Strategic analysis of the Brazilian federal government's performance in the COVID-19 pandemic: 2020-2021. / Análise estratégica da atuação do governo federal brasileiro na pandemia de COVID-19: 2020-2021.

The study aim is to analyze the performance of the Brazilian federal government (FG) in the COVID-19 pandemic, seeking to identify tensions and conflicts between actors and institutions of the three branches of the government and the FG with state governors. Data production included a review of articles, publications and documents that analyze the pandemic evolution and record announcements, decisions, actions, debates and controversies between these actors in the period of 2020 to 2021. The results include the characterization of the action style of the central Actor and the analysis of conflicts between the Presidency, the Ministry of Health, ANVISA, state governments, the House of Representatives and the Senate and the Federal Supreme Court, seeking to correlate them with the debate around the political projects for health in dispute under the current circumstances. It is concluded that the central actor largely used a communicative action aimed at his supporters and strategic action characterized by imposition, coercion and confrontation in the relationships he maintained with other institutional actors, especially when they diverged from his viewpoints about how to face the health crisis, consistently with his connection to the ultra-neoliberal and authoritarian political project of the FG, which includes the deconstruction of the Brazilian Unified Health System.

O objetivo é analisar a atuação do governo federal (GF) na pandemia de COVID-19 e identificar as tensões e conflitos entre atores e instituições dos três poderes e do GF com governadores estaduais. A produção de dados incluiu revisão de artigos, publicações e documentos que analisam a pandemia e registram pronunciamentos, decisões, ações, debates e controvérsias entre esses atores no período 2020-2021. Os resultados contemplam a análise do estilo de ação do ator central e dos conflitos entre a Presidência, Ministério da Saúde, Anvisa, governos estaduais, Câmara, Senado e Supremo Tribunal Federal, buscando correlacioná-los com os projetos políticos para a saúde em disputa na atual conjuntura. Conclui-se que o ator central utilizou largamente uma ação comunicativa dirigida a seus apoiadores e uma ação estratégica caracterizada pela imposição, coação e confronto nas relações que manteve com outros atores institucionais, sobretudo quando estes divergiram da sua visão acerca do enfrentamento da crise sanitária, coerentemente com sua vinculação ao projeto político ultra neoliberal e autoritário do GF, que inclui o desmonte do SUS.

Regulatory performance of the East African Community joint assessment procedure: The way forward for regulatory systems strengthening.

BACKGROUND: Seven national medicines regulatory authorities in the East African Community (EAC) have embraced regulatory reliance, harmonization and work sharing through the EAC Medicines Regulatory Harmonization programme. Measuring the performance of regulatory systems provides key baseline information to build on regulatory system-strengthening strategies. Therefore, the aim of the study was to evaluate the regulatory performance of the EAC joint scientific assessment of applications approved between 2018 and 2021. METHODS: Utilising a data metrics tool, information was collected reflecting timelines for various milestones including submission to screening, scientific assessment and communication of regional recommendations for biologicals and pharmaceuticals that received a positive regional recommendation for product registration from 2018 to 2021. RESULTS: Several challenges as well as possible solutions were identified, including median overall approval times exceeding the EAC 465-day target and median times to issue marketing authorisation following EAC joint assessment recommendation that far exceeded the 116-day target. Recommendations included establishment of an integrated information management system and automation of the capture of regulatory timelines through the EAC metric tool. CONCLUSIONS: Despite initiative progress, work is required to improve the EAC joint regulatory procedure to achieve regulatory systems-strengthening and ensure patients' timely access to safe, efficacious and quality medicines.

Required Elements for an Integrated Biosurveillance Platform: A Capacity and Needs Assessment of the Central Government in the Republic of Korea.

New and reemerging infectious disease outbreaks threaten human safety worldwide, increasing the urgency to implement biosurveillance systems that enhance government capacity in public health emergency preparedness and response. To do so, it is necessary to evaluate existing surveillance and response activities and identify potential barriers at the national level. This study aimed to assess the current status and readiness of government agencies in South Korea, particularly for information sharing and use, and to identify barriers and opportunities in developing an agency-integrated biosurveillance system. The target sample size was 66 government officials, working at 6 relevant government ministries. We invited a total of 100 officials to participate. A total of 34 government officials completed the survey (34.0% response rate), 18 (52.9%) of whom were affiliated with the Korea Disease Control and Prevention Agency or the Ministry of Health and Welfare. Findings revealed that information sharing between government agencies occurred frequently, but a discrepancy existed in terms of the type of information shared and stored. Although information sharing with other agencies and ministries occurred at all stages-prevention, preparation, response, and recovery-it mostly revolved around preventive activities, with no respondents reportedly sharing recovery-related information. An agency-integrated biosurveillance system is crucial in preparing for the next pandemic, as well as supporting information sharing, analysis, and interpretation across humans, animals, and the environment. It is key to national and global health security.

