Animal health emergencies: a gender-based analysis for planning and policy.

There has been increasing recognition of gender-based inequity as a barrier to successful policy implementation. This consensus, coupled with an increasing frequency of emergencies in human and animal populations, including infectious disease events, has prompted policy makers to re-evaluate gender-sensitivity in emergency management planning. Seeking to identify key publications relating to gendered impacts and considerations across diverse stakeholders in different types of animal health emergencies, we conducted a non-exhaustive, targeted scoping review. We developed a matrix for both academic and policy literature that separated animal health emergencies into two major categories: humanitarian crises and infectious disease events. We then conducted semi-structured interviews with key animal health experts. We found minimal evidence of explicit gender responsive planning in animal health emergencies, whether humanitarian or infectious disease events. This was particularly salient in Global North literature and policy planning documents. Although there are some references to gender in policy documents pertaining to endemic outbreaks of African swine fever (ASF) in Uganda, most research remains gender blind. Despite this, implicit gendered themes emerged from the literature review and interviews as being direct or indirect considerations of some research, policy, and implementation efforts: representation; gendered exposure risks; economic impact; and unpaid care. Absent from both the literature and our conversations with experts were considerations of mental health, gender-based violence, and intersectional impacts. To remedy the gaps in gender-based considerations, we argue that the intentional inclusion of a gender transformative lens in animal health emergency planning is essential. This can be done in the following ways: (1) collection of disaggregated data (race, gender, sexual orientation, etc.); (2) inclusion of gender experts; and (3) inclusion of primary gendered impacts (minimal representation of women in policy positions, gender roles, economic and nutrition impacts) and secondary gendered impacts (gender-based violence, mental health, additional unpaid care responsibilities) in future planning.

A legal mapping of 48 WHO member states' inclusion of public health emergency of international concern, pandemic, and health emergency terminology within national emergency legislation in responding to health emergencies.

WHO has determined a public health emergency of international concern (PHEIC) seven times, and beyond this nomenclature declared COVID-19 to be a pandemic. Under the International Health Regulations (IHR), and through their operationalisation in the joint external evaluation (JEE), governments are urged to create suitable legislation to be able to enact a response to a public health emergency. Whether the pandemic declaration had a greater effect than a PHEIC in encouraging goverments to act, however, remains conjecture, as there is no systemic analysis of what each term means in practice and whether either has meaningful legal implications at the national level. We undertook a legal scoping review to assess the utilisation of PHEIC and pandemic language within national legislation in 28 WHO member states. Data were collected from national websites, JEE reviews, COVID Analysis and Mapping of Policies Tool, Natlex, and Oxford Compendium of National Legal Responses to COVID-19. We found that only 16% of countries have any reference to the PHEIC in national legislation and 37·5% of countries reference the term pandemic. This finding paints a weakened picture of the IHR and PHEIC mechanisms. Having such legalese enshrined in legislation might enhance the interaction between WHO determining a PHEIC or declaring a pandemic and resulting action to mitigate transnational spread of disease and enhance health security. Given the ongoing negotiations at WHO in relation to the amendments to the IHR and creation of the pandemic accord, both of which deal with this declaratory power of the PHEIC and pandemic language, negotiators should understand the possible implications of any changes to these proclamations at the national level and for global health security.

Forum shifting in global health security.

Global health security is an increasingly complex regime. The failures of global governance and norms of cooperation during the coronavirus disease 2019 (COVID-19) pandemic and the re-entrenchment to nationalist policy-making have created impetus for new governance arrangements, institutions and policy development. These changes include amendments to the International health regulations (IHR), development of a pandemic convention or accord, convening of the High-Level Meeting on Pandemic Preparedness and Response, establishment of the Pandemic fund, and development of the medical countermeasures platform, among others. These various developments claim to be in synergy with each other, but understanding of regime complexes and forum shifting from international relations reveal the power dynamics which underlie these processes. I use these concepts to demonstrate how states are transferring negotiations from one institutional location to another in search of more favourable outcomes, or are creating strategic uncertainty within negotiations to avoid future accountability. I further highlight three risks posed by these developments: (i) an increasingly complex landscape for global health security; (ii) erosion of the World Health Organization's authority in global health security; and (iii) dominance of high-income state positions within these negotiations.

