COVID-19 has inflicted both beneficial and damaging effects on health systems responding to antimicrobial resistance (AMR). Data shows that the positive impacts of the pandemic (including enhanced hygiene, mask wearing and widespread use of personal protective equipment), are likely to have been overshadowed by the negative effects: emerging AMR pathogens and mechanisms; further outbreaks and geographic spread of AMR to non-endemic countries; rising infections from multidrug-resistant pathogen; an overall higher burden of AMR. The multisectoral complexities of AMR and the totality of health systems challenge our ability to understand the impact of the COVID-19 pandemic on country responses to AMR. In this analysis, we synthesise international evidence characterising the role of the pandemic on the six key building blocks of health systems in responding to AMR across low- and middle-income countries (LMICs). We apply systems thinking within and between the building blocks to contextualise the impact of one pandemic on another.

The traditional approach to comparing research and development (R&D) capacity across countries has been to compare Gross Domestic R&D expenditures (GERD). In this paper, we argue for an expansion of R&D capacity that includes people engaged in research and research and development activities (research human capital density, RHCD). To achieve this goal, we first discuss how to estimate counts of researchers and create a measure of researcher human capital density within a country. Next, we examine whether RHCD is a useful variable in models of innovation capacity. Finally, we consider whether RHCD has explanatory power for models of research outputs including patents and publications. We find that RHCD has more explanatory power than GERD in the production of patents and publications. We argue that surveys of individuals that include questions on R&D activities are useful for assessing innovation capacity, and, if adopted more broadly, can provide a strategic framework for countries and regions to develop human capital to support innovative activities.

It is widely assumed that the fragmentation of global governance can affect coordination efforts among international institutions and organisations. Yet, the precise relationship between the fragmentation of global governance and the extent to which international organisations coordinate their activities remains underexplored. In this article, we offer new empirical evidence derived from the so-called custodianship arrangements in which numerous international organisations have been mandated to coordinate data collection and reporting for 231 indicators of the 17 Sustainable Development Goals (SDGs). These complex custodianship arrangements provide a fertile testing ground for theories on the relationship between fragmentation and coordination because the institutional arrangements for each of the 17 SDGs have emerged bottom-up with varying degrees of fragmentation. Through a comparative approach covering 44 custodian agencies and focusing on the most and least fragmented custodianship arrangements, we make three key contributions. First, we offer a novel operationalisation of institutional fragmentation and coordination. Second, we present empirical evidence in support of the claim that fragmentation negatively affects coordination. Third, we provide nuances to this claim by identifying factors that affect the strength of this relationship. Based on our analysis, we suggest further steps that might facilitate coordination in global sustainability governance.

The purpose of this article is to demonstrate how a lack of policy attention has exacerbated the extreme circumstances faced by the Rohingya and how they can contribute to deterioration of their health, livelihood, and education, as well as their repatriation to their homeland. This article is based on data collected from field observations and interviews prior to and during the pandemic. This study confirms that the Rohingya refugee populations endure a higher level of suffering from lack of food security and livelihood, lack of basic amenities and financial resources, and accommodation is overcrowded compared with the pre-pandemic period. The lack of a specific policy for the Rohingya has compounded the current situation in Bangladesh. This research is crucial for countries receiving refugees as well as the countries from which they flee and other actors.

The world faces a multiplicity of global catastrophic risks (GCRs), whose functionality as individual and collective complex adaptive networks (CANs) poses unique problems for governance in a world that itself comprises an intricately interlinked set of CANs. Here we examine necessary conditions for new approaches to governance that consider the known properties of CANs-especially that small changes in one part of the system can cascade and amplify throughout the system and that the system as a whole can also undergo rapid, dramatic, and often unpredictable change with little or no warning.

