Governance, policy, and health systems responses to the COVID-19 pandemic in Thailand: a qualitative study.

Background: Since 2020, Thailand has experienced four waves of COVID-19. By 31 January 2022, there were 2.4 million cumulative cases and 22,176 deaths nationwide. This study assessed the governance and policy responses adapted to different sizes of the pandemic outbreaks and other challenges. Methods: A qualitative study was applied, including literature reviews and in-depth interviews with 17 multi-sectoral actors purposively identified from those who were responsible for pandemic control and vaccine rollout. We applied deductive approaches using health systems building blocks, and inductive approaches using analysis of in-depth interview content, where key content formed sub-themes, and different sub-themes formed the themes of the study. Findings: Three themes emerged from this study. First, the large scale of COVID-19 infections, especially the Delta strain in 2021, challenged the functioning of the health system's capacity to respond to cases and maintain essential health services. The Bangkok local government insufficiently performed due to its limited capacity, ineffective multi-sectoral collaboration, and high levels of vulnerability in the population. However, adequate financing, universal health coverage, and health workforce professionalism and commitment were key enabling factors that supported the health system. Second, the population's vulnerability exacerbated infection spread, and protracted political conflicts and political interference resulted in the politicization of pandemic control measures and vaccine roll-out; all were key barriers to effective pandemic control. Third, various innovations and adaptive capacities minimized the supply-side gaps, while social capital and civil society engagement boosted community resilience. Conclusion: This study identifies key governance gaps including in public communication, managing infodemics, and inadequate coordination with Bangkok local government, and between public and private sectors on pandemic control and health service provisions. The Bangkok government had limited capacity in light of high levels of population vulnerability. These gaps were widened by political conflicts and interference. Key strengths are universal health coverage with full funding support, and health workforce commitment, innovations, and capacity to adapt interventions to the unfolding emergency. Existing social capital and civil society action increases community resilience and minimizes negative impacts on the population.

The Role of Political Belief in COVID-19 Vaccine Resistance, Virus Transmission, and Closure Policy Response.

We employ unique panel data on the universe of COVID-19 vaccination and infection cases in Israel to examine the role of political belief in COVID-19 vaccine uptake, virus transmission, and closure policy response. The paper identifies political beliefs based on statistical area votes in national elections held in Israel on the eve of the COVID-19 outbreak in March 2020. Unlike the U.S. and elsewhere, pandemic policy intervention in Israel was broadly supported by politicians across the belief spectrum. As such, household response to virus risk was not biased by contemporaneous partisan disagreement and debate among political leaders. Findings show, all things equal, that in the wake of emergent and localized virus risk, voters in politically right-of-center and religious areas displayed substantially higher odds of both vaccine resistance and virus transmission as compared to their left-center counterparts. Moreover, political belief is highly salient to aggregate pandemic outcomes. Model simulation shows that had all areas responded to virus risk with the more risk-averse behaviors of left-of-center areas, the number of vaccinations nationwide would have increased by 15 percent. That same scenario results in a full 30 percent reduction in total infection cases. Results also show that coercive policy measures such as economic closure were more effective in reducing virus transmission among less risk-averse right-wing and religious areas. Findings provide new evidence of the role of political belief in household response to health risks. Results further underscore the importance of timely, targeted messaging and intervention among divergent political belief groups to reduce vaccine hesitancy and enhance disease control. Future studies should explore the external validity of findings, including the use of individual voter data, if available, to evaluate political belief effects.

Variation in Global Policy Responses to COVID-19: A Bidirectional Analysis.

Against the unprecedented outbreaks of the COVID-19 variants, countries have introduced restrictive measures with discretion, ranging from lifting the closure thoroughly to implementing stringent policies, but all together guarding the global public health. Under the changing circumstances, we firstly apply the panel data vector autoregression (PVAR) model, using a sample of 176 countries/territories from 15 June 2021 to 15 April 2022, to estimate the potential associations among the policy responses, the progression of COVID-19 in deaths and vaccination, and medical resources possessed. Furthermore, we use the random effect method and the fixed effect speculation, to examine the determinants of policy variances across regions and over time. Our work has four main findings. Firstly, it showed the existence of a bidirectional relationship between the policy stringency and variables of interest including new daily deaths, the fully vaccinated percentage and health capacity. Secondly, conditional on the availability of vaccines, the sensitivity of policy responses to the death numbers tends to decline. Thirdly, the role of health capacity matters in coexisting with the virus mutation. Fourthly, regarding the variance in policy responses over time, the impact of new deaths tends to be seasonal. As to geographical differences in policy responses, we present the analysis for Asia, Europe, and Africa, and they show different levels of dependencies on the determinants. These findings suggest that bidirectional correlations exist in the complex context of wrestling with the COVID-19, as government interventions exert influence on the virus spread, the policy responses also progress alongside multiple factors evolving in the pandemic. This study will help policymakers, practitioners, and academia to formulate a comprehensive understanding of the interactions between policy responses and the contextualized implementation factors.

