Search

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.

Gender norms, roles and relations differentially affect women, men, and non-binary individuals' vulnerability to disease. Outbreak response measures also have immediate and long-term gendered effects. However, gender-based analysis of outbreaks and responses is limited by lack of data and little integration of feminist analysis within global health scholarship. Recognising these barriers, this paper applies a gender matrix methodology, grounded in feminist political economy approaches, to evaluate the gendered effects of the COVID-19 pandemic and response in four case studies: China, Hong Kong, Canada, and the UK. Through a rapid scoping of documentation of the gendered effects of the outbreak, it applies the matrix framework to analyse findings, identifying common themes across the case studies: financial discrimination, crisis in care, and unequal risks and secondary effects. Results point to transnational structural conditions which put women on the front lines of the pandemic at work and at home while denying them health, economic and personal security - effects that are exacerbated where racism and other forms of discrimination intersect with gender inequities. Given that women and people living at the intersections of multiple inequities are made additionally vulnerable by pandemic responses, intersectional feminist responses should be prioritised at the beginning of any crises.

While it is important to be able to evaluate and measure a country’s performance in health research (HR), HR systems are complex and multifaceted in nature. As such, attempts at measurement can suffer several limitations which risk leading to inadequate indices or representations. In this study, we critically review common indicators of HR capacity and performance and explore their strengths and limitations. The paper is informed by review of data sources and documents, combined with interviews and peer-to-peer learning activities conducted with officials working in health and education ministries in a set of nine African countries. We find that many metrics that can assess HR performance have gaps in the conceptualisation or fail to address local contextual realities, which makes it a challenge to interpret them in relation to other theoretical constructs. Our study identified several concepts that are excluded from current definitions of indicators and systems of metrics for HR performance. These omissions may be particularly important for interpreting HR performance within the context and processes of HR in African countries, and thus challenging the relevance, utility, appropriateness and acceptability of universal measures of HR in the region. We discuss the challenges that scholars may find in conceptualising such a complex phenomenon—including the different and competing viewpoints of stakeholders, in setting objectives of HR measurement work, and in navigating the realities of empirical measurement where missing or partial data may necessitate that proxies or alternative indicators may be chosen. These findings are important to ensure that the global health community does not rely on over-simplistic evaluations of HR when analysing and planning for improvements in low-income and middle-income countries.

The COVID-19 pandemic affects all countries, but how governments respond is dictated by politics. Amid this, the World Health Organization (WHO) has tried to coordinate advice to states and offer ongoing management of the outbreak. Given the political drivers of COVID-19, we argue this is an important moment to advance International Relations knowledge as a necessary and distinctive method for inclusion in the WHO repertoire of knowledge inputs for epidemic control. Historical efforts to assert technical expertise over politics is redundant and outdated: the WHO has always been politicized by member states. We suggest WHO needs to embrace the politics and engage foreign policy and diplomatic expertise. We suggest practical examples of the entry points where International Relations methods can inform public health decision-making and technical policy coordination. We write this as a primer for those working in response to COVID-19 in WHO, multilateral organizations, donor financing departments, governments and international non-governmental organizations, to embrace political analysis rather than shy away from it. Coordinated political cooperation is vital to overcome COVID-19.

Made available in DSpace on 2022-04-28T19:41:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-28 Universidade Estadual Paulista Júlio de Mesquita Filho London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy Instituto de Medicina Integral Professor Fernando Figueira University of Ottawa Faculty of Health Sciences Institute for Global Health and Development Queen Margaret University School of Health Sciences London School of Economics and Political Science Universidade Estadual Paulista Júlio de Mesquita Filho

Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas.

