Sensing pedestrian flows for real-time assessment of non-pharmaceutical policy interventions during the COVID-19 pandemic

IntroductionTo combat and mitigate the transmission of the SARS-CoV-2 virus, reducing the number of social contacts within a population is highly effective. Non-pharmaceutical policy interventions, e.g. stay-at-home orders, closing schools, universities, and (non-essential) businesses, are expected to decrease pedestrian flows in public areas, leading to reduced social contacts. The extent to which such interventions show the targeted effect is often measured retrospectively by surveying behavioural changes. Approaches that use data generated through mobile phones are hindered by data confidentiality and privacy regulations and complicated by selection effects. Furthermore, access to such sensitive data is limited. However, a complex pandemic situation requires a fast evaluation of the effectiveness of the introduced interventions aiming to reduce social contacts. Location-based sensor systems installed in cities, providing objective measurements of spatial mobility in the form of pedestrian flows, are suited for such a purpose. These devices record changes in a population’s behaviour in real-time, do not have privacy problems as they do not identify persons, and have no selection problems due to ownership of a device. ObjectiveThis work aimed to analyse location-based sensor measurements of pedestrian flows in 49 metropolitan areas at 100 locations in Germany to study whether such technology is suitable for the real-time assessment of behavioural changes during a phase of several different pandemic-related policy interventions. MethodsSpatial mobility data of pedestrian flows was linked with policy interventions using the date as a unique linkage key. Data was visualised to observe potential changes in pedestrian flows before or after interventions. Furthermore, differences in time series of pedestrian counts between the pandemic and the pre-pandemic year were analysed. ResultsThe sensors detected changes in mobility patterns even before policy interventions were enacted. Compared to the pre-pandemic year, pedestrian counts were 85% lower. ConclusionsThe study illustrated the practical value of sensor-based real-time measurements when linked with non-pharmaceutical policy intervention data. This study’s core contribution is that the sensors detected behavioural changes before enacting or loosening non-pharmaceutical policy interventions. Therefore, such technologies should be considered in the future by policymakers for crisis management and policy evaluation.

Donations Made and Received: A Study of Disclosure Practices of Pharmaceutical Companies and Patient Groups in Canada

Given the increasing role of patient groups in pharmaceutical policy making in Canada, this observational study was undertaken to determine whether companies that are members of Innovative Medicines Canada (IMC) list, on their publicly available websites, the names of patient groups that they make donations to and reciprocally, whether patient groups publicly list the names of the companies that they receive donations from. Websites of IMC members were searched for the names of the patient groups receiving donations, value of the donations and year the donations were made. The website of each patient group that was listed as receiving a donation was then searched for information about the name of companies making donations along with the value of the donations, year the donations were made and percent of the patient group’s income represented by the donation. For donations over $50,000, an attempt was made to match donations that companies made to donations that patient groups received. Eleven of 44 IMC members reported making 165 donations to 114 different patient groups. Seventy-nine of these 114 groups reported receiving 373 donations from IMC members. Information about the value of donations, the year that they were given and received and the percent of patient groups’ income that they represented was limited. Donations made and received could not be matched because of the absence of information about the donations. Reporting on websites about donations by both companies and patient groups in Canada is haphazard, inconsistent and incomplete. Reforms are need to both the way that companies and patient groups report donations.

Transparency in public pharmaceutical sector: the key informants’ perceptions from a developing country

Background Policymaking in the pharmaceutical sector plays a pivotal role in achieving the health systems’ goals. Transparency in the pharmaceutical policy could increase confidence in decision-making processes. This study aims to assess transparency in the public pharmaceutical sector of Iran. Methods This qualitative study with a content analysis approach was conducted in 2017 using the World Health Organization tool to explore pharmaceutical transparency. The perceptions of the various stakeholders of the health system through semi-structured interviews with a maximum variation of stakeholders were obtained in eight functions, including registration, licensing, inspection, promotion, clinical trials, selection, procurement, and distribution of medicines. Results There are some problems in two main categories: (1) General problems, including lack of transparency, conflict of interest, centralization, and monopoly. (2) Ethical problems include illegal payments, gifts, bribes, conflicts of interest, hidden power, hoarding, relationship-oriented behavior, medicine trafficking, and counterfeit medicine. Suggested solutions include evidence-based decision-making, the use of transparent and accountable processes, standardization, needs assessment, declaring a conflict of interest, skilled human resources, and tracking prescription. Conclusion Despite the development of effective pharmaceutical policy in the health care system and government interventions for the control of the market, in some functions, reviewing the pharmaceutical policy is essential. Additionally, declaring a conflict of interest statement must be at the core of policy development to provide greater transparency.

