National Response Research Articles

Validation of the effectiveness of pig farm repopulation protocol following African swine fever outbreaks in the Philippines

The African swine fever (ASF) epidemic has severely challenged the Philippines’ swine industry since 2019. The National African Swine Fever Prevention and Control Program (NASFPCP), launched in 2021, aims to provide guidance for managing ASF through surveillance, monitoring, and swine repopulation. This study evaluates the effectiveness of post-outbreak disinfection protocols and government-mandated measures for repopulation standard. Surveillance data from three repopulation phases—(I) depopulation, cleaning, and disinfection; (II) downtime (20 days); and (III) sentinel animals (40 days)—were collected from February 2020 to December 2021 in the province of Batangas. Time-to-detection of positive events were analyzed for different farm types, seasons, or location using survival analysis modeling. Probability of detecting infected farms at different sampling times was estimated in terms of sensitivity of the sampling time. Data from 145 swine farms, including 99 backyard and 46 commercial farms, revealed positive rates of 10.1 and 8.7%, respectively. The failure rate during repopulation surveillance was 9.66%, whereas 90.34% farms remained ASF negative. Sensitivity estimate increased from 18–21 to 89% by day 27, with sentinel animals on that day exhibiting the highest estimated sensitivity. This highlights the importance of sentinel pigs in the NASFPCP for effective ASF control in the Philippines. Survival analysis showed no statistically significant differences in the results between either farm type, season, or municipality level. Geographic mapping of surveyed farms and those with positive detections identified high-risk locations including San Juan and Lipa City as key areas of concern. Enhancing targeted surveillance is critical for improving an early ASF detection and national response in the Philippines.

Factors Influencing School‐Based Mental Health Program Selection: Insights From Educational Stakeholders

ABSTRACTSchool mental health programs are an important component of the national response to the current student mental health crisis. However, evidence‐based programs often face numerous barriers to their selection, scale‐up, and sustainability in real‐world settings. In this study, we interviewed 15 educational stakeholders to examine what influences their selection of school‐based mental health programs. Interviews focused on factors influencing the selection and sustainability of mental health programs in schools. We coded transcribed interview data using a hybrid, iterative process, and generated themes from these codes. We identified five categories of themes related to key decision‐making criteria: program fit with student and school needs, evidence of program effectiveness, stakeholder buy‐in, logistical considerations for staff delivering programs, and cost and resource requirements. Findings have implications for researchers who wish to improve dissemination strategies for school‐based mental health prevention programs and for policymakers who wish to shape funding priorities to support greater diversity in program availability. Findings are also useful to practitioners who may use these insights to reflect on their own program selection practices or may see their own experiences reflected and normalized through the lens of the key themes presented here.

The complexity of addressing equity in COVID-19-related global health governance and population health research priorities in Canada: a multilevel qualitative study

BackgroundSince COVID-19 emerged in 2020, the promotion of health equity, including in research, has further been challenged worldwide by both global health governance (GHG) processes and decisions, and national public health control measures. These global and national decisions have also led to the ‘covidization’ of health research agendas where resources have been massively channelled to address COVID-19, especially during the first years of the pandemic. This situation could potentially result in current and future population health research priorities not explicitly tackling equity as a central tenet. The study objective examined how and to what extent the COVID-19-related GHG architecture is affecting population health research priorities in Canada.MethodsWe conducted a multilevel qualitative study informed by the intersectionality-based policy analysis and multiple streams frameworks. We collected and thematically analysed data from four groups of respondents (n = 35: researchers, research funders and global and public health research institutes in Canada, and WHO/international actors) and an interactive feedback workshop (n = 40 participants).ResultsStudy findings generated four main themes. First, both global and national COVID-19 responses failed to address equity considerations, especially among populations in situations of vulnerability and marginalisation. Second, the integrated examination of funding, equity, and accountability was judged as necessary determinants of GHG and population health research priorities in Canada. Third, contrary to common beliefs about COVID-19, the consequences were not all negative, but they were also positive and unintended, and lessons can be learned. Fourth, study respondents proposed multiple recommendations to address inequities in the complex intersection between COVID-19-related GHG and population health research in Canada.ConclusionThis study provides substantial evidence of the multilayered and complex intersection between COVID-19-related GHG and population health research priorities in Canada. Although the window of opportunity was slim according to study respondents, there was still a unique collective effort to address COVID-19-related socioeconomic and health inequities by considering the numerous recommendations proposed by the four groups of study respondents. These recommendations can directly contribute to improving knowledge of global and national population health and equity research strategies in the context of an evolving pandemic and for policy- and decision-makers to adjust and rectify the course of global and public health governance.

