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101. Vaccine Equity in ConflictAffected Areas: The Challenges of Development, Production, Procurement, and Distribution

Author:
Katherine DeLand
Publication Date:
05-2022
Content Type:
Policy Brief
Institution:
International Peace Institute (IPI)
Abstract:
While the wide-ranging impacts of COVID-19 are being felt in all countries and communities, the pandemic is having a disproportionately large impact on vulnerable populations, such as people living in areas affected by fragility, conflict, and violence. Vaccines hold enormous promise to mitigate these impacts, but the complications inherent to armed conflict make accessing vaccines especially challenging. Even when countries do receive vaccines, they often face challenges in rolling out vaccination programs, whether because they lack adequate capacity or because the doses are set to expire or are not acceptable to the communities set to receive them. This issue brief focuses on the challenges of equitably distributing COVID-19 vaccines to populations in conflict-affected areas. It begins by looking at general issues related to the development, approval, production, procurement, and distribution of vaccines. It then examines the particular challenges to distributing vaccines in conflict-affected areas both before and during the vaccine rollout. The report concludes with several recommendations for stakeholders and policymakers to improve the delivery of vaccines in conflict-affected areas: Redistribute global resources to increase the supply of vaccines to conflict-affected countries; Increase the transparency and predictability of global vaccine supplies; Enhance cooperation and coordination at the national and local levels to deliver vaccines to conflict-affected areas through existing humanitarian response mechanisms; and Ensure that vaccination campaigns in conflict-affected areas adhere to humanitarian principles.
Topic:
Health, Conflict, Vaccine, COVID-19, and Humanitarian Response
Political Geography:
Global Focus

102. Does Europe need a Health Union?

Author:
Anne Bucher
Publication Date:
02-2022
Content Type:
Policy Brief
Institution:
Bruegel
Abstract:
Health outcomes in the European Union are good by international standards, even compared to other developed economies, and improved continuously before COVID-19. This reflects the alignment of the objectives of improving health and wellbeing with the overall socio-economic objective of prosperity, and suggests that a radical overhaul of EU health policy is not needed. However, the EU could benefit from closer integration in some areas and be more effective in delivering a high level of health protection. Action could be taken in the following areas: The European Commission’s November 2020 Health Union package to increase resilience to cross-border health threats is ambitious, in particular with the establishment of the Health Emergency Response Authority, which extends the scope of cooperation in health emergencies. The EU should pursue further the Health Union approach to address cross-border externalities and enhance health security. It could, for instance, do more to tackle anti-microbial resistance, or define minimum requirements for the resilience of health systems. For non-communicable diseases, the EU should tap the economies of scale of research and knowledge organised at EU level, and put in place systems for the surveillance of non-communicable diseases and consolidation of scientific knowledge. This could be achieved through an extension to non-communicable diseases of the European Centre for Disease Prevention and Control mandate. The ‘Health in all Policies’ principle is a key channel to deliver good health outcomes at EU level. EU scientific agencies provide health risk assessments in a number of areas, but the EU should better organise, coordinate and consolidate the scientific knowledge that underpins health-protection measures in sectoral legislation, and should more systematically apply better regulation rules to the health impacts of EU policies. The EU should support the digital transformation of health systems and set high targets for the European Health Data Space initiative, which is a critical infrastructure for the future of health research, regulation and policymaking. Several non-health EU policy objectives (cohesion policies, European Pillar of Social rights, economic governance) are linked to the performance of health systems. A common understanding on how to measure this performance would inform these policies in a consistent way. Moreover favourable health outcomes in the EU have not reduced health inequalities, which remain high between and within EU countries. Monitoring of health inequalities, including those related to access to and quality of healthcare, should be improved as an initial step.
Topic:
Health, European Union, Regional Integration, and COVID-19
Political Geography:
Europe

103. COVID-19 in the European Union: health impacts and effects on economic activity

Author:
Leonardo Cadamuro, Scott Marcus, and Francesco Papadia
Publication Date:
07-2022
Content Type:
Working Paper
Institution:
Bruegel
Abstract:
This paper quantitatively describes different aspects of the COVID-19 pandemics: new cases, hospitalisations, intensive-care admissions and deaths, while illustrating their changing relationships over time. It then assesses how the different variables have affected relevant sectoral and macroeconomic indicators. Finally, it concludes that, from an economic perspective, what matters when it comes to managing the pandemic is to prevent intensive-care admissions and deaths arising from COVID-19. The success of vaccination should be measured in terms of its ability to prevent the most serious consequences, rather than its ability to prevent infections and hospitalisations.
Topic:
Health, European Union, Economy, Macroeconomics, and COVID-19
Political Geography:
Global Focus

