The Trajectory of Brazilian Immunization Program between 1980 and 2018: From the Virtuous Cycle to the Vaccine Coverage Decline.

BACKGROUND: Public health policies are crossed by economic and political interests that can affect the maintenance of the immunization programs and their vaccination coverages. The aim was to investigate the political and economic conditions that marked the trajectory of the Brazilian immunization program from 1980 to 2018. METHODS: Documentary research gathered data on public expenditures with epidemiological surveillance and vaccine procurement and nationwide estimates of vaccine coverage. The scientific literature on the program's implementation and the country's political and economic conditions was examined. The theoretical approach was based on historical institutionalism. RESULTS: The results showed rising, high rates maintaining and falling vaccination coverages in the period. As of 2010, there was a tendency for a reduction in total federal spending on epidemiological surveillance, putting pressure on the budgets of the sub-national governments in their respective areas of coverage, and on federal spending in dollars for the acquisition of immunobiologicals and inputs. CONCLUSIONS: The amplitude and complexity of the program's trajectory have been crossed by diverse dynamics conditioned by economic and political interests reflecting at a deeper level the advance of capitalism through fiscal austerity measures over democracy's aspirations for greater balance and justice in the distribution of resources.

Health poverty alleviation in China from the perspective of historical institutionalism: policy changes and driving factors.

Health poverty alleviation is an effective tool for improving the living quality and developmental conditions of impoverished populations. Since 1978, China has been actively implementing health poverty alleviation projects, resulting in a more robust rural healthcare service network and increased convenience for the local population to access medical treatment. However, it is crucial to acknowledge that China still faces a complex situation with the simultaneous existence of multiple disease threats and the interweaving of various health influencing factors. Ongoing risks of emerging infectious diseases persist, and some previously controlled or eliminated infectious diseases are at risk of resurgence. The incidence of chronic diseases is on the rise and exhibits a trend toward affecting younger populations. Therefore, examining the successful experiences of China's health poverty alleviation over the past 40 years becomes a critically important issue. The study focuses on China's health poverty alleviation policies, employing historical institutionalism as a theoretical perspective to analyze the historical changes and evolutionary logic of health poverty alleviation policies. A historical institutionalist analytical framework for health poverty alleviation policies is constructed. The research findings reveal that China's health poverty alleviation policy has undergone three distinct periods since 1978: the initial phase (1978-2000), the exploratory phase (2000-2012), and the stable development phase (2013-present). At the macro level, the political, economic, and social contexts of different periods have influenced the evolution of health poverty alleviation policies. On the meso level, coordination effects and adaptive expectations have had an impact on China's health poverty alleviation policy. At the micro level, various actors, including the central government, local governments at different levels, social forces, and impoverished communities, interact during the evolution of health poverty alleviation policies. This paper summarizes the theoretical aspects of China's health poverty alleviation policy experience. The research conclusions, viewed through the lens of historical institutionalism, offer practical insights into the evolution of government policies. This provides directional guidance for enhancing health poverty alleviation projects.

Biodefense and emergency use authorization: different originations, purposes, and evolutionary paths of institutions in the United States and South Korea.

BACKGROUND: Emergency-use-authorization (EUA) is the representative biodefense policy that allows the use of unlicensed medical countermeasures or off-label use of approved medical countermeasures in response to public health emergencies. This article aims to determine why the EUA policies of the United States and South Korea produced drastically different outcomes during the COVID-19 pandemic, and how these outcomes were determined by the originations and evolutionary paths of the two policies. METHOD: Historical institutionalism (HI) explains institutional changes-that is, how the institution is born and how it evolves-based on the concept of path dependency. However, the HI analytical narratives remain at the meso level of analysis in the context of structure and agency. This article discusses domestic and policy-level factors related to the origination of the biodefense institutions in the United States and South Korea using policy-learning concepts with the Event-related Policy Change Model. RESULTS: The 2001 anthrax letter attack (Amerithrax) and the 2015 Middle East Respiratory Syndrome (MERS) outbreak prompted the establishment of biodefense institutions in the United States and South Korea, respectively. Due to the different departure points and the mechanism of path dependency, the two countries' EUAs evolved in different ways-the United States EUA reinforced the Post-Exposure Prophylaxis (PEP) function, while the South Korea EUA strengthened the Non-Pharmaceutical Intervention (NPI) function. CONCLUSIONS: The evolution and outcomes of the two EUAs are different because both policies were born out of different needs. The United States EUA is primarily oriented toward protecting homeland security against CBRN (chemical, biological, radiological, and nuclear) threats, whereas the South Korea EUA is specifically designed for disease prevention against infectious disease outbreak.

