Belgian Case Research Articles

Disruptive accountability? Temporal regimes and social change in decolonization struggles in Belgium

AbstractTo address the legacies of colonialism, several former colonial states have implemented a range of initiatives commonly considered to belong to the domain of transitional justice (TJ). These contexts are, however, very different from those for which TJ was initially conceptualized. As such, the implementation of elements from the TJ toolbox in these decolonization struggles raises several questions, which this article seeks to address. One of these questions relates to how diverging temporalities affect central normative objectives of TJ, such as accountability. The Belgian case is used to explore how a more pertinent approach to transitional temporalities enables a ‘thicker’ understanding of accountability that re‐centres the debate around accountability's normative objectives in ways that are aligned with the objectives of decolonization struggles. I call this encompassing approach to accountability ‘disruptive accountability’ to underline the normative objective of disrupting harmful social structures and relations.

VACCINE MANDATES, DENIALISM AND FREEDOM OF CONSCIENCE AND THOUGHT: EXAMPLES FROM BELGIUM AND BOTSWANA

Vaccine mandates and vaccine denialism appear to be in stark opposition, but closer analysis will reveal that those who propagate both such ideals are rigid. Public buy-in on matters of public health is an important precondition for healthy social environments inasmuch as informed consent is important to individual autonomy, freedom of conscience and democracy. Botswanan case law provides an example of how vaccine denialism can lead to fatal consequences in the face of religious extremism, while Belgian case law provides an example of how vaccine mandates and their accompanying modalities may be held to be unlawful and discriminatory. Both freedom of conscience and administrative action are subject to the rule of law and every norm that is imposed on the population must be accompanied by liability for those propagating such norms if harm is the result. As South Africa has grappled with whether or not it should make vaccination mandatory, lessons have been noted and recommendations made – in line with the Constitution as the supreme law in the land. (Section 2 of the Constitution of the Republic of South Africa, 1996 affirms the supremacy of the Constitution.)

К вопросу о дискурсивных параметрах типологизации политических партий

The newest trends in the development of political parties and their ideologies have caused the emergence of a set of new concepts, such as catch-all parties, electoral-professional parties, cartel parties, firm parties, and parties in power. These concepts are focused on the functions a party performs, and not on the discursive considerations, so, they do not encompass the entire spectrum. For instance, populist and regionalist parties are hard to localize in the given models. On the other hand, such discursive concepts as “niche” parties or “horseshoe” spectrum, as well as the widespread Hans Eysenck’s “political compass”, suggest their own ways to typologize party phenomena. They complement each other but do not form a coherent matrix integrating all the significant elements of party discourses. Intentionally leaving structural-functionalist classifications aside, the authors propose to synthesize the established discursive typologies with some newly-emerged parameters and to localize party actors along such axes as economic agenda (conventionally, right or left), political agenda (conventionally, right or left), the scope of discourse (from “niche” to “catch-all”) and the salience of identity aspects. The latter should be combined with the indication of the loyalty level: ethnic/regional, national, or civilizational. The scope of discourse is found as a result of thematic analysis of party programs/manifestos and the identification of the presence and quantity of significant thematic blocs: economy, security/internal affairs, foreign affairs, education/culture, values/rights. The final matrix is illustrated in the example of the Belgian party system based on expert scaling. The Belgian case is chosen because the Belgian party system contains the entire ideological spectrum inherent in Western Europe and is relatively stable. While proposing the employment of qualitative methods, such as thematic analysis, Critical Discourse Analysis (CDA) and expert scaling, the authors think that it is possible and desirable to further develop the parameters by applying quantitative methods.

Exploring alternative financing models and early access schemes for orphan drugs: a Belgian case study.