Impact of policy response on health protection and economic recovery in OECD and BRIICS countries during the early stages of the COVID-19 pandemic.

OBJECTIVES: During the early stages of the COVID-19 pandemic, the full reopening of the economy typically accelerated viral transmission. This study aims to determine whether policy response could contribute to the dual objective of both reducing the spread of the epidemic and revitalising economic activities. STUDY DESIGN: This is a longitudinal study of Organization for Economic Cooperation and Development (OECD) and Brazil, Russia, India, Indonesia, China, and South Africa (BRIICS) from the first quarter (Q1) of 2020 to the same period of 2021. METHODS: From a health-economic perspective, this study established a framework to illustrate the following outcomes: suppression-prosperity, outbreak-stagnancy, outbreak-prosperity and suppression-stagnancy scenarios. Multinomial logistic models were used to analyse the associations between policy response with both the pandemic and the economy. The study further examined two subtypes of policy response, stringency/health measures and economic support measures, separately. The probabilities of the different scenarios were estimated. RESULTS: Economic prosperity and epidemic suppression were significantly associated with policy response. The effects of policy response on health-economic scenarios took the form of inverse U-shapes with the increase in intensity. 'Leptokurtic', 'bimodal' and 'long-tailed' curves demonstrated the estimated possibilities of suppression-prosperity, outbreak-prosperity and suppression-stagnancy scenarios, respectively. In addition, stringency/health policies followed the inverted U-shaped pattern, whereas economic support policies showed a linear pattern. CONCLUSIONS: It was possible to achieve the dual objective of economic growth and epidemic control simultaneously, and the effects of policy response were shaped like an inverse U. These findings provide a new perspective for balancing the economy with public health during the early stages of the pandemic.

Economic and behavioral determinants of forced household savings during the COVID-19 pandemic.

This study seeks to identify the determinants of forced household savings in 16 European Union (EU) member states in 2020. We show that the higher the severity of the COVID-19 pandemic in the state, measured by the intensity of government restrictions or the number of COVID-19-related deaths, the higher the level of forced savings. Such savings also increased with gross domestic product per capita and the financial support provided for households and enterprises by the government. Additionally, savings cultures and personality traits that support compliance with pandemic-related restrictions and enhance coping with the hardship of the pandemic had a positive impact on forced savings. Our results show that while common pandemic shock may lead to discrepancies in forced savings in affected countries, their level depends largely on government response in the form of imposed restrictions as well as financial support for households and enterprises. Therefore, strong fiscal support during the pandemic can be likened to sowing the seeds for post-pandemic recovery, as savings accumulated during the pandemic shock may be used to finance the pent-up demand. This, in turn, suggests that fiscal responses during the pandemic may act as a significant driver of post-pandemic business cycle (de)synchronization and inflation differentials among EU member states and, more importantly, euro-area countries.

Children with medical complexities: their distinct vulnerability in health systems' Covid-19 response and their claims of justice in the recovery phase.

In this paper, we discuss the lack of consideration given to children in the COVID-19 health systems policy response to the pandemic. We do this by focusing on the case of children with complex medical needs. We argue that, in broad terms, health systems policies that were implemented during the pandemic failed adequately to meet our obligations to both children generally and those with complex medical needs by failing to consider those needs and so to give them fair protection against harm and disadvantage. We argue that justice requires that the distinct needs and vulnerabilities of children with medical complexities are explicitly integrated and prioritised in decisions concerning healthcare and operational planning in the recovery phase and beyond.

The impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization in China.

