Pandemic Policy Research Articles

Impact of coronavirus disease 2019 on the utilization of hospital services and development of optimal pandemic control strategy in Chinese tertiary hospitals during the Omicron wave

BackgroundThis study aimed to assess the impact of coronavirus disease 2019 (COVID-19) on hospital service utilization and revenue in Chinese tertiary hospitals and develop an optimal pandemic control strategy (OPCS) for the peak period of the Omicron wave.MethodsRetrospective data from three Chinese tertiary hospitals (provincial, city, and county level) were analyzed for three phases: pre-outbreak (Jan-Apr 2019), outbreak (Jan-Apr 2020), and post-outbreak (Jan-Apr 2021). OPCS was developed under the guidance of the China government pandemic control policy during post-break phase of COVID-19. A decision-tree model was constructed to compare OPCS to strict pandemic control strategy during outbreak phase for the hospital service utilization and hospital revenue in a provincial tertiary hospital during the Omicron wave.ResultsOutpatient, emergency room (ER) visits, hospitalizations, and intensive care admissions dropped by 33.8–53.4% during the outbreak, with the provincial hospital being the most affected. Hospital revenue also declined, especially for the provincial hospital (40.1%). Post-outbreak, most services recovered, but ER visits remained lower (11.6% decrease for provincial hospital, 46.5% for county hospital). Total income and expenditure decreased, with the provincial hospital experiencing the most significant revenue reduction (45.7%). OPCS showed greater utilization of medical services (31.6 times more outpatient visits; 1.7 times more inpatient days; 3.4% more surgery volume) and higher revenue (¥220.8 million more) compared to the strict pandemic control strategy.ConclusionsCOVID-19 measures were associated with less hospital service utilization and revenue in Chinese tertiary hospitals. The developed OPCS in Chinese tertiary hospitals, focusing on isolating infected inpatients but not shutting down the hospital facilities exposed to virus, could be effective in optimizing hospital service utilization and hospital revenue during the Omicron wave.

A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective

BackgroundPregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18–28 years, and ii) factors characterising the decision to terminate.MethodsIn-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.ResultsAn application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants’ decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants’ decisions through detrimental changes in interpersonal support and financial situation.ConclusionsAmongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

Pandemic Impact, Support Received, and Policies for Health Worker Retention: An Environmental Scan.

The COVID-19 pandemic has brought additional strain to health workers in the Philippines, leading to a significant proportion of them leaving the workforce. The purpose of this study is to explore the impact of the pandemic on health workers, the support that they received and associated challenges; and identify relevant policies for better workplace conditions. An environmental scanning method was utilized. Particularly, a literature review and policy scan that were validated through key informant interviews with administrators and frontline health workers from selected urban and rural sites in the three main islands in the Philippines. These were framed into a background note to springboard the discussions during a national policy dialogue participated by representatives from key government organizations, professional organizations of physicians, nurses, and midwives, professional regulatory bodies, hospital administrators, frontline health workers, and donor agencies in the Philippines. Deaths, burn-out, mental health problems, lack of personal protective equipment and poor allocation of vaccines were reported in the early phases of the pandemic. Support varied across settings but included additional allowance, free meals, accomodation, transportation, training and psychosocial services. Furthermore, pre-pandemic issues such as as low salaries and heavy workload continue to be the main reasons for leaving the workforce or the country. The proposed solutions are as follows: (1) creating policies and strategies for appropriate production, recruitment, and retention of human resources for health; (2) allocating regular permanent positions for both the education and health sector; (3) augmenting and continuation of deployment programs; (3) expanding roles of nurses to push for advanced practice nursing; (4) providing fair compensation along with risk allowances, non-financial incentives, and expanded benefits; (5) supporting mental health wellness by providing an appropriate work-rest balance and safe work environment; (6) providing opportunities for professional development and scholarships with accompanying return-service agreement; and (7) strengthening the reintegration programs for returning overseas health workers. The pandemic has affected the well-being of health workers and disparities in support were reported due to longstanding workplace issues and policy implementation gaps. Stakeholder commitments require sustained monitoring while policies that are in place and yet to be developed demand stronger support from the government, members of Congress, the private sector, and other key decision-makers.