Critical junctures and events in the trajectory of information modeling in Curitiba / Coyuntura y eventos críticos en la trayectoria del modelado de información en Curitiba / Conjunturas e eventos críticos na trajetória da modelagem da informação em Curitiba

Abstract Although it is a promising theory for understanding complex ongoing political processes, historical institutionalism has rarely been used to adress urban management and urban planning issues. We aim to (re)construct the trajectory of management and dissemination of communication and information technologies (ICTs) in Curitiba to identify critical junctures and events. Methodologically, it is a case study based on documents and discourse analysis. The results show that Curitiba used to be avant-garde in technological diffusion but today it develops more responsive than anticipatory actions; over time, the role of technology diffusion and management shifted from the urban management and planning structure to the direct municipal administration structure; technological initiatives have always taken place and are taking place sharply and decentrally for the consolidation of an ecosystem; the ideals of forming a digital or a smart city were motivators of Curitiba's current situation. The ideology underlying the game of politicians and party affiliations has been put aside in alignments of local groups to carry out technological adjustments; and that the management and diffusion of ICTs remain controversial in political disputes. The conclusion is that the political-technology dyad has absorbed the impacts of critical events, resulting in the remodeling of municipal institutions and organizations linked to the management and diffusion of ICTs that also need to deal with the game of interests and external pressures.

Resumen Aunque sea una teoría prometedora para comprender procesos políticos complejos en curso, el institucionalismo histórico ha sido poco utilizado en temas de planificación y gestión urbana. Así, el objetivo de este estudio es (re)construir la trayectoria de gestión y difusión de las tecnologías de la información y la comunicación en el municipio de Curitiba para identificar coyunturas y eventos críticos. Metodológicamente, se utilizan los procedimientos de levantamiento documental y análisis del discurso. Los resultados muestran que Curitiba fue vanguardista en difusión tecnológica, pero hoy desarrolla acciones más responsivas que anticipatorias; con el tiempo, el papel de la difusión y gestión de la tecnología pasó de la estructura de gestión y planificación urbana a la estructura de administración municipal directa; las iniciativas tecnológicas siempre se han dado y se están dando de manera acentuada y descentralizada para la consolidación de un ecosistema; los ideales de formar una ciudad digital o una ciudad inteligente fueron motivadores de la coyuntura más reciente; la ideología que subyace al juego de los políticos y las afiliaciones partidarias parece haber sido dejada de lado en alineamientos de grupos locales para realizar ajustes tecnológicos; y que la gestión y difusión de las TIC sigue siendo controvertida en las disputas políticas. La conclusión es que la díada política-tecnología ha absorbido los impactos de los eventos críticos, lo que termina redundando en la remodelación de las instituciones y organismos municipales vinculados a la gestión y difusión de las TIC que también necesitan lidiar con el juego de intereses y las presiones externas.