Digital Warfare: The Evolution of U.S. and Russian Cybersecurity Strategies

This article will explore the evolution of U.S and Russian cyber security strategies As the world becomes increasingly interconnected, the importance of cybersecurity has surged, particularly in the context of geopolitical rivalries. This article explores the evolution of cybersecurity strategies employed by the United States and Russia, highlighting how historical tensions have shaped their approaches to digital warfare. From the early days of the internet to the sophisticated cyber operations of 2024, the U.S. and Russia have engaged in a complex interplay of offense and defense, employing advanced technologies and strategies to protect national interests. The article examines key incidents that have defined their cybersecurity landscapes, including state-sponsored cyberattacks, espionage efforts, and the manipulation of public opinion through disinformation campaigns. By analyzing the motivations, tactics, and responses of both nations, this research aims to provide a comprehensive understanding of the dynamics of digital warfare and its implications for global security. Ultimately, the findings underscore the necessity for robust international cooperation and the establishment of norms to mitigate risks associated with cyber conflicts, as both nations continue to navigate this evolving battlefield.

Graying arts access: crafting creative online programming to promote older adults' artistic engagement in and beyond pandemic time

IntroductionDeclared a global pandemic by the World Health Organization (WHO) in March 2020, the COVID-19 virus and attendant patchwork of local, regional, and national government-initiated public health responses to it unexpectedly opened possibilities for greater access to culture for disabled and chronically ill people in ways that were unimagined in pre-pandemic times. During the “emergency” period of the pandemic, the fields of critical disability studies and aging studies independently demonstrated the importance and value of shifting to digital technologies for disabled people and older adults respectively; however, to date, little scholarship has considered the value of digital technologies for older adults aging with and into disabilities beyond pandemic time.MethodsInformed by the theoretical insights of scholarship exploring critical access and the aging-disability nexus, this paper draws from empirical data collected during Phase 2 of Direct[Message]: Digital Access to Artistic Engagement, a collaborative, community-based, arts-informed research project based in Southwestern Ontario (Canada). Drawing from 50 qualitative interviews with aging adults from un/under/represented communities, findings explore the intersections of older age and disability, including dynamics related to gender, sexuality, migration, size, race/ethnicity, and other differences, as these relate to access to and enjoyment of creative spaces before, during, and “after” the COVID-19 pandemic.ResultsResults show that older adults aging with/into disabilities in Southwestern Ontario express an overwhelming desire and even urgent need to access interactive arts programming from the relatively safe spaces of their homes both within and outside pandemic time.DiscussionAs the normative world pushed for a return to ableist normative life in 2022, a year marked by “severe” rates of the highly infectious Omicron variant and the loss of effective public measures, such as community masking and widely available testing, participants described the need for continued access to creative and social participation via remote options that sidestepped socially exclusive and physically inaccessible spaces. Findings indicate a need for increased investment in digital arts programming for older adults aging with/into disabilities.

Evaluating COVID-19 impact, vaccination, birth registration, and underreporting in a predominantly indigenous population in Chiapas, Mexico

Background Indigenous populations globally face significant health disparities compared to non-Indigenous groups, primarily due to marginalization and limited access to healthcare. In Mexico, which is home to the largest Indigenous population in the Americas, these disparities were further exacerbated by the COVID-19 pandemic, with impacts intensified by factors such as marginalization, discrimination, and inadequate access to essential services.MethodsThis study aimed to investigate the COVID-19 pandemic's impact on mortality, vaccination access and uptake, and official birth registration among a predominantly Indigenous population in San Juan Chamula, Chiapas. We conducted an online survey among high school students at the Colegio de Bachilleres del Estado de Chiapas, supplemented with epidemiological and socio-demographic data (N = 107).ResultsThe survey revealed that 14% of respondents reported being infected with COVID-19, while national dashboard data indicated only 212 confirmed cases and one death in Chamula between April 2021 and June 2023. Additionally, 79.4% of respondents were unvaccinated, with significant communication barriers and a lack of information in Indigenous languages contributing to low vaccination rates. Additionally, 5.6% of surveyed family members and 4.7% of community residents lacked official birth certificates, significantly impeding their ability to access essential services such as education, healthcare, and vaccinations.ConclusionOur findings highlight significant underreporting of COVID-19 cases and deaths in Indigenous communities, likely due to inadequate diagnostic resources and medical evaluation. The study underscores the urgent need for tailored public health strategies that integrate local Indigenous languages, cultures, and knowledge systems supported by trusted Indigenous leaders. Investing in education in Indigenous languages is crucial for improving vaccination adherence and overall public health outcomes. These strategies can inform national preparedness and response plans to address the unique challenges faced by Indigenous populations during pandemics and other public health crises.

