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.

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.

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.

Governance of health research in four eastern and southern African countries.

BACKGROUND: Health research governance is an essential function of national health research systems. Yet many African countries have not developed strong health research governance structures and processes. This paper presents a comparative analysis of national health research governance in Botswana, Kenya, Uganda and Zambia, where health sciences research production is well established relative to some others in the region and continues to grow. The paper aims to examine progress made and challenges faced in strengthening health research governance in these countries. METHODS: We collected data through document review and key informant interviews with a total of 80 participants including decision-makers, researchers and funders across stakeholder institutions in the four countries. Data on health research governance were thematically coded for policies, legislation, regulation and institutions and analysed comparatively across the four national health research systems. RESULTS: All countries were found to be moving from using a research governance framework set by national science, technology and innovation policies to one that is more anchored in health research structures and policies within the health sectors. Kenya and Zambia have adopted health research legislation and policies, while Botswana and Uganda are in the process of developing the same. National-level health research coordination and regulation is hampered by inadequate financial and human resource capacities, which present challenges for building strong health research governance institutions. CONCLUSION: Building health research governance as a key pillar of national health research systems involves developing stronger governance institutions, strengthening health research legislation, increasing financing for governance processes and improving human resource capacity in health research governance and management.

Measuring health science research and development in Africa: mapping the available data.

BACKGROUND: In recent years there have been calls to strengthen health sciences research capacity in African countries. This capacity can contribute to improvements in health, social welfare and poverty reduction through domestic application of research findings; it is increasingly seen as critical to pandemic preparedness and response. Developing research infrastructure and performance may reduce national economies' reliance on primary commodity and agricultural production, as countries strive to develop knowledge-based economies to help drive macroeconomic growth. Yet efforts to date to understand health sciences research capacity are limited to output metrics of journal citations and publications, failing to reflect the complexity of the health sciences research landscape in many settings. METHODS: We map and assess current capacity for health sciences research across all 54 countries of Africa by collecting a range of available data. This included structural indicators (research institutions and research funding), process indicators (clinical trial infrastructures, intellectual property rights and regulatory capacities) and output indicators (publications and citations). RESULTS: While there are some countries which perform well across the range of indicators used, for most countries the results are varied-suggesting high relative performance in some indicators, but lower in others. Missing data for key measures of capacity or performance is also a key concern. Taken as a whole, existing data suggest a nuanced view of the current health sciences research landscape on the African continent. CONCLUSION: Mapping existing data may enable governments and international organizations to identify where gaps in health sciences research capacity lie, particularly in comparison to other countries in the region. It also highlights gaps where more data are needed. These data can help to inform investment priorities and future system needs.

COVID-19 and the Gendered Use of Emojis on Twitter: Infodemiology Study.

BACKGROUND: The online discussion around the COVID-19 pandemic is multifaceted, and it is important to examine the different ways by which online users express themselves. Since emojis are used as effective vehicles to convey ideas and sentiments, they can offer important insight into the public's gendered discourses about the pandemic. OBJECTIVE: This study aims at exploring how people of different genders (eg, men, women, and sex and gender minorities) are discussed in relation to COVID-19 through the study of Twitter emojis. METHODS: We collected over 50 million tweets referencing the hashtags #Covid-19 and #Covid19 for a period of more than 2 months in early 2020. Using a mixed method, we extracted three data sets containing tweets that reference men, women, and sexual and gender minorities, and we then analyzed emoji use along each gender category. We identified five major themes in our analysis including morbidity fears, health concerns, employment and financial issues, praise for frontline workers, and unique gendered emoji use. The top 600 emojis were manually classified based on their sentiment, indicating how positive, negative, or neutral each emoji is and studying their use frequencies. RESULTS: The findings indicate that the majority of emojis are overwhelmingly positive in nature along the different genders, but sexual and gender minorities, and to a lesser extent women, are discussed more negatively than men. There were also many differences alongside discourses of men, women, and gender minorities when certain topics were discussed, such as death, financial and employment matters, gratitude, and health care, and several unique gendered emojis were used to express specific issues like community support. CONCLUSIONS: Emoji research can shed light on the gendered impacts of COVID-19, offering researchers an important source of information on health crises as they happen in real time.

