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Despite widespread acknowledgement that trust is important in a pandemic, few concrete proposals exist on how to incorporate trust into preparing for the next health crisis. One reason is that building trust is rightly perceived as slow and challenging. Although trust in public institutions and one another is essential in preparing for a pandemic, countries should plan for the possibility that efforts to instil or restore trust may fail. Incorporating trust into pandemic preparedness means acknowledging that polarization, partisanship and misinformation may persist and engaging with communities as they currently are, not as we would wish them to be. This paper presents a practical policy agenda for incorporating mistrust as a risk factor in pandemic preparedness and response planning. We propose two sets of evidence-based strategies: (i) strategies for ensuring the trust that already exists in a community is sustained during a crisis, such as mitigating pandemic fatigue by health interventions and honest and transparent sense-making communication; and (ii) strategies for promoting cooperation in communities where people mistrust their governments and neighbours, sometimes for legitimate, historical reasons. Where there is mistrust, pandemic preparedness and responses must rely less on coercion and more on tailoring local policies and building partnerships with community institutions and leaders to help people overcome difficulties they encounter in cooperating with public health guidance. The regular monitoring of interpersonal and government trust at national and local levels is a way of enabling this context-specific pandemic preparedness and response planning. Bien qu'il soit largement admis que la confiance est un facteur crucial lors d'une pandemie, peu de propositions concretes ont ete formulees quant aux modalites de son integration dans la preparation aux prochaines crises sanitaires. L'une des raisons tient au fait qu'etablir la confiance est considere, a juste titre, comme un processus lent et complexe. La confiance mutuelle et celle placee dans les institutions publiques est essentielle dans la preparation aux pandemies, les pays devraient donc tenir compte de la possibilite que leurs efforts pour instaurer ou restaurer cette confiance echouent. Integrer ce facteur dans la preparation aux pandemies signifie reconnaitre que la polarisation, la partialite et la desinformation sont susceptibles de persister. Cela signifie aussi travailler avec les communautes telles qu'elles sont actuellement, et non telles que nous souhaiterions qu'elles soient. Le present document devoile un programme politique concret visant a inclure la mefiance comme facteur de risque dans la planification des mesures de preparation et de riposte aux pandemies. Nous suggerons deux types de strategies fondees sur des donnees factuelles: (i) des strategies visant a preserver la confiance preexistante au sein d'une communaute durant une crise, notamment en luttant contre la lassitude face aux pandemies par le biais d'interventions de sante et d'une communication honnete, transparente et sensee; mais aussi (ii) des strategies qui favorisent la cooperation dans les communautes dont les membres se mefient de leur gouvernement et de leurs voisins, parfois pour des raisons historiques legitimes. Lorsque des doutes subsistent, les mesures de preparation et de riposte aux pandemies doivent eviter de recourir a la contrainte et privilegier des politiques locales adaptees ainsi que des partenariats avec les responsables et les institutions de la communaute, afin d'aider les gens a surmonter les difficultes qu'ils rencontrent vis-a-vis des directives de sante publique. Un suivi regulier de la confiance envers les autres et les autorites a l'echelle regionale et nationale permet de planifier une preparation et une riposte specifiques face aux pandemies. A pesar del reconocimiento generalizado de que la confianza es importante en una pandemia, existen pocas propuestas concretas sobre como incorporarla a la preparacion para la proxima crisis sanitaria. Uno de los motivos es que generar confianza se percibe, con razon, como algo lento y dificil. Aunque la confianza en las instituciones publicas y en los demas es esencial en la preparacion para una pandemia, los paises deben prever la posibilidad de que fracasen los esfuerzos por infundir o restablecer la confianza. Incorporar la confianza a la preparacion ante una pandemia significa reconocer que la polarizacion, el partidismo y la desinformacion pueden persistir y comprometerse con las comunidades tal y como son actualmente, no como deseariamos que fueran. Este documento presenta una agenda politica practica para incorporar la desconfianza como factor de riesgo en la planificacion de la preparacion y respuesta ante una pandemia. Proponemos dos conjuntos de estrategias basadas en la evidencia: (i) estrategias para garantizar que la confianza que ya existe en una comunidad se mantenga durante una crisis, como mitigar la fatiga pandemica mediante intervenciones sanitarias y una comunicacion honesta y transparente que haga entrar en razon; y (ii) estrategias para promover la cooperacion en comunidades donde las personas desconfian de sus gobiernos y vecinos, a veces por razones legitimas e historicas. Cuando hay desconfianza, la preparacion y las respuestas ante una pandemia se deben basar menos en la coercion y mas en la adaptacion de las politicas locales y la creacion de asociaciones con las instituciones y los lideres de la comunidad para ayudar a las personas a superar las dificultades que encuentran en la cooperacion con las orientaciones de salud publica. El seguimiento periodico de la confianza interpersonal y gubernamental a nivel nacional y local es una forma de hacer posible esta planificacion de la preparacion y respuesta ante una pandemia especifica para cada contexto. [phrase omitted], Introduction Many studies of how well countries responded to health crises acknowledge the importance of trust. (1-5) Higher levels of trust in government and interpersonal trust (i.e. trust in others) [...]