We investigate the impact of the COVID-19 pandemic and related policy responses on non-COVID-19 healthcare utilization (i.e., different types of outpatient care) up to October 2020 in China. Using an administrative database from a large prefecture-level city, we find that both direct exposure to the COVID-19 pandemic and the strict containment policy responses led to reductions in outpatient care utilization. The largest decline during the lockdown was observed in preventive care visits, which nevertheless recovered to pre-pandemic levels 2 months after the lockdown. The disruptions in prenatal care visits could not be offset by the recovery later on. Chronic care and emergency department visits had not returned to pre-pandemic levels as of October 2020, which may be driven by extended days' supply of prescription medication, increased use of telemedicine, and improved health-protective behaviors. In the reopening period, there were increases in visits for mental and sleep disorders, especially among children, and for medical abortion. Among health facilities at all levels, primary care facilities saw the least reductions in total outpatient visits. Our results emphasize the need for strategies to ensure access to urgent or essential care services when managing the current epidemiologic transition and future crises.

Application of the Policy Regime Framework to understand COVID-19 policy response in the Southeast U.S.: How RAPID research can provide lessons learned after a public health crisis.

Quick-response research during a time of crisis is important because time-sensitive findings can inform urgent decision-making, even with limited research budgets. This research, a National Science Foundation-funded Rapid Response Research (RAPID), explores the United States (U.S.) government's messaging on science in response to the COVID-19 pandemic, and how this messaging informed policy. Using rapidly emerging secondary data (e.g., policy documents taken from government websites and others), much of which has since been removed or changed, we examined the interactions between governing bodies, non-governmental organizations, and civilian populations in the Southeastern U.S. during the first 2 years of the pandemic. This research helps to better understand how decision-makers at the federal, state, and local levels responded to the pandemic in three states with the lowest vaccine rates and highest levels of poverty, income inequality, and disproportionate impacts borne by people of color in the nation: Alabama, Louisiana, and Mississippi. This study incorporates the Policy Regime Framework to discuss how two foundational concepts (ideas and institutions) helped govern policy implementation during the COVID-19 pandemic. This research fills a significant information gap by providing a better understanding of how policy regimes emerge across multiple levels of government and impact vulnerable populations during times of a public health crisis. We use automated text analysis to make sense of a large quantity of textual data from policy-making agencies. Our case study is the first to use the Policy Regime Framework in conjunction with empirical data, as it emerged, from federal, state, and local governments to analyze the U.S. policy response to COVID-19. We found the U.S. policy response included two distinct messaging periods in the U.S. during the COVID-19 pandemic: pre and post-vaccine. Many messaging data sources (agency websites, public service announcements, etc). have since been changed since we collected them, thus our real-time RAPID research enabled an accurate snapshot of a policy response in a crisis. We also found that there were significant differences in the ways that federal, state, and local governments approached communicating complex ideas to the public in each period. Thus, our RAPID research demonstrates how significant policy regimes are enacted and how messaging from these regimes can impact vulnerable populations.

When Water Quality Crises Drive Change: A Comparative Analysis of the Policy Processes Behind Major Water Contamination Events.

The occurrence of major water contamination events across the world have been met with varying levels of policy responses. Arsenic-a priority water contaminant globally, occurring naturally in groundwater, causing adverse health effects-is widespread in Bangladesh. However, the policy response has been slow, and marked by ineffectiveness and a lack of accountability. We explore the delayed policy response to the arsenic crisis in Bangladesh through comparison with water contamination crises in other contexts, using the Multiple Streams Framework to compare policy processes. These included Escherichia coli O157:H7 and Campylobacter in Walkerton, Canada; lead and Legionella in Flint, Michigan, USA; and chromium-6 contamination in Hinkley, California, USA. We find that, while water contamination issues are solvable, a range of complex conditions have to be met in order to reach a successful solution. These include aspects of the temporal nature of the event and the outcomes, the social and political context, the extent of the public or media attention regarding the crisis, the politics of visibility, and accountability and blame. In particular, contaminants with chronic health outcomes, and longer periods of subclinical disease, lead to smaller policy windows with less effective policy changes. Emerging evidence on health threats from drinking water contamination raise the risk of new crises and the need for new approaches to deliver policy change.

Cervical Cancer and Human Papillomavirus Vaccine Knowledge, Utilisation, Prevention Educational Interventions and Policy Response in Nigeria: A Scoping Review.

