Search

This article analyzes two longitudinal datasets (October – December 2020; April 2021) of 1,000 and 900 women in Kenya and Nigeria, respectively, alongside in-depth qualitative interviews with women at risk of changes to time use, to study two pandemic issues: women’s substitution of paid for unpaid work and how these shifts compromise their mental health. Women devote more time to domestic care (30–38 percent), less time to employment (29–46 percent), and become unemployed (12–17 percent). A rise in domestic work is correlated with depressive (Nigeria) and anxiety symptoms (Kenya and Nigeria). Women with greater agency (Kenya) and fewer children (Nigeria) are less likely to report a domestic burden or loss in paid activities. Social protection programs may fill the void of assistance traditionally provided by informal networks in the short term, while campaigns shifting norms around household work may preserve women’s economic participation in the long term.

The World Health Organization (WHO) is tasked with the ‘attainment by all peoples of the highest possible level of health’, yet, it is widely struggling to meet this mandate, and COVID-19 has revealed significant limitations of the organisation. Despite clear guidance provided by the institution as to how best to respond to the pathogen, many governments departed from WHO's guidance in their response efforts. Is this a new crisis for WHO? Does WHO need to restore its legitimacy in the eyes of the global community? As renewed calls for changes to WHO emerge, in this perspective we lay out the obstacles WHO face to become the WHO ‘we’ need. The assumption is that UN member states need an empowered and well-funded organisation. Yet, many years of discussion of reform of WHO have failed to lead to meaningful change, and glaring challenges remain in its financing, governance and politics, which are considered in turn. The reality may be that we have the WHO that UN member states need – one that can provide guidance and advice, but also take criticism for health governance failures when states want to avoid blame or responsibility. We discuss this, by analysing three key areas of WHO'S challenges: mandate and scope; structure, governance and money and domestic vs international.

Este artículo parte de la necesidad de responder a la pregunta de cómo vivieron las mujeres los efectos de las medidas sanitarias de confinamiento y de circulación por sexo y cédula, adoptadas en el marco de la COVID-19 en la República de Panamá, sobre todo en materia de los trabajos remunerados y no remunerados. Se utilizó la entrevista a profundidad como herramienta metodológica, que fue aplicada a informantes clave: lideresas de organizaciones de mujeres, sindicales y LGBTI+, funcionarias y funcionarios estatales y de organismos internacionales. Las transcripciones se analizaron con base en la bibliografía académico-feminista y, de manera complementaria, con legislación, informes y datos estadísticos. Fue generalizada la opinión de que el gobierno adoptó medidas que no consideraron la desigualdad de género, lo cual tuvo efectos en las vidas de las mujeres, tales como sobrecarga e invisibilización del trabajo en el hogar y de las mujeres vulnerables, aumento de su carga laboral remunerada, inseguridad e incertidumbre económica.

This article reviews the state of the literature on the politics of global health governance and associated political dynamics of actors involved in this issue space. We identify seven eras in the field, beginning with the period of empire and colonialism and ending with the COVID-19 outbreak. The field of global health has long had a focus on infectious disease, often rooted within a state-centered approach to transnational global health problems with recurrent debates about whether and how restrictions on trade and travel should be imposed in the wake of disease outbreaks. This statist focus is in tension with more cosmopolitan visions of global health, which require broader health system strengthening. In the mid-2000s, a golden age emerged with the influx of new financing and political attention to addressing HIV/AIDS and malaria, as well as reducing the risk posed by infectious disease outbreaks to economies of the Global North. Despite increased awareness of noncommunicable diseases and the importance of health systems, events of recent years (including but not limited to the COVID-19 outbreak) reinforced the centrality of states to global health efforts and the primacy of infectious diseases. Expected final online publication date for the Annual Review of Political Science, Volume 26 is June 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

A growing body of research has highlighted the disproportionately negative impact of the COVID-19 pandemic on women globally. This article contributes to this work by interrogating the lived realities of sixty-four women in the United Kingdom through semi-structured in-depth interviews, undertaken during the first and second periods of lockdown associated with COVID-19 in 2020. Categorizing the data by subgroup of women and then by theme, this article explores the normative and policy-imposed constraints experienced by women in 2020 with regard to paid and unpaid labor, mental health, access to healthcare services, and government representation and consideration of women. These findings highlight women’s varied and gendered experiences of the COVID-19 pandemic and emphasizes the role that government can proactively play in attending to gender inequalities throughout its COVID-19 response.