Resumo Embora seja uma teoria promissora para compreender complexos processos políticos continuados, o institucionalismo histórico tem sido pouco utilizado em questões de gestão e planejamento urbano. Assim, o objetivo deste estudo é (re)construir a trajetória de gestão e difusão tecnologias de comunicação e informação do município de Curitiba para identificar conjunturas e eventos críticos. Metodologicamente, utilizam-se os procedimentos de levantamento documental e análise de discurso. Os resultados mostram que Curitiba foi vanguardista na difusão tecnológica, mas hoje desenvolve ações mais responsivas do que antecipativas; com o passar do tempo o protagonismo da difusão e gestão tecnológica se deslocou da estrutura de gestão e planejamento urbano para a estrutura da administração municipal direta; as iniciativas tecnológicas sempre ocorreram e vêm ocorrendo acentuada e descentralizadamente para a consolidação de um ecossistema; os ideais de formação de uma cidade digital ou uma cidade inteligente foram motivadores da conjuntura mais recente; a ideologia subjacente ao jogo dos políticos e das filiações partidárias parece ter sido posta de lado em alinhamentos dos grupos locais para realizar ajustes tecnológicos; e que a gestão e a difusão de TIC's se mantém controversa nas disputas políticas. A conclusão é que a díade política-tecnologia tem absorvido os impactos dos eventos críticos, o que acaba por resultar na remodelagem das instituições e organizações municipais ligadas à gestão e à difusão das TIC's que também precisam lidar com o jogo de interesses e as pressões externas.

A historical review of performance appraisal of public hospitals in China from the perspective of historical institutionalism.

The government performance appraisal of public hospitals serves as an effective management tool to promote high-quality development. It is also an important means of realizing the "Healthy China" initiative. Since the founding of the People's Republic of China, changes in performance appraisal have been divided into the following four periods: the early stage of performance appraisal (1949-1977), the exploration period (1978-2008), the development period (2009-2018), and the integration period (2019-present). This clarifies the regional practice of public hospital performance and identifies the institutional factors of the evolution. It also demonstrates that administrative forces, market-driving forces, and mission-driving forces combine to bring about change in the public hospital performance appraisal system. However, problems such as insufficient application of performance appraisal and coordination between health administrative departments and medical insurance departments still loom large.

The political economy of health financing reform in Malaysia.

There is growing evidence that political economy factors are central to whether or not proposed health financing reforms are adopted, but there is little consensus about which political and institutional factors determine the fate of reform proposals. One set of scholars see the relative strength of interest groups in favour of and opposed to reform as the determining factor. An alternative literature identifies aspects of a country's political institutions-specifically the number and strength of formal 'veto gates' in the political decision-making process-as a key predictor of reform's prospects. A third group of scholars highlight path dependence and 'policy feedback' effects, stressing that the sequence in which health policies are implemented determines the set of feasible reform paths, since successive policy regimes bring into existence patterns of public opinion and interest group mobilization which can lock in the status quo. We examine these theories in the context of Malaysia, a successful health system which has experienced several instances of proposed, but ultimately blocked, health financing reforms. We argue that policy feedback effects on public opinion were the most important factor inhibiting changes to Malaysia's health financing system. Interest group opposition was a closely related factor; this opposition was particularly powerful because political leaders perceived that it had strong public support. Institutional veto gates, by contrast, played a minimal role in preventing health financing reform in Malaysia. Malaysia's dramatic early success at achieving near-universal access to public sector healthcare at low cost created public opinion resistant to any change which could threaten the status quo. We conclude by analysing the implications of these dynamics for future attempts at health financing reform in Malaysia.

All exclusive: the politics of offshore finance in Mexico.

At first sight, Mexico appears to be a textbook example of a state affected by off-shore finance. Offshore financial services allow corporations and the wealthy to plan taxes, avoid regulations or to launder money. The literature holds that large, developing, open economies, with geographical proximity to offshore centers and problems of crime and corruption are particularly affected by offshoring. By this logic, we should expect Mexico to show a significant demand for offshore financial services. Yet, new empirical evidence derived from interviews and banking statistics suggests otherwise. Mexican firms and individuals make only limited use of offshore finance. The article explains why. Building on a Weberian notion of the state, the article shows that the historically exclusive nature of Mexico's state concentrates political and economic power such that the onshore economy offers similar rents for economic elites as offshoring. Moreover, in instances where economic actors use offshore services it is driven by banking, not taxation. These findings have two theoretical implications. First, they confirm that institutions matter, though differently than hitherto thought. Second, we must look beyond taxation to include banking into our analyses.