Preferences for the Societal Impacts of a Pandemic when it Transitions into an Endemic: A Discrete Choice Experiment.

The stage of the pandemic significantly affects people's preferences for (the societal impacts of) COVID-19 policies. No discrete choice experiments were conducted when the COVID-19 pandemic was in a transition phase. This is the first study to empirically investigate how citizens weigh the key societal impacts of pandemic policies when the COVID-19 pandemic transitions into an endemic. We performed two discrete choice experiments among 2181 Dutch adults that included six attributes: COVID-19 deaths, physical health problems, mental health problems, financial problems, surgery delays and the degree to which individual liberties are restricted. We used latent class choice models to identify heterogeneous preferences for the impacts of COVID-19 measures across different groups of respondents. A large majority of the participants in this study was willing to accept deaths to avoid that citizens experience physical complaints, mental health issues, financial problems and the postponement of surgeries. The willingness to tolerate COVID-19 deaths to avoid these societal impacts differed substantially between participants. When participants were provided with information about the stringency of COVID-19 measures, they assigned relatively less value to preventing the postponement of non-urgent surgeries for 1-3 months across all classes. Having gone through a pandemic, most Dutch citizens clearly prefer pandemic policies that consider citizens' financial situations, physical problems, mental health problems and individual liberties, alongside the effects on excess mortality and pressure on healthcare.

Therapeutic management of peritonsillar abscess during COVID-19.

The purpose of this study is to examine the effects of the Covid-19 pandemic and lockdown policies in Germany on frequency and treatment of peritonsillar abscess at a tertiary referral center in Germany. This retrospective case-control study analyzed all cases of peritonsillar abscess treated from 03/01/2018 until 08/30/2022 at Augsburg ENT University Hospital, Germany, through abscess tonsillectomy and/ or incisional drainage. Data was collected and correlated to Covid-19 Stringency Index using codes based on the Institute for Hospital Remuneration System in Germany. After excluding 303 cases, 975 abscess tonsillectomy and incisional drainage cases were studied, with the first German lockdown serving as cutoff date. Treatment algorithm was maintained regardless of co-infection with Covid-19. A total of 174 patients received abscess tonsillectomy as therapy, while 801 patients underwent incisional drainage. Before the first German lockdown, 452 patients received incisional drainage. Since the pandemic, 349 cases of incisional drainage were registered (OR = 0.54, 95%-CI [0.27-0.86], p = 0.04), despite no significant change in the percentage of peritonsillar abscess of all ENT emergencies. The mean age at presentation with PTA was 39.8 years, and the rate of relapse was 4.0%. The study found no association between the scale of policy measures and treatment (OR = 1.00, 95%-CI [0.99-1.01], p = 0.52). The results indicate that, despite the reduction in capacities due to Covid-19, the proportion of patients with peritonsillar abscess treated through abscess tonsillectomy increased at Augsburg ENT University Hospital since the first German lockdown. Hospitalization times could still be reduced with comparable relapse rates.

The impact of the COVID-19 pandemic and the free vaccination policy on seasonal influenza vaccination uptake among older adults in Ningbo, Eastern China

