Cross-border Health Threats Research Articles

2.Y.2. International Health Regulations – role on disease control and global challenges

Abstract The International Health Regulations (IHR) are a legal instrument aimed to control infectious disease epidemics worldwide and that makes countries accountable for monitoring and promptly notifying the World Health Organization (WHO) of events that are likely to represent a public health emergency. The 196 signatory countries are bound by this international agreement. This workshop aims to present evidence on the role and updates of the IHR as a framework for global health preparedness. It will do that by exploring the main components of the IHR and their practical implications for public health practice, with particular emphasis on their function in preventing, detecting, and responding to cross-border public health threats. The workshop will feature four short presentations, in a total of 15 minutes, beginning with three presentations showcasing the findings of literature reviews covering various aspects of the IHR. These topics include the main challenges to implementation, the effectiveness of the IHR during the COVID-19 pandemic, its relevance to travel medicine and zoonosis prevention, and strategies for controlling vector-borne diseases. The last presentation will delve into the challenges and opportunities associated with implementing the IHR at both national and international levels, in the context of the proposals from the Working Group on Amendments to the International Health Regulations (2005). Throughout the workshop, emphasis will be placed on understanding how the IHR facilitate collaboration and coordination among countries during health emergencies, as well as the importance of capacity-building, information sharing, and multisectoral collaboration. This structure will allow for discussion aimed at areas for improvement to the IHR, especially in the context of its revision process and global health governance. We believe the added value of this workshop will be creating a platform for critical analysis and dialogue, sharing insights into the evolution of the IHR, ongoing debates, controversies, and emerging trends in global health regulations. Key messages • This workshop provides a platform for in-depth exploration of the IHR’s role in global health preparedness, offering evidence on its components and practical implications. • Through analysis of challenges and discussions on disease control, attendees will engage in critical dialogue aimed at improving the IHR and enhancing global health governance.

Integrated sentinel surveillance of influenza, SARS-CoV-2, RSV and respiratory viruses in Serbia

Abstract Introduction Integrated sentinel SARI surveillance of influenza, SARS -CoV-2 and RSV has been established in Serbia since 2021-2022 influenza season. Nine sentinel hospitals in 3 cities participated in the SARI surveillance system. The aim of this study is to provide a review of integrated sentinel surveillance of SARI in Serbia in 2023-2024 influenza season, from October 2023 to April 2024. Methods On a weekly basis, both epidemiological and virological data were collected. Surveillance is be conducted year-round. Specimens were tested for influenza, SARS-CoV-2,RSV and other respiratory viruses. Respiratory disease wards, intensive care units (ICUs) and pediatric wards were all represented. Real time polymerase chain reaction (RT-PCR) was used. Results From October 2023 to April 2024, a total of 1571 SARI cases were reported with 100% recorded age. Of these, 35% were 0-4 years old, 16% were 5-14, 6% were 15-29, 14% were 30-64, 18% were 65-79 and 11% were 80+. Among these cases, 1002 (64%) respiratory specimens were collected. The number of positive samples for influenza was 294 (29%). The positivity rate was 10% for SARS-CoV-2 and 19 % for RSV. The highest proportion of laboratory-confirmed influenza cases was 67% in week 04/2023. Then above 50% in week 05/2023 and 06/2023. Type A viruses was predominated, accounting for 97% of all influenza SARI detections. Activity was dominated by A(H3) with 42% positivity rate. Also, collected swabs were tested for rhinoviruses, positivity rate was 26%, for adenoviruses, 12%, for human metapneumovirus, 7% and for parainfluenza 3 viruses, 4%. Conclusions Sustaining and intensified effective integrated surveillance for influenza, SARS-CoV-2,RSV and other respiratory viruses in Serbia is the priority especially in the frame of International Health Regulations. In this way, we improve national capacity for preparedness and emergency response to national and cross-border public health threats. Key messages • Building and maintaining integrated respiratory surveillance that can rapidly integrate the surveillance of a new viruses is crucial. • Establishing well structured surveillance of severe acute respiratory infections, strengthening and expanding respiratory viral surveillance is one the base pillars preparation for future pandemics.