High prevalence and non-suppression of HIV/AIDS in the East and Central African region heightens risk of severe outcomes for Clade I monkeypox virus infection, and may be a driver for subsequent adaptation

In September 2023, a re-emergence of mpox was noted in the province of South Kivu, in DR Congo. So far, active transmission has been reported in 23 of the 26 provinces. Despite localisation within DRC, there are emerging concerns about possibility of cross-border transmission. In this perspective, we highlight the threat posed to HIV positive patients, particularly those with unsuppressed viral loads. We make several prepositions as part of the preparedness and response plans in the countries in the East and Central Africa region. The six prepositions include: 1) operationalize the Joint Africa Task Force for mpox consistent with Kinshasa declaration on mpox, 2) increased surveillance, 3) deployment of point of care diagnostics, 4) targeted reactive vaccination and enhanced antiretroviral therapy of HIV positive patients in areas of active transmission, 5) community engagement, 6) foster capacity building of national rapid response teams in East and Central Africa in mpox care and management through collaboration with DRC counterparts.

Service coverage for major depressive disorder: estimated rates of minimally adequate treatment for 204 countries and territories in 2021

Access to effective treatment for major depressive disorder remains limited and difficult to track across place and time. We analysed the available data on minimally adequate treatment (MAT) for major depressive disorder globally with the aim of providing a useful metric against which to monitor national responses to the growing public health burden imposed by major depressive disorder. MAT was defined as pharmacotherapy (1 month of medication, plus four visits to a medical doctor) or psychotherapy (eight visits with any professional). From existing reviews, we identified mental health surveys that assessed major depressive disorder within the general population as well as health service uptake by individuals with major depressive disorder. Data by ethnicity were not available. Estimates of MAT, antidepressant use, or use of any mental health service were extracted. The latter two estimates were adjusted to reflect likely MAT rates via a network meta-analysis. Adjusted MAT estimates were analysed via a Bayesian meta-regression using the Disease Modelling Meta-Regression (DisMod-MR 2.1) tool. This analysis estimated MAT coverage among people with major depressive disorder by age, sex, location, and year. Final MAT estimates were standardised by age and sex against the existing age and sex distribution of people with major depressive disorder globally. People with lived experience were involved in the design, preparation, interpretation, and writing of this manuscript. The analysed dataset included 145 estimates from 32 studies, covering 31 countries, 14 regions, and six super-regions. The proportion of people with major depressive disorder receiving MAT globally in 2021 was 9·1% (95% uncertainty interval 7·2-11·6), with 10·2% (8·2-13·1) of females and 7·2% (5·7-9·3) of males with major depressive disorder receiving MAT. MAT coverage was highest in high-income locations (27·0% [21·7-34·4]), with Australasia having the highest rate (29·2% [21·4-40·8]). MAT coverage was lowest in sub-Saharan Africa (2·0% [1·5-2·6]), within which western sub-Saharan Africa (1·8% [1·4-2·5]) had the lowest coverage. Seven countries (Australia, Belgium, Canada, Germany, the Netherlands, South Korea, and Sweden) were estimated to have MAT coverage exceeding 30%, while 90 countries were estimated to have coverage lower than 5%. Despite many gaps in the available data, estimates show that, globally, most individuals with major depressive disorder do not receive MAT. Services must improve to reach a global coverage that better meets the mental health needs of those with major depressive disorder. Urgent attention should be given to the scale-up of effective intervention strategies, especially in low-income and middle-income countries, as well as further research into better quality treatment options for major depressive disorder. We present a means by which the MAT gap for major depressive disorder can be quantified, to monitor and inform action by governments and international partners. Queensland Health and the Bill & Melinda Gates Foundation.

Implementation of a paraprofessional role across the public health sector in Manitoba: Impacts on system capacity.