Providing collective solutions to global pandemics requires the coordination of information that is accurate and accountable. In recent years there has been a global push for reliable pandemic preparedness indicators. This push has come from U.S. foreign policy, the World Health Organization (WHO), NGOs, and private foundations. These actors want control over how data for preparedness indicators is collected, analysed, and promoted. Governments want to influence how they are assessed, using poor performance to attract attention and good performance to deflect blame. In this article we discuss how the push for pandemic preparedness indicators comes from the dual aims of repelling national risk, the spread of disease, while reducing global harm through stronger transnational governance arrangements. We delve into the development of indicators from the WHO and the privately-run Global Health Security Index, and examine how their claims to authority measure-up against standards of transparency, veracity, and accountability. We stress the importance of understanding how these indicators are composed. This is vital given the current drive to include social and governance metrics in revised efforts at data collection, as well as efforts to include pandemic preparedness indicators in how intergovernmental organizations, NGOs, donors, and funders devise health and development policies.

The COVID-19 experience has sharpened debates about democracy's future worldwide. In reflecting on these debates, this paper does three things. First, it assesses how resilient democracy has been in the COVID-19 emergency. Second, it examines the effect the pandemic has had on the pre-existing trends in democratic politics. And third, it suggests ways in which the COVID-19 crisis both requires and possibly opens the door to democratic rejuvenation.

A long-standing debate amongst international relations scholars has surrounded the question of whether international institutions with judicial authority enjoy more autonomy and discretion than other global institutions. This is mainly because international courts are established as impartial third-party actors tasked with performing adjudicative functions for conflicting parties. As such, the delegation contracts of international institutions with judicial authority are expected to minimize control by states, even in cases where the members of a court engage in judicial overreach. This article contributes to that debate by examining the case of the crisis of the WTO Appellate Body. The article analyzes the Trump administration's successful efforts at rendering dysfunctional one of the most powerful courts in the international system. The findings showcase how powerful states are capable and willing to take advantage of the available control mechanisms and the institutional opportunity structures inherent in the design of international courts. The article speaks to the scholarship on the contestation of international institutions. The analysis relies on original data obtained through 22 interviews with WTO officials, state representatives, and experts.

Apart from economic, political, and cultural cooperation for an equal growth of all developing countries, science and technology are an integral significant component in these levels of engagement for leveraging mutual gains. The current pandemic not only brought about an 180 shift in the relationship between the government, policy makers, and the scientific community but highlights the importance of South-South Cooperation (SSC). SSC may serve as a mode of cooperation to foster the transfer of need-based technologies among developing and least developing countries and open many fronts for mutual sharing in terms of geopolitical, available resources, and expertise. The cooperation under the SSC does not substitute but complements North-South development cooperation to achieve the Sustainable Development Goals (SDGs). The use of science diplomacy would be an effective tool to bring all the stakeholders of the Global South to a common platform to combat future global challenges. Science policy instruments would need to incorporate scope for international collaborations as a means of furthering the national and global imperatives.

The global COVID-19 pandemic has exacerbated existing health, social, and economic challenges and threatened progress towards achieving the UN sustainable development goals. We discuss lessons learned from the COVID-19 pandemic for global policymaking for health security governance, with a particular focus on antimicrobial resistance. We identify One Health as the primary foundation of public health risk management owing to the collaborative, multidisciplinary, and multisectoral efforts that underpin the One Health approach and that enhance understanding of the complex interactions at the human-animal-environment interface. We discuss the narrow human-centric focus of the One Health approach, highlight the underrepresentation of the environmental sector in One Health networks, and encourage greater representation from the environmental sector. Furthermore, we highlight the importance of the social sciences for health security research and the need for effective communication and trust. Finally, we underscore the importance of strengthened and collaborative health, social care, and disaster management systems. The application of these lessons will facilitate holistic, multisectoral, collaborative, and ethical actions on antimicrobial resistance.

Adequately preparing for and containing global shocks, such as COVID-19, is a key challenge facing health systems globally. COVID-19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system-the global health actors and the governance, finance, and delivery arrangements within which they operate-is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID-19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non-transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.