La sécurité sanitaire mondiale est un système de plus en plus complexe. Les échecs essuyés par la gouvernance mondiale et les normes en matière de coopération durant la pandémie de maladie à coronavirus 2019 (COVID-19), ainsi que le retour à une élaboration nationaliste des politiques, ont entraîné la création de mécanismes de gouvernance, d'institutions et de programmes politiques inédits. Ces transformations se traduisent notamment par des amendements au Règlement sanitaire international (RSI), la mise au point d'une convention ou d'un accord face aux pandémies, l'organisation de la Réunion de haut niveau inédite sur la prévention, la préparation et la riposte face aux pandémies, l'établissement du Fonds de lutte contre les pandémies, mais aussi l'instauration de la plateforme de contre-mesures médicales. Ces différents changements affirment œuvrer en synergie, mais la compréhension des complexités du système et l'évolution des débats, qui se détachent des relations internationales, révèlent les dynamiques de pouvoir qui sous-tendent ces processus. J'utilise ces concepts pour montrer comment les États transfèrent les négociations d'un siège institutionnel à l'autre en quête de résultats plus favorables, ou créent une incertitude stratégique dans le cadre des négociations pour se soustraire à de futures responsabilités. Je souligne également trois risques que comportent ces changements: (i) un paysage sans cesse plus complexe pour la sécurité sanitaire mondiale; (ii) l'érosion de l'autorité exercée par l'Organisation mondiale de la Santé en la matière; et enfin, (iii) la position dominante des États à revenu élevé dans les négociations.

La seguridad sanitaria mundial es un sistema cada vez más complejo. Los fracasos de la gobernanza mundial y de las normas de cooperación durante la pandemia de la enfermedad por coronavirus de 2019 (COVID-19) y el repliegue hacia la formulación de políticas nacionalistas han impulsado nuevos acuerdos de gobernanza, instituciones y desarrollo de políticas. Estos cambios incluyen enmiendas al Reglamento Sanitario Internacional (RSI), el desarrollo de una convención o acuerdo sobre pandemias, la convocatoria de la Reunión de Alto Nivel sobre Preparación y Respuesta ante Pandemias, el establecimiento del Fondo para Pandemias y el desarrollo de la plataforma de contramedidas médicas, entre otros. Estos diversos desarrollos pretenden funcionar en sinergia, pero la comprensión de las complejidades del sistema y la evolución de los debates, al margen de las relaciones internacionales, revelan la dinámica de poder que subyace a estos procesos. Utilizo estos conceptos para demostrar cómo los Estados trasladan las negociaciones de un lugar institucional a otro en busca de resultados más favorables o crean incertidumbre estratégica dentro de las negociaciones para evadir futuras responsabilidades. Además, destaco tres riesgos que plantean estos acontecimientos: (i) un panorama cada vez más complejo para la seguridad sanitaria mundial; (ii) la pérdida de autoridad de la Organización Mundial de la Salud en materia de seguridad sanitaria mundial; y (iii) el predominio de las posiciones de los Estados de ingresos altos en estas negociaciones.

How can gender considerations be better integrated into animal health emergency preparedness and response?

Global and national authorities have not historically approached animal health emergencies through a gendered lens. Yet these events almost certainly have gendered dimensions, such as differential engagement of women or men depending on their culturally accepted or assigned roles for animal care; risk of exposure to zoonoses; and access to emergency resources during response and recovery. Despite the role that gender seems to play with respect to animal health emergencies, little research has been conducted to better understand such dynamics, and little policy has been promulgated to address it in a way that optimizes response while ensuring equitable outcomes. This piece summarizes 3 key themes that emerged from a panel discussion on gender and animal health emergencies at the World Organisation for Animal Health Global Conference on Emergency Management in April 2023. These themes were differential gendered exposure to pathogens; a lack of equitable gender representation in animal health decision-making; and enhancement of pathways for recognizing gender in national and international actions in preparing for, detecting, and responding to animal health emergencies. Beyond increasing opportunities for women to engage in leadership, the animal health and veterinary communities will benefit from connecting practitioners with gender experts to develop more integrative approaches to emergency preparedness and management. Animal health professionals should also advocate for further research to elucidate gender-specific dynamics in human populations in the context of animal emergencies and the promulgation of evidence-based policies. Such transformative efforts will lead to better outcomes for all people who depend on and provide care for animals.

Policy responses to the COVID-19 pandemic in West Africa: a scoping review protocol.

