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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.

Background The COVID-19 pandemic caused severe disruptions in healthcare systems and societies and exacerbated existing inequalities for women and girls across every sphere. Our study explores health systems responses to gender equality goals during the COVID-19 pandemic and which role these goals play in pandemic recovery policies. Methods We apply a qualitative comparative approach. Country case studies (expert information, secondary sources) were collected in March/April 2022. The sample comprised Australia, Brazil, Germany, United Kingdom and USA, reflecting conditions of high to upper-middle income countries with established public health systems, democratic political institutions and gender equality policies. Selected topics: maternity care/reproductive services, violence against women, and gender equality/female leadership. Results All countries tried to keep essential maternity and reproductive services open, but strong limitations applied especially for prevention and counselling services; at the same time, digitalisation/telemedicine supported service expansion. Violence against women and children strongly increased during the pandemic. Routine services were partly kept open and new helplines occasionally established, but no action was taken to scale-up mental health support and respond to new demand. A push-back of gender equality was observed across countries in all areas of health and social care, often coupled with strong increase in intersecting social inequalities; participation of women in decision-making bodies was generally weak and not monitored. Conclusions Across countries, gender equality policies cracked under the pressure of the COVID-19 pandemic; this is true for countries with male and female political leaders, and for different areas of SDG5 and health. There is an urgent need for more effective intersectional gender equality policies and improved participation of women in global health and in health system recovery plans. Key messages • Health systems failed to take action to protect SDG5 goals; gender and intersecting inequalities strongly increased during the pandemic. • Building back better after COVID-19 will only be possible with an intersectional gender equality programme and feminist policy approaches.

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.

The social and economic impacts of COVID-19 fall harder on women than on men. Governments need to gather data and target policy to keep all citizens equally safe, sheltered and secure. The social and economic impacts of COVID-19 fall harder on women than on men. Governments need to gather data and target policy to keep all citizens equally safe, sheltered and secure.

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.

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.

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.

Minority ethnic status, class, education, and sexuality determine who is represented in unpaid community health-care worker roles 8 The unpaid and low paid labour of women has contributed to profits for private health-care providers and saved the bottom line of health spending in national budgets: capitalism and patriarchy combine to systematically undervalue social reproductive labour—ie, unpaid care roles as women's work 9 Governments’ ability to fund health-care services is dictated by their revenue and fiscal policy space Yet the IMF and the World Bank continue to prioritise austerity measures and “private sector first” strategies that systematically undermine the ability of governments to provide public services and achieve UHC 14,15 Neither institution has linked its rhetoric on promotion of gender equality to the development of a systematic approach for evaluating the implications of its austerity policies on gender inequality, health delivery, or outcomes 16,17 The key funders of the IMF and the World Bank, and those that hold the greatest number of Executive Board votes, are G7 and G20 members A feminist economic approach to health requires that all people at all levels of health-care decision making reorient their notion of wellbeing to include gender equality for women in all their diversities 19 Feminist knowledge informs what we count as costs and savings: the national income saved from women's low wages or volunteerism as health-care workers;20 the benefit to national budgets and health outcomes when there are gender-based violence health-care prevention programmes;21 and the negative burdens carried by health-care workers exposed to violence, harassment, and exploitation when their work is located in unregulated environments, including homes, non-governmental organisations, and provincial health clinics 22 A WHO economic engagement strategy that does not address the social and political determinants of health delivery, resourcing, and decision making risks perpetuating the falsehood that health is a technical enterprise that can be achieved in a silo

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.