ABSTRACT In 2020–21, during the COVID-19 pandemic, a free influenza vaccination program was initiated among the elderly residents in Ningbo, China. The impact of the COVID-19 pandemic and free vaccination policy on influenza vaccine uptake needs to be evaluated. The influenza vaccine uptake among individuals born before 31 December, 1962 from 2017–18 to 2022–23 season in Ningbo was analyzed. Multivariate logistic regressions were used to estimate the impact of the COVID-19 pandemic and free vaccination policy. Our analysis included an average of 1,856,565 individuals each year. Influenza vaccination coverage increased from 1.14% in 2017–18 to 33.41% in 2022–23. The vaccination coverage among the free policy target population was 50.03% in 2022–23. Multivariate analysis showed that free vaccination policy increased influenza vaccine uptake most (OR = 11.99, 95%CI: 11.87–12.11). The initial phase of the pandemic was associated with a positive effect on influenza vaccination (OR = 2.09, 95%CI: 2.07–2.12), but followed by a negative effect in the subsequent two seasons(2021–22: OR = 0.75, 95%CI: 0.73–0.76; 2022–23: OR = 0.40, 95%CI: 0.39–0.40). COVID-19 vaccination in the current season was a positive predictor of influenza vaccine uptake while not completing booster COVID-19 vaccination before was negative predictor in 2022–23. Having influenza vaccine history and having ILI medical history during the last season were also positive predictors of influenza vaccine uptake. Free vaccination policies have enhanced influenza vaccination coverage among elderly population. The COVID-19 pandemic plays different roles in different seasons. Our study highlights the need for how to implement free vaccination policies targeting vulnerable groups with low vaccination coverage.

Optimal design of vaccination policies: A case study for Newfoundland and Labrador

This paper proposes pandemic mitigation vaccination policies for Newfoundland and Labrador (NL) based on two compact mixed integer programming (MIP) models of the distance-based critical node detection problem (DCNDP). Our main focus is on two variants of the DCNDP that seek to minimize the number of connections with lengths of at most one (1-DCNDP) and two (2-DCNDP). A polyhedral study for the 1-DCNDP is conducted, and new aggregated inequalities are provided for the 2-DCNDP. The computational experiments show that the 2-DCNDP with aggregated inequalities outperforms the one with disaggregated inequalities for graphs with a density of at least 0.5%. We also study the strategic vaccine allocation problem as a real-world application of the DCNDP and conduct a set of computational experiments on a simulated contact network of NL. Our computational results demonstrate that the DCNDP-based strategies can have a better performance in comparison with the real-world strategies implemented during COVID-19.

Corona blue among us: associations between risk perception, visits to urban spaces, and mental health in Seoul, Korea and Shanghai, China

ABSTRACT The so-called “Corona Blue” decline in mental health after the COVID-19 outbreak. This study examines how COVID-19 risk perception affects mental health via urban space usage in Seoul, Korea, and Shanghai, China. It uniquely explores direct PR-MH and OS-MH effects, along with indirect effects mediated by pandemic-driven changes in urban space utilization. Results reveal that visits to urban destinations and open spaces mediate the relationship between perceived risk and MH, with differing significance levels between the two cities. In Seoul, disruptions in daily life negatively affected mental health through decreased interactions with urban destinations and outdoor spaces, with a statistically significant impact on stress through urban destinations. This suggests that maintaining access to and engagement with these spaces is crucial for mental health during crises. Conversely, Shanghai showed indirect effects predominantly through perceptions of safety, which significantly influenced anxiety levels through urban destinations, but did not manifest similarly through interactions with outdoor spaces. Caution in interpretation is necessary for better generation, but the outcomes of this study underscore the importance of considering cultural, historical, and political contexts in understanding the varying impacts of future pandemic policies on mental health.

Pandemic Governance: Responses for COVID-19 Management of Zamboanga City

The challenges brought by pandemic governance include the efficient management of socioeconomic, political, and health issues. In today's sociodemographic and globalized environment, a rational and scientific approach to pandemic governance and public health policy formulation necessitates a combination of science, culture, and people. Effective pandemic governance requires an approach that is adaptive, and lesson based. In instances when faith in governmental institutions and political leadership are crucial, knowledge of the public health system, epidemiology, and socio-political issues is also important. Effective pandemic governance can impact COVID-19 management outcomes. This study looks into the Zamboanga City's COVID-19 management responses. It examines the effectiveness of the measures implemented by Zamboanga City in the critical areas specified for the management of the COVID-19 epidemic. This study employs a descriptive-qualitative method using secondary data analysis and interview guide. This study demonstrates that Zamboanga City's approaches to the management of the COVID-19 pandemic are effective in thirteen (13) assessment categories. This study also reveals flaws in the application of countermeasures against the spread of the COVID-19 virus. Thus, there is a need to improve responses on the part of political leaders by designing, integrating, and implementing sound governance strategies in the fight against COVID-19 pandemic.

