Mobilising “vulnerability” in the public health response to pandemic influenza

"More Concerned About Mr. and Mrs. Denmark": Coping with Pandemic Crisis at the Intersection of Homelessness and Drug Use

This article builds on fieldwork conducted during lockdown in Denmark among users of services at the intersection of homelessness and drug use. The paper bridges two distinct approaches to understanding the relation between marginalization and crisis, with one focused on the impact of "big events" on marginalized populations, and another on everyday strategies employed to survive situations of homelessness and drug use. The paper shows how past experiences of hardship became relevant for coping with pandemic crisis. It further exploreshow, through critical engagement with dominant accounts of vulnerability, research participants carved out a space for negotiating their marginality in the Danish welfare state.

Reconceiving vulnerabilities in relations of care how to account for and deal with carers' vulnerabilities

While carers' vulnerability has often been neglected in the literature, the recent COVID-19 pandemic brought this issue to the fore. This article explores why it has been so often ignored and how could it be dealt with differently. It does so in the form of a philosophical and conceptual investigation illustrated by various examples and situations, related primarily, but not exclusively, to the COVID period. Criticising a property-based view, and based on examples of carers' vulnerability during the pandemic, our investigation suggests that carers' vulnerability is relationally constructed and played out on multiple interwoven dimensions that may contradict each other. Our examples also suggest that the relational construction of vulnerabilities is socially and organisationally mediated, calling for the development of social and organisational forms of mediation that may help carers deal with their vulnerabilities. Second, and rather counterintuitively with regard to the COVID-period, we question the negative valence usually associated with vulnerability and analyse how this affects ways of dealing with carers' vulnerabilities and the co-creation of care. Finally, following Gilson (2014), we propose an ambivalent, relational conception of vulnerability, considered as 'openness to affectation by' and offer some theoretical and practical implications. Theoretically, this conception also allows us to consider such openness as an ability that may nurture carers' 'response-ability'. It also allows us to develop specific relational ethics for and in care relationships. Practically, this re-conceptualisation may help carers better embrace and process their vulnerabilities, including responses to negative affectations following exposure to carees. It may also facilitate their 'reception' of carees, and help co-create and adapt responses to carees' calls, thus avoiding paternalistic responses.

Locating vaccine uptake and public participation in Ukraine: An exploratory qualitative study on attitudes and barriers to early childhood vaccination

A growing body of literature on vaccine hesitancy considers context and the intersecting factors affecting vaccine uptake. This study attempts to add focus to the conversation of vaccines in Ukraine by exploring how vaccines are perceived and how local stakeholders envision solutions to the problems surrounding vaccine uptake. Twenty-five in-depth interviews were carried out among parents of children under 6 years of age as well as health practitioners and other experts in Ukraine. Results were presented to stakeholders during a dialogue session to discuss the implications for policy recommendations. The Roma parents interviewed faced structural barriers to vaccine access, while other groups received vaccine information from others in their communities, such as family members or religious organisations. Mistrust of the health system and lack of access to reliable information preceded many doubts parents expressed surrounding vaccines. Stakeholders agreed that better, more targeted communication strategies are needed, as well as increased engagement with and training of medical practitioners. Qualitative methods allowed for a deeper, more nuanced understanding of the factors contributing to low vaccine uptake, of which vaccine hesitancy is only one part. The vulnerability-informed approach used may have broader applications for community engagement and responding to infectious diseases and crises.

Adoption of Preventive Behaviour Strategies and Public Perceptions About COVID-19 in Singapore

BACKGROUND

The unprecedented severity of coronavirus disease 2019 (COVID-19) constitutes a serious public health concern. However, adoption of COVID-19-related preventive behaviours remain relatively unknown. This study investigated predictors of preventive behaviours.