How Should the US Federal Government Oversee Clinicians' Relationships With Industry?

Many clinicians, including those who work in government, experience potential clashes between their professional responsibilities and personal interests that can create conflicts of interest (COIs). Some clinicians might assert that their personal stakes do not influence their professional actions, but data suggest otherwise. This commentary on a case suggests that COIs must be acknowledged with sincerity and managed such that they are eliminated or, at least, credibly mitigated. Moreover, policies and procedures that guide responses to clinicians' COIs must be in place before clinicians assume roles in government. Without external accountability and respect for the limits of self-regulation, clinicians' capacity to reliably promote the public interest without bias could be compromised.

Do political incentives promote or inhibit corporate social responsibility? The role of local officials' tenure.

The existing literature on corporate social responsibility (CSR) drivers focuses on firm- and institution-level factors and rarely on the role of political incentives. Public officials control enormous resources in China, and their political incentives substantially shape certain firm behaviors. As CSR is one of the critical measures that the central government uses to evaluate the performance of local government, local officials have the incentive to channel firms into accomplishing their political goals. Correspondingly, local firms may strategically implement CSR to build a good relationship with local governments. This study investigates the impact of local officials' political incentives (measured by tenure) on firms' CSR. Using a panel of publicly listed Chinese firms covering 2009-2019, it documents a U-shaped effect of government officials' tenure on the CSR performance of firms within their jurisdiction. To wit, the firm's CSR decreases first and then increases with the growth of tenure. Moreover, this U-shaped effect will be strengthened in regions with a high priority of gross domestic product (GDP) growth and will be weakened in regions with good market development. In addition, there is no significant evidence that party officials' tenure affects firms' CSR. Overall, this study advances our understanding of the political determinants of CSR in emerging markets.

Eroding trust and collaboration.

It wasn't that long ago when scientific collaboration between the United States and China was enthusiastically encouraged as a means to accomplish the best science. American universities established campuses in China, set up exchange programs for students and trainees, and hired highly productive Chinese researchers. That all changed in 2018, when then-President Trump launched the China Initiative to rid US academia of Chinese spies. As reporter Jeffrey Mervis describes in this issue of Science, the National Institutes of Health (NIH)-the largest federal funder of biomedical research-vigorously responded to this charge. The agency's allegations and investigations have not only destroyed careers but also eroded trust in the agency and federal government across the scientific community.

Fix the backlash against public health.

Societies generally have reacted to deadly epidemics by strengthening health systems, including laws. Under American federalism (the constitutional division of power between states and the federal government), individual states hold primary public health powers. State legislatures have historically granted health officials wide-ranging authority. After the anthrax attacks in the United States in 2001, the US Centers for Disease Control and Prevention (CDC) supported the Model State Emergency Health Powers Act, which granted public health officials even more expansive powers to declare a health emergency and respond swiftly. But all that ended with COVID-19, as state legislatures and courts gutted this authority. The next pandemic could be far deadlier than COVID-19, but when the public looks to federal and state governments to protect them, they may find that health officials have their hands tied behind their backs.

A Platform for Data-Centric, Continuous Epidemiological Analyses (EpiGraphHub): Descriptive Analysis.

BACKGROUND: Guaranteeing durability, provenance, accessibility, and trust in open data sets can be challenging for researchers and organizations that rely on public repositories of data critical for epidemiology and other health analytics. The required data repositories are often difficult to locate and may require conversion to a standard data format. Data-hosting websites may also change or become unavailable without warning. A single change to the rules in one repository can hinder updating a public dashboard reliant on data pulled from external sources. These concerns are particularly challenging at the international level, because policies on systems aimed at harmonizing health and related data are typically dictated by national governments to serve their individual needs. OBJECTIVE: In this paper, we introduce a comprehensive public health data platform, EpiGraphHub, that aims to provide a single interoperable repository for open health and related data. METHODS: The platform, curated by the international research community, allows secure local integration of sensitive data while facilitating the development of data-driven applications and reports for decision-makers. Its main components include centrally managed databases with fine-grained access control to data, fully automated and documented data collection and transformation, and a powerful web-based data exploration and visualization tool. RESULTS: EpiGraphHub is already being used for hosting a growing collection of open data sets and for automating epidemiological analyses based on them. The project has also released an open-source software library with the analytical methods used in the platform. CONCLUSIONS: The platform is fully open source and open to external users. It is in active development with the goal of maximizing its value for large-scale public health studies.