Enhancing port preparedness in Germany in the event of infectious diseases – a best practice study

Abstract Background The maritime sector is exposed to specific risks in the area of communicable diseases. In Germany, five ports are designated to enforce the International Health Regulations (IHR) and must have certain core capacities to respond immediately to cross-border health threats. A joint external evaluation conducted by the World Health Organization (WHO) revealed a need to reinforce central structures in Germany. The overarching objective of the study is to harmonize and consolidate the requisite capacities for maritime health security. Methods Qualitative interviews (n = 35) at baseline were conducted with various stakeholders, including port medical services, port authorities and other stakeholders. The parameters to be analysed included specific activities and interfaces during infectious incidents, experience with past infection incidents, training and exercise, and the need for action. Furthermore, a document analysis was conducted, during which the existing contingency plans and standard operating procedures were reviewed. Results In essence, the initial challenges posed by the COVID-19 pandemic have led to the establishment of well-defined procedures and interfaces between the various stakeholders involved. There is a necessity for enhanced interpersonal communication between the various stakeholders and the implementation of sustainable training practices. Furthermore, greater transparency and standardisation of regulations in international health emergencies is desired. Conclusions Given the infrequency of cross-border infection incidents on board ships, targeted preparation within stakeholders is often given a lower priority than other work priorities. The participatory study design is intended to develop comprehensive concepts in collaboration with the IHR ports in the ongoing project. Subsequently, these concepts will be tested in tabletop exercises and incorporated into training formats for public health actors. Key messages • The qualitative interview study at baseline revealed a substantial need for sustained communication and training practices among stakeholders for infectious disease preparedness in German IHR ports. • The document analysis revealed relevant differences in the extent and scope of contingency plans of German ports designated under the International Health Regulations.

A Framework for Studying EU Health Policy through a Political Determinants of Health Lens: The Case of the European Health Union

Context: The COVID-19 pandemic has highlighted how the European Union (EU) impacts national health systems and people's health. In November 2020, the European Commission launched the European Health Union (EHU) to better coordinate and maximize EU member states’ abilities to deal with cross-border health threats. This article scrutinizes the early institutionalization of the EHU and its implications for EU health policy as a political determinant of health (PDoH). Methods: The article explores how EU health policy may be appreciated from a PDoH perspective. It draws from EU documents and existing research to analyze the early-stage institutionalization of the EHU. The study complements this policy output–focused perspective with an outcome-based exploratory assessment of EU health policy as a PDoH focusing on three examples: joint vaccine procurement, health reforms and investments under the Recovery and Resilience Facility, and the development of a European Health Data Space. Findings: The article shows that the policy change triggered by the EHU and the potential impact on citizens’ health are not necessarily congruent. Modest change can have a potentially strong impact on health outcomes and vice versa. Conclusions: The article argues that the PDoH perspective provides a useful approach that is complementary to policy output–based perspectives, allowing for a more comprehensive assessment of the EU's role in health.

Mapping of surveillance systems for health crisis preparedness and response in Member States

Abstract The Health Emergency Preparedness and Response Authority (HERA) was established by the European Commission in the aftermath of the COVID-19 pandemic to improve EU preparedness and response to cross-border health threats. The HERA IT platform for intelligence gathering and threat assessment is being developed to support HERA's activities through collection of data from relevant sources at European and national level. In this regard the EU-HIP project is collaborating with HERA to map surveillance systems for health crisis preparedness and response in different European countries, focusing on how to ensure interoperability between these systems and HERA's IT platform for intelligence gathering and threat assessment. The methodology to be used will be based on best practice from previous assessments, incorporating assessment indicators relevant to health emergency preparedness and data flows. During the presentation, initial results from the first countries analyzed will be presented, covering the identified digital infrastructures and systems, stakeholder networks and pertinent legislative aspects for threat assessment and response.

The launch of the EU Health Emergency Preparedness and Response Authority (HERA): Improving global pandemic preparedness?

The crowded global health landscape has been joined by the European Union Health Emergency Preparedness and Response Authority (HERA). HERA will assume four broad areas of responsibility: horizon scanning for major health threats; research and development; support for capacity to manufacture drugs, vaccines, and equipment; and procuring and stockpiling key medical countermeasures. In this Health Reform Monitor article, we outline the reform process and describe HERA's structure and responsibilities, explore issues that arise from the creation of this new organisation, and suggest options for collaboration with existing bodies in Europe and beyond. The COVID-19 pandemic and other infectious disease outbreaks have shown the need to treat health as a cross-border issue, and there is now a broad consensus that greater direction and coordination at the European level is needed. This ambition has been matched with a considerable increase in EU funding to tackle cross-border health threats, and HERA can be used to deploy this funding in an effective manner. Yet this is contingent upon clearly defining its role and responsibilities vis-à-vis existing agencies to reduce redundancies.