Pandemic policies and sleeping problems in older adults.

Sleep quality is fundamental to physical and mental health. Recent research shows that the COVID-19 pandemic has affected individuals' sleep quality. This study aims to investigate whether the containment and health policies (Oxford Coronavirus Government Response Tracker indexes) adopted by European countries and Israel during the pandemic are related to sleep problems in people aged 50 and over. A cross-sectional study was conducted using a logistic regression analysis based on data from the Survey of Health, Ageing and Retirement in Europe, collected in 27 European countries and Israel, in 2021. The results show that containment and health policies affect older adults' sleep, once we neutralise the influence of the sociodemographic, economic, and health characteristics of the individuals and close contact with COVID-19. In fact, the more containment and health policies, the fewer chances of sleep problems. A possible explanation for this is that these policies give people over 50 a sense of safety and security in relation to COVID-19, which may reduce sleep problems.

Researching into Chinese university students' mental health in the post-pandemic era - problems and causes.

Mental health challenges have still been widely pervasive among Chinese university students after the outbreak of the COVID-19 pandemic. This article aims to explore mental health challenges encountered by Chinese university students in the post-pandemic era and explain causes to these challenges using a qualitative approach. We conducted six focus group interviews with university students in Zhuhai, China, and altogether 61 students including 43 female students, and 18 male students participated in the study. Our results indicate that sleep difficulties, anxiety, and stress are the three primary mental health challenges experienced by students. Academic pressure, social influence including peer pressure and pursuit of social acceptance, and pandemic related policies and measures are the causes to the above mental health challenges. The results of this study will inform the development of mental health promotion, intervention, and education activities for university students to bolster their resilience and cope with mental health problems in the post-pandemic era. Meanwhile, our results could illuminate the services stakeholders provide to university students in the future.

To give or not to give? Pandemic vaccine donation policy

ObjectivesThe purpose of this work is to characterize scenarios under which it may be in a donor country's own public health interests to donate vaccine doses to another country before its own population has been fully vaccinated. In these scenarios, vaccinating other countries can delay the evolution of new variants of the virus, decrease total deaths, and, in some cases, decrease deaths in the donor countries. Study designWe simulate the effects of different vaccine donation policies using an epidemiological model employing COVID-19 transmission parameters. MethodsWe use the epidemiological model of Holleran et al. that incorporates virus mutation to simulate epidemic progression and estimate numbers of deaths arising from several vaccine allocation policies (donor-first, non-donor-first, and vaccine sharing) across a number of scenarios. We analyze the results in light of herd immunity limits derived in Holleran et al. ResultsWe identify realistic scenarios under which a donor country prefers to donate vaccines before distributing them locally in order to minimize local deaths during a pandemic. We demonstrate that a non-donor-first vaccination policy can delay, sometimes dramatically, the emergence of more-contagious variants. Even more surprising, donating all vaccines is sometimes better for the donor country than a sharing policy in which half of the vaccines are donated, and half are retained because of the impact donation can have on delaying the emergence of a more contagious virus. Non-donor-first vaccine allocation is optimal in scenarios in which the local health impact of the vaccine is limited or when delaying the emergence of a variant is especially valuable. ConclusionIn all cases, we find that vaccine distribution is not a zero-sum game between donor and non-donor countries, illustrating the general moral reasons to donate vaccines. In some cases, donor nations can also realize local health benefits from donating vaccines. The insights yielded by this framework can be used to guide equitable vaccine distribution in future pandemics.

Regional variation in financial hardship among US veterans during the COVID-19 pandemic.

Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform. Regional variation in veteran financial hardship demonstrates a need for further research about the role and interaction of federal and state financial-assistance policies in shaping risks for financial hardship as well as potential opportunities to mitigate risks among veterans and reduce variation across regions.