McGirt v Oklahoma and What Clinicians Should Know About Present-Day Child Abuse and Legacies of Forced Migration.

In 1997, Jimcy McGirt was convicted by the State of Oklahoma for sex crimes against a minor. McGirt appealed his conviction, citing that Oklahoma lacked jurisdiction over the case due to his tribal citizenship, since the crime took place on tribal territory. On July 9, 2020, the Supreme Court of the United States (SCOTUS) reversed the Oklahoma Court of Criminal Appeals' original decision for the case, citing that Congress had failed to disestablish reservations with regard to the Major Crimes Act, which gave the federal government jurisdiction over major felony crimes perpetrated by Native Americans on reservations.This ruling has already caused sweeping changes in the investigations and prosecutions of child maltreatment in eastern Oklahoma, as such cases may fall under the jurisdiction of federal agencies or tribal law enforcement. This article details the historic significance of the decision and the experiences of 3 child abuse pediatricians working as part of a multidisciplinary team while jurisdictional changes were implemented following the SCOTUS ruling.

Landmark Plastic Surgeon Advocacy within the Federal Government: Four Case Studies.

BACKGROUND: Throughout history, plastic surgeons have advocated for the protection of the specialty and for better care for their patients. Whether through efforts to support and move legislation through Congress or through preventative advocacy in the form of lobbying against legislation, plastic surgeons have often used their expertise in the political sphere to shape patient care. We hope to inspire current and future plastic surgeons to be politically active and to devise ways in which their expertise can be used within the legislative system to better care for their patients. METHODS: This article highlights four historical examples of plastic surgeon-led advocacy within the federal government: the U.S. Flammable Fabrics Act; the American Society of Plastic and Reconstructive Surgeons and the Federal Trade Commission, 1979; the Women's Health and Cancer Rights Act; and the Breast Cancer Patient Education Act. RESULTS: We hope that plastic surgeons will-like Dr. Crikelair, Dr. Wider, and the members of American Society of Plastic Surgeons/American Society of Plastic and Reconstructive Surgeons-continue to play an active role in the shaping of the legislative system for our profession and, ultimately, our patients. CONCLUSIONS: To ensure the best care for their patients, plastic surgeons must continue to maintain their relationship with public health and legal professionals and legislators. Through relationships with patients and a firm understanding of their stories, plastic surgeons can have great impacts in all local, state, and national political spheres.

Moved to partner: A case study of faith-based congregations in disaster response.

When disaster strikes, many players are involved in the response: local, state, and federal governments; public entities; community and faith-based organizations (FBOs). Some of these players are prepped to respond to disasters, while others emerge spontaneously to assist when need (or perceived need) arises. Consistently, FBOs are involved with disaster response efforts. "Faith-Based Congregations" or "FBCs" are a subsect of FBOs that are formally organized, stationary religious congregations such as churches, temples, mosques, etc. Unlike some FBOs, FBCs are embedded in communities and steeped in those communities' cultures. The value of FBCs to disaster management is recognized at the federal level, as FEMA encourages local emergency managers to engage their "Whole Community." Though shown to provide for many needs following disaster, FBCs' role in disaster is largely understudied. Additionally, the mechanics of engaging with FBCs are not simple to implement. The role of FBCs, how they adapt, and the predictors of their involvement need to be better understood in order for improved cross-sector collaboration pre- and post-disaster. The purpose of this study was to explore the role of FBCs in the disaster response process and how FBCs are impacted by the early transition to recovery. This study addressed two primary research questions: What is the role of FBCs during disaster response? How do FBCs change (temporarily and permanently) during disaster response, and what factors may promote or inhibit change? To answer these questions, this qualitative study employed telephone interviews with leaders of FBCs who helped provide disaster response assistance to those impacted by Hurricane Harvey in Katy, Texas.

Comparison of the Financial and Operational Characteristics of For-Profit and Nonprofit Hospitals Receiving Federal Graduate Medical Education Payments, 2011-2020.

This study compares graduate medical education (GME) payments between nonprofit and for-profit hospitals between 2011 and 2020 to assess how hospitals value GME.