How sharp are your health security arrangements against cross-border health threats? Attend the sharp joint action workshop to find out exactly that

How sharp are your health security arrangements against cross-border health threats? Attend the sharp joint action workshop to find out exactly that

The European Health Union and the protection of public health in the European Union: Is the European Union prepared for future cross-border health threats?

The Covid 19 pandemic has cast traditional health protection issues in a new light due to their cross-border significance with far-reaching consequences for almost all areas of social life and places health protection in the European Union in a broader context that goes beyond the national consideration of necessary measures at EU Member State level. The pandemic has made it clear that the responsibility for public health remains in principle with the EU Member States and that the competences of the European Union under Article 168 TFEU are – with a few exceptions – generally limited to supporting, coordinating and assisting tasks. This article examines whether the European Union is adequately prepared for future pandemics and other cross-border health threats based on its responsibilities under the current system of competences between the EU and its Member States in the area of health policy under article 168. The article concludes with some suggestions for discussion and consideration.

The EU response to NCDs: a content analysis on building resilient post-COVID health systems

Abstract Background Non-communicable diseases (NCDs) impose a heavy burden on healthcare systems of countries in the European Union (EU). An estimated 91.3% of all deaths and 86.6% of DALYs in the EU-28 were attributable to NCDs. It is imperative that the EU act on mitigating this challenging health issue and help create trajectories for building resilient health systems. Using qualitative analysis, this study examines the question of how the European Commission 2019-2024 is planning to mitigate the impact of NCDs on health systems, while taking into account the COVID-19 pandemic. Methods Content analysis was applied to understand how NCDs are framed and how an EU narrative is constructed to mitigate the impact of NCDs on health systems by the European Commission. A total of 44 documents were analysed, including speeches, press releases, newsletters, statements and policy documents. In vivo coding was performed using the software package ATLAS.ti 9. Unique codes were simplified and clustered into descriptive themes with a high level of abstraction. Results This study identified five main themes: ‘health plan', ‘COVID-19', ‘future direction', ‘collaboration and solidarity', and ‘persuasion'. Themes show that the Commission is emphasising the impact of the pandemic and the relevance of policies tackling NCDs for developing EU-wide resilient health systems. By calling for more cross- and multi-sectoral collaboration, like creating a European Health Union, the Commission hopes to create the right climate for a European framework for cooperation, which can help develop harmonised and resilient EU health systems. Conclusions Although increasing health systems resilience is high on the Commission’s agenda, it seems that there are no actionable points for Member States in terms of addressing national health policy. We recommend the Commission looks towards eliminating this observed disconnect and creating actionable points in line with Member States’ health systems’ capabilities. Key messages • Our findings show emphasis is placed on EU-wide health policies, more robust health systems, and the collective power of the EU. However, there are no concrete actions coupled with these concepts. • COVID-19 highlighted the limitations of national policy for protecting health systems against cross-border health threats. It tested the Commission’s resolve in pushing for more European cooperation.

