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This chapter presents our research design. First, in recognition of our theory’s emphasis on judicial independence, we select four cases – the United States, Germany, Hungary, and Poland – that vary in their levels of judicial independence but share important political, legal, and socio-economic characteristics. We use surveys of elites and the public to demonstrate that variation in judicial independence is observed by experts and citizens alike. Second, the chapter establishes the crucial role the COVID-19 pandemic plays in our research design. The global pandemic presented a unique and fleeting opportunity to probe citizens’ reactions to rule-of-law violations because it produced real threats to the rule of law in ways that were felt simultaneously and similarly around the world. Third, we discuss the benefits of using survey experiments for a study like ours. Finally, we introduce the four countries in detail, describing their general political characteristics, the institutional characteristics of their constitutional courts, and their handling of the pandemic.
This study explored the enablers and challenges influencing the performance of community health volunteers (CHVs) in Machakos County, Kenya, during the COVID-19 pandemic.
Background:
The COVID-19 pandemic disrupted healthcare systems globally, with particularly severe impacts in developing countries. Community health workers (CHWs) played a critical role in crisis communication, community engagement, case detection, referrals, and maintaining care continuity. However, limited evidence exists on the factors enabling and hindering their performance during the pandemic.
Methods:
This study employed a convergent mixed-methods design, integrating focus group discussions (FGDs), in-depth interviews (IDIs), and structured data extraction from the Kenya Health Information System (KHIS). Analysis of the data was guided by Agarwal et al.’s conceptual framework for measuring community health workforce performance with the quantitative data being analyzed using descriptive statistics, while qualitative data being analyzed through thematic analysis.
Findings:
CHVs effectively disseminated COVID-19 information, addressed vaccine hesitancy, and mobilized communities, supported by training, supervision, and community recognition. Their efforts led to significant improvements in healthcare services, including increased household visits, immunizations, and maternal health referrals. Despite their contributions, CHVs faced challenges such as delayed stipends, limited resources, and occasional community stigma, which hindered performance. Social support networks, community appreciation, and priority healthcare access emerged as key enablers, fostering resilience and motivation. Improved reporting mechanisms also highlighted CHVs’ expanded roles during the pandemic.
Conclusion:
This study underscores the critical role of CHVs in sustaining healthcare services during the COVID-19 pandemic, despite facing financial, logistical, and social barriers. Their resilience and adaptability led to significant improvements in key health services, supported by effective supervision and training. Strengthening systemic support, integrating CHVs into long-term strategies, and enhancing community recognition are essential to maximize their impact in future health challenges.
This article contributes to understanding how inexperience and lack of commitment to evidence-based decision making may undermine an otherwise broadly functional framework for constitutional risk management. As part of a focus on the “Visegrád Four” countries, it also helps understand regional dynamics since the COVID-19 pandemic as the most visible emergency after 1989. The article starts with a brief elucidation of the political contexts that have shaped Slovakia’s constitutional risk management, focusing on the developments from 2020 through early 2025. An analysis of mechanisms of emergency risk management in the constitutional framework follows, that helps identify key state authorities attempting to make decisions under serious time pressures. The implementation of the constitutional framework during the COVID-19 pandemic demonstrates the creation of new avenues for restricting rights and bolstering executive competence, with the formally powerful constitutional review mechanisms struggling to challenge these decisions. Ultimately, political context emerges as key: Slovakia entered the COVID-19 pandemic with a governing coalition enjoying constitutional majority and an aura of reform and hope. The emergency mismanagement not only facilitated the breakup of this coalition and early elections, but also a rise in emergency conspiracies openly hostile to institutions and actors committed to evidence-based decision making.
The impact of the COVID-19 pandemic on psycho-social, economic, and biological factors on depression trajectories are poorly understood. The aim of this study was to determine the association of pandemic-related social and economic risk factors with depression. This baseline survey provides a foundation for the longitudinal panel study to assess the trajectory of psychopathologies and mental health resilience as the societal recovery from this pandemic occurs.
