Assessing the value of healthcare innovations: a proposal for an integrated health technology assessment-responsible innovation in health approach in the "new normal".

There has been tremendous technological innovation in the healthcare sector, but it has also raised serious ethical and social concerns. The COVID-19 pandemic has only magnified these existing challenges. Hence, addressing these challenges becomes imperative in the "new normal." In this context, this article uses a narrative synthesis approach to discuss the linkages of health technology, innovation, and policy to identify the challenges of this complex interaction by applying the principles of pragmatism and historicity to the existing literature. Moreover, the existing scientific mechanisms in the form of health technology assessment (HTA) and responsible innovation in health (RIH) are described to address these challenges. Using inductive epistemology, the linkages between HTA and RIH within a health innovation ecosystem framework are discussed for the future application of an integrated approach to address societal challenges. The proposed integrated approach of HTA and RIH is a work in progress and conceptualized as transdisciplinary, flexible, and adaptive, which is expected to facilitate future discussion, research, and policy action.

A Novel Indicator for COVID-19 Pandemic Assessment and Comparison (preprint)

Introduction In an increasingly globalized world, no country can remain immune to the effect of the COVID-19 pandemic. The pandemic has exposed the need for effective public health surveillance in the interest of global health security. However, current indicators are limited in doing a comparative intercountry assessment and comparison because of variation in testing rates and reporting standards. Hence, this study attempts at addressing this gap. Methods The study proposes incremental change in cases per testing rate (ICTR) as an indicator for doing cross country comparison of the pandemic progress. The equation for calculating this indicator is explained in this study. This is followed by measuring its strength of association and predictive power for determining change in SARS-CoV-2 cases in five countries (USA, UK, India, Pakistan and Bangladesh). Results and discussion ICTR was found to have a significantly higher strength of association and predictive power (than the existing indicator-test positivity rate) for determining change in cases over different time periods. Using ICTR, cross country comparison was done for the five countries for15 months to draw deeper insights into the progress of the pandemic. Conclusions The study finds ICTR to be a suitable indicator for intercountry comparison and intracountry monitoring of the pandemic, which would be useful for global COVID-19 surveillance.

Leadership, Crisis and COVID-19: Vuja de or Déjà vu (preprint)

The novel corona virus disease (COVID-19) challenged the world leaders on their leadership skills. Using the ‘lockdown’ decision as the unit of analysis, this paper uses the theory of social constructivism to provide insights into the variation in early decisive decision making across some of the worst affected countries due to COVID-19. Using the typology of ‘tame’ and ‘wicked’ problems, this article argues how situation and contexts are created by leaders and reconstructed as a political arena. Hence, actors and contexts interact to define and situate a problem, which is influenced by the political system of a country as well as the personality of these leaders. Insights drawn from this study would be useful for future leadership decisions in ‘crisis’.

Federal Vaccine Policy and Interstate Variation in COVID-19 Vaccine Coverage in India (preprint)

IntroductionOn August 13, 2021, India completed 30 weeks of vaccination against COVID-19 for its eligible citizens. While the vaccination has made progress, there has been no study analyzing the federal/union vaccine policy and its effect on vaccination coverage across Indian states. In this context, this study analyses the federal vaccination policy and its effect on interstate variation in vaccine coverage and the correlation of state economy with vaccination coverage. MethodsThe study analyses vaccine policy documents, secondary data on vaccination coverage and state gross domestic product (GDP) available in public domain. ANOVA test has been used to assess the effect of vaccine policy on interstate vaccine coverage and correlation-regression analysis has been conducted to assess the type and strength of association between gross state domestic product and vaccination coverage. ResultsInterstate variation in vaccination coverage in the first 15 weeks was the least (F=3.5), when vaccine procurement and supply was entirely provided by the union/federal government and vaccination was limited to priority groups. However, with the extension of vaccine policy to other groups and reduction in federal government involvement in vaccine procurement, the interstate variation in vaccination coverage increased significantly (F=10.74) by the end of 30 weeks. The highest interstate variation was observed in the period between 23-30 weeks (F=25.31). State GDP was positively and strongly correlated with state vaccination coverage with a high coefficient of correlation (R=0.94) and high coefficient of determination (R2= 0.88). ConclusionsThe study finds that federal procurement and supply of vaccination among prioritized groups has been the best strategy till date to address the inequity in vaccination coverage across the states of India.

COVID-19 and lockdown: Insights from Mumbai.

BACKGROUND: Mumbai is facing the full brunt of the COVID-19 pandemic epidemiologically and economically. OBJECTIVES: The objective was to understand the spatial distribution and trends of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) in Mumbai during the lockdown period and draw insights for effective actions. METHODS: Spatial and trend analysis was conducted to trace the spread of the virus during the lockdown period in April 2020. The administrative divisions of Mumbai, in the form of wards and zones, have been used as units of analysis. RESULTS: Greater Mumbai area occupies only 0.015% of the landmass of India, but is contributing to over 20% of the SARS-CoV-2 cases in India. Cases of SARS-CoV-2 infections have increased over 375 times within 50 days of the lockdown. An analysis of trends across the wards during the 3-week period (April 4 to April 25) shows a skewed pattern, with three zones out of six contributing to the vast majority of cases in Mumbai. The wards with higher formal economic activity are relatively less affected than the other wards. The test positivity rate in Mumbai is much higher than the rest of India. CONCLUSION: The study suggests that the virus had already spread to the community in Mumbai before the lockdown started.