Manitoba experiences sexually transmitted and blood-borne infection (STBBI) incidence rates above the national average and fundamental public health sector responses face human resource constraints. Manitoba implemented a paraprofessional role, the Communicable Disease Technician (CD Tech), to complete low-complexity STBBI investigations and support STBBI testing, care engagement initiatives, provider reporting, harm reduction supply distribution, and community engagement. Secondary roles included tuberculosis directly observed treatment (DOT) and virtual DOT, and flu and COVID immunization support. Twenty CD Tech positions were allocated to regional public health teams along with additional Public Health Nurse (PHN) positions to support the role. Mixed methods were used to evaluate the impact on public health system capacity. Follow-up of chlamydia and gonorrhea case investigations increased from 35% to 98%. Volume of contacts followed by public health increased for chlamydia (114%), gonorrhea (33%), and HIV (68%). Health care provider reporting for cases of STBBI and treatment more than doubled (116%). No significant differences in case investigation data quality were found between CD Techs and PHNs. Qualitative interviews by public health staff (n = 24) found CD Techs highly flexible and competent team members who can fill gaps and expand capacity in direct client service, outreach, administration, data entry, or community/partner engagement. Mentorship, ongoing supervision, role clarity, training, and clear practice standards are required to optimize the role. There is potential to expand this innovation and build surge capacity in other areas of public health practice, and other public health jurisdictions.

Responding to platform firm power: differing national responses

ABSTRACT Aware of the power of platform firms and the risks of the platform economy, governments are reconsidering the dominant laissez faire approach in favour of strategies that regulate the power of platform firms. transnational dynamics play an important role in shaping emerging national regimes, but we argue that governments are also influenced by three factors that operate primarily at domestic level: the agency of platform firms, the impact of first-mover US platforms, and domestic politics. We illustrate our approach through an analysis of the trajectories and regulatory measures of four economies: the US, the EU, China, and India. As governance efforts expand to emerging technologies such as AI, our analysis presages broader changes to the structure of what was, with a few important exceptions, a relatively borderless global online economy.

Sociopolitical Impacts of the Russia-Ukraine Conflict on Poland, Germany, and Turkey: A Comparative Analysis of National Responses and Public Sentiment

Abstract: The Russia-Ukraine conflict began in 2022 and represents the biggest military action in 21st century Europe. However, this conflict did not arise out of the blue. The conflict is the culmination of many centuries worth of social and political factors. Like in any war, the effects of it have not only been felt in Ukraine and Russia but also in its neighboring and more distant countries across Europe and beyond. This essay will focus on the sociopolitical impacts of the conflict on three key countries: Poland, Germany and Turkey, exploring the specific ways in which these nations have been affected both socially and politically by the ongoing crisis. This paper explores the impacts of the conflict on wider European countries, analysing how the war has affected the sociopolitical structures of Poland, Germany and Turkey. Poland has demonstrated a closer alliance towards the West to protect itself from Russian aggression, resulting in strong humanitarian support for Ukraine and public solidarity towards Ukrainian refugees. Germany has shifted its long-standing foreign policy to adopt a similar anti-Russian stance, creating public concerns with regard to being drawn into the war. Turkey has a unique perspective, appeasing both the West and Russia as it relies on both to maintain its domestic socioeconomic situation. This analysis provides insight into the wider European sociopolitical response to the conflict.

Navigating wicked problems: the unrecognised contribution of social pedagogy to Aotearoa New Zealand’s successful Covid-19 response

Aotearoa New Zealand’s government, alongside its Indigenous Māori and Pacific communities, spearheaded a unique and effective response to the first three years of the Covid-19 crisis that swept the world. The measures taken enabled the country to largely keep its society within its borders open and functional, minimise the impact of the pandemic on individual lives and community well-being and keep morbidity rates low. While there have been numerous studies and articles exploring this national response, to this point no examination has been undertaken through a social pedagogical lens. This article identifies key concepts from the discipline that are relevant to Aotearoa New Zealand’s context, discusses the ways in which these were (albeit unknowingly) applied during the peak of the pandemic and explores future potential for application in social and public health policy and practice. Weaving together a shared framework of Māori, Pacific and unique Aotearoa New Zealand world views and cultural practices alongside the principles of social pedagogy presents an exciting opportunity to shape a national crisis response that is effective and meets the needs of diverse communities. It is argued that making the contribution of social pedagogy visible has the potential to enhance responses to wicked problems in times of crisis and further the acceptance of the discipline in the southern hemisphere.