Drones have been widely used by public authorities during the COVID-19 pandemic for pandemic-related problems. As an innovative tool with a wide range of potentialities, they have been deemed suitable for an exceptional situation marked by the persistence of social distance. Yet, the turn to new technology to solve complex problems is a political decision that has broad societal implications, especially in the context of declared states of emergency. In the article we argue that the extensive use of drones by national authorities during the COVID-19 pandemic has generated a new socio-technical assemblage of actors, technologies and practices. Building on the three main uses of drones as responses to specific pandemic-related challenges (disinfection, delivery, and surveillance), we analyse the actors and the practices involved in this new socio-technical assemblage. From the empirical material, we explore potential effects of drone uses on key issues such as the technology regulatory processes, public acceptance, and security and safety concerns.

Global civil society is often uncritically seen as a democratic force in global governance. Civil society organizations claim to hold states and intergovernmental institutions accountable and channel the voices of the world's poorest people in policy making. Yet to what extent do they succeed in performing that role? This article assesses the representation of the poor in global civil society, with a focus on the negotiations of the Sustainable Development Goals, a process widely hailed as one of the most democratic ever organized by the United Nations. We first analyse how the poor and their local representatives are procedurally included in global civil society (). We then quantitatively assess the actual representation of civil society organizations from the world's poorest countries in the civil society hearings of the SDG negotiations, where civil society was invited to speak on behalf of their constituencies (). Finally, we evaluate the extent to which global civil society representatives who claim to speak on behalf of the poor legitimately represented the interests of these people (). We found that global civil society fails to fully represent the poor on procedural, geographical and discursive terms, and eventually perpetuates postcolonial injustices in global sustainability governance.

The liberal international order is being challenged and international organizations (IOs) are a main target of contestation. COVID-19 seems to exacerbate the situation with many states pursuing domestic strategies at the expense of multilateral cooperation. At the same time, IOs have traditionally benefited from cross-border crises. This article analyzes the policy responses of IOs to the exogenous COVID-19 shock by asking why some IOs use this crisis as an opportunity to expand their scope and policy instruments? It provides a cross-sectional analysis using original data on the responses of 75 IOs to COVID-19 during the first wave between March and June 2020. It finds that the bureaucratic capacity of IOs is significant when it comes to using the crisis as an opportunity. It also finds some evidence that the number of COVID-19 cases among the member states affects policy responses and that general purpose IOs have benefited more.

Typically, disaster damages are measured separately in four dimensions: fatalities, injuries, dislocations, and the financial damage that they wreak. Noy (2016) developed a lifeyears index of disaster damage which aggregates these disparate measures. Here, we use this lifeyears index to assess the costs of the COVID-19 pandemic across countries and compare these costs to the average annual costs of all other disasters that have occurred in all countries in the past 20 years. We find that the costs of the pandemic, measured for 2020, far outweigh the annual costs associated with other disasters in the past two decades. It is the economic loss that dominates this impact. The human and social implications of this economic loss are plausibly much greater than the direct toll in mortality and morbidity in almost all countries. Finally, it is small countries like the Maldives and Guyana that have experienced the most dramatic and painful crisis, largely under the radar of the world's attention. Our conclusion from these findings is not that governments' policy reactions were unwarranted. If anything, we find that the loss of lifeyears is correlated positively across the three dimensions we examine. Countries that experienced a deeper health crisis also experienced a deeper economic one.

