Citizens' reactions to global crises: a longitudinal study during the COVID-19 pandemic in Israel.

This paper investigated citizens' reactions to global crises using the COVID-19 pandemic as a natural experiment. Theories in this field are controversial and thus knowledge on such reactions, their evolution, drivers, and consequences is limited. Building on several socio-psychological foundations such as trust building theories, the fear appeal theory, the theory of planned behavior, and the spillover theory, we explain developments in three major human responses: (1) perceptual and attitudinal responses such as trust in governance and interpersonal trust; (2) emotional responses such as fear of crises; and (3) behavioral responses such as civic engagement. Using a longitudinal design, we tracked the attitudes and behaviors of Israeli citizens over 22 months (7/2019-3/2021) and at four points in time (t1-t4). Findings are based on a time-lagged analysis of 3527 participants (n1 = 602; n2 = 750; n3 = 970; n4 = 1205), and a more focused analysis of panel data (n1-4 = 256). In accordance with our theoretical foundations and specific models, we revealed a reaction pattern of shock→recognition→adjustment→reframing. We maintain that our findings improve understanding of citizens' reactions to government policies. They provide unique empirical evidence for resilience among citizens and across social structures which testify to bouncing-back capacities from global crises in various ways. Its lessons may thus direct future studies on the relationship between citizens and governments in other global crises and emergencies. Supplementary Information: The online version contains supplementary material available at 10.1007/s43545-023-00610-0.

Alternative provision of public health care: the role of citizens' satisfaction with public services and the social responsibility of government.

This paper explores the factors that influence citizens' attitudes toward the alternative provision of health care services, leading them to be willing to make extra, informal payments within the public health care system. We question whether these attitudes depend primarily on inherent normative preferences, such as beliefs about the government's responsibility to its citizens, or on certain aspects of the reality that they experience, such as satisfaction with the quality and quantity of services as well as the fairness of public systems. Analyzing the findings from a national survey, the paper shows that practical considerations and real-world conditions strongly relate to attitudes more than normative perceptions do.

How Well Do They Manage a Crisis? The Government's Effectiveness During the COVID-19 Pandemic.

The COVID-19 pandemic clearly highlighted the importance of effective crisis management and its relationship with citizens' willingness to cooperate with the government in such turbulent times. We develop a theory and hypotheses about the impact of citizens' experiences on their perceptions of the government's effectiveness during times of crisis. We do so with data collected at two points in time: in late March 2020 during the first peak of the COVID-19 crisis in Israel, and in October 2020 when Israel was exiting from a second lockdown. The findings demonstrate that during crises citizens focus on the short term and seek immediate results in terms of readiness and preparedness. During such times, the government's responsiveness and transparency, as well as the public's participation in decisions, seem even more important than their trust in the government. Implications and practical recommendations follow.

A neo-institutional analysis of the hidden interaction between the Israeli Supreme Court and the Ministry of Finance: the right to healthcare services.

BACKGROUND: Under structural conditions of non-governability, most players in the policy arena in Israel turn to two main channels that have proven effective in promoting the policies they seek: the submission of petitions to the High Court of Justice and making legislative amendments through the Economic Arrangements Law initiated by the Ministry of Finance. Nevertheless, an analysis of the principal trends emerging from the High Court of Justice rulings and legislative amendments through the Economic Arrangements Law indicates that these channels are open to influence, primarily by forces that are essentially neo-liberal. Little is known about the effects of these trends on the right to healthcare services, which in Israel has not been legislated as an independent constitutional law in Basic Laws. METHODS: We use four major legal cases decided by the Supreme Court of Israel in the past 10 years where the Court reviewed new legislative initiatives proposed by the Economic Arrangements Law in the area of healthcare. We utilize an institutional approach in our analysis. RESULTS: A neo-institutional analysis of the legal cases demonstrates that petitions against the Economic Arrangements Law in the area of healthcare services have been denied, even though the Court uses strong rhetoric against that law and the government more generally in addressing issues that concern access to healthcare services and reforms in the healthcare system. This move strengthens the trend toward a neo-liberal public policy and significantly weakens the legal protection of the right to healthcare services. CONCLUSION: In deciding petitions against the Economic Arrangements Law in the area of healthcare, the Supreme Court allows the Ministry of Finance to be a dominant player in the formation of public policy. In doing so, it may be promoting a goal of strengthening its position as a political institution that aspires to increase the public's trust in the judiciary and especially in the Supreme Court itself, in addition to exercising judicial restraint and allowing more leeway to the executive and legislative branches more generally.