6.C. The revised EU health security framework

Abstract As a response to the pandemic, the Commission's communication of 11 November 2020 proposed building blocks for a European Health Union (EHU) and advocated the strengthening of existing structures and mechanisms for better EU level protection, prevention, preparedness and response against human health hazards. It recommended a reinforced framework for cross-border cooperation against all health threats to protect better human lives and the internal market as well as to maintain the highest standards in the protection of human rights and civil liberties, and a strengthened EU role in international cooperation to prevent and control cross-border health threats and improve global health security. By upgrading the EU health security framework for cross-border health threats, the building blocks of the European Health Union bring greater overall impact while fully respecting the Member States’ competence in the area of health. Concretely, before the end of 2022, two pieces of legislation will have been adopted: the upgrading of Decision 1082/2013/EU and the strengthened mandate of the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) that go hand in hand. The new Regulation on serious cross-border threats to health, the overarching legislative piece of the EU Health Union Package, aims at a stronger and more comprehensive legal framework for the Union to better prepare and respond to serious cross-border threats to health and public health emergencies. It better governs actions at Member States and Union level on prevention, preparedness and response, surveillance, risk assessment, and early warning. Further, it ensures better arrangements for joint procurement at EU level. With its revised mandate, the ECDC will be able to issue recommendations to Member States regarding preparedness and response, host a new network of EU reference laboratories and establish an EU Health Task Force for crisis preparedness and rapid public health interventions in case of a major outbreak. The regulation reinforcing EMA's role in crisis preparedness and management of medicinal products and medical devices puts some of the structures and processes established during the COVID-19 pandemic on a permanent footing. EMA is now responsible for monitoring medicine shortages, as well as reporting shortages of critical medicines during a crisis. It will also coordinate responses of EU / EEA countries to shortages of critical medical devices and in-vitro diagnostics in crises. The EU Health Security Framework will link up to IHR (where EU is requesting to become a contracting party) and the pandemic treaty, and the parallel developments to improve pandemic preparedness and response in G7 and G20 framework (also new global health strategy). The revised legislation addresses the weaknesses evidenced by the COVID-19 pandemic and support actions that can be financed via the EU4Health programme and other EU funding instruments. DG SANTE and ECDC will present the new legislation; two Member States will share their views on the newly adopted legislation. HaDEA will present the funding opportunities through EU4Health to support the implementation of th e two new legislation. Speakers/Panellists Ingrid Keller European Commission, Luxembourg, Luxembourg Florina Telea European Commission, Brussels, Belgium

Leviathan versus the super bugs: free riding drives support for EU power over antimicrobial resistance

ABSTRACT The Covid-19 pandemic has spurred a discussion about the role of the European Union (EU) in the governance of cross-border health threats. Antimicrobial resistance (AMR) is another major global health challenge that requires international collective action to be resolved. By using survey data from experts on AMR from 29 European countries, this paper investigates the support for an increase in the power of EU over AMR. Based on insights from collective action theory, we hypothesize that experts who believe that other countries free ride, will be more supportive of EU as a Leviathan in the European response to AMR. The results show that the experts generally were strongly in favor of expanding the authority of the EU over AMR. Furthermore, in line with theoretical expectations, experts who think that other countries free ride, are particularly supportive of more EU power over AMR.

EUROPEAN UNION COMPETENCES IN THE AREA OF COMMUNICABLE DISEASES – EXPERIENCES AND LESSONS LEARNED FROM THE COVID-19 CRISIS

In the European Union, healthcare and public health are mostly within the competence of Member States. Still, in a number of sub-domains, coordination between Member States led to the adoption of legislation that formed the healthcare acquis, together with a whole set of programs and initiatives aimed at improving public health within the Union. The European Centre for Disease Prevention and Control (ECDC) was formed in 2004 to help EU institutions and Member States identify and assess the risk of current and emerging threats to human health from communicable diseases. At the end of July 2020, Member States reached a general agreement on the recovery plan, but the final agreement had not been adopted by the end of the year. On the other hand, in the spring of 2020, EU launched a global action for universal access to tests, treatments and vaccines against coronavirus and for global recovery, while in October 2020, it presented the strategies on vaccine allocation and additional Covid-19 response measures. In November 2020, a new framework was proposed for the improvement of the response to cross-border health threats, as well as for the expansion of the role of EU agencies – ECDC and the European Medicines Agency, related to coordination of preparedness measures and response to public health threats. This initiative came within a wider proposal entitled “European Health Union”. Hence, soon after the crisis broke out, different initiatives were launched to improve the institutional system for communicable disease control in Europe and assistance provided to the Member States. Still, these changes remain within the framework prescribed in the contracts and keep the responsibility, for the most part, at the level of Member States with the possibility of EU assisting, coordinating and helping the Member States in the situations that exceed their capacities; they also emphasize that the main role of the Union can and should be in the field of economic assistance, which is what the unique proposed assistance package has shown.

The European Health Union: European Union's Concern about Health for All. Concepts, Definition, and Scenarios.