METHODS

An analytical sample of 897 Singaporean adults who were quota sampled based on age, gender, and ethnicity were recruited through a web-enabled survey. Outcomes were adoption of, or increased frequency of preventive behaviours (avoiding social events; avoiding public transport; reducing time spent shopping and eating out; wearing a mask in public; avoiding hospitals/clinics; keeping children out of school, washing hands/using sanitisers; keeping surroundings clean; avoiding touching public surfaces; working from/studying at home). Public perceptions regarding COVID-19 (chances of getting COVID-19; perceived likelihood of COVID-19-related intensive care unit (ICU) admission; government trust; self-efficacy; perceived appropriateness of COVID-19 behaviours; response efficacy), anxiety, and demographic characteristics (age; ethnicity; marital status; education; chronic conditions; current living arrangements) were investigated as predictors of preventive behaviours adopted during COVID-19 in binomial and ordered logistic regressions.

RESULTS

Though adoption of preventive behaviours among Singaporeans varied, it was, overall, high, and consistent with government recommendations. Nearly a quarter reported moderate to severe anxiety (General Anxiety Disorder 7-item - GAD-7 scores). Respondents who perceived higher COVID-19 risks, had higher government trust, higher self-efficacy, and perceived that others acted appropriately reported increased adoption/frequency of preventive measures. The strongest indicator of behavioural change was response efficacy. Respondents who were older, highly educated, anxious and married reported higher adoption/frequency of preventive measures.

CONCLUSION

To successfully influence appropriate preventive behaviours, public health messages should highlight response efficacy, increase self-efficacy, and promote trust in governmental response. Focus should be on demographic segments with low adoptions, such as younger individuals and those with low education.

'We thank you for your sacrifice': Clinical vulnerability, shielding and biosociality in the UK's Covid-19 response

The UK response to Covid-19 has been unusually complex in its ever-shifting classifications of clinical vulnerability. By May 2020, 2.2 million people had been identified as 'clinically extremely vulnerable' (CEV) and were asked to 'shield' at home for over four months. To adhere to this strict guidance, they were enfolded within the patchy infrastructure of the 'shielding programme'. However, membership of the 'shielded list' has changed-often without warning or explanation-through time and across space. Drawing on policy and evidentiary documents, government speeches, reports, press conferences and media analysis of Covid-19 coverage between March 2020 and April 1, 2021, this paper traces the shifting delineations of clinical vulnerability in the UK response across three lockdowns. It argues that the complexities and confusions generated by the transience of the CEV category have fed into forms of biosociality that have been as much about making practical sense of government guidance as a form of mutual support amid crisis. This uncertainty has not eased as restrictions have been relaxed and vaccines rolled out. Instead, tracing individual immune response has become a burgeoning industry as 'the shielded' navigate the uneasy demands of taking 'personal responsibility' rather than being protected by 'the rules'.

Epidemics and pandemics risk governance: a case of post-COVID-19 in the United Kingdom

COVID-19 made significant health, economic, and social impact across the world. The situation urgently needs to strengthen disaster risk reduction strategies to reduce risks and enhance resilience. Nevertheless, many instances have evidenced disaster risk governance–related issues. This study examined the United Kingdom's present disaster risk governance system since the country has been hit significantly by the pandemic. The study evaluates the risk governance system in the United Kingdom across the key elements of the International Risk Governance Framework. The study conducted a systematic literature review following a literature review protocol. Documents were selected from the Science Direct, Emerald, and Google Scholar databases. Across the framework elements, several challenges were found within the UK's pandemic risk governance system. The study highlights the strength of the well-developed legal and policy supported the country's risk governance system. Even though the study was conducted at the early stage of the pandemic, the early findings will benefit policymakers and practitioners shaping the pandemic risk governance system in the country for a resilient society.