104. Beyond Statelessness: 'Unchilding' and the Health of Palestinian Children in Jerusalem

Author:
Osama Tanous, Bram Wispelwey, and Rania Muhareb
Publication Date:
07-2022
Content Type:
Journal Article
Journal:
Statelessness & Citizenship Review
Institution:
Peter McMullin Centre on Statelessness, Melbourne Law School
Abstract:
Understanding the key determinants of health of Palestinian children in occupied East Jerusalem is enhanced by analyzing Jerusalem as a settler colonial frontier. Structural racism, prolonged occupation, and settler colonialism shape the social and political determinants of health in Jerusalem, generating ill health and insecurity for Palestinian children who are rendered stateless in their own city. They are “unchilded” and, in fact, treated like enemies of the settler state. Colonial violence penetrates their family stability, homes, classrooms, and targets their bodies and health. In providing a thorough analysis of the lived experience of indigenous Palestinian children in Jerusalem, a broadened understanding of the effects of statelessness on their health can begin to take shape.
Topic:
Health, Territorial Disputes, Children, Citizenship, Displacement, and Stateless Population
Political Geography:
Middle East, Israel, and Palestine

105. Financial Analysis of Health System Shifts in Egypt: Searching for “gratuitousness” and the right to health

Author:
Mohamed Gad
Publication Date:
05-2022
Content Type:
Research Paper
Institution:
Arab Reform Initiative (ARI)
Abstract:
Throughout the formation and development of the modern state of Egypt,1 health policies played two key roles: First, the state played a powerful and efficient role in the provision of medical services through facilities funded by public treasury revenues. Secondly, it strived to provide these services at the lowest possible costs or free of charge in what is known as the “gratuitousness” policy. Like many other free social policies that took root during the interwar period and were given new impetus with the advent of Arab socialism in the 1960s, the “free public hospital” principle was a subject of conflict between two movements that fiercely competed to control public policy in recent decades. The first movement defended the “gratuitousness” policy through tax-based expansionary fiscal policies targeting the wealthiest segments of society — a model similar to the welfare state adopted in some Western European countries. The second movement believed that tax reduction and redistribution policies in general were of vital importance to help the country attract investments and achieve the highest possible rate of economic growth and capital accumulation — in parallel with the rise of neoliberalism globally. The second movement recommended fiscal policies aimed at reducing the budget deficit, claiming that the latter affects investment opportunities in a multitude of ways. For example, it contributes to the rise of inflation rates, not to mention that public debt crowds out private borrowing opportunities, etc. This movement calls for transforming the interwar and Arab socialism policy legacy into a new pattern relying less on the public treasury and more on middle-class contributions, with “gratuitousness” policies being restricted to the poorest segments of society. This system requires continuous updates to the citizens’ income distribution database to help identify affluent and disadvantaged groups. This movement managed to gain traction in Egypt thanks to two major financial crises in the country. The first took place in the late 1980s with the steep rise in external debt, which led Egypt to adopt economic liberalization policies in the early 1990s known as stabilization and structural adjustment programs, which were supported by the International Monetary Fund (IMF) and the World Bank. The second crisis happened when the global financial crisis reached Egypt and political instability following the 2011 revolution, with the subsequent emergency of a black market for hard currency in 2016, leading to a new phase of financial and monetary policies with the support of the IMF and international donors. During the two crises, international financial institutions were reinforcing their policies in Egypt, particularly the scaling down of social protection policy costs covered by the public treasury. In this context, a new health insurance law was introduced and approved in 2018. The provisions of the new law represented a major transformation in the role of the state in the health sector in Egypt. The law is the first piece of legislation aimed at restructuring the health insurance system in Egypt since the 1960s. In essence, it aims to reduce dependency on “gratuitous hospitals funded by the public treasury” model and, instead, to adopt a new model that is more reliant on the middle-class to fund the public health system via deductions from their income. This model could improve public health services, while enabling the state to maintain its social role in supporting the disadvantaged. As the new health insurance law created a major shift in the history of health policies in Egypt, it also sparked widespread controversy. It is likely to stir even more controversy during its 15-year implementation period. So far, the law has only been applied in a small number of the least populated governorates.2 This research paper is not biased towards either of the two abovementioned movements, as both of them entail numerous contradictions. The “gratuitous” hospital model funded by the public treasury has long been criticized for the poor quality of services, even during its beginnings in the 1960s. The movement defending this model also did not propose any broader perceptions on distributive tax policies to increase public treasury resources, and it focused on the improvement of medical services.
Topic:
Health, Health Care Policy, Finance, and Financial Development
Political Geography:
Africa and Egypt

106. North Korea’s Covid-19 Outbreak: An Opening for Engagement?

Author:
Lorenzo Mariani and Leonardo Bruni
Publication Date:
06-2022
Content Type:
Commentary and Analysis
Institution:
Istituto Affari Internazionali
Abstract:
In January 2020, in response to the novel coronavirus, the Democratic People’s Republic of Korea (DPRK; North Korea) closed its borders and for the next two years claimed it had not experienced a single case of Covid-19. However, on 12 May 2022, North Korea disclosed a severe domestic outbreak and in the following weeks began reporting millions of cases of “fevers” and several deaths.[1] Pyongyang’s admission was initially interpreted as a veiled request for international assistance as the country is particularly vulnerable due to its zero per cent vaccination rate, inadequate healthcare system and chronic food insecurity. However, as with previous attempts during the height of the pandemic, offers of aid and vaccines from the Republic of Korea (ROK; South Korea), the US, international organisations (IOs) and multilateral initiatives like COVAX received no response; most likely due to suspicion of the aid being politicised.[2]
Topic:
Health, Foreign Aid, European Union, Economy, and COVID-19
Political Geography:
Asia and North Korea