Policy entrepreneurship and policy networks in healthcare systems - the case of Israel's pediatric dentistry reform.

BACKGROUND: Can the entry of a policy entrepreneur challenge the equilibrium of a policy network and promote changes that might clash with the goals of powerful civil-servants and/or interest groups and, if so, why and how? Our goal is to examine two sides of the same coin: how does an in-depth analysis of Israel's dental care reform enrich our understanding of policy networks and policy entrepreneurship? Second, how does the literature on policy networks and policy entrepreneurship help us understand this reform? Based on a theoretical framework that appears in the literature of policy entrepreneurship and policy networks, we analyze the motivations, goals and strategies of the main actors involved in the process of reforming pediatric dental care in Israel. We demonstrate how a policy entrepreneur navigated within a policy network and managed to promote a reform that, until his appearance, no one else in that network had succeeded in enacting. METHODS: Our goals are advanced through a case study of a reform in pediatric dentistry implemented in Israel in 2010. It rests on textual analyses of the literature, reports, committee minutes, parliamentary proceedings, print and online media, and updates in relevant legislation and case law between 2009 and 2015. In addition, the case study draws on the insights of one of the authors (TH), who played a role in the reform process. RESULTS: Historical circumstances and the Israeli public's longstanding lack of interest in changing the existing model as well as interest groups that preferred the dominance of the private sector in the dental healthcare system kept that area out of the services supplied, universally, under the National Health Insurance Law. This situation changed significantly following the publication in 2007 of a policy analysis that contributed to shifts in the motivations and balance of power within the policy network, which in turn prepared the ground for a policy change. In this environment a determined policy entrepreneur, who identified a window of opportunity, took the lead and instituted an innovative and far-reaching reform. CONCLUSIONS: A policy entrepreneur can leverage external factors as well as the previous activities of a policy network that has already matured to create a policy change. Such entrepreneurial activity includes maneuvering around opponents and overcoming resistance from various stakeholders.

An alternative way of understanding exit, voice and loyalty: the case of informal payments for health care in Israel.

This study examines Hirschman's model of exit, voice and loyalty with regard to informal payments in the Israeli healthcare system. Based on a national survey, we investigate the extent of "black" payments, its characteristics and its correlated factors. We find that informal payments do exist in Israel-although it seems that there has been a decline in the phenomenon. Contrary to the literature, we find no relationship between the option of voice or dissatisfaction with healthcare services and informal payments. However, we do find a negative correlation between trust and the use of such payments. This finding is consistent with Hirschman's insight that a lack of loyalty may lead people to strategies of exit. We suggest that given the fact that health care in Israel is a public service, the exit option may actually be a quasi-exit behavior. Copyright © 2015 John Wiley & Sons, Ltd.

Blurring the boundaries between public and private health care services as an alternative explanation for the emergence of black medicine: the Israeli case.

Black medicine represents the most problematic configuration of informal payments for health care. According to the accepted economic explanations, we would not expect to find black medicine in a system with a developed private service. Using Israel as a case study, we suggest an alternative yet a complimentary explanation for the emergence of black medicine in public health care systems - even though citizens do have the formal option to use private channels. We claim that when regulation is weak and political culture is based on 'do it yourself' strategies, which meant to solve immediate problems, blurring the boundaries between public and private health care services may only reduce public trust and in turn, contribute to the emergence of black medicine. We used a combined quantitative and qualitative methodology to support our claim. Statistical analysis of the results suggested that the only variable significantly associated with the use of black medicine was trust in the health care system. The higher the respondents' level of trust in the health care system, the lower the rate of the use of black medicine. Qualitatively, interviewee emphasized the relation between the blurred boundaries between public and private health care and the use of black medicine.