Community engagement and vulnerability in infectious diseases: A systematic review and qualitative analysis of the literature

The global response to infectious diseases has seen a renewed interest in the use of community engagement to support research and relief efforts. From a perspective rooted in the social sciences, the concept of vulnerability offers an especially useful analytical frame for pursuing community engagement in a variety of contexts. However, few have closely examined the concept of vulnerability in community engagement efforts, leading to a need to better understand the various theories that underline the connections between the two. This literature review searched four databases (covering a total of 537 papers), resulting in 15 studies that analyze community engagement using a framing of vulnerability, broadly defined, in the context of an infectious disease, prioritizing historical and structural context and the many ways of constituting communities. The review identified historical and structural factors such as trust in the health system, history of political marginalization, various forms of racism and discrimination, and other aspects of vulnerability that are part and parcel of the main challenges faced by communities. The review found that studies using vulnerability within community engagement share some important characteristics (e.g., focus on local history and structural factors) and identified a few theoretical avenues from the social sciences which integrate a vulnerability-informed approach in community engagement. Finally, the review proposes an approach that brings together the concepts of vulnerability and community engagement, prioritizing participation, empowerment, and intersectoral collaboration.

Emotional well-being in COVID-19 mass quarantine: the role of personal response and life activity: a 14-day diary study in China

OBJECTIVES

This study aims to explore quarantined individuals' emotional well-being over time and how personal response and life activity predict emotional well-being and its change.

DESIGN/METHODS

Daily data were collected from 134 participants with 71 having 14 consecutive days' data. Hierarchical linear modeling (HLM) and General Linear Model (GLM) were used to examine the primary tests.

RESULTS

Overall, positive and negative emotions declined significantly during the surveyed period. Meanwhile, differences were observed in the level of positive, depressed, and negative emotions and/or patterns of change among different population categories. The personal response of worrying about work and life was positively related to depressed and negative emotions at baseline, but was negatively related to the development of both depressed and negative emotions over time. Among life activities, family stressor was a significant predictor for both depressed and negative emotions while social support predicted positive emotions. Moreover, health & hygiene activity was positively related to positive emotions at baseline.

CONCLUSIONS

The results provide scientific evidence for public health policymakers on quarantine policies and inform the general public about quarantine life. They highlight the importance of addressing the needs of vulnerable groups (parents with young children, divorcees, clinicians) during the pandemic, and demonstrate the benefits of promoting healthcare and hygiene activity, having a sense of worry and access to social support.

Community engagement for outbreak preparedness and response in high-income settings: A systematic review

BACKGROUND

This review aims to (i) identify and critique existing methods of community engagement for outbreak preparedness and response in high-income settings, and (ii) understand community members' experiences of community engagement, and their views and concerns towards pandemic planning/response.

METHODS

Following the PRISMA guidelines, a systematic review was conducted by searching Medline, Embase, PubMed, Global Health, CINAHL Plus and Scopus for publications from 2004 to June 2019. Potential literature was screened using explicit inclusion and exclusion criteria. Included studies were appraised using the Critical Appraisal Skills Programme Qualitative Research checklist. Those using deliberative approaches were appraised using additional criteria for judging deliberation quality. Thematic synthesis was then conducted.

RESULTS

Primary studies employed participatory research approaches, deliberative forums, interviews/focus groups to engage community members on pandemic planning/response with varying degrees of involvement and methodological rigour. This review indicates such endeavours must take into account instrumental and relational considerations: socioeconomic pressures; agency and capacity; diversity and divergent views; educate, communicate and engage; trust and transparency.

CONCLUSION

Community engagement for pandemic planning/response requires clear methods, processes and who 'community' constitutes. Instrumental and relational considerations must be addressed concurrently in pandemic planning/response to enhance preparedness for public health emergencies.

Community Disaster Resilience in the COVID-19 Outbreak: Insights from Shanghai's Experience in China

Purpose

Communities are central to the practice of public health emergency preparedness and response. This article mainly focuses on COVID-19 and discusses the formation and structure of community disaster resilience, which is an effective method for coping with such a public health emergency.

Methods

Based on the management of the COVID-19 outbreak in China, this article uses Shanghai's experience to illustrate how a community disaster resilience was formed for risk management. Resorting to the analytical framework of risk city, principles of community disaster resilience are given.

Results

Four actions can be recommended based on Shanghai's experience: 1) Applying a vulnerability analysis matrix for targeted risk governance, 2) empowering volunteer groups for emergency response, 3) policy and action for public health emergency prevention, and 4) risk communication for uncertainty-oriented planning.

