This article addresses the interstate differences in outcomes from the coronavirus disease COVID-19 pandemic by focusing on state capacity. State capacity refers to states’ ability to create and implement policy. We posit that states want to limit death and destruction within their borders. COVID-19 created an instance in which states had a shared, preferred outcome but had very different levels of success. Using a novel measure of state capacity that allows for subnational comparisons – and is independent of ideological political will – we show that states with greater capacity experienced fewer excess deaths during 2020 and more successfully distributed vaccines in early 2021. The findings are robust to various measures of partisanship, social capital, geography, and demographics. Our work bridges US state politics literature and comparative politics literature on state capacity, and it contributes to research on the politics of pandemics.

The need to maintain transport during a pandemic places transport workers at higher risk of infection and can have other effects on health and well-being. The aim of this study was to understand the current state of research on the impact of respiratory diseases on transport workers and to identify any existing evidence-based recommendations that can help mitigate the risks associated with these diseases in the transport industry. A scoping review was undertaken as per PRISMA guidelines. A search was conducted in English-language databases for peer-reviewed research articles. We reviewed research articles published over 20 years (2002–2022). We found 12540 articles, of which 39 deemed relevant, were analysed. The review highlighted the high risk of transport workers’ exposure to respiratory diseases during pandemics, exacerbated by structural inequalities including the significant number holding precarious/non-standard jobs. Increased financial strains led to poorer mental health outcomes and risks of detrimental behaviours for health. Economic measures implemented by governments were found to be insufficient in addressing these issues. The review found that transport is a significant transmission point for pandemics of respiratory diseases, and it suggests some remedies to best meet these challenges.

This article addresses whether responses to COVID-19 created opportunities for future policy change. We explore this matter by presenting a framework rooted in political economy and the literature on pandemics. We argue that the opportunities created by emergency responses are context-specific and that narratives, policy tools, and pro-equity state actors are variables that mediate emergency responses and future opportunities. We ground our analytical contribution on the emergency cash transfers deployed during 2020 following the COVID-19 outbreak in two contrasting Central American countries, Costa Rica and Guatemala. The paper promotes further policy discussion on the opportunities for progressive change in unequal contexts.

This manuscript addresses a critical topic: navigating complexities of conducting clinical trials during a pandemic. Central to this discussion is engaging communities to ensure diverse participation. The manuscript elucidates deliberate strategies employed to recruit minority communities with poor social drivers of health for participation in COVID-19 trials. The paper adopts a descriptive approach, eschewing analysis of data-driven efficacy of these efforts, and instead provides a comprehensive account of strategies utilized. The Accelerate COVID-19 Treatment Interventions and Vaccines (ACTIV) public–private partnership launched early in the COVID-19 pandemic to develop clinical trials to advance SARS-CoV-2 treatments. In this paper, ACTIV investigators share challenges in conducting research during an evolving pandemic and approaches selected to engage communities when traditional strategies were infeasible. Lessons from this experience include importance of community representatives’ involvement early in study design and implementation and integration of well-developed public outreach and communication strategies with trial launch. Centralization and coordination of outreach will allow for efficient use of resources and the sharing of best practices. Insights gleaned from the ACTIV program, as outlined in this paper, shed light on effective strategies for involving communities in treatment trials amidst rapidly evolving public health emergencies. This underscores critical importance of community engagement initiatives well in advance of the pandemic.

Vaccines are not the only public health tool, but they are critical in routine and emergency settings. Achieving optimal vaccination rates requires timely access to vaccines. However, we have persistently failed to secure, distribute, and administer vaccines in a timely, effective, and equitable manner despite an enduring rhetoric of global health equity.

The effect of filtering face piece grade 2 (FFP2) masks for infection prevention is essential in health care systems; however, it depends on supply chains. Efficient methods to reprocess FFP2 masks may be needed in disasters. Therefore, different UV-C irradiation schemes for bacterial decontamination of used FFP2 masks were investigated.

Seventy-eight masks were irradiated with UV light for durations between 3 and 120 seconds and subsequently analyzed for the presence of viable bacteria on the inside. Ten masks served as the control group. Irradiation on the inside of the masks reduced bacteria in proportion to the dose, with an almost complete decontamination after 30 seconds. Outside irradiation reduced the quantity of colonies without time-dependent effects. Both sides of irradiation for a cumulated 30 seconds or more showed almost complete decontamination.

Overall, this study suggests that standardized UV irradiation schemes with treatment to both sides might be an efficient and effective method for FFP2 mask decontamination in times of insufficient supplies.

Questions concerning border closures during pandemics often focus on international borders or rights-based considerations. Closures of internal borders in federal countries, such as Canada, raise independent concerns regarding who can close internal borders when. Those questions are not exhausted by rights-based considerations and cannot be resolved using brute empirical measures. They instead implicate the nature and ends of federalism. This text uses the case of internal border restrictions in Canada during COVID-19 to explore whether the kinds of closures that took place there can be justified on federalism grounds. It argues that the case for provinces being able to unilaterally enact interprovincial border closures in federal countries, as observed in Canada during COVID-19, do not withstand scrutiny. It attends to possible justifications for federalism to demonstrate that the best arguments for federalism do not support provincial control over borders that justify provinces possessing, let alone exercising, unilateral authority to close interprovincial borders to persons residing in other provinces.

This article provides a narrative about archival research experience in Sierra Leone as the coronavirus outbreak spread globally in early 2020. Coincidentally, the research concerned the country’s history of epidemics since 1787, when Freetown, its first city, accommodated freed Blacks repatriated from Britain and the Americas. As Sierra Leone prepared for another disease outbreak after Ebola in 2014, leaving or staying in Freetown (after seven months into a ten-month Fulbright US Scholar term) had health and research outcomes at stake. Historicizing the pandemic while engaging personal/social memory in historical accounts, the article highlights containment measures adopted against epidemics/pandemics across time.

In response to a crisis, policymakers face the decision of whether to enumerate specific actions the public must do or, instead, to aim at an overall outcome while leaving room open for choice. This essay evaluates the merits and demerits of crisis response that leaves room open for choice, with a particular focus on pandemic response. I evaluate two approaches: trades and offsets. Trades allow individuals or groups to exchange protection against harm or entitlement to engage in risky activity. Offsets allow the same actors to pay to mitigate the effects of decisions that increase risk for others. Choice-friendly approaches can free people to better align their actions with their values, harness local knowledge for better social outcomes, and act as natural experiments. However, they also are subject to objections, including negative externalities, agency problems, exploitation, and exacerbating inequality.

During the COVID-19 pandemic the international community repeatedly called for the equitable distribution of vaccines and other medical countermeasures. However, there was a substantial gap between this rhetoric and State action. High-income countries secured significantly more doses than they required, leaving many low-income countries unable to vaccinate their populations. Current negotiations for the new Pandemic Treaty under the World Health Organization (WHO) attempt to narrow the gap between rhetoric and behaviour by building the concept of equity into the Treaty's substantive content. However, equity is difficult to define, much less to operationalize. Presently, WHO Member States appear to have chosen ‘access and benefit-sharing’ (ABS) as the predominant mechanism for operationalizing equity in the Treaty. This article examines ABS as a mechanism, its use in public health, and argues that ABS is fundamentally flawed, unable to achieve equity. It proposes other options for an equitable international response to future pandemic threats.