The pursuit of political will: politicians' motivation and health promotion.

The health promotion literature points out a significant gap between declared health promotion policy and practice. The common assumption is that one of the main obstacles to progress is "political will" and the intersectoral action necessary to create healthy environments. The concept of political will is most frequently invoked to explain a lack of action usually rooted in politicians' lack of personal courage or good sense. While stressing the fact that health and its promotion are profoundly political, we claim that the lack of political will is usually not because politicians have shown insufficient personal courage or good sense. Rather, we suggest that one of the reasons for the gap between the need for health promotion policies and political will derives from politicians' lack of attraction to several aspects associated with this policy area. In many cases, politicians are not attracted to the issue of health promotion because of the unique structural conditions usually associated with this policy domain. Using tools related to public policy theory, we suggest a conceptual framework that explains what those conditions are and answers the question of why politicians seem to lack the political will to undertake the design of health promotion policies.

"We are talking about saving lives": the welfare state, health care policy, and nongovernability--a case study of an Israeli Hospital.

Literature about welfare states worldwide, and specifically in Israel, emphasizes economic and political variables and the importance of ideology in explaining a given social policy in those societies. According to this literature, ideology and strategic long-term goals account for the waning of the Israeli welfare state since the 1970s. At the same time, for upwards of a decade, the literature dealing with Israeli public policy has emphasized that Israeli society suffers from a crisis of "nongovernability" and a political culture that is characterized by illegality. The author defines nongovernability as the inability to formulate public policy and implement it effectively over time. In such an environment, long-term strategic considerations based on a coherent ideology take a back seat to short-term considerations in the conduct of the various players in the public policy arena. The author discusses the building of a hospital in Ashdod as a case study in nongovernability. The hospital's construction was steeped in political intrigue based wholly on short-term considerations and was built in a political culture characterized by either illegality or outright rejection of the law. This behavior is characteristic of Israeli politicians, bureaucrats, and interest groups. The author maintains that the creation of this hospital is emblematic of the Israeli health care policy overall, a policy shaped by bottom-up processes whose defining characteristic is a political culture based on illegality and narrow, short-term interests.

Informal payments for health care--the phenomenon and its context.

This paper reviews current research and literature on the issue of informal payments for health care and its context and suggests a new perspective for a better understanding of this phenomenon. This perspective, based on political culture and behavior and on wider social processes, is already used to explain various phenomena from different fields of public policy. The paper explains the impact of a specific type of political culture, called 'alternative politics' (AP) in the Israeli literature, on healthcare policy and institutional healthcare settings. AP is based on a 'do-it-yourself' approach adopted by citizens to address their dissatisfaction with governmental services. When such a mode of political culture is diffused to all sectors and levels of society, all players, including bureaucrats and politicians, are guided by short-term considerations and apply unilateral strategies that bypass formal rules either through illegal activity or by marginalizing formal rules. Explaining informal payments by analyzing social processes and political culture and behavior has some disadvantages, but it provides us with a better understanding of the phenomenon while covering most of its characteristics and configurations.

The P1N-isopropyl motif bearing hydroxyethylene dipeptide isostere analogues of aliskiren are in vitro potent inhibitors of the human aspartyl protease renin.

Novel nonpeptide small molecule renin inhibitors bearing an N-isopropyl P(1) motif were designed based on initial lead structures 1 and aliskiren (2). (P(3)-P(1))-Benzamide derivatives such as 9a and 34, as well as the corresponding P(1) basic tertiary amine derivatives 10 and 35 were found to display low nanomolar inhibition against human renin in vitro.

Structure-based drug design and the discovery of aliskiren (Tekturna): perseverance and creativity to overcome a R&D pipeline challenge.