Methods
We telephonically surveyed 2000 randomly selected participants 18 years-and-older, stratified by 2 cosmopolitan cities in the high middle-income former-Soviet country of Kazakhstan. Survey-adjusted Poisson regression analyses produced probable depression (CESD-16) prevalence ratios (PRs) for COVID-19 death and disease, economic duress, and other socio-psychological factors.
Results
Household suspected having-or-diagnosed with COVID-19 with prevalence ratio (PR) = 1.48 (95% CI 1.09-2.02; P = 0·013), friends/coworkers diagnosed with COVD-19 with PR = 1.43 (1.04-1.95; P = 0.026), lost employment PR = 1.80 (1.04-3.11; P = 0.037), and insufficient income for food PR = 1.54 (1.15-2.06; P = 0.004) were independently associated with depression. Having COVID-19 deaths among family/friends or acquaintances/coworkers were not associated with depression, but family stress had a dose-response association, with PR = 13.42 (7.11-25.32; P < 0.001) for very high stress.
Conclusions
The study findings can inform future effective interventions and policies for protecting population mental health during and after extended periods of the pandemics.
The coronavirus disease 2019 (COVID-19) pandemic has impacted global mental health, with individuals with severe mental illness (SMI) being particularly vulnerable. Research on changes in psychiatric symptoms during this pandemic has yielded inconsistent results, often due to individual heterogeneity and a limited focus on broader outcomes such as psychosocial functioning, societal and personal recovery, and quality of life (QoL). Furthermore, long-term effects remain underexplored. This longitudinal cohort study aimed to assess the COVID-19 pandemic’s impact on mental and psychosocial functioning, QoL, and recovery in individuals with SMI, and to explore individual and treatment characteristics associated with outcome changes.
Methods
Two cohorts were included, involving adults (≥18 years) diagnosed with DSM-5 disorders and experiencing long-term impairments. Participants received care between January 1, 2018 and December 31, 2023. Outcomes included the Health of the Nation Outcome Scales, the Manchester Short Assessment of Quality of Life, and the Individual Recovery Outcomes Counter. Changes were analyzed across five pandemic periods using linear mixed models.
Results
Improvements in mental and psychosocial functioning, QoL, and recovery were observed over time, regardless of the COVID-19 pandemic period. However, progress was slower during the COVID-19 pandemic compared to pre-pandemic levels. No individual or treatment characteristics were significantly linked to changes in outcomes.
Conclusion
The findings suggest that the COVID-19 pandemic had a minimal negative impact on individuals with SMI. This may be due to the marginal negative effects of the pandemic on this population, or the mitigating role of stabilizing factors within the current Dutch care models.
We examine the impact of decentralisation on COVID-19 mortality and various health outcomes. Specifically, we investigate whether decentralised health systems, which facilitated greater regional participation and information sharing, were more effective in saving lives. Our analysis makes three contributions. First, we draw on evidence from several European countries to assess whether the decentralisation of health systems influenced COVID-19 mortality rates. Second, we explore the regional disparities in one of the most decentralised health systems, Spain, to untangle some of the determinants shaping health outcomes. Third, we estimate the regional loss of Quality Adjusted Life Years (QALYs) due to COVID-19 mortality, broken down by the wave of the pandemic. Our findings suggest that coordinated decentralisation played a critical role in saving lives throughout the COVID-19 pandemic.
The COVID-19 pandemic and lockdowns had a significant impact on mental well-being and (mental) healthcare systems globally.
Aims
To describe trends and dynamics of out-patient prescribing of psychotropic medications during the COVID-19 pandemic in The Netherlands.
Method
Dispensed psychotropic medication prescriptions during the COVID-19 pandemic from March 2020 to March 2022 were retrieved from national registry data. Numbers of total and incident dispensed prescriptions and defined daily doses (DDDs) were identified for six medication groups. Overall pandemic-related changes in prescribing trends were analysed using interrupted time-series analyses. Lockdown-related prescribing dynamics were described using monthly risk ratios.