BackgroundA key purpose of the International Health Regulations (IHR) is to prevent unwarranted interruptions to trade and travel during large and/or transnational infectious disease outbreaks. Nevertheless, such outbreaks continue to disrupt the travel industry. This aspect of the IHR has received little attention in the academic literature despite its considerable impact on affected States and commercial activity. This article outlines the challenges and gaps in knowledge regarding the relationship between outbreaks and the travel sector and discusses the opportunities for further research and policy work to overcome these challenges.MethodologyWe conducted a literature review on the relationship between outbreaks and travel restrictions, with a particular focus on the 2014–16 Ebola epidemic in West Africa. This review was complemented by an expert roundtable at Chatham House and further supported by case studies and qualitative interviews.ResultsNumerous travel stakeholders are affected by, and affect, large-scale infectious disease outbreaks. These stakeholders react in different ways: peer pressure plays an important role for both governments and the travel sector, and the reactions of the media and public influence and are influenced by these stakeholders. While various data sources on travel are available, and World Health Organization is mandated to work with States, there is no recognized coordinating body to disseminate timely, consistent, reliable and authoritative information and best practices to all stakeholders.ConclusionThis article highlights the interdependent relationship between various travel stakeholders. The reasons for interruption of travel during the 2014–16 Ebola outbreak were complex, with decisions by States only partly contributing to the cessation. Decisions by non-state actors, particularly the travel industry itself, contributed significantly and were based on a variety of factors. Further research, analysis and policy development are required to mitigate the health and economic consequences of infectious disease outbreaks. Any further research will also need to take account of COVID-19 travel-related issues.

The outbreaks of Severe Acute Respiratory Syndrome (SARS) in 2003, influenza A (H1N1) in 2009 and Ebola in 2014 have shown that increasingly infectious diseases can spread globally in a short timeframe, affecting both high- and low-income countries. Taking action to mitigate the impact of future crises relies on sharing public health surveillance data across national borders in an efficient and effective way. However, data users, particularly in high-income countries, often use surveillance data, particularly from low- and middle-income countries, with little or no benefit to the data generator. As Indonesia's refusal to share influenza virus sequences during the 2006 H5N1 outbreak illustrates, this imbalance increases reluctance to share and jeopardizes the global good that can be achieved. In order to share public health surveillance data internationally in an equitable way, technical, political, ethical, and legal issues need to be addressed. The Centre on Global Health Security at Chatham House is producing guidance that will address both the policy and technical issues with the aim of establishing new norms so that data can be shared in an open, transparent and equitable way.

During pregnancy immunolglobulin G (IgG) antibodies are transferred from mother to neonate across the placenta. Studies in high transmission areas have shown transfer of P. falciparum-specific IgG, but the extent and factors influencing maternal-foetal transfer in low transmission areas co-endemic for both P. falciparum and P. vivax are unknown. Pregnant women were screened weekly for Plasmodium infection. Mother-neonate paired serum samples at delivery were tested for IgG to antigens from P. falciparum, P. vivax and other infectious diseases. Antibodies to malarial and non-malarial antigens were highly correlated between maternal and neonatal samples (median [range] spearman ρ = 0.78 [0.57–0.93]), although Plasmodium spp. antibodies tended to be lower in neonates than mothers. Estimated gestational age at last P. falciparum infection, but not P. vivax infection, was positively associated with antibody levels in the neonate (P. falciparum merozoite, spearman ρ median [range] 0.42 [0.33–0.66], PfVAR2CSA 0.69; P. vivax ρ = 0.19 [0.09–0.3]). Maternal-foetal transfer of anti-malarial IgG to Plasmodium spp. antigens occurs in low transmission settings. P. vivax IgG acquisition is not associated with recent exposure unlike P. falciparum IgG, suggesting a difference in acquisition of antibodies. IgG transfer is greatest in the final weeks of pregnancy which has implications for the timing of future malaria vaccination strategies in pregnant women.

This article introduces the Variome Annotation Schema, a schema that aims to capture the core concepts and relations relevant to cataloguing and interpreting human genetic variation and its relationship to disease, as described in the published literature. The schema was inspired by the needs of the database curators of the International Society for Gastrointestinal Hereditary Tumours (InSiGHT) database, but is intended to have application to genetic variation information in a range of diseases. The schema has been applied to a small corpus of full text journal publications on the subject of inherited colorectal cancer. We show that the inter-annotator agreement on annotation of this corpus ranges from 0.78 to 0.95 F-score across different entity types when exact matching is measured, and improves to a minimum F-score of 0.87 when boundary matching is relaxed. Relations show more variability in agreement, but several are reliable, with the highest, cohort-has-size, reaching 0.90 F-score. We also explore the relevance of the schema to the InSiGHT database curation process. The schema and the corpus represent an important new resource for the development of text mining solutions that address relationships among patient cohorts, disease and genetic variation, and therefore, we also discuss the role text mining might play in the curation of information related to the human variome. The corpus is available at http://opennicta.com/home/health/variome.