Although some jurisdictions have implemented particular adjustments to accommodate often-expensive orphan drugs in their healthcare systems, availability of these drugs remains complex. This study investigates alternative financing models and early access schemes for orphan drugs in the context of the Belgian healthcare system. Three focus group discussions were held with a panel of eleven experts from the Belgian Drug Reimbursement Committee, the Colleges for Orphan Drugs, the pharmaceutical industry, physicians, ethicists and pharmacists. Retrieved data were pseudonymised, analysed and coded according to the Qualitative Analysis Guide of Leuven. Experts disfavoured the insulated fund as well as private insurance for financing orphan drugs, as, respectively, isolation of a separate budget and a mostly profit-driven mechanism would contradict the Belgian fundamental principle of solidarity. Moreover, an insulated fund could, albeit on a smaller scale, reproduce the same budgetary constraints as the general reimbursement system. As the Special Solidarity Fund is intended for urgent care and exclusively accommodates financial needs subject to eligibility criteria, its design would not allow general financing of orphan drugs. Overall, implementation of an alternative financing model was not endorsed, instead, improving the current reimbursement system was preferred. Suggestions mentioned were; increased collaboration and transparency, robust and quality real-world evidence but also digitalization of data. Alleviating administrative burden and simplifying the admission process of compassionate use program, medical need program and early treatment reimbursement should be prioritized to facilitate early access. Furthermore, a legal framework for off-label use could stimulate proper implementation. Efforts on collaboration of expertise centres and coordination of orphan drug databases across Europe could foster a robust data network to support orphan drug availability in individual countries. This research reveals that reassessing current financing models and early access schemes by eliminating inadequacies, may be more conducive than establishing alternative systems to increase availability of orphan drugs in Belgium. Other jurisdictions may rely on this information to review their own models of early access and financing to cultivate a more sustainable delivery of orphan drugs.

HPR102 Exploring Alternative Financing Models and Early Access Schemes for Orphan Drugs: A Belgian Case Study

HPR102 Exploring Alternative Financing Models and Early Access Schemes for Orphan Drugs: A Belgian Case Study

Responsibility or Responsibilization in Medical Evidencing of Domestic Violence? The Belgian Case Analyzed Through a Care Ethical Lens.

The prosecution of domestic violence remains a complex process within criminal policy in Belgium. Evidence is often reliant on medical certificates or injury reports, necessary for victims who want to file official complaints. However, medical evidencing is a contentious issue. Based on qualitative research among public prosecutors, victims, and general practitioners in Belgium, this study analyses the challenges these groups face through an ethics of care lens. Despite their crucial importance in legal procedures, the use of certificates is surrounded by contradictions. The issues point to an unequal distribution of responsibilities, which masks institutional and political responsibilities and enhances the responsibilization of victims.

‘Captains of industry’ of the metropolitan nexus: private mass housing development in twentieth-century Belgium

ABSTRACT This paper focusses on the production of the two major commercial residential developers, Jean-Florian Collin (Etrimo) and François Amelinckx (Amelinckx N.V.), who constructed over 70,000 apartments in the metropolitan agglomerations of Belgium between 1924 and 1985. Their short-lived, but large-scale, production defines an ‘invisible city’ of which we know very little but can be used to analyse key aspects of the process of twentieth-century metropolization in Belgium. Both developers were ‘champions of a game of their creation’, as they applied precise strategies in constructing specific circumstances that seized the latent potential of development (that hovered over the capitalist metropolitan landscape) into concrete, often opportunistically defined, built commodities. By applying a production perspective on planning history, it is possible to look at the processes of metropolitan expansion and twentieth-century planning in Belgium from a different angle, starting from the actual built reality and the ‘captains of industry’ 1 1 Dixon, “Retrospectives, Captains of Industry”. that this urban reality was grounded upon. A perspective which has been little-applied in the Belgian case, and is particularly pertinent for interpreting development patterns in a context like Belgium that lacks a strong planning culture and is historically compromised the absence of an emancipated scene of developers ready to take on the urban agenda.