Results
No overall pandemic-related changes in prescribing were detected, except for alcohol addiction medication, for which a pre-pandemic decline in total dispensed prescriptions and DDDs levelled off during the pandemic: +10 prescriptions per week (95% CI 7–11, P ≤ 0.001) and +111 DDDs per week (95% CI 56–165, P = 0.001). Monthly prescribing dynamics showed transient increases in all medication groups during the second and third lockdown periods. There were decreases in dispensed incident antidepressant and opioid addiction medication prescriptions during the first lockdown (average risk ratios: 0.87 and 0.88 respectively), and DDDs of dispensed incident and total attention-deficit hyperactivity disorder medication prescriptions and incident benzodiazepine prescriptions were elevated from the end of the second lockdown (average risk ratios: 1.40, 1.12 and 1.17, respectively).
Conclusions
These findings raise concerns regarding possible over- and under-prescribing during the pandemic. Further understanding of specific factors driving these changes is necessary to help prepare for future mental health(care) challenges.
Internationally, the home is legally protected as a bastion of private life, where one may retreat to and recollect oneself after a day’s work and enjoy family life. With the outbreak of the Covid-19 pandemic, working from home – facilitated by new collaborative information and communications technology (ICT) platforms and tools – became mandatory in several countries. For many, the workplace was brought into the home. This article examines how working from home on a mandatory basis during the pandemic affected employees’ perceptions and practices of privacy, and its implications for the legal understanding of privacy. With Norway as a case, it investigates the measures taken by employees and employers to safeguard privacy during this period. The data collection and method combine an interpretation of legal sources with qualitative interviews. The analysis shows experiences and practices that suggest a blurring of roles and physical spaces, and the adoption of boundary-setting measures to safeguard privacy.
This conversation addresses the impact of artificial intelligence and sustainability aspects on corporate governance. The speakers explore how technological innovation and sustainability concerns will change the way companies and financial institutions are managed, controlled and regulated. By way of background, the discussion considers the past and recent history of crises, including financial crises and the more recent COVID-19 pandemic. Particular attention is given to the field of auditing, investigating the changing role of internal and external audits. This includes a discussion of the role of regulatory authorities and how their practices will be affected by technological change. Further attention is given to artificial intelligence in the context of businesses and company law. As regards digital transformation, five issues are reflected, namely data, decentralisation, diversification, democratisation and disruption.
How do different regime types execute a security response during a pandemic? We interrogate the politics of monopolistic securitization which we argue to have significantly directed and influenced the COVID-19 policy strategies adopted in the ‘democratic’ United Kingdom (UK) and ‘authoritarian’ Thailand. Despite their stark political differences, we contend that the British and Thai states’ parallel resort to monopolistic securitization as an overarching pandemic approach effectively made them ‘functionally similar’ by producing security responses that differed only in magnitude and scale but not in kind. Integrating securitization and democratic standards violations frameworks, we find out that the British and Thai authorities’ monopolistic securitization of COVID-19 initially constrained the intersubjective process required to socially construct the pandemic as a primary existential threat endangering both countries. This significantly diminished their public audiences’ individual/agential and collective/institutional capacity to deliberate the immediate emergency measures they unilaterally deployed, particularly during the pandemic’s early stages. Consequently, whether it was in the UK with a supposedly robust democracy or in Thailand with at best a hybrid regime if not outright authoritarian, the security responses that emerged constituted varying types and degrees of violations within the illiberal-authoritarian spectrum. Nevertheless, as the pandemic progressed, the fundamental deliberative-iterative mechanism underpinning securitization enabled the British and Thai public audiences to gradually reclaim their role and space, allowing them to challenge the appropriateness and legitimacy of the existing emergency measures, thereby weakening the states’ monopolistic control over the process.