Background: Regional cooperation on health in Africa is not new. The institutional landscape of regional cooperation for health and health research, however, has seen important changes. Recent health emergencies have focussed regional bodies’ attention on supporting aspects of national health preparedness and response. The state of national health research systems is a key element of capacity to plan and respond to health needs – raising questions about the roles African regional bodies can or should play in strengthening health research systems. Methods: We mapped regional organisations involved in health research across Africa and conducted 18 interviews with informants from 15 regional organisations. We investigated the roles, challenges, and opportunities of these bodies in strengthening health research. We deductively coded interview data using themes from established pillars of health research systems – governance, creating resources, research production and use, and financing. We analysed organisations’ relevant activities in these areas, how they do this work, and where they perceive impact. Results: Regional organisations with technical foci on health or higher education (versus economic or political remits) were involved in all four areas. Most organisations reported activities in governance and research use. Involvement in governance centred mainly around agenda-setting and policy harmonisation. For organisations involved in creating resources, activities focused on strengthening human resources, but few reported developing research institutions, networks, or infrastructure. Organisations reported more involvement in disseminating than producing research. Generally, few have directly contributed to financing health research. Informants reported gaps in research coordination, infrastructure, and advocacy at regional level. Finally, we found regional bodies’ mandates, authority, and collaborations influence their activities in supporting national health research systems. Conclusion: Continued strengthening of health research on the African continent requires strategic thinking about the roles, comparative advantages, and capability of regional organisations to facilitate capacity and growth of health research systems.

The recommendations of the Independent Panel for Pandemic Preparedness and Response do not go far enough

L´évolution et les défis contemporains de la recherche pour la santé (RS) à Madagascar sont peu documentés. Notre objectif est de faire un état des lieux du Système National de Recherche pour la Santé (SNRS) dans le but de comprendre les facteurs qui influencent son développement. Nous avons mené une étude de cas qualitative, qui consistait en une revue documentaire et des entretiens semistructurés avec 38 informateurs clés. Nous avons effectué une analyse thématique et nous sommes inspirés des composantes du Baromètre des SNRS de l´OMS/AFRO pour structurer la présentation des résultats. À Madagascar, les institutions de RS opèrent sans un cadre législatif spécifique. Il existe toutefois un document de politique présentant les orientations nationales de la RS. Les ressources humaines sont insuffisantes, du fait de défis dans l´accès à la formation et la rétention des chercheurs. La collaboration internationale représente quasiment l´unique source de financement de la RS. Elle contribue également au renforcement des capacités humaines, institutionnelles mais ne favorise pas toujours l´adéquation entre la recherche effectuée et les besoins prioritaires du pays. Les efforts inaboutis de régulation et la modicité de l´investissement public dans la formation et la mise en œuvre de la recherche traduisent un engagement insuffisant des gouvernants pour la RS. La négociation de partenariats internationaux équitables, la disponibilité de financements publics, et l´alignement de la RS aux priorités nationales de santé constitueraient une base solide pour le développement du SNRS à Madagascar.

This chapter introduces the book’s proposal that Zika offers a window for analysing broader themes in global health security: those of perpetuating global-local inequalities and silencing of women in securitised policy, governed by Westphalian and domestic politics. It outlines how the global health security narrative promoted a path dependency which reproduced state security-focused policies of masculine evidence based medicine and short-term response efforts and rendered the everyday lives of those (women) most at risk of the disease invisible. The chapter analyses the lack of gender considerations in global health security policy and further justifies the need for a feminist global health security, through highlighting the ways in which women are differentially infected and affected by infectious disease.

Feminist Global Health Security highlights the ways in which women are disadvantaged by global health security policy, through engagement with feminist concepts of visibility; social and stratified reproduction; intersectionality; and structural violence. The book argues that an approach focused on short-term response efforts to health emergencies fails to consider the differential impacts of outbreaks on women. This feminist critique focuses on the policy response to the Zika outbreak, which centred on limiting the spread of the vector through civic participation and asking women to defer pregnancy, actions that are inherently gendered and reveal a distinct lack of consideration of the everyday lives of women. The book argues that because global health security lacks a substantive feminist engagement, policies created to manage an outbreak of disease focus on protecting economies and state security and disproportionately fail to protect women. This state-based structure of global health security provides the fault-line for global health security and women. Women are both differentially infected and affected by epidemics and, the book argues: it was no coincidence that poor, black women living in low quality housing were most affected by the Zika outbreak. More broadly, it poses the question: What would global health policy look like if it were to take gender seriously, and how would this impact global disease control sustainability?

