Differential impacts of health systems and sociocultural environment on vulnerable populations during the COVID-19 pandemic: lessons from four Asia-Pacific countries.

BACKGROUND: This study aims to evaluate healthcare systems and pandemic responses in relation to marginalized and vulnerable groups, identify populations requiring urgent care, and assess the differential impacts on their health during the pandemic. METHODS: Data were collected by the Asia-Pacific Observatory on Health Systems and Policies (APO)-National University of Singapore and APO-International Health Policy Program consortium members: Korea, Indonesia, Philippines, and Singapore. Data were collected through a combination of semi-structured interviews, policy document reviews, and analysis of secondary data. RESULTS: Our findings reveal that the pandemic exacerbated existing health disparities, particularly affecting older adults, women, and children. Additionally, the study identified LGBTI individuals, healthcare workers, slum dwellers, and migrant workers as groups that faced particularly severe challenges during the pandemic. LGBTI individuals encountered heightened discrimination and limited access to health services tailored to their needs. Healthcare workers suffered from immense stress and risk due to prolonged exposure to the virus and critical working conditions. Slum dwellers struggled with healthcare access and social distancing due to high population density and inadequate sanitation. Migrant workers were particularly hard hit by high risks of virus transmission and stringent, often discriminatory, isolation measures that compounded their vulnerability. The study highlights the variation in the extent and nature of vulnerabilities, which were influenced by each country's specific social environment and healthcare infrastructure. It was observed that public health interventions often lacked the specificity required to effectively address the needs of all vulnerable groups, suggesting a gap in policy and implementation. CONCLUSIONS: The study underscores that vulnerabilities vary greatly depending on the social environment and context of each country, affecting the degree and types of vulnerable groups. It is critical that measures to ensure universal health coverage and equal accessibility to healthcare are specifically designed to address the needs of the most vulnerable. Despite commonalities among groups across different societies, these interventions must be adapted to reflect the unique characteristics of each group within their specific social contexts to effectively mitigate the impact of health disparities.

COVID-19 public health and social measures: a comprehensive picture of six Asian countries.

The COVID-19 pandemic will not be the last of its kind. As the world charts a way towards an equitable and resilient recovery, Public Health and Social Measures (PHSMs) that were implemented since the beginning of the pandemic need to be made a permanent feature of health systems that can be activated and readily deployed to tackle sudden surges in infections going forward. Although PHSMs aim to blunt the spread of the virus, and in turn protect lives and preserve health system capacity, there are also unintended consequences attributed to them. Importantly, the interactions between PHSMs and their accompanying key indicators that influence the strength and duration of PHSMs are elements that require in-depth exploration. This research employs case studies from six Asian countries, namely Indonesia, Singapore, South Korea, Thailand, the Philippines and Vietnam, to paint a comprehensive picture of PHSMs that protect the lives and livelihoods of populations. Nine typologies of PHSMs that emerged are as follows: (1) physical distancing, (2) border controls, (3) personal protective equipment requirements, (4) transmission monitoring, (5) surge health infrastructure capacity, (6) surge medical supplies, (7) surge human resources, (8) vaccine availability and roll-out and (9) social and economic support measures. The key indicators that influence the strength and duration of PHSMs are as follows: (1) size of community transmission, (2) number of severe cases and mortality, (3) health system capacity, (4) vaccine coverage, (5) fiscal space and (6) technology. Interactions between PHSMs can be synergistic or inhibiting, depending on various contextual factors. Fundamentally, PHSMs do not operate in silos, and a suite of PHSMs that are complementary is required to ensure that lives and livelihoods are safeguarded with an equity lens. For that to be achieved, strong governance structures and community engagement are also required at all levels of the health system.

Research priority-setting for human, plant, and animal virology: an online experience for the Virology Institute of the Philippines.

BACKGROUND: Viral pandemics have had catastrophic consequences on population health and economies. The Philippine government intends to establish the Virology Institute of the Philippines, one of the key areas of which will be virology research. This project aimed to develop the institute's research agenda across the fields of human, plant, and animal virology. METHODOLOGY: Key considerations for the prioritization methodology were (1) the imminent establishment of the Virology Institute of the Philippines, (2) mobility restrictions caused by the coronavirus disease 2019 (COVID-19) pandemic, (3) the timeline to develop the research agenda, and (4) the need to separate the research agenda for the three fields of human, plant, and animal virology. The process was fully conducted online in four steps: stakeholder identification, soliciting research priorities, generating initial research priorities, and final prioritization consultations conducted on Zoom Pro. RESULTS: Twenty-eight participants attended three online consultations between 21 and 27 July 2020 through Zoom Pro. Participants selected the research prioritization criteria and its weights, and used these to evaluate the research priorities. The final research agenda covers topics in epidemiology, diagnostics, surveillance, biosafety, and genomics. CONCLUSION: This initiative resulted in the first research agenda for the Virology Institute of the Philippines across the three fields of human, plant, and animal virology. An expert-driven process which places a premium on consensus-building facilitated through online platforms was the most feasible approach to develop the research agenda. This process resulted in an agenda aligned with the mandates of national research councils but leaves gaps on areas such as emerging infectious diseases. Pre-COVID-19 literature expressed apprehensions on the online medium that weakens social ties necessary for consensus. Our experience with changing the mode of consensus-building shows that users will continually adapt to technology. Online tools are currently able to address the limitations of the virtual space.