Young people with childhood adversity (CA) were at increased risk to experience mental health problems during the COVID-19 pandemic. Pre-pandemic research identified high-quality friendship support as a protective factor that can buffer against the emergence of mental health problems in young people with CA. This longitudinal study investigated friendship buffering effects on mental health symptoms before and at three timepoints during the pandemic in 102 young people (aged 16–26) with low to moderate CA. Multilevel analyses revealed a continuous increase in depression symptoms following the outbreak. Friendship quality was perceived as elevated during lockdowns and returned to pre-pandemic baseline levels during reopening. A stress-sensitizing effect of CA on social functioning was evident, as social thinning occurred following the outbreak. Bivariate latent change score modeling revealed that before and during the pandemic, young people with greater friendship quality self-reported lower depression symptoms and vice versa. Furthermore, sequential mediation analysis showed that high-quality friendships before the pandemic buffered depression symptoms during the pandemic through reducing perceived stress. These findings highlight the importance of fostering stable and supportive friendships in young people with CA and suggest that through reducing stress perceptions high-quality friendships can mitigate mental health problems during times of multidimensional stress.
This article analyses the constitutional framework regulating states of emergency in Poland and addresses key issues related to their interpretation and implementation. The first part discusses the conditions for declaring martial law, a state of an extraordinary situation, and a state of natural disaster, as well as the specific rules for the operation of public authorities in such emergencies. The next part analyses the practice, revealing the consistent reluctance of Polish authorities to invoke states of emergency, even in circumstances that seem to justify such measures. Consequently, a state of emergency under the 1997 Constitution was declared in Poland only once – in 2021, in response to a migration crisis on the border with Belarus. No constitutional emergency was declared during the COVID-19 pandemic, despite the introduction of far-reaching restrictions on individual rights and freedoms. The article argues that state authorities can abuse emergency regulations, either through their unjustified application or by deliberately circumventing them.
The COVID-19 pandemic has presented multifaceted challenges globally, impacting adolescent health. Among these, food security and nutrition are intertwined closely with mental health outcomes. In Indonesia, with its diverse socio-economic landscape, these interconnections may have been exacerbated by the pandemic. This study investigated the relationship between food security, nutrition and adolescent mental health in Indonesia during COVID-19. Longitudinal data were collected from 511 adolescent boys and girls in 2021–2022 in Gunungkidul district, Yogyakarta. Food security was measured using the Household Food Insecurity Access Scale (HFIAS), and the validated Kessler-10 Psychological Distress Scale (K10) was used to measure adolescent depression. Multivariate linear regression and linear mixed-effects regression were employed to explore associations between these variables, while adjusting for sex, age, pubertal status and household income. Overall, food insecurity score was positively associated with depressive symptoms (β: 0·72, 95 % CI 0·52, 0·92), while BMI z-score was inversely associated (β: −0·31, 95 % CI 0·68, −0·03). We found an increase in strength of association between food insecurity and depressive symptoms over time (moderately food-insecure: β: 1·36 (95 % CI −0·10, 2·83) to 4·63 (95 % CI 2·17, 7·09); severely food-insecure: β: 1·89 (95 % CI 0·36, 3·41) to 3·30 (95 % CI 1·50, 5·10). Enhancing food access, improving nutritional status and providing mental health support are crucial components of adolescent health.
Determining whether the incidence of suicidal behavior during the COVID-19 pandemic changed for those with severe mental disorders is essential to ensure the provision of suicide preventive initiatives in the case of future health crises.
Methods
Using population-based registers, quarterly cohorts from the first quarter of 2018 (2018Q1) to 2021Q4 were formed including all Swedish-residents >10 years old. Interrupted time series and generalized estimating equations analyses were used to evaluate changes in Incidence Rates (IR) of specialised healthcare use for suicide attempt and death by suicide per 10 000 person-years for individuals with or without specific severe mental disorders (SMDs) during, compared to before the pandemic.