Prospective clinical surveillance for severe acute respiratory illness and COVID-19 vaccine effectiveness in Kenyan hospitals during the COVID-19 pandemic.

There are limited data from sub-Saharan Africa describing the demographic characteristics, clinical features and outcome of patients admitted to public hospitals with severe acute respiratory infections during the COVID-19 pandemic. We conducted a prospective longitudinal hospital-based sentinel surveillance between May 2020 and December 2022 at 16 public hospitals in Kenya. All patients aged above 18 years admitted to adult medical wards in the participating hospitals were included. We collected data on demographic and clinical characteristics, SARS-CoV-2 infection and COVID-19 vaccination status and, admission episode outcomes. We determined COVID-19 vaccine effectiveness (VE) against admission with SARS-CoV-2 positive severe acute respiratory illness (SARI) (i.e., COVID-19) andprogression to inpatient mortality among patients admitted with SARI, using a test-negative case control design. Of the 52,636 patients included in the study, 17,950 (34.1%) were admitted with SARI. The median age was 50 years. Patients were equally distributed across sexes. Pneumonia was the most common diagnosis at discharge. Hypertension, Human Immunodeficiency Virus (HIV) infection and Diabetes Mellitus were the most common chronic comorbidities. SARS-CoV-2 test results were positive in 2,364 (27.9%) of the 8,471 patients that underwent testing. After adjusting for age, sex and presence of a chronic comorbidity, SARI patients were more likely to progress to inpatient mortality compared to non-SARI patients regardless of their SARS-CoV-2 infection status (adjusted odds ratio (aOR) for SARI and SARS-CoV-2 negative patients 1.22, 95% CI 1.10-1.37; and aOR for SARI and SARS-CoV-2 positive patients 1.32, 95% CI 1.24-1.40). After adjusting for age, sex and presence of a chronic comorbidity, COVID-19 VE against progression to inpatient mortality following admission with SARI for those with a confirmed vaccination status was 0.59 (95% CI 0.27-0.77). We have provided a comprehensive description of the demographic and clinical pattern of admissions with SARI in Kenyan hospitals during the COVID-19 pandemic period as well as the COVID-19 VE for these patients. These data were useful in providing situational awareness during the first three years of the pandemic in Kenya and informing national response measures.

THE NEXUS BETWEEN CORRUPTION AND RESOURCE THEFT: IMPLICATIONS FOR NATIONAL SECURITY IN RESOURCE-RICH NATIONS

The nexus between crude oil theft, corruption, and national security in Nigeria is complex and multifaceted. Oil theft directly impacts the nation's economy by reducing government revenue, which in turn limits the resources available for critical public services, including security and law enforcement. Corruption, by weakening governance and fostering impunity, compounds these security threats, allowing criminal networks to thrive This study investigates the intricate relationship between crude oil theft, corruption, and national security in Nigeria. The study utilised a longitudinal research design, examining secondary data from 2013 to 2023, including metrics such as oil theft, political corruption, violent events, and fatalities. Data from sources like the Armed Conflict Location & Event Data Project (ACLED), the National Oil Spill Detection and Response Agency (NOSDRA), and the World Bank's political corruption index were analysed using Poisson regression to assess the effects of oil theft and corruption on national security. Findings revealed that crude oil theft has a statistically significant positive relationship with violent events, while political corruption, represented by the political corruption index, shows a strong negative relationship with security, with an estimate of - 26.475. This could imply that corruption may sometimes act as a stabilising force whereby, in corrupt systems, those in power might suppress violence to maintain order and avoid public attention that could threaten their positions. However, political corruption has a substantial positive effect on fatalities, with an estimate of 19.589. This highlights that as corruption increases, fatalities rise significantly, pointing to the detrimental impact of corruption on state institutions and the rule of law. These findings also suggest that while crude oil theft directly contributes to insecurity, political corruption may reduce overt violence by maintaining fragile stability. Therefore, addressing these issues requires a nuanced approach. Policymakers must recognise that combating corruption and oil theft alone will not be sufficient to ensure national security; instead, strategies should tackle both issues simultaneously, understanding that reducing visible violence does not always eliminate the underlying causes of insecurity.

10.P. Scientific session: Improving health security and preparedness: are we leaving someone behind?