PURPOSE: This review evaluated the knowledge, utilisation, prevention education, and policy response across the six geopolitical regions of Nigeria to inform national efforts for the prevention and control of cervical cancer. METHODS: A keyword-based systematic search was conducted in PubMed/MEDLINE (NCBI), Google Scholar, and AJOL electronic databases, including a manual scan of papers, journals and websites to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility. RESULTS: Many (158) articles were downloaded and after duplicates were removed, 110 articles were included in the final analysis. These were made up of qualitative, quantitative (cross-sectional), intervention and policy studies. Studies have generally reported poor knowledge and awareness of cervical cancer screening but those carried out in urban areas demonstrated a slightly higher level of awareness of Human Papilloma Virus (HPV) vaccine, HPV vaccination uptake and utilization of cervical cancer preventive services than the rural studies. The studies did not show strong government support or policies in relation to cervical cancer control. CONCLUSION: Knowledge and uptake of cervical cancer preventive services across diverse groups in Nigeria remain poor. These could be linked to socio-cultural factors, the lack of an organised cervical cancer screening programme and low financial resource pool for cervical cancer prevention. Therefore, it is necessary to increase government, donor prioritisation and political support in order to ensure increased investment and commitment to cervical cancer elimination in Nigeria.

The policy response to COVID-19 pandemic and its impact on the equity market sentiment: The Indian experience.

We examine the dynamics of the impact of the evolving policy response during the COVID-19 pandemic on the equity market sentiment in India. We operationalise our study by examining the India VIX, the fear gauge of the Indian equity market as an indicator for the market sentiment, and the country level Government Response Index of the Blavatnik School of Government, Oxford University as an indicator for the policy response. The relation is examined through the Markov-switching model using high-frequency daily data from January 30, 2020, to May 31, 2021. The evidence suggests that the policy response has a positive impact on the market sentiment when the market is fearful. Further, the evidence suggests that both the high-fear state and the low-fear state of the market sentiment given by the model are short-lived indicating heightened volatility and possible speculation during the ongoing pandemic in the Indian equity market.

Can relief measures nudge compliance in a public health crisis? Evidence from a kinked fiscal policy rule.

We show that compensation measures aimed at improving the fairness of a crisis policy response can unintendedly nudge compliance with emergency rules. We combine information on the distribution of relief funds across Italian municipalities during the novel coronavirus pandemic with data tracking citizens' movements through mobile devices and navigation systems. To assess the impact of transfers on compliance, we exploit a sharp kink schedule in the allocation of funds. The empirical analysis provides evidence that compliance increased with transfers, suggesting that the observance of emergency rules also depends on the fairness of the pandemic policy response.

Culture and COVID-19-related mortality: a cross-sectional study of 50 countries.

Using a cross-sectional sample of 50 countries we investigate the influence of Hofstede's six-dimensions of culture on COVID-19 related mortality. A multivariable regression model was fitted that controls for health-related, economic- and policy-related variables that have been found to be associated with mortality. We included the percentage of population aged 65 and above, the prevalence of relevant co-morbidities, and tobacco use as health-related variables. Economic variables were GDP, and the connectedness of a country. As policy variables, the Oxford Stringency Index as well as stringency speed, and the Global Health Security Index were used. We also describe the importance of the variables by means of a random forest model. The results suggest that individualistic societies are associated with lower COVID-19-related mortality rates. This finding contradicts previous studies that supported the popular narrative that collectivistic societies with an obedient population are better positioned to manage the pandemic.

Centering the Right to Health of Childbearing People in the US During the COVID-19 Pandemic.

Childbearing people in the US have experienced the double burden of increased risks from infection and significant disruptions to access and quality of essential health care services during the COVID pandemic. A single person could face multiple impacts across the course of their reproductive trajectory. We highlight how failure to prioritize this population in the COVID-19 policy response have led to profound disruptions from contraception services to vaccination access, which violate foundational principles of public health, human rights and perpetuate inequities. These disruptions continued through the omicron surge, during which many health systems became overwhelmed and re-imposed earlier restrictions. We argue that an integrated pandemic response that prioritizes the healthcare needs and rights of childbearing people must be implemented to avoid deepening inequities in this and future pandemics.

Macroeconomic and monetary policy responses in selected highly indebted MENA countries post Covid 19: A structural VAR approach.

With limited fiscal space, MENA governments with flexible exchange rates have been relying extensively on accommodative monetary policy to circumvent external shocks such as Covid 19 and other domestic macroeconomic imbalances. Other MENA countries with high debt levels and fixed exchange rates are not able to use conventional monetary policy effectively. We use a battery of econometric models to identify domestic and external nominal shocks affecting the MENA region and their dynamic transmission mechanisms through impulse response functions and granger causality tests derived from a structural VAR. Once the nature of those shocks is identified, we formulate appropriate macroeconomic policy responses to mitigate their effects. We show that shocks to Saudi Arabia's macroeconomic fundamentals and oil prices have a significant impact on MENA countries' GDP, inflation, and interest rates. In the absence of an effective conventional monetary policy, MENA central banks will have to rely more on non-conventional monetary policy tools.