Polarização federativa do SUS nos anos 1990: uma interpretação histórico-institucionalista / Federalismo polarizado en el sistema de salud en Brasil / The polarized federalism in the health system in Brazil

Resumo Este artigo busca explicar a dinâmica político-institucional que produziu um quadro polarizado de relações federativas no SUS nos anos 1990, com base no arcabouço teórico do neoinstitucionalismo histórico. Nessa perspectiva, analisa-se a trajetória das relações intergovernamentais como o resultado de uma cadeia de decisões tomadas em contextos singulares dos governos Collor, Itamar e FHC, onde o jogo entre os atores políticos do SUS e as tendências do contexto federativo nacional estabeleceu a direção da estratégia de descentralização em cada etapa. A intensidade de institucionalização dependeu ainda das escolhas desses governos relativas à direção da política nacional e à estrutura de coordenação federativa do Ministério da Saúde, da estabilidade e do volume do financiamento setorial, e das capacidades institucionais de estados e municípios para assumirem novas responsabilidades.

Resumen Este artículo propone un punto de vista histórico-institucionalista para explicar la polarización de las relaciones federativas en SUS a finales en los años 1990. En este enfoque, la trayectoria de las relaciones intergubernamentales es el resultado de una larga cadena de decisiones tomadas en contextos políticos concretos de los tres gobiernos en los años 1990: Collor, Itamar y FHC. La dinâmica de forças entre los actores políticos del SUS y las tendencias del contexto federativo nacional establecieron la dirección de la estrategia de descentralización en cada etapa. La intensidad de institucionalización resultó también de las elecciones de esos gobiernos relativas a la dirección de la política nacional y a la estructura de coordinación federativa del Ministerio de Salud, de la estabilidad y volumen del financiamiento sectorial, y de las capacidades institucionales de estados y municipios para asumir nuevas responsabilidades.

Abstract This article proposes a historical-institutionalist perspective to explain the political and institutional dynamics that polarized the intergovernmental relations in health policy in the 1990s. In this perspective, the history of intergovernmental relations is understood as the result of a long chain of decisions made in particular political contexts of the three governments in the 90s: Presidents Fernando Collor, Itamar Franco and Fernando Henrique Cardoso. During this period, the relations between the political actors of the Brazilian Health Unified System (SUS) and the trends of the national federative context established the direction of the decentralization strategy at each stage. The intensity of institutionalization also depended on the choices of these governments regarding the direction of the national policy and the federative coordination structure of the Ministry of Health, the stability and volume of financing, and the institutional capacities of states and municipalities to take on new responsibilities.

Institutional Knots: A Comparative Analysis of Cord Blood Policy in Canada and the United States.

Umbilical cord blood is a rich source of blood stem cells, which are of critical clinical importance in the treatment of a variety of malignant and genetic conditions requiring stem cell transplantation. Many countries have established national public cord blood banks; such banks often coexist with a panoply of private options for cord blood banking. Until recently, Canada was the only G8 country without a national cord blood bank. This differs markedly from the United States, which years ago established a national cord blood bank policy and inventory. This article investigates potential reasons for this discrepancy through a comparative analysis of the evolution of programs and policies on national cord blood banking in Canada and the United States. My analysis suggests that cross-national discrepancies in policy on public cord blood banking were determined primarily by institutional factors, principal among them formal governmental structure and the legacy of past policies. Institutional entrepreneurialism in the health sector played a constitutive role in the earlier evolution of national cord blood policy in the United States as compared to Canada.

