as the adaptive use of solar panels for shading, and improving heat safety guidance for workers and volunteers.

Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19).

Background: The psychological and behavioral responses during the early stage of Coronavirus disease 2019 (COVID-19) in South Korea were investigated to guide the public as full and active participants of public health emergency preparedness (PHEP), which is essential to improving resilience and reducing the population's fundamental vulnerability. Methods: Data were collected through an online survey four weeks after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first case in South Korea; 973 subjects were included in the analysis. Results: Respondents' perceived risk of COVID-19 infection; the majority of respondents reported that their perceived chance of infection was "neither high nor low" (51.3%). The average perceived severity score was higher than perceived susceptibility; 48.6 % reported that the severity would be "high," while 19.9% reported "very high." Many respondents reported taking precautions, 67.8% reported always practicing hand hygiene, and 63.2% reported always wearing a facial mask when outside. Approximately 50% reported postponing or canceling social events, and 41.5% were avoiding crowded places. Practicing precautionary behaviors associated strongly with perceived risk and response efficacy of the behavior. Conclusions: Our study confirmed the significance of the psychological responses, which associated with behavioral responses and significantly influenced the public's level of public health emergency preparedness regarding the COVID-19 pandemic. This result has consequences not only for implementing public health strategies for the pandemic but also for understanding future emerging infectious diseases.

Precautionary Behavior Practices and Psychological Characteristics of COVID-19 Patients and Quarantined Persons.

BACKGROUND: since the coronavirus disease (COVID-19) was first reported in 2019, South Korea has enforced isolation of patients with confirmed cases of COVID-19, as well as quarantine for close contacts of individuals diagnosed with COVID-19 and persons traveling from abroad, in order to contain its spread. Precautionary behavior practices and psychological characteristics of confirmed and quarantined persons were investigated for planning pandemic recovery and preparedness. METHODS: this study was conducted with 1716 confirmed patients and quarantined persons in Daegu and Busan, regions where a high number of cases were confirmed during the early stage of the COVID-19 outbreak in South Korea. We collected online survey data from 23 April to 20 May 2020, in Daegu, and 28 April to 27 May 2020, in Busan, in cooperation with Daegu and Busan Infectious Disease Control Centers and public health centers in the regions. COVID-19 symptoms, pre-cautionary behavior practices, psychological states, and the need for improvement in isolation/quarantine environments were examined using an online survey. RESULTS: compared to patients infected with coronavirus, quarantined persons engaged in more hygiene-related behaviors (e.g., hand washing, cough etiquette, and proper mask-wearing) and social distancing. COVID-19 patients had a strong fear of stigma, while quarantined persons had a strong fear of contracting COVID-19. Study participants responded that it was necessary to provide financial support and adequate information during isolation/quarantine. CONCLUSIONS: the study highlights the importance of precautionary behavior to prevent COVID-19 infection and the need to provide support (both psychological and financial) to patients and quarantined persons, to reinforce effective communication, social solidarity, and public health emergency preparedness (PHEP) in a pandemic situation.