This paper examines the anti-mask and anti-lockdown online movement in connection to the COVID-19 pandemic. To combat the spread of the coronavirus, health officials around the world urged and/or mandated citizens to wear facemasks and adopt physical distancing measures. These health policies and guidelines have become highly politicized in some parts of the world, often discussed in association with freedom of choice and independence. We downloaded references to the anti-mask and anti-lockdown social media posts using 24 search terms. From a total of 4209 social media posts, the researchers manually filtered the explicit visual and textual content that is related to discussions of different genders. We used multimodal discourse analysis (MDM) which analyzes diverse modes of communicative texts and images and focuses on appeals to emotions and reasoning. Using the MDM approach, we analysed posts taken from Facebook and Instagram from active anti-mask and anti-lockdown users, and we identified three main discourses around the gendered discussion of the anti-mask movement including hypermasculine, sexist and pejorative portrayals of “Karen”, and appropriating freedom and feminism discourses. A better understanding of how social media users evoke gendered discourses to spread anti-mask and anti-lockdown messages can help researchers identify differing reactions toward pandemic measures.

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.

IntroductionThe COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies.MethodsWe apply a qualitative comparative approach, drawing on secondary sources and expert information; the data was collected from March–July 2022. Australia, Brazil, Germany, the United Kingdom, and the USA were selected, reflecting upper-middle and high-income countries with established public health and gender policies but different types of healthcare systems and epidemiological and geo-political conditions. Three sub-goals of SDG5 were analyzed: maternity care/reproductive health, gender-based violence, and gender equality/women's leadership.ResultsWe found similar trends across countries. Pandemic policies strongly cut into women's health, constrained prevention and support services, and weakened reproductive rights, while essential maternity care services were kept open. Intersecting gender inequalities were reinforced, sexual violence increased and women's leadership was weak. All healthcare systems failed to protect women's health and essential public health targets. Yet there were relevant differences in the responses to increased violence and reproductive rights, ranging from some support measures in Australia to an abortion ban in the US.ConclusionsOur study highlights a need for revising pandemic policies through a feminist lens.

In response to COVID-19, Panama implemented a sex-segregated lockdown policy whereby women were allowed to access essential services on Monday, Wednesday and Friday and men on Tuesday, Thursday and Saturday. The logic was to reduce disease transmission by controlling population circulation at any one time. We sought to understand the impact of this policy approach on Panamanian society. To do so, we undertook key informant interviews with representatives from groups of society that have been significantly affected by this policy across Panamanian society. Framework analysis was undertaken on interview transcripts to identify key trends, which were latterly triangulated with academic, media and grey literature. Firstly, we engage with intersectional analyses to show that those most affected were marginalised groups including trans population, disabled groups, indigenous groups and migrants who faced discrimination as a consequence of this policy. Secondly, we highlight practical tensions that individuals faced relating to access to resources (financial, health-related and beyond), and third we interrogate the methods used to enforce this policy, and the role of the police and exemption passes. We conclude that this policy was regressive in that it affected those most vulnerable in Panamanian society, entrenching existing inequalities. Before implementing sex-segregated policies in future health crises, governments must seek advice of gender and equality advisors and ensure impact assessments are undertaken to understand the burden such policies may pose across society.

In November 2021, the World Health Assembly (WHA) is hosting a special session to discuss the proposed plans for a pandemic treaty. Despite the fact that there are scant details concerning the treaty, the proposal has gained considerable support in both the academic community, and at the international level. While we agree that in the wake of the numerous governance failures during COVID-19, we need to develop appropriate global solutions to be able to prevent, detect, respond to, and recover from future global health crises—and that such mechanisms should be rooted in global equity—we disagree, however, that this pandemic treaty, currently, is the most appropriate way in which to achieve this. Indeed, notions of global community, solidarity, fairness are far removed from the reality that we have seen unfolding in the actions of states responding to the pandemic. This is the crux of the tension with the proposed treaty: the balance between the ideal cosmopolitan worldview held by those in power in global health, and the practice of national security decision-making witnessed in the last 18 months. Indeed, we do not believe that a pandemic treaty will deliver what is being extolled by its proponents, and it will not solve the multiple problems of global cooperation in global health that supporters believe it will.