China's Changing Alcohol Market and Need for an Enhanced Policy Response: A Narrative Review.

This study describes trends in alcohol consumption in the context of an expanding commercial context, current policy responses, and flaws in relation to international best practice for alcohol control in China. We surveyed the literature and other documents in Chinese or English up to December 2020 on policy responses to alcohol consumption and harm, industry structure, and marketing practices in China. Databases searched included PubMed, China National Knowledge Internet, Wanfang Data, Web of Science, and Baidu Scholar. We also scanned the official websites of government organizations and gathered information using snowballing. We analyzed existing alcohol policy against evidence-based, cost-effective policies for reducing alcohol harm. Our findings show that although some restrictive policies have been enacted with potential impacts on alcohol harm, they are not comprehensive, and some are poorly executed. The long history of alcohol use remains an important element in alcohol consumption by the Chinese population. However, alcohol marketing and promotion, ease of access, and affordability have become increasingly prominent. The gaps identified in alcohol policy suggest improved strategies and measures to reduce the harmful use of alcohol are urgently needed in China.

Policy responses to COVID-19 pandemic waves: Cross-region and cross-sector economic impact.

This paper proposes a modelling approach to assess the cross-region and cross-sector economic impacts of the restrictions imposed by governments to contain the COVID-19 pandemic. The nationwide lockdown imposed in Italy during the first wave of the pandemic is used as a benchmark. However, the adopted approach allows an ex-ante assessment of alternative policy responses, in the event of successive pandemic waves, in order to rationalise the policy intervention and reach the best possible compromise between containing the risk of contagion and reducing economic losses. The used approach consists of a non-linear programming model based on a multiregional Input-Output (I-O) table, which guarantees greater flexibility than traditional I-O analysis. It is applied to estimate both direct and indirect losses of GDP and employment produced by alternative policy responses represented by general and differentiated lockdowns. The evidence deriving from the Italian experience shows a sort of learning process through successive waves based on the introduction of increasingly flexible and tailored policy responses to the pandemic.

Intra-household gender disparity: effects on climate change adaptation in Arsi Negele district, Ethiopia.

Women empowerment in agriculture influences adaptation capacity to climate change impacts. Women are disempowered in rural households. This affects household's adaptive capacity to climate change negatively. Household survey, focus group discussion, key informant interview and workshop were used to track stakeholders' opinions on gender disparity in agriculture and policy issues. The objective of the study was to assess the gender parity index in agriculture, resource governance patterns and how these impact the capacity to climate change adaptation. The results show wives were imparity with their husbands. The parity gap on ownership, access to, and decision-making power over agricultural equipment was as wide as 59% and this affects women's adaptation capacity to climate change impacts. Indeed, 94% of the coupled households have got their land by redistribution and inheritance land acquisition forms by which both forms of acquiring land favored the husband. Half of the respondent households acknowledged that they have already acquired certification for their farmlands. However, the certification was mostly given by the names of husbands and in few cases by both. Certification of farmlands by the name of a wife and a husband has built confidence on ownership and manage their farmlands. This has helped a household to better adapt climate change impacts. Gender disparity in agricultural productive resources combined with policy and cultural distortions could exacerbate household's vulnerability to the impacts of climate change. This indicates the need for gender mainstreaming in climate change policy reforms and formulation so as to empower women and build their adaptive capacity.

Role of professionalism in response to the COVID-19 pandemic: Does a public health or medical background help?

In response to the outbreak of coronavirus disease 2019 (COVID-19), there have been substantial variations in policy response and performance for disease control and prevention within and across nations. It remains unclear to what extent these variations may be explained by bureaucrats' professionalism, as measured by their educational background or work experience in public health or medicine. To investigate the effects of officials' professionalism on their response to and performance in fighting the COVID-19 pandemic, we collect information from the résumés of government and Party officials in 294 Chinese cities, and integrate this information with other data sources, including weather conditions, city characteristics, COVID-19-related policy measures, and health outcomes. We show that, on average, cities whose top officials had public health or medical backgrounds (PHMBGs) had a significantly lower infection rate than cities whose top officials lacked such backgrounds. We test the mechanisms of these effects and find that cities whose officials had a PHMBG implemented community closure more rapidly than those lacked such backgrounds. Our findings highlight the importance of professionalism in combating the pandemic.