At the Intersection of Faith, Allegiances Toward the State, and Economic Deprivation: The Case of the Christian Democratic Unions in 19th Century Western Europe

Why were Christian democratic unions (CDUs) among workers and farmers more proactive in some Western European states than in others? Marxist theories explain union activity by industrialization. However, CDUs were not the most active in the late 19th century in rapidly industrializing states, e.g., Italy and Germany. Using social identity theory and Lipset’s & Rokkan’s cleavage theory, this paper conducts process tracing on the German, French, Italian, Dutch, and Belgian cases to test the following argument: CDUs were more likely to develop in states where anticlerical attacks unleashed a center-periphery conflict. CDUs are less likely to expand in states where anticlerical attacks precipitated a church-state conflict. The presence of a Catholic minority moderated this relationship. In the Protestant-dominant states, Catholicism allowed for mobilizing individuals and maintaining cohesion. The Lutheran states’ hostility toward Catholic activism and the regional concentration of the minority accentuated this denominational difference, which catalyzed CDU development.

Negotiating Post-Colonial Legacies: Conflicting Justice Notions in the Belgian Case

Abstract Do parties handle conflicting justice notions when they negotiate about the legacy of a colonial past? This question is at the core of an increasing number of judicial and non-judicial processes around the world. In settler-colonial societies, this debate is far from new. The objective of this article is neither to consider the general debate about reparations nor to study theoretically how communities can digest “a past that is hard to swallow.” It is to detect the conflicting justice notions mobilized in the negotiation process when seeking to come to an agreement or other kind of conclusion to the process. Do the parties explicitly refer to these conflicting justice notions or do they avoid them? To address this question, the article focuses on one in-depth empirical case study, namely the Belgian case.

Integration of Chronic Care in a Fragmented Healthcare System Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study".

The authors of "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study" present a fresh perspective on the inertia of integrated care (IC) implementation. They conclude that the decisive power in Belgium is fragmented and undermines efforts towards IC. As researchers in integrated heart failure (HF) care and active primary healthcare professionals, we comment on the three policy initiatives evaluated by Martens et al from a bottom-up perspective. A Learning Healthcare Network (LHCN) was established September 2019 to overcome fragmentation, the lack of evaluation and capacity loss each time a pilot project ends. This commentary wishes to illustrate that a LHCN can be a powerful meso-level mechanism to engage in alignment work and to overcome macro-level barriers that are often difficult to change and not supportive of IC.

Integration of Healthcare in Belgium: Insufficient, but There Is Hope Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study".

The maturity of integrated care in Belgium is rather low. The reasons are the country's complex organization, a lack of leadership and finances, an abundance of pilot projects, very long implementation and change processes, a healthcare system driven by providers and different cultures of action. However, new projects and ongoing research can help overcome these barriers. The primary care zones in Flanders, the National Hospital Plan and the Federal Plan to support mental health in particular are luxating opportunities. Well planned research is urgently needed to confirm the hope these projects arouse.

Policy by Pilot? Learning From Demonstration Projects for Integrated Care Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study".

Analysis of policy implementation for chronic disease in Belgium highlights the difficulties of launching experiments for integrated care in a health system with fragmented governance. It also entreats us to consider the inherent challenges of piloting integrated care for chronic disease. Sociomedical characteristics of chronic disease -political, social, and economic aspects of improving outcomes - pose distinct problems for pilot projects, particularly because addressing health inequity requires collaboration across health and social sectors and a long-term, life-course perspective on health. Drawing on recent US experience with demonstration projects for health service delivery reform and on chronic disease research, I discuss constraints of and lessons from pilot projects. The policy learning from pilots lies beyond their technical evaluative yield. Pilot projects can evince political and social challenges to achieving integrated chronic disease care, and can illuminate overlooked perspectives, such as those of community-based organizations (CBOs), thereby potentially extending the terms of policy debate.