A Review of the Evidence on Attitudes, Perceived Impacts and Motivational Factors for European Member State Collaboration for Pricing and Reimbursement of Medicines: Time for the EEA Member States to Apply Their Experience and Expertise in Evidence-Based Decision Making to Their Current Pharmaceutical Policy Challenges

In 2018/2019 there were a number of initiatives for collaboration between Member States in the European Economic Area (EEA) and the European Commission published a Proposal for a Regulation on Health Technology Assessment. In view of the perceived benefits from collaboration, the experiences and challenges of these collaborative initiatives and the possible implications of the proposed legislation, a study of the evidence on attitudes, perceived impacts and the motivational factors towards European Member State collaboration regarding the pricing and reimbursement of medicines was conducted. This study adopted an evidence–based management approach by Barends and Rousseau. The main findings showed that Member States differed in their motivation for collaboration for different pharmaceutical activities. Member States favoured voluntary co-operation for all activities of pricing and reimbursement except for relative effectiveness assessments where Member State authorities had divergent attitudes and prioritised activities related to the sustainability of their healthcare systems and access to medicines. Contrastingly pharmaceutical companies strongly favoured mandatory cooperation for evaluation. Member States motivation for collaboration was highly dependent on the purpose, political will, implementation climate and cultural factors. Currently, with the experiences of ongoing collaborations, following the progress of the discussion at Council, and with a number of inititatives for new pharmaceutical strategy and policy, it is proposed that Member States use their trust, expertise and knowledge of application of evidence-based decision making for pricing and reimbursement of medicines and apply it to decide the future model for Member State collaboration. The applicability of principles of evidence-based management to pharmaceutical policy can be used as a starting point.

Comparative analysis of awareness of medical professionals in three Balkan countries (Bulgaria, Croatia, and Slovenia) of continuing education of medical professionals in the area of pharmaceutical policy in the respective countries

Aim: The objectives of our study were to establish the extent to which medical professionals are willing to upgrade their skills, to find out whether they have to resort often in their daily work to the support of colleagues in matters related to pharmaceutical policy, and to find out if they attend any forms of continuing education and whether such forms are available at their workplaces. The study also aimed to establish what web-based forms of continuous education the graduated medical professionals in Bulgaria, Croatia, and Slovenia know and consider to be up-to-date and adequate to their needs for specialised training programmes which ensure that their knowledge will be adequate to the constantly evolving environment in the area of pharmaceutical policy and pharmaceutical regulation. Materials and methods: A survey was carried out among a representative sample drawn from three Balkan countries: Bulgaria, Croatia, and Slovenia. The survey was based on voluntary participation and relied on the ‘snowballing’ technique in order to recruit respondents and disseminate questionnaires. Results: The results from the study demonstrate that the respondents are willing to, and are aware that they should, join forms of continuing education in the area of pharmaceutical policy since some of them encounter certain challenges related to the level of their knowledge in this domain, and that the deployment of specialised online programmes and other activities (such as workshops, conferences, etc.) for professional qualification of employees will certainly contribute to the enhancement of their qualification and to the improvement of the health services provided to citizens. Conclusions: To keep in pace with modern trends in the area of postgraduate education, the medical universities which are most trusted by the respondents from the three countries included in survey as well as the career development services providers which offer postgraduate training courses should focus on the development and implementation of innovative forms of web-based postgraduate/upskilling education in the area of pharmaceutical policy to ensure that more potential learners can join and update their understanding of this dynamic and rapidly evolving area of scientific knowledge.

Public support for lockdown policies

Due to the outbreak of the COVID-19 disease, many countries have been forced to impose non-pharmaceutical policy interventions such as lockdowns to stop community transmission. We investigate public support for the lockdown policy in Spain, one of the countries most affected by the pandemic and with the strictest lockdown in Europe. Based on survey data collected during the first weeks of March and April 2020, we investigate how public support for the lockdown relates to the number of confirmed cases in the province of residence, personal institutional trust and concern about the severity of coronavirus. We find that public approval of the lockdown significantly relates to the evolution of COVID cases, institutional trust, political ideology and personal economic situation.