Social media can be both a source of information and misinformation during health emergencies. During the COVID-19 pandemic, social media became a ubiquitous tool for people to communicate and represents a rich source of data researchers can use to analyse users’ experiences, knowledge and sentiments. Research on social media posts during COVID-19 has identified, to date, the perpetuity of traditional gendered norms and experiences. Yet these studies are mostly based on Western social media platforms. Little is known about gendered experiences of lockdown communicated on non-Western social media platforms. Using data from Weibo, China’s leading social media platform, we examine gendered user patterns and sentiment during the first wave of the pandemic between 1 January 2020 and 1 July 2020. We find that Weibo posts by self-identified women and men conformed with some gendered norms identified on other social media platforms during the COVID-19 pandemic (posting patterns and keyword usage) but not all (sentiment). This insight may be important for targeted public health messaging on social media during future health emergencies.

Gender intersects with healthcare systems; this is equally true for arboviral vector control efforts. However, there is as yet no comprehensive analysis as to how vector control is gendered. Hence, our objective is to provide the first thematic scoping and spatial distribution of the literature on gender, community health workers, and vector control. The authors use a systematic review approach to collect the academic literature on gender, community health workers, and vector control in Web of Science, Scopus, and PubMed (7,367 articles). After applying the exclusion criteria, 2,812 articles were analyzed using machine learning techniques: text mining and quantitative text analysis. The authors use topic modeling to assess the thematic scope of the literature and analyze the spatial distribution of themes. Our results show that the literature’s spatial scope is strongly represented by the global south as research was conducted mainly in Latin America, Africa, and Asia, places with greater incidence of vector-borne disease and with health systems, which incorporate community healthcare workers. However, there are significant spatial heterogeneities in where and how research is conducted. The topic analysis reveals that the literature predominantly considers issues of sex (e.g., pregnancy) and gender as it relates motherhood. Gendered considerations occur upon implementation of vector control policies, rather than being mainstreamed into their development and delivery. There is a need to deepen the analysis to allow for gendered aspects to be understood beyond binary sex differences and/or reproductive health.

The World Health Organisation’s (WHO) Scientific Advisory Group on the Origins of Novel Pathogens (SAGO) has recently been established to “define and guide studies into the origins [of Novel Pathogens]” and “advise WHO on prioritising studies and field investigations into [Novel Pathogens].” In both of these, an attention to political questions like “which pathogens deserve investigation?” and “how should countries’ possible pathogen origins be prioritised?” will need to be addressed. However, arguments have been made by WHO that SAGO should “follow the science” and “avoid politicisation.”1 There is a clear tension here. The statement to “avoid politicisation” is a political act in itself. It is an act that suggests states, government, and citizens have no business in holding science to account. In turn it is an act that both recognises the role and importance of politics, but sees the answer as doing nothing about it. Politics is framed as a problem—a major stumbling block to both pandemic preparedness and response, and for science to do its work—but one best avoided rather than understood. Political expertise is reduced to the important work of diplomacy or political communication. There is also an assumption that all political engagement means partisan or geo-politics, which is a misnomer. Politics is located at all levels, from the micropolitics of the Wuhan laboratory to the geopolitics of the G7 and UN systems. The publication of the membership of SAGO shows a lack of attention to expertise in the social sciences, and politics in particular.2 This is sure to …

Pandemic preparedness and COVID-19 response indicators focus on public health outcomes (such as infections, case fatalities, and vaccination rates), health system capacity, and/or the effects of the pandemic on the economy, yet this avoids more political questions regarding how responses were mobilized. Pandemic preparedness country rankings have been called into question due to their inability to predict COVID-19 response and outcomes, and COVID-19 response indicators have ignored one of the most well documented secondary effects of the pandemic - its disproportionate effects on women. This paper analyzes pandemic preparedness and response indicators from a feminist perspective to understand how indicators might consider the secondary effects of the pandemic on women and other equity deserving groups. Following a discussion of the tensions that exist between feminist methodologies and the reliance on indicators by policymakers in preparing and responding to health emergencies, we assess the strengths and weakness of current pandemic preparedness and COVID-19 response indicators. The risk with existing pandemic preparedness and response indicators is that they give only limited attention to secondary effects of pandemics and inequities in terms of who is disproportionately affected. There is an urgent need to reconceptualize what 'successful' pandemic preparedness and response entails, moving beyond epidemiological and economic measurements. We suggest how efforts to design COVID response indicators on gender inclusion could inform pandemic preparedness and associated indicators.