Biological site suitability for exposed self-regulating cultivation of blue mussel (Mytilus edulis): A Belgian case study

Several reasons, from stakeholder conflicts to water quality issues, are pushing bivalve cultivation to less accessible, exposed, and offshore waters. Because sheltered areas are absent along the Belgian coastline, the possibility to culture mussels with self-regulated systems in exposed conditions has been explored by various research projects. Farmers consider offshore environments unsuitable on the assumption that spat densities are low, and growth is insufficient for commercialization.This study evaluates the potential for self-regulated mussel cultivation in an exposed North Sea environment based on data collected from several research projects that evaluated the biological and technical feasibility of commercial longline cultivation in Belgium. The cultivation methods were variable, but always relied on wild spat that was grown to market size. No husbandry practices such as seed harvesting, thinning, grading, or socking were performed. This cultivation technique, also called self-regulating cultivation, reduces operational costs when extreme weather and exposed conditions limit handling.A 3D hydro-dynamic larvae dispersal model (LDM) was used to simulate the spatial variability in arrivals and the timing of the arrival peak. In addition, a locally validated metabolic model (DEB) for the blue mussel (M. edulis) was forced with 10 year optimized remote sensing observations (Copernicus, Sentinel-3/OLCI) to predict industry-relevant information such as site suitability, inter-annual growth variability, and cultivation time.This study concludes that exposed mussel cultivation near the Belgian east coast is characterised by fast growth. Mussels grown in this area will reach a marketable size (6 cm) after 12–15 months of cultivation, which is just in time for the peak consumption season (July-August). Moving offshore prolongs the cultivation cycles to 17–25 months, but provides more stable growth conditions with less inter-annual variability. When considering a cultivation period of 12 months, the mussels originating from offshore cultivation are comparable in size to the smaller Dutch “Smitse” and French "Bouchots".

Joris Vandendriessche and Benoît Majerus (eds), Medical Histories of Belgium. New Narratives on Health, Care and Citizenship in the Nineteenth and Twentieth Centuries

This interesting book’s aim is to go beyond the relation between ‘the’ medical profession and ‘the’ state and to explore a variety of themes such as gender, religion, disability, media and colonialism and a variety of actors, doctors but also, for example, religious sisters and lay helpers, alternative healers, architects and patients in Belgium. The timeframe is broadly the beginning of the nineteenth century up to very recent developments. The editors emphasise their ambition to enrich the European historiography of medicine by adding a detailed exploration of the Belgian case. The editors rightly state that the broadening of actors and themes has led to some fragmentation. The three thematic parts ‘Beyond the Nation State’, ‘Institutions and Beyond’ and ‘Beyond Physicians’ ‘serve as idealistic exhortations to produce new histories’ (p.16). Even in original and well-researched chapters, authors point to the fact that Belgian medical historical research has lagged behind. The book...

Belgium's Healthcare System: The Way Forward to Address the Challenges of the 21st Century Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study".

In this paper we have tried, starting from the results of an analysis of the functioning of integrated care in the Belgian Health System by Martens et al, to design a strategy that could contribute to better addressing the challenges of the 21st century in Belgium. We proposed health system changes at the macro-, meso- and micro-level. We focused on health policy development and organization of care, emphasizing the importance of a shift from a hospital-centric towards a primary care based approach. Special attention was paid to the need for institutional reforms, in order to facilitate the further development of interprofessional integrated care, that focuses on the achievement of the life-goals of a person.

Overcoming Political Fragmentation: The Potential of Meso-Level Mechanisms Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study".

Martens and colleagues' paper "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study," offers an in-depth examination of integrated care policy efforts in Belgium. A key finding in this case study was that political fragmentation proved too great an obstacle for integration efforts. In this commentary, I draw on the organizational behaviour and integrated care literatures to suggest how meso-level mechanisms related to sensemaking, distributive leadership, and evaluation could help overcome policy (or macro) level challenges like those experienced in Belgium. The commentary also suggests we need to consider and address both the process and normative challenges in these transformation efforts.