Da colonização à agência dos atores: a implementação de políticas públicas por organizações civis / From colonization to the doing of actors: the implementation of public policy by civil organizations / De la colonización a la agencia de los actores: la implementación de políticas públicas por las organizaciones civiles

O artigo discute as diferentes apropriações de uma política pública – Programa Rede Parceria Social – pelas organizações civis que atuam na área da Assistência Social no Rio Grande do Sul, através da realização de dois estudos de caso nos anos de 2011 e 2012. A partir de uma perspectiva teórica assentada na sociologia relacional e no institucionalismo histórico, analisa-se de que forma a trajetória institucional dos atores sociais, a qual os levou a ocupar no presente determinadas posições (relacionais) no campo da Assistência, condiciona a sua forma de interpretar se apropriar de oportunidades políticas como a representada pelo Programa Rede Parceria Social. Nesse sentido, coloca-se sob suspeição as teses proferidas pelas Ciências Sociais brasileiras que apontam para processos generalizados de “colonização” das organizações da sociedade civil pelo mercado ou da sua “hegemonização” por um projeto político neoliberal. Neste artigo parte-se da premissa de que a forma através da qual as organizações irão se relacionar com as oportunidades políticas, em determinada conjuntura, é algo a ser verificado por intermédio de investigações empíricas e, portanto, não pode ser respondido através de inferências causais que respondem a priori sobre a intencionalidade dos agentes e sobre os resultados de suas ações.(AU)

The article discusses the different appropriations of a public policy - Programa Rede Parceria Social - through the civil organizations that act in the field of Social Assistance in Rio Grande Do Sul, by two case studies made in 2011 and 2012. Through a theoretical framework based on relational sociology and historical institutionalism, it is evaluated how the institutional trajectory of social actors, which led them to currently occupy certain (relational) positions in the field of Assistance, conditions their way to interpret and take appropriation of political opportunities as the one represented by the Programa Rede Parceria Social. In this sense, it is put under suspicion the thesis presented by Brazilian Social Sciences that lead to generalized processes of "colonization" of civil society by the market and or its "hegemonization" through a neoliberal political project. In this article, we start from the premise that the way through which the organizations will relate with political opportunities, in a certain scenario, is something to be verified by empirical investigations and, thus, cannot be answered through causal inferences that respond a priori about the intentions of the agents and the results of their actions.(AU)

El artículo aborda las diferentes apropriaciones de una política pública – Programa Rede Parceria Social – por las organizaciones sociales que operan en el campo de la AsistenciaSocial en Río Grande do Sul, a través de dos estudios de caso en los años 2011 y 2012. Desde una perspectiva teórica de la sociologia relacional y el institucionalismo histórico, examina cómo la trayectoria institucional de los actores sociales, que los llevó a ocupar ciertasposiciones (relacionales) en el campo de la asistencia, ha condicionado la forma como talesorganizaciones interpretan y se apropian de las oportunidades políticas como la representadapor el Programa Rede Parceria Social. Por consiguiente, quedan bajo sospecha las tesisproferidas por las ciencias sociales brasileñas que apuntan a procesos generalizados de "colonización" de organizaciones de la sociedad civil por el mercado o de su “hegemonización” por um proyecto político neoliberal. En este artículo partimos de la premisa que el camino por el cual las organizaciones se relacionan con las oportunidades políticas, en particular, es algo a ser verificado a través de investigaciones empíricas y, por lo tanto, no pueden ser contestadas a través de inferencias causales que responden a priori sobre la intencionalidad de los agentes y sobre los resultados de sus acciones.(AU)

Da colonização à agência dos atores: a implementação de políticas públicas por organizações civis / From colonization to the doing of actors: the implementation of public policy by civil organizations / De la colonización a la agencia de los actores: la implementación de políticas públicas por las organizaciones civiles