INTRODUCTION: Four years after the devastating Ebola outbreak, governments in West Africa were quick to implement non-pharmaceutical interventions (NPIs) in response to the rapid spread of SARS-CoV-2. The NPIs implemented included physical distancing, closure of schools and businesses, restrictions on public gatherings and mandating the use of face masks among others. In the absence of widely available vaccinations, NPIs were the only known means to try to slow the spread of COVID-19. While numerous studies have assessed the effectiveness of these NPIs in high-income countries, less is known about the processes that lead to the adoption of policies and the factors that influence their implementation and adherence in low-income and middle-income countries. The objective of this scoping review is to understand the extent and type of evidence in relation to the policy formulation, decision-making and implementation stages of NPIs in West Africa. METHODS AND ANALYSIS: A scoping review will be undertaken following the guidance developed by Arskey and O'Malley, the Joanna Briggs Institute (JBI) methodology for scoping reviews and the PRISMA guidelines for Scoping Reviews. Both peer-reviewed and grey literature will be searched using Web of Science, Embase, Scopus, APA PsycInfo, WHO Institutional Repository for Information Sharing, JSTOR and Google Advanced Search, and by searching the websites of the WHO, and the West African Health Organisation. Screening will be conducted by two reviewers based on inclusion and exclusion criteria, and data will be extracted, coded and narratively synthesised. ETHICS AND DISSEMINATION: We started this scoping review in May 2023, and anticipate finishing by April 2024. Ethics approval is not required since we are not collecting primary data. This protocol was registered at Open Science Framework (https://osf.io/gvek2/). We plan to disseminate this research through publications, conference presentations and upcoming West African policy dialogues on pandemic preparedness and response.

Increasing compliance with international pandemic law: international relations and new global health agreements.

Across multiple pandemics, global health governance institutions have struggled to secure the compliance of states with international legal and political commitments, ranging from data sharing to observing WHO guidance to sharing vaccines. In response, governments are negotiating a new pandemic treaty and revising the International Health Regulations. Achieving compliance remains challenging, but international relations and international law research in areas outside of health offers insights. This Health Policy analyses international relations research on the reasons why states comply with international law, even in the absence of sanctions. Drawing on human rights, trade, finance, tobacco, and environmental law, we categorise compliance mechanisms as police patrol, fire alarm, or community organiser models. We show that, to date, current and proposed global health law incorporates only a few of the mechanisms that have shown to be effective in other areas. We offer six specific, politically feasible mechanisms for new international agreements that, together, could create compliance pressures to shift state behaviour.

What's the ideal World Health Organization (WHO)?

The World Health Organization (WHO) is tasked with the 'attainment by all peoples of the highest possible level of health', yet, it is widely struggling to meet this mandate, and COVID-19 has revealed significant limitations of the organisation. Despite clear guidance provided by the institution as to how best to respond to the pathogen, many governments departed from WHO's guidance in their response efforts. Is this a new crisis for WHO? Does WHO need to restore its legitimacy in the eyes of the global community? As renewed calls for changes to WHO emerge, in this perspective we lay out the obstacles WHO face to become the WHO 'we' need. The assumption is that UN member states need an empowered and well-funded organisation. Yet, many years of discussion of reform of WHO have failed to lead to meaningful change, and glaring challenges remain in its financing, governance and politics, which are considered in turn. The reality may be that we have the WHO that UN member states need - one that can provide guidance and advice, but also take criticism for health governance failures when states want to avoid blame or responsibility. We discuss this, by analysing three key areas of WHO'S challenges: mandate and scope; structure, governance and money and domestic vs international.

SDG5 "Gender Equality" and the COVID-19 pandemic: A rapid assessment of health system responses in selected upper-middle and high-income countries.

Introduction: The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. Methods: We apply a qualitative comparative approach, drawing on secondary sources and expert information; the data was collected from March-July 2022. Australia, Brazil, Germany, the United Kingdom, and the USA were selected, reflecting upper-middle and high-income countries with established public health and gender policies but different types of healthcare systems and epidemiological and geo-political conditions. Three sub-goals of SDG5 were analyzed: maternity care/reproductive health, gender-based violence, and gender equality/women's leadership. Results: We found similar trends across countries. Pandemic policies strongly cut into women's health, constrained prevention and support services, and weakened reproductive rights, while essential maternity care services were kept open. Intersecting gender inequalities were reinforced, sexual violence increased and women's leadership was weak. All healthcare systems failed to protect women's health and essential public health targets. Yet there were relevant differences in the responses to increased violence and reproductive rights, ranging from some support measures in Australia to an abortion ban in the US. Conclusions: Our study highlights a need for revising pandemic policies through a feminist lens.