This epilogue discusses COVID-19, which reveal much about gender in global health security. It highlights that women are more likely to be healthcare workers, demonstrating the visibility missing in COVID-19, yet this is not recognised by policymakers. Women are also more likely to suffer the downstream effects of social reproduction through school closures and stay-at-home orders as well as the associated mental load. The epilogue also shows how COVID-19 has affected access to SRH services with an impact on stratified reproduction. It concludes that the everyday crisis of women trying to manage the response, whilst at risk of soaring rates of GBV and lack of access to sanitation and space, verifies the argument made throughout this book. Now the world is listening.

This chapter reconceptualises the findings from Zika to the global level to understand what global heath security can learn from unpacking this health emergency and how global health security policy can be made more gender inclusive. It also readdress the state-centric focus of the global health security narrative, which has systematically excluded women, through repositioning women as the referent object of securitisation. The chapter suggests that women’s needs and lived reality should be taken into consideration and that policy might be developed which makes tangible approaches to counteracting the risks posed to women, rather than focusing on broader systems, economies or societies. Finally, it considers that the book has not done justice to women’s agency within outbreaks, and painting them as victims of a broader structural failure within third wave feminism overlooks the activities that women have undertaken to protect themselves from disease or its effects.

This chapter conceptualises global health security, discussing its genesis and how it has been theorised. First, the chapter establishes that global health security has failed to consider women and the gendered impact of securitised health policy then conversely, explores how feminists have contended with other security debates, through analysing the sub-discipline of feminist security studies (FSS). FSS seeks to understand women within the security terrain but has yet to consider global health as an area of security analysis. The chapter demonstrates why it is so vital to develop a dialogue between feminist theory and global health security for meaningful development in pandemic preparedness and response activities. It also provides a springboard for the following empirical chapters which engage with a range of further feminist concepts to explore the empirical case of Zika and highlight the need to engage with feminist approaches in order to develop a more comprehensive response to health emergencies and ensure truly global health security.

This chapter begins with the premise that women are not a homogenous group; and some women are more important than others to global health security, which relays important information about political prioritisation. The chapter then shows how the Zika outbreak provides a pertinent example for a detailed nuanced analysis of in/visibility, which might have wider ramifications for understanding this concept in feminist discourse. Women cradling babies born with CZS were on the front pages of newspapers, policy reports and the collective global psyche. But it was a certain type of woman, performing a particular function of motherhood to legitimise activity within a security narrative, instrumentalised to garner support for extraordinary measures amid the public audience of the security threat. The affected women were conspicuous in the narrative of global health security, and were instrumentalised to facilitate Zika’s securitisation, but that these same Zika infected and affected women were invisible as the target group for public health interventions, particularly when considering intersectionality—these women were poor, black, single, and living in northeast Brazil.

Drawing on social reproduction, and stratified reproduction, this chapter demonstrates that there is a tension between the securitised approach of the Zika response and the lived reality of the women most affected. In doing so, it also reveals a struggle between the state and women. The securitised policy response at national levels placed the responsibility onto women to avoid being bitten by mosquitoes, to reduce mosquito breeding grounds, and ultimately to avoid bearing a child with CZS. This is problematic: women were not included in the decision-making to create suitable policy pathways to reduce their risks of infection, to the extent that the very population the response should have provided for, has been systematically excluded from the response. Women were instrumentalised, objectified, and responsibilised by the state. Thus, the chapter shows, global health security through a state-centric delivery of security is failing women.

This chapter offers a contextual narrative to the Zika outbreak and justifies a pertinent case study for gender analysis in global health security. It contends that Zika was constructed as a security threat at multiple levels of analysis. This framing perpetuated an exclusion and problematization of women in global health security more broadly. The chapter argues that the key policies developed—integrated vector control, vaccine development and behavioural requests around reproduction, to paraphrase, ‘clean your houses and don’t get pregnant’—were inherently gendered given the activities required are socially prescribed women’s activities. It further argues that although the outbreak revolved around women, gender was not mainstreamed into any of the policies developed, and the securitised policies failed to protect those women most at risk from the disease.