107. Heroes on Strike: Trends in Global Health Worker Protests During COVID-19

Author:
Sorcha A. Brophy, Veena Sriram, Haotian Zong, Chloei Andres, Maria Paz Mawyin, and Narayanan GL
Publication Date:
04-2022
Content Type:
Working Paper
Institution:
Accountability Research Center (ARC), American University
Abstract:
This Accountability Note describes global trends in health worker protests between March 11, 2020 and March 10, 2021. We argue that the frequent characterization of health workers as heroes of the pandemic obscures the fact that health workers themselves describe the challenges they face during this time as violations of their rights as workers, highlighting the obligations of their employers to provide working conditions and remuneration that justify the risk they assume. Using data from the Armed Conflict Location & Event Data (ACLED) Project, we first provide a global overview of the growth in health worker protest activity in the March 2020–2021 period as compared to the March 2019–2020 period. Health workers engaged in protest activity with greater frequency during the first year of the pandemic than during the prior year. The eighty-five countries included in the ACLED data set in both the March 2019–2020 period and the March 2020–2021 period experienced a sixty-two percent increase in health worker protest activity (from 2416 protests to 3913 protests). We then provide an overview of the content of the 6589 health worker protests in the ACLED dataset between March 2020 and March 2021, describing protests in 149 countries in terms of five categories: working conditions and remuneration, resources, health system delivery issues, public policy, and other. By far, the largest category of protests during this period are those related to working conditions and remuneration. Approximately sixty-six percent (N=4358) of global protests in the 2020–2021 period expressed health worker dissatisfaction about issues such as: occupational hazards, unpaid wages, risk allowances and job security. Surprisingly, personal protective equipment (PPE) concerns—an issue covered frequently in the media—motivated a relatively low percentage of the protests (less than nine percent). We note this not to downplay the gravity of global PPE shortages, but to situate PPE shortages as one among many health worker concerns during the pandemic. Protests initiated by health workers about health system delivery issues provide an important reminder that even in the middle of a pandemic, not everything was about COVID-19. Sixty-two percent of the health system-related protests during the 2020–2021 period were about issues that were not coded as directly related to the COVID-19 pandemic. Similarly, the vast majority of health workers’ protests around public policy were not about pandemic-related government policy, but about social issues like climate change, immigration, police brutality, and elections. The aim of this analysis is to understand what health workers advocated for during a time of immense pressure, and to identify some broad areas of concern for health sector accountability. Through this analysis, we prepare the groundwork for future research and action, and share preliminary guidance regarding how health sector stakeholders—including government, health worker associations, unions, and civil society—might develop improved systems of accountability.
Topic:
Health, Protests, Crisis Management, and COVID-19
Political Geography:
Global Focus

108. A Healthier and More Sustainable Global Food System: What is at Stake for the EU?

Author:
Marta Antonelli
Publication Date:
01-2022
Content Type:
Commentary and Analysis
Institution:
Istituto Affari Internazionali
Abstract:
Fixing the global food system is arguably the most powerful leverage to nurture the world’s population while keeping human activity within the biophysical limits of the planet. Yet, food systems are today a threat to both human and planetary health, and thus require bold and forward-looking strategies as well as multi-stakeholder collaboration.
Topic:
Agriculture, Climate Change, Health, Politics, Natural Resources, European Union, Food Security, and Sustainable Development Goals
Political Geography:
Europe

109. The Complex History of US-Philippine Health Partnerships

Author:
Leslie V. Advincula-Lopez
Publication Date:
06-2022
Content Type:
Special Report
Institution:
East-West Center
Abstract:
Leslie V. Advincula-Lopez, Development Studies Program and Institute of Philippine Culture Ateneo de Manila University, explains that, "[l]ong before the term, global health diplomacy (GHD) became a buzzword in international relations, an efficient Philippine public health system... was a focal point of US-Philippine relations."
Topic:
Diplomacy, Health, Bilateral Relations, Partnerships, Public Health, and COVID-19
Political Geography:
Philippines, North America, Asia-Pacific, and United States of America

110. The COVID-19 Pandemic in Oceania: Health Policy Decisions Matter

Author:
Neal A. Palafox and Wilfred C. Alik
Publication Date:
06-2022
Content Type:
Special Report
Institution:
East-West Center
Abstract:
Neal A. Palafox, MD, MPH, Professor, Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, & Wilfred C. Alik, MD, Clinic Chief for the Kaiser Permanente Medical Center in Hilo, HI, Co-Founder of the Micronesian Health Advisory Coalition, and Chairman of Marshallese COVID-19 Task Force, "articulate a disparate range of pandemic experiences across Pacific Island countries and territories (PICTs), in terms of COVID 19 community transmission, cases, mortality, and vaccination rates."
Topic:
Health, Vaccine, and COVID-19
Political Geography:
Asia-Pacific and Oceania