Gender and Race on the Frontline: Experiences of Health Workers in Brazil during the COVID-19 Pandemic.

Studies on the differential effects of health emergencies have largely overlooked women health workers. Whilst the literature has shown the impact of Coronavirus disease-19 (COVID-19) on women and on healthcare workers, little research has considered the gendered effects of the health workforce. This article analyses the impact of COVID-19 on healthcare workers and working conditions in Brazil's public healthcare system, through consideration of gendered and racialized understandings of care and work. Data were taken from an online survey of 1,263 health workers, undertaken between September and October 2020, disaggregated by sex and by race in order to understand health workers' experiences of the pandemic in one of the countries most significantly affected by the crisis.

"I Was Facilitating Everybody Else's Life. And Mine Had Just Ground to a Halt": The COVID-19 Pandemic and its Impact on Women in the United Kingdom.

A growing body of research has highlighted the disproportionately negative impact of the COVID-19 pandemic on women globally. This article contributes to this work by interrogating the lived realities of sixty-four women in the United Kingdom through semi-structured in-depth interviews, undertaken during the first and second periods of lockdown associated with COVID-19 in 2020. Categorizing the data by subgroup of women and then by theme, this article explores the normative and policy-imposed constraints experienced by women in 2020 with regard to paid and unpaid labor, mental health, access to healthcare services, and government representation and consideration of women. These findings highlight women's varied and gendered experiences of the COVID-19 pandemic and emphasizes the role that government can proactively play in attending to gender inequalities throughout its COVID-19 response.

The gendered dimensions of the anti-mask and anti-lockdown movement on social media.

This paper examines the anti-mask and anti-lockdown online movement in connection to the COVID-19 pandemic. To combat the spread of the coronavirus, health officials around the world urged and/or mandated citizens to wear facemasks and adopt physical distancing measures. These health policies and guidelines have become highly politicized in some parts of the world, often discussed in association with freedom of choice and independence. We downloaded references to the anti-mask and anti-lockdown social media posts using 24 search terms. From a total of 4209 social media posts, the researchers manually filtered the explicit visual and textual content that is related to discussions of different genders. We used multimodal discourse analysis (MDM) which analyzes diverse modes of communicative texts and images and focuses on appeals to emotions and reasoning. Using the MDM approach, we analysed posts taken from Facebook and Instagram from active anti-mask and anti-lockdown users, and we identified three main discourses around the gendered discussion of the anti-mask movement including hypermasculine, sexist and pejorative portrayals of "Karen", and appropriating freedom and feminism discourses. A better understanding of how social media users evoke gendered discourses to spread anti-mask and anti-lockdown messages can help researchers identify differing reactions toward pandemic measures.

Reconceptualizing successful pandemic preparedness and response: A feminist perspective.

Pandemic preparedness and COVID-19 response indicators focus on public health outcomes (such as infections, case fatalities, and vaccination rates), health system capacity, and/or the effects of the pandemic on the economy, yet this avoids more political questions regarding how responses were mobilized. Pandemic preparedness country rankings have been called into question due to their inability to predict COVID-19 response and outcomes, and COVID-19 response indicators have ignored one of the most well documented secondary effects of the pandemic - its disproportionate effects on women. This paper analyzes pandemic preparedness and response indicators from a feminist perspective to understand how indicators might consider the secondary effects of the pandemic on women and other equity deserving groups. Following a discussion of the tensions that exist between feminist methodologies and the reliance on indicators by policymakers in preparing and responding to health emergencies, we assess the strengths and weakness of current pandemic preparedness and COVID-19 response indicators. The risk with existing pandemic preparedness and response indicators is that they give only limited attention to secondary effects of pandemics and inequities in terms of who is disproportionately affected. There is an urgent need to reconceptualize what 'successful' pandemic preparedness and response entails, moving beyond epidemiological and economic measurements. We suggest how efforts to design COVID response indicators on gender inclusion could inform pandemic preparedness and associated indicators.