Zika was framed globally as a ‘crisis’ with a narrative demonstrating a paternalistic approach to policymaking and failing to take local contexts into consideration. This chapter examines structural and gender-based violence in juxtaposition to the framing of Zika as a global health crisis at the local level. Despite being invisibilised by global health security and responsibilised by domestic governments, women most susceptible to the Zika outbreak, while providing for their children’s needs, were fighting everyday challenges of financial security, increasing community and gender violence, poverty, and state structural failures in provision of routine health, sanitation, and housing. Zika became just one of a string of individual security threats these women had to battle. This disjuncture needs to be exposed and counteracted, and the lived reality of those infected must be addressed to meaningfully respond to these health crisis events.

The UK government has largely failed to consider gender in its COVID-19 response, despite the many and varied differential impacts of policy interventions on women and men. Since government policy is informed by the advice ministers receive, we sought to understand whether and how gender had been considered by the UK government’s COVID-19 Scientific Advisory Group on Emergencies (SAGE). This paper uses two forms of policy analysis to assess 73 SAGE meeting minutes and background documents for 1) the explicit references to sex and/or gender, and 2) references to issues evidenced in the literature to be gendered, to understand whether the gendered implications of policy were considered. We find that the acknowledgement of the gendered dynamics of particular issues, such as school closures and feminised (or masculinised) employment sectors, were largely absent in SAGE meeting minutes and that explicit references to women were largely of a biological (sex) nature, rather than social (gender). Over time we saw increased references to the gendered impacts of policy in meeting background documents, though these references largely reproduced gendered stereotypes and roles rather than actively engaging with the gender issues. However, not all blame can be put at the feet of SAGE members, who did show awareness of equity issues and were predominantly epidemiologists and behavioural scientists likely untrained in gender analysis. SAGE members are selected based on the government’s framing of the type of emergency at hand, and COVID-19 has been treated by the government as a an epidemiological emergency, rather than a social, political and economic one. We argue that reframing emergencies like the COVID-19 pandemic in a more holistic way enables us to redefine the scientific advice deemed necessary for SAGE membership, and facilitates the inclusion of gender advisors to mitigate the downstream gendered impacts of non-pharmaceutical interventions associated with the government’s COVID-19 response.

Background: In recent years there have been calls to strengthen health sciences research capacity in African countries. This capacity can contribute to improvements in health, social welfare, and poverty reduction through domestic application of research findings; it is increasingly seen as critical to pandemic preparedness and response. Developing research infrastructure and performance may reduce national economies’ reliance on primary commodity and agricultural production, as countries strive to develop knowledge-based economies to help drive macroeconomic growth. Yet efforts to date to understand health sciences research capacity are limited to output metrics of journal citations and publications, failing to reflect the complexity of the health sciences research landscape in many settings. Methods: We map and assess current capacity for health sciences research across all 54 countries of Africa by collecting a range of available data. This included structural indicators (research institutions and research funding), process indicators (clinical trial infrastructures, intellectual property rights, and regulatory capacities) and output indicators (publications and citations). Results: While there are some countries which perform well across the range of indicators used, for most countries the results are varied – suggesting high relative performance in some indicators, but lower in others. Missing data for key measures of capacity or performance is also a key concern. Taken as a whole, existing data suggest a nuanced view of current health sciences research landscape on the African continent.Conclusion: Mapping existing data may enable governments and international organisations to identify where gaps in health sciences research capacity lie, particularly in comparison to other countries in the region. It also highlights gaps where more data are needed. These data can help to inform investment priorities and future system needs.

A growing body of research has highlighted the disproportionately negative impact of the COVID-19 pandemic on women globally. This paper contributes to this work by interrogating the lived realities of 64 women in the UK through semi-structured interviews, undertaken during the first and second periods of lockdown associated with COVID-19 in 2020. Categorising the data by theme and type of gendered disadvantage, this paper explores the normative and policy-imposed constraints experienced by women in 2020, highlighting the role that government can and should proactively play in attending to gender inequalities throughout its COVID-19 response.