Partisanship, elections and lockdowns: Evidence from US states

AbstractIn this article, we use state‐level variation in Senate elections and partisanship to understand the variation in lockdown characteristics in the US. We argue that the state‐level decision makers and their parties weigh off the perceived political costs in an election year of a depressed economy against risks to public health. Democrats and Republicans, and their voters, vary in the weights they attach to these costs and benefits. We are thus exploring the marginal effect of the party–election interaction after accounting for other likely drivers of variations in lockdown characteristics. We find that Republican states with an election have less strict and shorter lockdowns compared to Democratic states with an election. Our results have implications for the communication of pandemic policies, including vaccination strategies.

Assessing and Clustering Countries Based on COVID-19 and Related Indicators: Clustering and MULTIMOORA Approaches

The COVID-19 pandemic has been one of humanity's most difficult times. The pandemic spread and impact were not at the same level for all countries. Investigation of the variation of the countries is crucial for policymakers. Therefore, the study proposed to cluster countries according to the number of COVID-19 cases, deaths, vaccinations and related socioeconomic, disease, and health risk factors and rank them by using MULTIMOORA (MOORA plus the full multiplicative form) in an integrated way. The data set consists of 148 countries and 13 indicators. K-Means algorithm was used to cluster countries. Optimal cluster was found as six according to Silhouette Index. The cluster consisted of mostly developed countries ranked as best perform cluster. It had the highest number of COVID-19 vaccinations, GDP per capita, share health expenditure in GDP, life expectancy, elderly population portion, and environmental performance index values, and the least mortality of chronic diseases. Moreover, Norway, Iceland, and Denmark were the best-performing countries in this cluster. In addition to this, Turkey was located in the second-ranked cluster. It was also determined that COVID-19 indicators (cases, deaths, and vaccinations) were related to GDP per capita, environmental index, and life expectancy. As a result, policymakers can develop pandemic policies for country groups separately, and assistance can be provided in this regard according to the priority order of the countries.

The impact of COVID-19 on medical education and training.

The COVID-19 pandemic social isolation policies have accelerated the shift to online teaching for medical students and doctors in training worldwide. Online learning is cost-effective, available, and flexible. However, it can be challenging due to the technical system errors, which results in the disruption of the learning process and social isolation yielding to less satisfaction among students and teachers. The above can have negative consequences on the mental health of medical students and trainees, which is an under-researched area. United Kingdom based medical students and doctors in speciality training encountered disruptions to medical education and training due to the pandemic. Medical school and deaneries had to endorse adjustments to teaching and training delivery methods, examination, and assessments to ensure the continued progression of learning and training. A successful e-learning model depends on motivated and well-prepared medical students and teachers and structured educational materials in supported learning environment and institutions. A blended model is likely to be utilised by medical institutions for medical training in the future, which will need to be researched.

The Impact of Differential COVID-19 Pandemic Containment Policies on International Trade and Capital Flows

ABSTRACT This article develops a two-period two-country model to examine the impact of differential COVID-19 pandemic containment policies on international trade and capital flows. The theoretical analysis shows that asymmetric labor supply shocks resulting from the pandemic generate capital outflows from more affected countries to less affected ones, with the former running current account deficits. The greater the asymmetry in supply shocks, the more pronounced the impact on cross-border capital and trade flows. As the pandemic abated, these flows reversed, creating significant fluctuations over the pandemic cycle. However, globalization acted as a risk-sharing mechanism, moderating potential welfare losses. Using panel data from 42 countries, we investigate how specific containment policies like workplace closures and home isolation mandates affect trade and capital flows. Contrary to findings using higher frequency data, our empirical results confirm key predictions of our model, suggesting more stringent temporary containments, while dampening economic activity initially, may reduce COVID-19 cases and induce current account surpluses and capital inflows over a longer horizon.