Governance and Corruption in Arm’s Length Public Institutions: Two Belgian Case Studies

Recent major corruption cases in Belgium center around arm’s length public institutions. Is there is a specific relationship between governance mechanisms and corruption in such institutions that weakens their accountability? To answer this question, the principal-agent framework was applied to two Belgian case studies. This study supports the hypothesis that New Public Management reforms, such as decentralization and diminishing state intervention have rendered the character of corruption more sophisticated. The study also shows how failures in governance mechanisms led to corruption, but more importantly how corruption, both by the agent and by the principal, contributed to that failure in the first place. Consociationalism and partitocracy, characteristic of the Belgian political system, are important contextual elements that help explain this relationship between governance and corruption, and suggest that the observed corruption is probably not exceptional. To better prevent corruption in arm’s length public institutions, the focus should be on strengthening the independence and expertise of members in governance structures, ensuring the independence of the audit and regulatory functions, and investing the limited means available to fight corruption in the principal-agent relationship rather than in the agent-client relationship.

Fostering the Political Participation of EU Non-national Citizens: The Case of Brussels

Political participation is considered an essential feature of democracy. The European Union (EU) aimed to foster political participation with the introduction of European citizenship, which gives the right to vote and stand as a candidate in municipal and European Parliament elections in whichever EU country the citizen resides. However, from the few figures available, registration and turnout rates among mobile EU citizens seem very low. In this article, we investigate the effectiveness of a proactive campaign in order to promote the participation of European non-national residents in municipal elections by focusing on a specific initiative: the VoteBrussels Campaign. Focusing on Brussels, and in the general on the Belgian case, offers us the opportunity to carry out a quasi-experimental design. Our findings suggest that a mobilisation campaign has a positive regionwide effect on the participation of mobile EU citizens.

WGS- versus ORF5-Based Typing of PRRSV: A Belgian Case Study.

Porcine reproductive and respiratory syndrome virus (PRRSV) is the causative agent of one of the most widespread and economically devastating diseases in the swine industry. Typing circulating PRRSV strains by means of sequencing is crucial for developing adequate control strategies. Most genetic studies only target the highly variable open reading frame (ORF) 5, for which an extensive database is available. In this study, we performed whole-genome sequencing (WGS) on a collection of 124 PRRSV-1 positive serum samples that were collected over a 5-year period (2015–2019) in Belgium. Our results show that (nearly) complete PRRSV genomes can be obtained directly from serum samples with a high success rate. Analysis of the coding regions confirmed the exceptionally high genetic diversity, even among Belgian PRRSV-1 strains. To gain more insight into the added value of WGS, we performed phylogenetic cluster analyses on separate ORF datasets as well as on a single, concatenated dataset (CDS) containing all ORFs. A comparison between the CDS and ORF clustering schemes revealed numerous discrepancies. To explain these differences, we performed a large-scale recombination analysis, which allowed us to identify a large number of potential recombination events that were scattered across the genome. As PRRSV does not contain typical recombination hot-spots, typing PRRSV strains based on a single ORF is not recommended. Although the typing accuracy can be improved by including multiple regions, our results show that the full genetic diversity among PRRSV strains can only be captured by analysing (nearly) complete genomes. Finally, we also identified several vaccine-derived recombinant strains, which once more raises the question of the safety of these vaccines.

Out of family, into history: A comparative study of the superchild in Corriere dei Piccoli, TBO and The Adventures of Tintin

Through the sagacious insights of Jean-Marie Apostolidès about Hergé’s well-known character Tintin, this article gathers a comparative investigation on the relationship between the child and the absence of family. More specifically, we address the figure defined by Apostolidès as ‘superchild’ through a comparison between the publications Corriere dei Piccoli (CdP), in Italy, TBO, in Spain and, in the Belgian case, of the figure that motivated the term used by Apostolidès, Tintin. The article forms a comparative comics exercise from a hermeneutical-historical, narratological methodology linked to the figural study of images (; ), in order to underline some of the singularities of the bond between the superchild and the absent family.