Abstract Prisons are unique, high-risk, high-security, complex settings; however, the impact of emergencies on prisons is a concern not only to the prison but also to the functioning of, for example, the criminal justice system, policing and courts, as well as to the general public. Prison environments can amplify infectious diseases. In the context of emerging health threats, this risk could be made into an asset through early warning surveillance and epidemiological studies. Many global and public health actors advocated for the inclusion of prisons and custodial settings in a comprehensive response to emerging threats since the early days of the COVID-19 pandemic and again during the Mpox epidemic. The increase in risk in closed environments and the vulnerability of people living in prisons make prisons and other custodial settings potential hotspots for transmission of infectious diseases and for excess morbidity and mortality. Yet, as mentioned above, prisons have been included to only a limited extent in national preparedness and response plans. Similarly, prisons are not always explicitly mentioned in international guidance on the preparation of national plans or in measures taken in the absence of such guidance. Preventing, predicting and responding to threats to the health of prison populations require scientifically valid, evidence-based interventions and assessment of the positive and negative impact of control measures on the population, especially in view of the unequal distribution of harm and disease among people living in prison and unequal access to mitigation or therapeutic interventions. Because of a general lack of timely, good-quality, translatable evidence on prison health, guidance for the management of health threats in prisons is often based on adapting other sources to the prison setting (so-called “prisonification” of guidelines), rather than on evidence specific to prisons. Prisons and custodial settings may also be affected by other biological, chemical, radionuclear and environmental hazards, all of which must be catered for in comprehensive preparedness and response plans. Timely collection of information is essential for national preparedness and response capacity to ensure rapid identification and response to threats. Again, however, the prison population is often excluded from or not explicitly identified in national surveillance systems. As a result, cases or outbreaks may not be identified or not receive an effective response, due to lack of collaborative structures between prison and public health authorities. Inclusion of prisons in local, regional, national and international emergency planning is therefore essential to test plans and revise guidance on the basis of evidence, exercises and/or real events. This workshop aims at exploring the current landscape and deriving implications for preparedness and health security in Europe and beyond. Key messages • Prison authorities should be included as stakeholders in the development of national preparedness and contingency plans according to good governance approach. • Explicit inclusion of prisons and other custodial settings in international and national plans for preparedness and response to emerging health threats is needed.

Large scale system transformation: Ukraine

Abstract In the context of the EU-Ukraine Accession agreement, Ukraine started large scale public health systems reform back in 2015. The COVID-19 pandemic tested the response capacity of the national public health system and led to some improvement during the pandemic such as on laboratory capacity. It also generated lessons for strengthening national and subnational health emergency preparedness and response. Multiple interventions, including a Joint External Evaluation led to the adoption of the Public Health System Law in 2022, laying the foundation to bolster health promotion, disease prevention, and health protection. The Ukrainian Public Health Centre was substantially strengthened, partly oriented on models in other European countries. Corresponding centers for diseases control and prevention at the oblast level were reformed and a subnational network of these centers was created. While the war has a significant impact on the public health system, infrastructure, people and more, decision makers and professionals keep working on sustaining and moving forward the achievements on public health reforms, for example with the adoption of the National Health Strategy 2030 and the adoption of the National Health Security Plan. Further legal and strategic preparations are afoot to strengthen public health services governance capacity, financing, institutional innovation and development, and public health workforce development.

Are prison settings included in national preparedness plans?

Abstract With the aim to explore the extent to which places of detention are considered in national preparedness planning in the WHO European Region, a desktop review was conducted and combined with responses to the Health in Prisons European Database (HIPED) survey from Member States referring to 2020. In both searches, the aim was to identify the existence of: 1) national pandemic preparedness plans written prior to the COVID-19 pandemic; and 2) national pandemic preparedness and response plans specific to the COVID-19 pandemic. Where prisons were included, all aspects of pandemic preparedness relating to prisons were extracted and collated as per the main domains of the WHO checklist for influenza pandemic preparedness plans. The desktop review found that 30 Member States had pandemic plans accessible online, but only seven included any mention of prisons. Responses to the HIPED survey suggested wide dissemination of a COVID-19 preparedness and/or response plan, but only six out of 36 Member States referred to prisons or the vulnerabilities of people living in places of detention. The combined findings suggest that prisons are rarely considered in national planning and that lessons from previous pandemics have not led to a change in recognizing that prisons are high-risk environments for pathogen transmission and that failing to consider them in national planning may lead to impacts that affect the wider community.