We conclude this book by arguing that the PHEIC declaration has been subject to multiple failures over successive outbreaks. Firstly, that the criteria for the PHEIC have been inconsistently applied by DGs and ECs to date. Secondly, that political considerations have plagued all stages of the PHEIC process, and that such political input must only be reserved for the DG as a political elected actor. Third, in failing to consistently apply the legal criteria, the PHEIC risks jeopardising the normative power of the PHEIC tool, and in allowing these inconsistencies the normative power of the WHO in global disease control. We highlight the lack of transparency which mires the process of decision-making, as well as the lack of evidence base as to the effect of the PHEIC in practice.

This chapter analyses the empirical examples of each PHEIC which has been declared, to understand the application of the legal criteria and political considerations. Starting with H1N1, and considering polio; Ebola in West-Africa; Zika; Ebola in DRC; and COVID-19 – for each outbreak we consider the background to the epidemic, the PHEIC decision making offered by supporting documentation; the temporary recommendations suggested by WHO; and further additional reflections as to the PHEIC process and utilisation.

This chapter introduces the PHEIC mechanism within global health security and highlights the inconsistencies apparent in the PHEIC declarations to date – that PHEICS are declared by the WHO Director General, on advice of an Emergency Committee, without due regard to the legal criteria required for their implementation and on account of political assessments. We establish the central question to be posed: to what extent is the PHEIC declaration process ambiguous and what is the risk of such ambiguity to achieving global disease control? and explore why this lack of consistency in the PHEIC declaration matters for global health security. The chapter further covers the methodology used for the book, and its layout

Amid a global health emergency, the process for Declaring a Public Health Emergency of International Concern (PHEIC) is at a crossroads. As a formal declaration by the World Health Organization, a PHEIC is governed by clear legislation as to what is, and what is not, deemed a global health security threat. However, it has become politicized and the legal criteria now appear to be secondary to the political motivation or outcome of the announcement. Addressing multiple empirical case studies, including COVID-19, this multidisciplinary book explores the relationship between international law and international relations to interrogate how a PHEIC is declared and the impact of its inconsistent use on the PHEIC tool, WHO and global health security more broadly.

This chapter provides the background and historical context to the development of global disease governance structures through the World Health Organization. Starting with the International Sanitary Conferences, covering the International Health Regulations 1969, and the reforms to the IHR in 2005 to facilitate changes to global governance to mitigate the bottlenecks identified during SARS (2003). It considers the reform process of the IHR and adds reflections to the latest assessments of the IHR (2005) during COVID-19. Importantly, this chapter outlines challenges with global disease control, in getting governments to comply, and the justification behind the introduction of the PHEIC.

This chapter analyses the empirical examples of those events for which EC meetings were called but a PHEIC was not declared, or those for which EC meetings were never convened, but the outbreaks warranted further consideration. This starts with MERS-CoV, Yellow Fever, Cholera in Zimbabwe and Haiti, chemical weapons in Syria and the Fukushima disaster. In each of these we consider the further inconsistencies apparent in the decision making by the EC or WHO.

This chapter lays out the legal criteria for the PHEIC declaration amid broader analysis of the International Health Regulations (2005). Importantly, it highlights that it is the Director General of WHO that decides on the declaration of the PHEIC, based on a series of evidence, one of which is the advice of the Emergency Committee. As an elected official, however, the DG is also able to take into consideration political considerations. On the other hand, the Emergency Committee, selected on the basis of their scientific expertise is only able to use the criteria of: unusual/unexpected; does the outbreak pose potential risk of international spread; and does the outbreak potentially require a coordinated international response in coming to its decision as to the need for a PHEIC declaration. We consider each of these in turn in more depth, and highlight how the roles of DG and EC have increasingly blurred in the use of the PHEIC in the last decade.