There is popular and bipartisan support for legalizing the importation of lower-cost medicines from Canada to help reduce the high prescription drug costs that Americans pay. Despite the wide interest in this policy, attempts over the last sixteen years to create a formal system for large-scale prescription drug importation in the United States have failed. The Trump Administration recently issued a final rule to enable the legal importation of prescription drugs from Canada, but the rule has important design flaws and seems destined to suffer a similar fate as previous efforts. In this Article, we argue that prescription drug importation is a form of international regulatory engagement that can work, but not in the manner that recent congressional legislation or the Trump Administration has proposed. Importation of prescription drugs, even foreign versions of already-approved drugs, requires the importing nation to accept the marketing approval standards, processes, and product-specific decisions of the exporting nation as equivalent to domestic regulation. The FDA, however, has made far fewer determinations of foreign regulatory equivalence than its counterpart regulators. As a result, the statutory requirements for the FDA maintaining direct oversight over prescription drug imports from Canada are onerous and unlikely ever to be fulfilled. Examining U.S. prescription drug importation as a form of reliance on the equivalence of foreign regulation is, as far as we can determine, a novel inquiry, and it offers useful insights. Foreign equivalence determinations have been successfully used in pharmaceutical regulation in two contexts: (1) trade initiatives and (2) circumstances in which regulatory agencies were unable to fulfill their core institutional mandates without relying on the decisionmaking of their foreign counterparts. The FDA has not fit neatly into either of these contexts. In contrast to many of its foreign counterparts, the FDA has consolidated authority over pharmaceutical regulation, which it sustains through its reputation among its constituents--appropriators, consumers, pharmaceutical product sponsors, and the relevant medical and scientific communities--for overseeing the safety, efficacy, and quality of medicines. The FDA has resisted risking any harm to that gatekeeper reputation that might follow from its pursuit of other policy objectives, such as lowering drug prices or facilitating trade. Furthermore, FDA officials describe themselves as 'the gold standard' for drug review--more thorough and rigorous about regulation than their counterparts--and, until recently, as able to fulfill their core institutional mandates without the cooperation of foreign counterparts. Based on this analysis of the political economy of pharmaceutical regulation and international regulatory cooperation at the FDA, we propose that U.S. prescription drug importation could be successfully used to reduce generic drug shortages, a persistent public health problem that the FDA has struggled to solve independently. We argue that the same analysis can help identify other circumstances when the FDA might usefully engage foreign counterparts, such as foreign manufacturer inspections for the rapidly increasing volume of U.S. drug imports, the growing complexity of global pharmaceutical supply chains, and the technological advances in personalized medicines., INTRODUCTION 1334 I. THE CURRENT LANDSCAPE OF U.S. PRESCRIPTION DRUG 1339 IMPORTATION A. U.S. Prescription Drug Spending 1340 B. The Current Pathways for Legally Permissible 1341 U.S. Prescription Drug Importation [...]

Globalization and human interdependence have created immeasurable value for humanity. These forces, however, also provide channels for health risks to spread throughout the world. Global functions for health, such as [...]

Many months after COVID‐19 vaccines were first authorised for public use, still limited supplies could only partially reduce the devastating loss of life and economic costs caused by the pandemic. Could additional vaccine doses have been manufactured more quickly some other way? Would alternative policy choices have made a difference? This paper provides a simple analytical framework through which to view the contours of the vaccine value chain. It then creates a new database that maps the COVID‐19 vaccines of Pfizer/BioNTech, Moderna, AstraZeneca/Oxford, Johnson & Johnson, Novavax and CureVac to the product‐ and location‐specific manufacturing supply chains that emerged in 2020 and 2021. It describes the choppy process through which dozens of other companies at nearly 100 geographically distributed facilities came together to scale up global manufacturing. The paper catalogues major pandemic policy initiatives – such as the United States' Operation Warp Speed – that are likely to have affected the timing and formation of those vaccine supply chains. Given the data, a final section identifies further questions for researchers and policymakers. [ABSTRACT FROM AUTHOR]

The article discusses how states will deal with the coronavirus pandemic and mentions the change in urbanization rates. It also discusses the broader societal reforms and infrastructure investments that accompany the urban health, pandemics of novel infectious diseases, and public health reforms on issues such as sanitation.

A decade ago, bitter disputes over access to patented HIV/AIDS medicines in developing countries transformed global health, elevating infectious diseases as a foreign policy concern and helping to mobilize billions [...]