A Sociotechnical Approach to Analyze Pharmaceutical Policy and Services Management in Primary Health Care in a Brazilian Municipality

The decentralization of the Brazilian health system required that municipalities took responsibility for the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system. We adopted a multi-methods approach and various data sources. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analyzing the External System (health system, stakeholders, financing) and Internal System (goals, management, workforce, infrastructure, processes, technology and culture). The “objective” component of the PPS system was identified as the central element. The lack of a unified objective and of a central coordination and unmanaged pharmaceutical services prevented integrated internal planning and planning with other sectors. Stakeholders and documents referred only to technical elements of the system: Infrastructure, technical process, and technology. The social components of the workforce and culture were not mentioned. The organizational culture established was the culture of isolation: “Each one does his own”. The pharmacists working in the municipal health system did not know each other. There was no integration strategy between pharmacists and their work processes. Consequently, the municipal PPS had limited scope as a public policy. It had constrained the characteristics of PPS as a complex and open system. Understanding the municipal PPS as a sociotechnical system can push the development of a new level of policy and practice to ensure the population’s right to the access to and rational use of medicines.

Deconstructing and Historicizing Access to Medicines: The Changing Priority of Pharmaceutical Governance in China

Securing access to medicines (ATM) is critical for improving public health outcomes. Existing research has long identified and analyzed various barriers that may impede ATM at the global, national, or local levels. However, it tends to adopt a normative perspective to prescribe what infrastructures, resources, and measures should be put in place to improve ATM. Little scholarship has explored how and why countries may prioritize certain dimensions of ATM over others in pharmaceutical governance within specific historical contexts. This article fills that gap by deconstructing and historicizing the concept of ATM. The author aims to make two arguments. First, tensions easily arise between different dimensions of ATM, and prioritizing certain dimensions in pharmaceutical policy may impede improvements in others (e.g., availability vs. affordability). Second, which dimension(s) of ATM might be prioritized in the state’s pharmaceutical policy hinges upon social, economic, and political forces. To substantiate these arguments, the author draws on interview and archival evidence from China. Specifically, the author provides a historical account of how and why the priorities of pharmaceutical governance in China changed over time: 1) 1949—late 1970s: pursuing both drug availability and affordability through socialist planning; 2) early 1980s—2015: priority shifting from availability (before the mid-1990s) to affordability (after the mid-1990s); 3) 2015—present: striving for a rebalance between drug availability and affordability.

A Sociotechnical Approach to Analyse Pharmaceutical Policy And Services In Primary Health Care

Background: Access to medicines and its rational use are persistent global concerns. It have a major impact on the quality and sustainability of the health system and on the health outcomes. In Brazil, access to medicines is a legal right and municipal government have the duty to ensure access and the best use of medicines in primary health care public facilities, stablishing the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system, aiming to prepare the interventions in the system.Methods:We adopted a multi-methods approach and various data sources were used. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analysing the Components of External System (health system, stakeholders, financing) and Components of the Internal System (Goals, Management, Workforce, Infrastructure, Processes, Technology and Culture).Results:The component “aim” was identified as the central element of the system. The other system components interrelate with its scope. Medicines availability was a key part of the PPS architecture. Lack of central coordination, pharmaceutical services without central management and a fragmented organization prevented an integrated internal planning, and with other sectors. The stakeholders and documents referred only technical elements of the system: infrastructure, technical process and technology. The social components of workforce and culture were not mentioned in the Municipal Health Plan. People are essential socio-technical elements, as well the components affecting them, but they are not privileged in the system. The organizational culture established was the culture of isolation: “each one does his own”.Conclusions:The municipal PPS emphasized medicines and technical components and had limited scope as a public policy. It had constrained the characteristics of a complex and open system. Stakeholders understood PPS as a set of technical processes, without planning or integration. PPS has had a great development in Brazil in the last twenty years. A new level of development to ensure the populations right to access of treatment requires a turning point of strategy to understand municipal PPS as a sociotechnical system.