Evidence shows that infectious disease outbreaks are not gender-neutral, meaning that women, men and gender minorities are differentially affected. This evidence affirms the need to better incorporate a gender lens into infectious disease outbreaks. Despite this evidence, there has been a historic neglect of gender-based analysis in health, including during health crises. Recognizing the lack of available evidence on gender and pandemics in early 2020 the Gender and COVID-19 project set out to use a gender analysis matrix to conduct rapid, real-time analyses while the pandemic was unfolding to examine the gendered effects of the coronavirus disease 2019 pandemic. This paper reports on what a gender analysis matrix is, how it can be used to systematically conduct a gender analysis, how it was implemented within the study, ways in which the findings from the matrix were applied and built upon, and challenges encountered when using the matrix methodology.

The Zika outbreak of 2015-7 is a lens to analyse the positioning of abortion within in global health security. The sequelae of the virus almost exclusively affected newborn children, manifested through Congenital Zika Syndrome (CZS), and a focus on women at risk of, planning or being pregnant. At the global level, debate considered whether Zika would provide impetus for regulatory change for reproductive rights in Latin America, a region with some of the most restrictive abortion regulation in the world. However, regulatory change for abortion did not occur. We analyse why the Zika health emergency did not lead to any changes in abortion regulation through multi-method analysis of the intersection between Zika, health emergencies and abortion in Brazil, Colombia and El Salvador. These case study countries were purposefully selected; each had Zika infected women (albeit with differing incidence) yet represent diverse regulatory environments for abortion. Our comparative research is multi-method: framework analysis of key informant interviews (n = 49); content analysis of women's enquiries to a medical abortion telemedicine provider; and, policy analysis of (inter)national-level Zika response and abortion policies. We consider this within literature on global health security, and the prioritisation of a particular approach to epidemic control. Within this securitized landscape, despite increased public debate about abortion regulatory change, no meaningful change occurred, due to a dominant epidemiological approach to the Zika health emergency in all three countries and prominent conservative forces in government and within anti-abortion rights movements. Simultaneously, we demonstrate that regulation did not deter all women from seeking such service clandestinely., Highlights • Zika affected reproductive decision making, but did not impact abortion regulation. • Epidemiological framing ignored reproductive dimensions of emergency responses. • Conservative forces instrumentalized disability concerns to oppose abortion rights. • Women sought abortions clandestinely, citing Zika as a justification. • Abortion provision must form part of health emergency planning and response.

Viewpoint paper.

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. However, we disagree 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.

The UK is well into the second wave of COVID-19, with 60 051 lives lost to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to date, according to provisional data from the Office for National Statistics. Official UK Government data show that cases have been rising exponentially since late August, 2020, with increases across all regions in England in recent weeks.As of Nov 4, 2020, the UK had 25 177 confirmed daily cases. These are almost certainly underestimates as between Oct 17 and Oct 23, 2020, England alone had 52 000 estimated daily cases.Estimates of the effective reproduction number in England vary between 1.1 and 1.6.Daily deaths have doubled every fortnight since early September, 2020, with 2067 deaths from COVID-19 in the past week and around 12 000 deaths more are likely in the next month—the majority among people who have already been infected. With 12 000 patients currently in hospital with COVID-19, health services are close to capacity in many regions. We are seeing more than 1400 daily hospital admissions in England, a single doubling period away from the peak of 3000 daily admissions that occurred in April, 2020, which could be reached within 2–3 weeks.

We collected over 50 million tweets referencing COVID-19 to understand the public’s gendered discourses and concerns during the pandemic. We filtered the tweets based on English language and among three gender categories: men, women, and sexual and gender minorities. We used a mixed-method approach that included topic modelling, sentiment analysis, and text mining extraction procedures including words’ mapping, proximity plots, top hashtags and mentions, and most retweeted posts. Our findings show stark differences among the different genders. In relation to women, we found a salient discussion on the risks of domestic violence due to the lockdown especially towards women and girls, while emphasizing financial challenges. The public discourses around SGM mostly revolved around blood donation concerns, which is a reminder of the discrimination against some of these communities during the early days of the HIV/AIDS epidemic. Finally, the discourses around men were focused on the high death rates and the sentiment analysis results showed more negative tweets than among the other genders. The study concludes that Twitter influencers can drive major online discussions which can be useful in addressing communication needs during pandemics.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