Conclusion

Shanghai's experience offers a reference to tackle the COVID-19 at the global level. The COVID-19 outbreak highlights that humans still face various unpredictable health risks in the future. Forming a connection-based resilience at the community level is an effective way to risk management.

Rethinking the COVID-19 Pandemic: Back to Public Health

The COVID-19 pandemic has highlighted vast differences across countries in their responses to the emergency and their capacities to implement public health measures that could slow the progression of the disease. As public health systems are the first line of defense during pandemics, it has become clear that sustained investment in strengthening public health infrastructure is a major need in all countries, irrespective of income levels. Drawing on the successful experiences of Switzerland, Georgia, and New Zealand in dealing with COVID-19, we suggest prioritizing core public health capacities with links to the International Health Regulations, improving international cooperation, coordination, and multisectoral action, addressing health inequities by targeting vulnerable groups, and enhancing health literacy, including through sophisticated and sustained communication campaigns to build resilience. These measures will ensure that health systems and communities will be better prepared for the disruptions that future disease outbreaks will inevitably bring.

CBT-Informed Interventions for Essential Workers During the COVID-19 Pandemic

Essential workers during the COVID-19 pandemic face heightened levels of anxiety and depression due to increased work demands, lack of adequate personal protective equipment, fear of contracting the virus, and fear of spreading it to loved ones. This is a time of urgent need for mental health support for workers affected by the pandemic crisis. Clinicians may employ empirically supported interventions derived from cognitive behavioral therapy (CBT) and related therapies. Psychological First Aid, an evidence-based crisis intervention, may be utilized to emphasize basic needs and support, but is intended as an acute disaster intervention. Given that a pandemic is an ongoing and prolonged stressor, additional CBT-informed interventions are likely needed to fully support essential workers during these times. It is recommended that clinicians help essential worker clients meet their basic needs by modifying health and sleep habits where possible and helping them advocate for their needs using interpersonal effectiveness skills. Empathic listening, validation of the crisis at hand, and values clarification can aid the therapeutic relationship, help them feel a renewed sense of purpose and meaning in their careers and with their families, and facilitate behavior change consistent with chosen values. Self-monitoring through a daily diary can help clients focus their thoughts and recognize maladaptive patterns in their thoughts and behaviors. In tandem with these techniques, behavioral activation and coping strategies including relaxation, distress tolerance, and acceptance promote engaging in positive and adaptive activities. Finally, therapists can help clients reduce anxiety related to the pandemic by helping them limit information intake.

Uncertainty and Immunity in Public Communications on Pandemics

This chapter examines uncertainty in the expert advice on pandemics given to members of the general public. The chapter draws on research conducted in Australia and Scotland on public engagements with the 2009 influenza (swine flu) pandemic and discusses implications for communications on more recent infectious disease outbreaks, including Ebola and Zika. It shows how public health messages aim to achieve a workable balance of warning and reassurance and deflect problems of trust in experts and science. The chapter considers how uncertainties which prevail in pandemics reinforce the personalization of responses to pandemic risk, in ways that undermine the cooperation and collective action which are also needed to respond effectively to pandemics.

Framing post-pandemic preparedness: Comparing eight European plans

Framing has previously been studied in the field of pandemic preparedness and global health governance and influenza pandemics have usually been framed in terms of security and evidence-based medicine on a global scale. This paper is based on the pandemic preparedness plans, published after 2009, from eight European countries. We study how pandemic preparedness is framed and how pandemic influenza in general is narrated in the plans. All plans contain references to 'uncertainty', 'pandemic phases', 'risk management', 'vulnerability' and 'surveillance'. These themes were all framed differently in the studied plans. The preparedness plans in the member states diverge in ways that will challenge the ambition of the European Union to make the pandemic preparedness plans interoperable and to co-ordinate the member states during future pandemics.

