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BackgroundEmergency risk communication (ERC) is key to achieving compliance with public health measures during pandemics. Yet, the factors that facilitated ERC during COVID-19 have not been analyzed. We compare ERC in the early stages of the pandemic across four socio-economic settings to identify how risk communication can be improved in public health emergencies (PHE).MethodsTo map and assess the content, process, actors, and context of ERC in Germany, Guinea, Nigeria, and Singapore, we performed a qualitative document review, and thematically analyzed semi-structured key informant interviews with 155 stakeholders involved in ERC at national and sub-national levels. We applied Walt and Gilson's health policy triangle as a framework to structure the results.ResultsWe identified distinct ERC strategies in each of the four countries. Various actors, including governmental leads, experts, and organizations with close contact to the public, collaborated closely to implement ERC strategies. Early integration of ERC into preparedness and response plans, lessons from previous experiences, existing structures and networks, and clear leadership were identified as crucial for ensuring message clarity, consistency, relevance, and an efficient use of resources. Areas of improvement primarily included two-way communication, community engagement, and monitoring and evaluation. Countries with recurrent experiences of pandemics appeared to be more prepared and equipped to implement ERC strategies.ConclusionWe found that considerable potential exists for countries to improve communication during public health emergencies, particularly in the areas of bilateral communication and community engagement as well as monitoring and evaluation. Building adaptive structures and maintaining long-term relationships with at-risk communities reportedly facilitated suitable communication. The findings suggest considerable potential and transferable learning opportunities exist between countries in the global north and countries in the global south with experience of managing outbreaks.

Background During outbreaks, uncertainties experienced by affected communities can influence their compliance to government guidance on public health. Communicators and authorities are, hence, encouraged to acknowledge and address such uncertainties. However, in the midst of public health crises, it can become difficult to define and identify uncertainties that are most relevant to address. We analyzed data on COVID-19-related uncertainties from four socio-economic contexts to explore how uncertainties can influence people’s perception of, and response to Risk Communication and Community Engagement (RCCE) strategies. Results This qualitative study, which adopts an interpretative approach, is based on data from a documentary review, key informant interviews (KII), and focus group discussions (FGD) with members of the general public and people with barriers to information from Germany, Guinea, Nigeria, and Singapore. Transcripts from the KII and FGD were coded and analyzed thematically. We interviewed a total of 155 KIs and conducted 73 FGD. Our analysis uncovered a divergence between uncertainties deemed relevant by stakeholders involved in policy making and uncertainties that people reportedly had to navigate in their everyday lives and which they considered relevant during the pandemic. We identified four types of uncertainties that seemed to have influenced people’s assessment of the disease risk and their trust in the pandemic control strategies including RCCE efforts: epidemiological uncertainties (related to the nature and severity of the virus), information uncertainties (related to access to reliable information), social uncertainties (related to social behavior in times of heightened risk), and economic uncertainties (related to financial insecurities). Conclusion We suggest that in future outbreaks, communicators and policy makers could improve the way in which affected communities assess their risk, and increase the trust of these communities in response efforts by addressing non-epidemiological uncertainties in RCCE strategies.

On a bi-weekly basis, COVID-19 control measures were analyzed through a deeper investigation by the Evidence-Based Public Health Unit at ZIG. The biweekly analysis focused on a list of countries selected on the basis of their accelerating or decelerating COVID-19 epidemiological trend. For this, a policy analysis framework was developed to contextualize the epidemiological trend in conjunction with the change in the public policy landscape.

We estimated the impact of a comprehensive set of non-pharmeceutical interventions on the COVID-19 epidemic growth rate across the 37 member states of the Organisation for Economic Co-operation and Development during the early phase of the COVID-19 pandemic and between October and December 2020. For this task, we conducted a data-driven, longitudinal analysis using a multilevel modelling approach with both maximum likelihood and Bayesian estimation. We found that during the early phase of the epidemic: implementing restrictions on gatherings of more than 100 people, between 11 and 100 people, and 10 people or less was associated with a respective average reduction of 2.58%, 2.78% and 2.81% in the daily growth rate in weekly confirmed cases; requiring closing for some sectors or for all but essential workplaces with an average reduction of 1.51% and 1.78%; requiring closing of some school levels or all school levels with an average reduction of 1.12% or 1.65%; recommending mask wearing with an average reduction of 0.45%, requiring mask wearing country-wide in specific public spaces or in specific geographical areas within the country with an average reduction of 0.44%, requiring mask-wearing country-wide in all public places or all public places where social distancing is not possible with an average reduction of 0.96%; and number of tests per thousand population with an average reduction of 0.02% per unit increase. Between October and December 2020 work closing requirements and testing policy were significant predictors of the epidemic growth rate. These findings provide evidence to support policy decision-making regarding which NPIs to implement to control the spread of the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s10654-021-00766-0.

In recent years, scholarship on international organisations (IO) has devoted increasing attention to the relations in which IOs are embedded. In this article, we argue that the rationalist-institutionalist core of this scholarship has been marked by agentic, repressive understandings of power and we propose an alternative approach to power as productive in and of relations among IOs. To study productive power in IO relations, we develop a theoretical framework centred on the concept of ‘metagovernance norms’ as perceptions about the proper ‘governance of governance’ that are shared among IOs in a governance field. Drawing on discourse theory, we contend that metagovernance norms unfold productive power effects, as dominant notions of how to govern well and effectively (i) fix meanings, excluding alternative understandings and (ii) are inscribed into practices and institutions, hence reshaping inter-organisational relations over time. To illustrate our framework, we trace metagovernance norms in discourses among health IOs since the 1990s. We find a historical transformation from beliefs in the virtues of partnerships, pluralisation, and innovation, towards discursive articulations that emphasise harmonisation, order, and alignment. Moreover, we expose the productive power of metagovernance norms by showing how they were enacted through practices and institutions in the global health field.

This article approaches the field of global health governance from the vantage point of shared discourses and norms on the good governance of governance amongst multiple international organizations (IOs). Conceptually, we introduce metagovernance norms as constitutive, reflexive beliefs concerned with institutional order and IO interactions in a given governance field. We argue that such norms are entangled with causal beliefs and problem perceptions that form part of contingent, contested repertoires of knowledge. Moreover, we illustrate how IO ‘expert’ groups form an authoritative subject position from which truth claims about governance are advanced. Empirically, we trace metagovernance norms in discourse(s) amongst eight health IOs since the 1970s. We show how metagovernance norms have been constructed around competing beliefs about governance ‘effectiveness’ and problem perceptions concerned with different forms of ‘complexity’. Our research demonstrates that discourses on institutional order in global health are shaped by metagovernance norms drawing on historically-specific knowledge repertoires.