BACKGROUND The online discussion around the COVID-19 pandemic is multifaceted, and it is important to examine the different ways by which online users express themselves. Since emojis are used as effective vehicles to convey ideas and sentiments, they can offer important insight into the public’s gendered discourses about the pandemic. OBJECTIVE This study aims at exploring how people of different genders (eg, men, women, and sex and gender minorities) are discussed in relation to COVID-19 through the study of Twitter emojis. METHODS We collected over 50 million tweets referencing the hashtags #Covid-19 and #Covid19 for a period of more than 2 months in early 2020. Using a mixed method, we extracted three data sets containing tweets that reference men, women, and sexual and gender minorities, and we then analyzed emoji use along each gender category. We identified five major themes in our analysis including morbidity fears, health concerns, employment and financial issues, praise for frontline workers, and unique gendered emoji use. The top 600 emojis were manually classified based on their sentiment, indicating how positive, negative, or neutral each emoji is and studying their use frequencies. RESULTS The findings indicate that the majority of emojis are overwhelmingly positive in nature along the different genders, but sexual and gender minorities, and to a lesser extent women, are discussed more negatively than men. There were also many differences alongside discourses of men, women, and gender minorities when certain topics were discussed, such as death, financial and employment matters, gratitude, and health care, and several unique gendered emojis were used to express specific issues like community support. CONCLUSIONS Emoji research can shed light on the gendered impacts of COVID-19, offering researchers an important source of information on health crises as they happen in real time.

Could covid-19 help unravel gender norms?

Cuba has been largely absent in academic and policy discourse on global health security, yet Cuba’s history of medical internationalism and its domestic health system have much to offer contemporary global health security debates. In this paper, we examine what we identify as key traits of Cuban health security, as they play out on both international and domestic fronts. We argue that Cuba demonstrates a strong health security capacity, both in terms of its health systems support and crisis response activities internationally, and its domestic disease control activities rooted in an integrated health system with a focus on universal healthcare. Health security in Cuba, however, also faces challenges. These concern Cuba’s visibility and participation in the broader global health security architecture, the social controls exercised by the state in managing disease threats in Cuban territory, and the resource constraints facing the island—in particular, the effects of the US embargo. While Cuba does not frame its disease control activities within the discourse of health security, we argue that the Cuban case demonstrates that it is possible to make strides to improve capacity for health security in resource-constrained settings. The successes and challenges facing health security in Cuba, moreover, provide points of reflection relevant to the pursuit of health security globally and are thus worth further consideration in broader health security discussions.

Brazil’s Zika virus crisis (2015–17), following hot on the heels of the Ebola outbreak (2014–15), dominated newsfeeds and high-level discussions amid governments, the UN system and beyond, with emerging fears relating to Congenital Zika Syndrome (CZS), embodied by microcephaly. However, beyond the ensuing panic in Latin America facing a generation of Zika babies, the outbreak demonstrates key developments in our understanding of the interaction between health and security, based on the Copenhagen School’s securitization approach. It suggests that unlike previous diseases that were securitized, it was not the virus that was the cause of the security threat, nor how many people were affected, but a combined concern over where (in Brazil at a time of domestic political crisis), when (immediately post-Ebola), who (foetuses and babies), how (unknown disease characteristics) and what was the existential threat (the vectorized unknown). This article shows these developments for global health security through empirical analysis of the multiple securitization processes that occurred within Brazil for the Zika virus, at the subnational and federal levels.

Linking health and security has become a mainstream approach to health policy issues over the past two decades. So much so that the discourse of global health security has become close to synonymous with global health, their meanings being considered almost interchangeable. While the debates surrounding the health–security nexus vary in levels of analysis from the global to the national to the individual, this article argues that the consideration of health as a security issue, and the ensuing path dependencies, have shifted in three ways. First, the concept has been broadened to the extent that a multitude of health issues (and others) are constructed as threats to health security. Second, securitizing health has moved beyond a rhetorical device to include the direct involvement of the security sector. Third, the performance of health security has become a security threat in itself. These considerations, the article argues, alter the remit of the global health security narrative; the global health community needs to recognize this shift and adapt its use of security-focused policies accordingly.