Zika, abortion and health emergencies: a review of contemporary debates.

BACKGROUND: The Zika outbreak provides pertinent case study for considering the impact of health emergencies on abortion decision-making and/or for positioning abortion in global health security debates. MAIN BODY: This paper provides a baseline of contemporary debates taking place in the intersection of two key health policy areas, and seeks to understand how health emergency preparedness frameworks and the broader global health security infrastructure is prepared to respond to future crises which implicate sexual and reproductive rights. Our paper suggests there are three key themes that emerge from the literature; 1) the lack of consideration of sexual and reproductive health (SRH) services in outbreak response 2) structural inequalities permeate the landscape of health emergencies, epitomised by Zika, and 3) the need for rights based approaches to health. CONCLUSION: Global health security planning and response should specifically include programmatic activity for SRH provision during health emergencies.

Self-Swabbing for Virological Confirmation of Influenza-Like Illness Among an Internet-Based Cohort in the UK During the 2014-2015 Flu Season: Pilot Study.

BACKGROUND: Routine influenza surveillance, based on laboratory confirmation of viral infection, often fails to estimate the true burden of influenza-like illness (ILI) in the community because those with ILI often manage their own symptoms without visiting a health professional. Internet-based surveillance can complement this traditional surveillance by measuring symptoms and health behavior of a population with minimal time delay. Flusurvey, the UK's largest crowd-sourced platform for surveillance of influenza, collects routine data on more than 6000 voluntary participants and offers real-time estimates of ILI circulation. However, one criticism of this method of surveillance is that it is only able to assess ILI, rather than virologically confirmed influenza. OBJECTIVE: We designed a pilot study to see if it was feasible to ask individuals from the Flusurvey platform to perform a self-swabbing task and to assess whether they were able to collect samples with a suitable viral content to detect an influenza virus in the laboratory. METHODS: Virological swabbing kits were sent to pilot study participants, who then monitored their ILI symptoms over the influenza season (2014-2015) through the Flusurvey platform. If they reported ILI, they were asked to undertake self-swabbing and return the swabs to a Public Health England laboratory for multiplex respiratory virus polymerase chain reaction testing. RESULTS: A total of 700 swab kits were distributed at the start of the study; from these, 66 participants met the definition for ILI and were asked to return samples. In all, 51 samples were received in the laboratory, 18 of which tested positive for a viral cause of ILI (35%). CONCLUSIONS: This demonstrated proof of concept that it is possible to apply self-swabbing for virological laboratory testing to an online cohort study. This pilot does not have significant numbers to validate whether Flusurvey surveillance accurately reflects influenza infection in the community, but highlights that the methodology is feasible. Self-swabbing could be expanded to larger online surveillance activities, such as during the initial stages of a pandemic, to understand community transmission or to better assess interseasonal activity.

Self-tests for influenza: an empirical ethics investigation.

BACKGROUND: In this article we aim to assess the ethical desirability of self-test diagnostic kits for influenza, focusing in particular on the potential benefits and challenges posed by a new, mobile phone-based tool currently being developed by i-sense, an interdisciplinary research collaboration based (primarily) at University College London and funded by the Engineering and Physical Sciences Research Council. METHODS: Our study adopts an empirical ethics approach, supplementing an initial review into the ethical considerations posed by such technologies with qualitative data from three focus groups. RESULTS: Overall, we map a range of possible considerations both for and against the use of such technologies, synthesizing evidence from a range of secondary literature, as well as identifying several new considerations previously overlooked. CONCLUSIONS: We argue that no single consideration marks these technologies as either entirely permissible or impermissible but rather tools which have the potential to incur certain costs and benefits, and that context is important in determining these. In the latter stages of the article, we explain how developers of such technologies might seek to mitigate such costs and reflect on the possible limitations of the empirical ethics method brought out during the study. TRIAL REGISTRATION: Not applicable.