The COVID-19 pandemic brought visibility and intensified the discussions on the European Union’s (EU) health mandate. The proposals of the European Commission (EC) to move towards a European Health Union (EHU) can be seen as a starting point towards more integration in health. However, the definition of what the EHU will look like is not clear. This paper searches to find a common definition, and/or features for this EHU through a systematic literature review performed in May 2021. “European Union’s concern about health for all” is suggested as a definition. The main drivers identified to develop an EHU are: surveillance and monitoring, crisis preparedness, funding, political will, vision of public health expenditures, population’s awareness and interest, and global health. Based on these findings, five scenarios were developed: making a full move towards supranational action; improving efficiency in the actual framework; more coordination but no real change; in a full intergovernmentalism direction; and fragmentation of the EU. The scenarios show that the development of a EHU is possible inside the current legal framework. However, it will rely on increased coordination and has a focus on cross-border health threats. Any development will be strongly linked to political choices from Member States.

What is next? Vision statement and reflections for sustaining project outcomes in a possibly post-pandemic era

IntroductionThe ongoing COVID-19 pandemic has demonstrated the importance in strengthening cooperation and coordinated action of Member States (MS) to improve preparedness and response capacities at points of entry (PoE). This emphasizes the need for perpetuating the work of EU HEALTHY GATEWAYS (EU HG) and the availability of this cross-European network to transfer lessons learned for future public health threats.MethodsAn interdisciplinary sustainability working group identified options for continuity of activities at EU level and provided a template national sustainability plan to be adapted by MS based on national needs and priorities.ResultsSince the beginning of the pandemic EU HG provided 37 consultations to MS, developed 15 advice documents, delivered training courses, produced a study on preparedness and response at PoE and developed the EU digital Passenger Locator Form (EUdPLF) system. A European web-based network for PoE was developed including discussion forums, e-learning platform, searchable network of professionals' at PoE registry, bibliographies, web-based training resources and best practice catalogues. Overall, the 533 inspectors in the EU SHIPSAN INFORMATION SYSTEM (EU SIS) recorded 29268 IHR (International Health Regulations) certificates, followed up 69 public health events via the communication network for EU ports, and recorded >4600 hygienic deficiencies.ConclusionsEU HG has a holistic approach, supporting operations on local, regional, national and European level and by taking into account all transport sectors. The web-based systems and capacity building activities support EU Decision 1082/2013/EU for serious cross-border health threats and the EUdPLF supports implementing Decision (EU) 2017/253 for the contact tracing of passengers identified through PLFs. Adoption of components of EU SIS will support implementation of Regulation (EU) 2019/1239 which includes the provision of a common ship sanitation database.

Development of a mechanism for the rapid risk assessment of cross-border chemical health threats.

Chemical incidents can result in harm to public health and the environment. Although most are localised and have little impact, some affect wide areas, a range of sectors and may lead to many casualties. A public health response to assess the risks and provide advice to authorities and the public is usually required. In some cases, incidents may affect more than one country and require effective cross-border communication and coordination. We describe tools and mechanisms to improve health security from cross-border chemical health threats and to support the implementation of the Decision of the European Parliament and the Council of the European Union (EU) on serious cross-border threats to health (Decision 1082/2013/EU). Experts were recruited to a network and their suitability was assessed by using a skills framework. Input by relevant stakeholders such as the World Health Organisation and the European Centre for Disease Prevention and Control, followed by EU-wide exercises, ensured that tools developed were fit for purpose. A network of public health risk assessors and a methodology for providing rapid independent expert public health advice during a chemical emergency have been developed. We discuss the legacy of these mechanisms including their incorporation into the working arrangements for the EU Scientific Committee for Health, Environment and Emerging Risks and future developments in the field.

Health Systems’ Challenges and Responses for Recovery in the Pre and Post COVID-19 Era

COVID-19 has been an unprecedented global crisis and health systems have put tremendous efforts to withstand the pandemic. It has brought new challenges by deeply impacting both the economies and the healthcare systems. This paper aims to provide an overview of the challenges and responses COVID-19 brought to the EU health systems and grasp investment opportunities which intend to improve their resilience, accessibility, effectiveness and sustainability. A review of policies and actions related to health systems’ challenges and responses considered as opportunities are presented and discussed. The key challenges are boosting the way towards optimising health systems’ capacity, ensuring access to healthcare, promoting R&D focused on the accelerated development of diagnostics, treatments and vaccines, improving health data digitalization as well as monitoring individual behaviour along with the socioeconomic impact. Numerous health policy recommendations, synergies and funding initiatives have been launched as responses to these challenges. EU is constantly obtaining lessons from the pandemic with coordination being the key component for response and for building in opportunities that will strengthen health systems’ preparedness and management of cross-border health threats. Governments need to ensure that the health systems are equipped with the critical capacities to promptly respond to future health crises.