Results
The IR (95% Confidence interval, CI) of suicide in individuals with SMDs decreased from 16.0 (15.0–17.1) in 2018Q1 to 11.6 (10.8–12.5) in 2020Q1 (i.e. the quarter before the start of the pandemic), after which it dropped further to 6.7 (6.3–7.2) in 2021Q2. In contrast, IRs of suicide attempt in SMDs showed more stable trends, as did the trends regarding suicide and suicide attempt for individuals without SMD. These discrepancies were most evident for individuals with substance use disorder and ASD/ADHD. Changes in IRs of suicide v. suicide attempt for one quarter during the pandemic for substance misuse were 11.2% v. 3.6% respectively. These changes for ASD/ADHD were 10.7% v. 3.6%.
Conclusions
The study shows pronounced decreases in suicide rates in individuals with SMDs during the pandemic. Further studies aiming to understand mechanisms behind these trends are warranted to consult future suicide prevention strategies.
During the global COVID-19 pandemic, many countries have expanded the level and coverage of current social insurance and social assistance programs as well as implemented new programs. Based on three separate datasets, V-Dem V-Party dataset; fourteen structured expert interviews; and a dataset of 114 social security measures, we study the link between the welfare regime, pandemic-related social policy measures, and incumbents’ ideological stand. Does the pandemic-related social policy measures mirror the political attitudes of the incumbents? What role did the welfare regime play? We scrutinise eight OECD countries (Denmark, Finland, Germany, Netherlands, Norway, Sweden, UK, and the US) representing three different welfare regimes: corporatist-conservative countries, liberal countries, and socio-democratic countries. The key findings of this article show that the pandemic-related social policy measures did not mirror the political attitudes of the incumbents.
Trade secrets raise three primary issues. First, if an entity is forced to share trade secrets to expedite development and to expand the supply of needed products, must or should the government compensate the rights holder? Although this chapter addresses this question, it is largely unnecessary to answer it. This is because compensation is not required under international law, and because reasonable compensation should normally be provided for compelled trade secret sharing. Second, does international law prohibit governments from compelling the sharing of trade secrets, including by compulsory licensing? The short answer is no. Third, what authorities currently exist or could be adopted for governments to compel the sharing of trade secrets? The chapter provides general overview of a range of existing authorities, as well as a framework for addressing the latter two questions and for understanding the complexity of the first question.
This chapter identifies three distinct reasons why China took a middle-of-the-road position in the debate on the COVID-19 TRIPS waiver at the WTO. It also recounts the country’s more assertive position in the run-up to the adoption of the Ministerial Decision on the waiver. Drawing eight lessons from the international debate on the waiver and the subsequent Ministerial Decision, the chapter offers insights into the future role China can or will play in future international policy debates at the intersection of intellectual property and public health, including during the next pandemic.
As has been the case outsideAfrica, African countries have experienced multiple consequences from the COVID-19 pandemic that extend beyond its immediate impact on human health. In Africa, much like elsewhere in the world, the pandemic has had a significant economic impact, leading to profound global economic distress. African countries have also experienced consequences that are unlike those of much of the rest of the world. For example, the pandemic has contributed to a sovereign debt crisis that led to sovereign defaults by Zambia in late 2020, Mali in early 2022, and Ghana in late 2022, and might lead to additional defaults. Travel bans and COVID-19 vaccine exclusion are key policies that have also had a particular impact in Africa. These and other COVID-19 policies in African contexts reflect patterns of exclusion that are at least in part a consequence of continuing colonial hangover.
The chapter begins with the genesis of relevant regulatory protections and their general parameters before discussing their prevalence among countries. It then turns to discussion of proposed and actual modification of TRIPS requirements for COVID and how that intersects with these regulatory barriers. The chapter concludes with recommendations.
For many years, some lawmakers, scholars, and activists have argued that firms located in each developing country (or each regional set of developing countries) should produce more of the drugs that the residents there need. They contend that local production would benefit the residents of those countries in two ways. The chapter first discusses some recent developments that have altered the relative strength of these competing considerations, sharply increasing the likelihood that fostering local production in developing countries would be socially beneficial.It then proposes five legal reforms and economic initiatives that could help build local pharmaceutical production capacity and thereby save lives.