Can we adapt fairly? Systematic review of health equity implications of climate change in coastal communities in the UK

Abstract As climate change becomes more apparent, it is important to evaluate the equity implications of adaptation interventions and policy measures. Many coastal populations experience high levels of social deprivation, which can be compounded by environmental factors. Coastal hazards, such as erosion and flooding can cause short and long term impacts on physical and mental health. To systematically review the published evidence on the differential impacts of coastal change on health inequalities and review the implications of adaptation responses for health inequality. We systemically reviewed the evidence for the UK only on a) inequalities in coastal flood impact or risk, and b) effectiveness and equity implications of current measures to manage the climate risks to an acceptable level of impact. Interventions included: plans and guidance, insurance, and infrastructure, including natural flood management. We found 8 papers quantifying differentials in current and future impacts of coastal flood risk and 6 papers assessing equity implications of adaptation measures. Coastal flood risk is unevenly distributed. Those owning their own home were more likely to experience flood impacts including increased stress and displacement. There is good evidence that policies for household insurance and property level protection measures have the potential to increase inequalities; other measures (community engagement; planning; defences) may reduce health inequalities, depending on implementation and local context. Adaptation to coastal change requires a range of approaches in the short and longer term, which potentially exacerbate current inequalities. Adaptation responses that rely on individual behaviour change, such as relocation, purchasing insurance, or retrofitting dwellings, may exacerbate inequalities within coastal communities. Climate change challenges organisations to deliver national and local policy responses ensuring that adaptation is effective and equitable.

Applying foresight methods at the national level in the field of substance use: Experience from the DRUG-PREP project

Abstract This presentation will focus on the experience from the DRUG-PREP project. While foresight has been used in other sectors, its implementation in the drugs field has previously remained relatively limited. The application of foresight to the drugs sphere is important in recognition of the fast-changing and intersectional nature of drugs and addiction. At the European level, a futures exercise was organized by the EMCDDA (as of July 2024 the European Union Drugs Agency, EUDA) to explore the future of drugs at the European level until 2030. In this landscape, the DRUG-PREP project implemented foresight approaches at the national level, to support preparedness of national drug monitoring and response systems. The DRUG-PREP partners carried out individual national exercises in six countries: Belgium, Czechia, Finland, Ireland, the Netherlands, and Portugal. The link to policy was a key aspect of the project, with each country organising a national dialogue to directly engage policymakers. The presentation will focus on the Belgian research. Horizon Scanning was performed to identify trends and megatrends with potential implications on the national drugs ecosystem, through a literature review. An expert workshop was organized to validate the trends and explore their implications. Subsequently, a small scenario building exercise was organised to explore the consequences of a clearly defined ‘disruptor’: the ban on opium production in Afghanistan. Finally, a national dialogue allowed discussion with stakeholders on how foresight can be integrated more structurally in the drugs field in Belgium. A summary of the results will be presented. Policymakers across all levels (local, regional, federal) have been active participants in the foresight activities and workshops. The link to policymaking has been crystallized in the integration of foresight into the new Belgian National Drugs Strategy 2024-2025.

Heatwaves, Hospitals, and Health System Resilience in England: A Qualitative Assessment (Summer 2019)

Abstract Background Frequent heatwaves challenge healthcare delivery in England, affecting patient safety and staff welfare. This study addresses the observational gap in how healthcare settings adapt to extreme weather. Methods We utilised a qualitative approach, conducting semi-structured interviews with fourteen NHS staff across England to explore experiences during the 2019 summer heatwave. Participants included clinical and non-clinical personnel, providing broad insights into operational challenges and adaptive strategies. Results The 2019 heatwave significantly disrupted service delivery, with variable staff awareness of the Heatwave Plan for England affecting responses. Key issues included managing infection control versus electric fan usage, impacting patient and staff comfort and safety. These conditions also led to an increase in hospital admissions. Conclusions The findings highlight the need for improved workforce training and strategic planning to enhance resilience to heat-related risks. Further research is essential to develop a comprehensive evidence base on the impacts and costs of heatwaves and to assess the effectiveness of adaptation strategies. This will support national health adaptation planning and emergency response. Key messages • Enhanced planning and training are crucial for health system resilience to heatwaves. • More research is needed to understand heatwave impacts and effective responses.