O artigo discute as diferentes apropriações de uma política pública – Programa Rede Parceria Social – pelas organizações civis que atuam na área da Assistência Social no Rio Grande do Sul, através da realização de dois estudos de caso nos anos de 2011 e 2012. A partir de uma perspectiva teórica assentada na sociologia relacional e no institucionalismo histórico, analisa-se de que forma a trajetória institucional dos atores sociais, a qual os levou a ocupar no presente determinadas posições (relacionais) no campo da Assistência, condiciona a sua forma de interpretar se apropriar de oportunidades políticas como a representada pelo Programa Rede Parceria Social. Nesse sentido, coloca-se sob suspeição as teses proferidas pelas Ciências Sociais brasileiras que apontam para processos generalizados de “colonização” das organizações da sociedade civil pelo mercado ou da sua “hegemonização” por um projeto político neoliberal. Neste artigo parte-se da premissa de que a forma através da qual as organizações irão se relacionar com as oportunidades políticas, em determinada conjuntura, é algo a ser verificado por intermédio de investigações empíricas e, portanto, não pode ser respondido através de inferências causais que respondem a priori sobre a intencionalidade dos agentes e sobre os resultados de suas ações.(AU)

The article discusses the different appropriations of a public policy - Programa Rede Parceria Social - through the civil organizations that act in the field of Social Assistance in Rio Grande Do Sul, by two case studies made in 2011 and 2012. Through a theoretical framework based on relational sociology and historical institutionalism, it is evaluated how the institutional trajectory of social actors, which led them to currently occupy certain (relational) positions in the field of Assistance, conditions their way to interpret and take appropriation of political opportunities as the one represented by the Programa Rede Parceria Social. In this sense, it is put under suspicion the thesis presented by Brazilian Social Sciences that lead to generalized processes of "colonization" of civil society by the market and or its "hegemonization" through a neoliberal political project. In this article, we start from the premise that the way through which the organizations will relate with political opportunities, in a certain scenario, is something to be verified by empirical investigations and, thus, cannot be answered through causal inferences that respond a priori about the intentions of the agents and the results of their actions.(AU)

El artículo aborda las diferentes apropriaciones de una política pública – Programa Rede Parceria Social – por las organizaciones sociales que operan en el campo de la AsistenciaSocial en Río Grande do Sul, a través de dos estudios de caso en los años 2011 y 2012. Desde una perspectiva teórica de la sociologia relacional y el institucionalismo histórico, examina cómo la trayectoria institucional de los actores sociales, que los llevó a ocupar ciertasposiciones (relacionales) en el campo de la asistencia, ha condicionado la forma como talesorganizaciones interpretan y se apropian de las oportunidades políticas como la representadapor el Programa Rede Parceria Social. Por consiguiente, quedan bajo sospecha las tesisproferidas por las ciencias sociales brasileñas que apuntan a procesos generalizados de "colonización" de organizaciones de la sociedad civil por el mercado o de su “hegemonización” por um proyecto político neoliberal. En este artículo partimos de la premisa que el camino por el cual las organizaciones se relacionan con las oportunidades políticas, en particular, es algo a ser verificado a través de investigaciones empíricas y, por lo tanto, no pueden ser contestadas a través de inferencias causales que responden a priori sobre la intencionalidad de los agentes y sobre los resultados de sus acciones.(AU)

The Long Road to Universal Health Coverage: Historical Analysis of Early Decisions in Germany, the United Kingdom, and the United States.

Abstract-Over the last several years the once-obscure idea of Universal Health Coverage (UHC) has blossomed into a movement embraced by leading authorities in global health. Both the World Bank and the World Health Organization have designated UHC as a core objective, but many details of this concept have yet to be specified, including the political economy process by which countries can increase financial protection to move toward UHC. Using an analysis of historical literature, this paper examines the development of the two common mechanisms for providing financial risk protection: national social health insurance as developed in Germany, and general tax revenue as used by the United Kingdom to launch the National Health Service. Because of the prominence of organized labor groups in demanding increased financial protection in these two cases, the paper then considers a comparison case from the Progressive Era in the United States where labor groups were far less engaged. Based on the categories used in the historical literature, I develop a framework for comparing the cases in six areas: related legal and cultural heritage; macro-historical conditions; demand for increased social protection; politics of expanding government role in health; financing and delivery systems; and UHC-related outcomes. The paper concludes with some reflections from this analysis for low- and middle-income countries attempting to move toward UHC.