Narrating narcolepsy--centering a side effect

The mass-vaccination with Pandemrix was the most important preventive measure in Sweden during the A(H1N1) influenza pandemic of 2009-2010, and covered 60% of the population. From 2010, an increased incidence of the neurological disease narcolepsy was reported, and an association with Pandemrix was affirmed for more than 200 children and young adults. The parental experience of this side effect provided a starting point for a collectively shaped critical narrative to be acted out in public, but also personalized narratives of continual learning about the disease and its consequences. This didactic functionality resulted in active meaning-making practices about how to handle the aftermath--using dark humor, cognitive tricks, and making themselves and their children's bodies both objects and subjects of knowledge. Using material from interviews with parents, this mixing of knowledge work and political work, and the potential for reflective consciousness, is discussed.

Preparedness as a technology of (in)security: Pandemic influenza planning and the global biopolitics of emerging infectious disease

This article takes as its starting point the idea that re-emerging infectious disease has become a paradigmatic way of thinking about disease. The framing of infectious disease as a threat to global public health and economic security coincides with preemptive forms of control. A particular type of preemptive regulation is global pandemic influenza planning that entails the governing of an imminent, albeit uncertain, global health event. We examine the discourse of 'preparedness' within pandemic planning documents produced by the World Health Organization from 1999 to 2009. We present key findings on: the construction of the influenza virus in terms of its potential to transform and expand across corporeal and territorial boundaries; and the integration of pandemic preparedness into everyday practices. Our analysis illustrates how the discourse of preparedness links the justification for population-level preemptive approaches to discursive constructions of the virus. By articulating this relationship, this article contributes to understandings of the implications of 'molecular' constructions for the biopolitical regulation of the global population.

Beyond resistance: social factors in the general public response to pandemic influenza

Background

Influencing the general public response to pandemics is a public health priority. There is a prevailing view, however, that the general public is resistant to communications on pandemic influenza and that behavioural responses to the 2009/10 H1N1 pandemic were not sufficient. Using qualitative methods, this paper investigates how members of the general public respond to pandemic influenza and the hygiene, social isolation and other measures proposed by public health. Going beyond the commonly deployed notion that the general public is resistant to public health communications, this paper examines how health individualism, gender and real world constraints enable and limit individual action.

Methods

In-depth interviews (n = 57) and focus groups (ten focus groups; 59 individuals) were conducted with community samples in Melbourne, Sydney and Glasgow. Participants were selected according to maximum variation sampling using purposive criteria, including: 1) pregnancy in 2009/2010; 2) chronic illness; 3) aged 70 years and over; 4) no disclosed health problems. Verbatim transcripts were subjected to inductive, thematic analysis.

Results

Respondents did not express resistance to public health communications, but gave insight into how they interpreted and implemented guidance. An individualistic approach to pandemic risk predominated. The uptake of hygiene, social isolation and vaccine strategies was constrained by seeing oneself ‘at risk’ but not ‘a risk’ to others. Gender norms shape how members of the general public enact hygiene and social isolation. Other challenges pertained to over-reliance on perceived remoteness from risk, expectation of recovery from infection and practical constraints on the uptake of vaccination.

Conclusions

Overall, respondents were engaged with public health advice regarding pandemic influenza, indicating that the idea of public resistance has limited explanatory power. Public communications are endorsed, but challenges persist. Individualistic approaches to pandemic risk inhibit acting for the benefit of others and may deepen divisions in the community according to health status. Public communications on pandemics are mediated by gender norms that may overburden women and limit the action of men. Social research on the public response to pandemics needs to focus on the social structures and real world settings and relationships that shape the action of individuals.

Understanding pandemic influenza behaviour: An exploratory biopsychosocial study

Pandemic influenza represents an ongoing public health threat. Understanding the associated behavioural domain is vital for future intervention development. Cross-sectional qualitative research employing purposive sampling employed a combination of one-to-one semi-structured interviews ( n = 57) and focus groups ( n = 59). Data were analysed using (1) inductive thematic analysis and (2) theoretical thematic analysis focusing upon resonance with psychosocial and sociocultural constructs. Two broad themes highlighted an important duality regarding the determinants of pandemic behaviour: (1) psychosocial determinants (e.g. agency, cognitions and identity) and (2) sociocultural determinants (e.g. social context and capacity). These findings suggest this duality should shape future intervention development.