Nigerians’ perception of newspaper framing of COVID-19 stories and adherence to government’s containment policy (2020–2021)

There is a known fact that the public depends largely on the media for information. However, such information might not have been perceived rightly as sent by the media. Hence, the objective of this study is to examine the extent to which information on the coronavirus 2019 (COVID-19) pandemic containment policy flows from the government to the public through the pages of newspapers. Aside from examining how these policies were framed, it seeks to also find out if Nigerians perceived the coverage by newspapers as relevant for them to comply with them. Adopting a descriptive methodological approach which systematically differs from most previous studies because substantial studies on the subject matter use qualitative methods. Findings reveal that Newspapers’ framing of COVID-19 stories does not correlate with public adherence to the government’s containment policy and the volume of newspaper coverage of COVID-19 stories does not correlate with public perception of the importance of the government containment policy on the disease. The study concluded that even though advancement in technology has given rise to the use of other media such as social media, the efficacy/potency and relevance of the newspaper cannot be brushed aside despite this advancement. It is, however, recommended that further studies should be conducted to examine the challenges faced by press through Key Informant Interview (KII) in the carrying coverage on the COVID-19 pandemic in other to strike balance.

Public attitudes toward COVID-19 prevention and control in China.

Based on the data of the Chinese General Social Survey (CGSS) in 2021, this study aims to investigate the public attitudes toward COVID-19 prevention and control in China. The household survey CGSS 2021 contains 8,148 valid samples gathered from 320 communities across 19 provinces in China. The logistic regression model is adopted to examine the relationship between public attitudes and influencing factors. The results show that the vast majority of respondents firmly believe that the government has the authority to implement strict measures; their confidence in the government and in the healthcare system has increased; and they willingly choose to be vaccinated. The regression results suggest that gender, age, health condition, political affiliation, source of information, sense of fairness, socio-economic status, and place of residence are significantly associated with individuals' attitudes toward COVID-19 prevention and control. These findings highlight the importance for the government to design epidemic or pandemic policies based on data and to tailor them toward specific demographics.

Impact of tariff liberalization on economic and social benefits: Computable general equilibrium application to Kenya

AbstractThis study employed computable general equilibrium policy simulations to examine the impact of import tariff liberalization on socioeconomic outcomes including living standards, cost of living, gross domestic product (GDP) from expenditure, total investment expenditure, intermediate input demand, output, value‐added, tariff revenue, sales tax revenue, indirect tax revenue, direct income tax revenue, factor income tax revenue, and factor demand. Findings from the simulations have policy implications touching on a need to embrace reciprocal tariff liberalization under agreements like strategic trade and investment partnerships and economic partnership agreements as they are associated with welfare gains, reduction in cost of living, and GDP growth. Targeted policy incentives could be directed to specific domestic sectors since tariff liberalization has negative impacts on investment expenditure. Incentives regarding intermediate inputs should be directed to the manufacturing and services sectors for liberalization of agrifood commodities. Targeted policy incentives should be directed to the manufacturing and services sectors which experience decrease in output with tariff reductions. Liberalization of manufactured commodities should be accompanied by value‐added incentives directed to the agrifood and home production–home consumption sectors. For the liberalization of manufactured commodities, targeted policy incentives should be directed to the services sector which experiences job losses while for the liberalization of tariffs on imports of agrifood commodities, targeted policy incentives should be directed to the agrifood and the home production–home consumption sectors, which also lose jobs. These targeted policy incentives could support industrial activity and compensate for revenue loss, especially from customs duties.Related ArticlesGruber, Lloyd. 2013. “Trade, Growth, Poverty, and Politics: Toward a Unified Theory.” Politics & Policy 41(5): 723–64. https://doi.org/10.1111/polp.12034.Onyango, Gedion, and Japheth Otieno Ondiek. 2022. “Open Innovation During the COVID‐19 Pandemic Policy Responses in South Africa and Kenya.” Politics & Policy 50(5): 1008–31. https://doi.org/10.1111/polp.12490.Soto, Gloria. 2012. “Environmental Impact of Agricultural Trade Liberalization under NAFTA.” Politics & Policy 40(3): 471–91. https://doi.org/10.1111/j.1747‐1346.2012.00354.x.