Towards a European Health Union: Time to Level Up

The European response to COVID-19 has revealed an inconvenient truth. Despite having integrated public health concerns across all its policies – be it agriculture, consumer protection, or security –, the Union cannot directly act to save people’s lives. Only member states can do so. Yet when they adopted unilateral measures to counter the spread of the virus, those proved not only ineffective but also disruptive on vital supply chains, by ultimately preventing the flow of essential goods and people across the Union. These fragmented efforts in tackling cross-border health threats have almost immediately prompted political calls for the urgent creation of a European Health Union. Yet this call raises more questions than answers. With the aim to offer a rigorous and timely blueprint to decision-makers and the public at large, this Special Issue of the European Journal of Risk Regulation contextualizes such a new political project within the broader constitutional and institutional framework of EU public health law and policy. By introducing the Special, this paper argues that unless the envisaged Health Union will tackle the root causes of what prevented the Union from effectively responding to COVID-19 – the divergent health capacity across the Union –, it might fall short of its declared objective of strengthening the EU’resilience for cross-border health threats.

Towards a European Health Union: Time to Level Up

The European response to COVID-19 has revealed an inconvenient truth. Despite having integrated public health concerns across all its policies – be it agriculture, consumer protection, or security –, the Union cannot directly act to save people’s lives. Only member states can do so. Yet when they adopted unilateral measures to counter the spread of the virus, those proved not only ineffective but also disruptive on vital supply chains, by ultimately preventing the flow of essential goods and people across the Union. These fragmented efforts in tackling cross-border health threats have almost immediately prompted political calls for the urgent creation of a European Health Union. Yet this call raises more questions than answers. With the aim to offer a rigorous and timely blueprint to decision-makers and the public at large, this Special Issue of the European Journal of Risk Regulation contextualizes such a new political project within the broader constitutional and institutional framework of EU public health law and policy. By introducing the Special, this paper argues that unless the envisaged Health Union will tackle the root causes of what prevented the Union from effectively responding to COVID-19 – the divergent health capacity across the Union –, it might fall short of its declared objective of strengthening the EU’resilience for cross-border health threats.

Time to strengthen capacity in infectious disease control at the European level

The COVID-19 pandemic has made the European Commission revaluate its role in member states health systems. In response, the European Union is planning to significantly increase investment to tackle cross-border health threats. The European Centre for Communicable Disease Prevention and Control is well positioned to capitalise upon this increased investment by designing and implementing a renewed European strategy for infection disease control. To secure meaningful and sustainable improvements, the European Centre for Communicable Disease Prevention and Control needs to be strengthened with more resources, an expanded geographical scope and legislative change.

The Need for the Right Socio-Economic and Cultural Fit in the COVID-19 Response in Sub-Saharan Africa: Examining Demographic, Economic Political, Health, and Socio-Cultural Differentials in COVID-19 Morbidity and Mortality.

The coronavirus disease (COVID-19) has spread quickly across the globe with devastating effects on the global economy as well as the regional and societies’ socio-economic fabrics and the way of life for vast populations. The nonhomogeneous continent faces local contextual complexities that require locally relevant and culturally appropriate COVID-19 interventions. This paper examines demographic, economic, political, health, and socio-cultural differentials in COVID-19 morbidity and mortality. The health systems need to be strengthened through extending the health workforce by mobilizing and engaging the diaspora, and implementing the International Health Regulations (2005) core capacities. In the absence of adequate social protection and welfare programs targeting the poor during the pandemic, sub-Saharan African countries need to put in place flexible but effective policies and legislation approaches that harness and formalise the informal trade and remove supply chain barriers. This could include strengthening cross-border trade facilities such as adequate pro-poor, gender-sensitive, and streamlined cross-border customs, tax regimes, and information flow. The emphasis should be on cross-border infrastructure that not only facilitates trade through efficient border administration but can also effectively manage cross-border health threats. There is an urgent need to strengthen social protection systems to make them responsive to crises, and embed them within human rights-based approaches to better support vulnerable populations and enact health and social security benefits. The COVI-19 response needs to adhere to the well-established ‘do no harm’ principle to prevent further damage or suffering as a result of the pandemic and examined through local lenses to inform peace-building initiatives that may yield long-term gains in the post-COVID-19 recovery efforts.