At Ciba-Geigy (now Novartis), the clinical development of the CGP38560 renin inhibitor was halted due to insufficient pharmacokinetics. This indicated that the peptidomimetic approach to the development of antihypertensive agents was improper. Real non-peptide drug candidates were then expected to provide the necessary framework for obtaining the desired properties. For this purpose a homology model of the enzyme was used to characterize the binding mode of CGP38560 in complex with the renin model and served as a basis for the four chemistry laboratories that were assigned to this project. The renin team worked in a full structure-based perspective with this model, and four chemically-unrelated non-peptide series were discovered acting as renin inhibitors at the 1-3 nanomolar level. One of these leads was selected for further development and led to Aliskiren, which has been just approved by the FDA. Here is presented the successful structure-based strategy that enabled the discovery of several non-peptide inhibitors and the recent launch of a new drug that will be commercialized in the United States under the name Tekturna (for the treatment of high blood pressure as monotherapy or in combination with other high blood pressure medications).

Novel 2,7-dialkyl-substituted 5(S)-amino-4(S)-hydroxy-8-phenyl-octanecarboxamide transition state peptidomimetics are potent and orally active inhibitors of human renin.

The action of renin is the rate-limiting step of the renin-angiotensin system (RAS), a key regulator of blood pressure. Effective renin inhibitors directly block the RAS entirely at source and, thus, may provide a vital weapon for hypertension therapy. Our efforts toward identifying novel small-molecule peptidomimetic renin inhibitors have resulted in the design of transition-state isosteres such as 1 bearing an all-carbon 8-phenyl-octanecarboxamide framework. Optimization of the extended P3 portion of 1 and extensive P2' modifications provided analogues with improved in vitro potencies in the presence of plasma. X-ray resolution of rh-renin/38a in the course of SAR work surprisingly unveiled the exploitation of a previously unexplored pocket (S3sp) important for strong binding affinities. Several inhibitors demonstrated oral efficacy in sodium-depleted marmosets. The most potent, 38a, induced dose-dependently a pronounced reduction in mean arterial blood pressure, paralleled by complete blockade of active plasma renin, up to 8 h post-dose. Oral bioavailability of 38a was 16% in marmosets.

Structural modification of the P2' position of 2,7-dialkyl-substituted 5(S)-amino-4(S)-hydroxy-8-phenyl-octanecarboxamides: the discovery of aliskiren, a potent nonpeptide human renin inhibitor active after once daily dosing in marmosets.

Due to its function in the rate limiting initial step of the renin-angiotensin system, renin is a particularly promising target for drugs designed to control hypertension, a growing risk to health worldwide. Despite vast efforts over more than two decades, no orally efficacious renin inhibitor had reached the market. As a result of a structure-based topological design approach, we have identified a novel class of small-molecule inhibitors with good oral blood-pressure lowering effects in primates. Further lead optimization aimed for improvement of in vivo potency and duration of action, mainly by P2' modifications at the hydroxyethylene transition-state isostere. These efforts resulted in the discovery of aliskiren (46, CGP060536B, SPP100), a highly potent, selective inhibitor of renin, demonstrating excellent efficacy in sodium-depleted marmosets after oral administration, with sustained duration of action in reducing dose-dependently mean arterial blood pressure. Aliskiren has recently received regulatory approval by the U.S. Food and Drug Administration for the treatment of hypertension.

Structure-based design of aliskiren, a novel orally effective renin inhibitor.

Hypertension is a major risk factor for cardiovascular diseases such as stroke, myocardial infarction, and heart failure, the leading causes of death in the Western world. Inhibitors of the renin-angiotensin system (RAS) have proven to be successful treatments for hypertension. As renin specifically catalyses the rate-limiting step of the RAS, it represents the optimal target for RAS inhibition. Several peptide-like renin inhibitors have been synthesized previously, but poor pharmacokinetic properties meant that these compounds were not clinically useful. We employed a combination of molecular modelling and crystallographic structure analysis to design renin inhibitors lacking the extended peptide-like backbone of earlier inhibitors, for improved pharmacokinetic properties. This led to the discovery of aliskiren, a highly potent and selective inhibitor of human renin in vitro, and in vivo; once-daily oral doses of aliskiren inhibit renin and lower blood pressure in sodium-depleted marmosets and hypertensive human patients. Aliskiren represents the first in a novel class of renin inhibitors with the potential for treatment of hypertension and related cardiovascular diseases.