One year after the World Health Organization declared COVID-19 a global pandemic, governments around the world adopt similar practices in containing the COVID-19 spread. Nevertheless, variation exists in the level of policy compliance, which directly contribute to policy success/failure across countries. As the pandemic continues, pandemic fatigue also decreases the public's willingness to comply. Increasing policy compliance during the remainder of pandemic has become a transnational concern. Using Taiwan's quarantine policy as an example, this article illustrates three aspects to craft an effective compliance regime to fight public health crises like COVID-19: (1) a comprehensive policy mix to reduce heterogeneous compliance barriers that impact different social groups; (2) constant and various policy communication with heterogeneous target audiences; and (3) leveraging and integrating street-level bureaucrats in the policy implementation stages. Taiwan's case provides several policy lessons for other countries: compliance regime is not driven by top-down enforcement but through the integration of policy design and implementation that remove all barriers for compliance. Taiwan's street level bureaucrats are the glue of the compliance regime. This article bears policy implications for policy makers around the world when aiming for increasing policy compliance.

The pandemic has shown a diplomatic system that is dysfunctional. No institution or groups of states was willing or able to take the lead in crafting shared actions to shared problems. The crisis coincided with pressures on diplomacy from deglobalization. This has accelerated a fragmentation of norms and increased willingness to use public diplomacy and digital communication as a point-scoring unidirectional method of self-gratification. The private, painstaking discourse of diplomacy is fading fast. The United Nations needs to urge its members to reassert the values and give new attention to how diplomacy is conducted, building on existing conventions. Meanwhile, tele-diplomacy offers a medium where diplomacy could reassert itself as the core activity that will enable collective global issues to be addressed. The paper examines how such tele-diplomacy might be established.

When there is no vaccine for a disease, 'Test, Trace, Treat/Isolate' is the public health go-to directive. During the COVID-19 pandemic, mobile phone apps are designed to improve on this. But COVID-apps have not been effective as a public health tool. Countries spend millions to develop them, yet they have been shown to have terrible return on investment. This commentary explores why COVID-apps are generally championed and provides three brief case studies (Germany, Sierra Leone, Canada) of non-app public health success. In conclusion, I argue that we need to get our public health care priorities straight: Better and more testing; increased investment in manual contact tracing and treatments; hospitalization when necessary; and wrap-around care - assistance with groceries, cleaning, child- or eldercare responsibilities, telehealth doctor appointment hookups - for sick people in home isolation.

COVID-19 has pulled back the curtain on health system fragility to expose persistent and deepening inequities worldwide. The limited capacity of low- and lower-middle income countries (LMICs) to respond to the pandemic and its impact on the health of populations - particularly the most vulnerable - presents a marked challenge. In this context, countries face the enormous task of rethinking the way essential services will be delivered. A critical and essential part of solving these challenges will be using information and communication technology and digital health to enhance direct communication with the public; scale proven and innovative service delivery models; and empower the frontlines. However, if the deployment, adaptation, or expansion of these innovations are not user-centered for the most marginalized or do not learn from past lessons, it could be highly wasteful at best. At worst, such shortcomings could exacerbate pre-existing weaknesses in the health care system such as exclusion of peripheral populations, disempowerment of health workers, and proliferation of unregulated private providers. We provide recommendations of which innovations should be prioritized and implementation principles to address the current challenges while responding to the need to fundamentally change service delivery for accelerated impact.

Digital health solutions offer tremendous potential to enhance the reach and quality of health services and population-level outcomes in low- and middle-income countries (LMICs). While the number of programs reaching scale increases yearly, the long-term sustainability for most remains uncertain. In this article, as researchers and implementors, we draw on experiences of designing, implementing and evaluating digital health solutions at scale in Africa and Asia, and provide examples from India and South Africa to illustrate ten considerations to support scale and sustainability of digital health solutions in LMICs. Given the investments being made in digital health solutions and the urgent concurrent needs to strengthen health systems to ensure their responsiveness to marginalized populations in LMICs, we cannot afford to go down roads that 'lead to nowhere'. These ten considerations focus on drivers of equity and innovation, the foundations for a digital health ecosystem, and the elements for systems integration. We urge technology enthusiasts to consider these issues before and during the roll-out of large-scale digital health initiatives to navigate the complexities of achieving scale and enabling sustainability.