Recovery, Renewal, Resilience

The pandemic has disrupted children and young people’s education, physical health, mental well-being, and social development. There is an abundance of evidence that shows how play is crucial for children’s “health, their physical-and emotional growth, and intellectual and educational development”. The social and behavioural skills that children acquire during play can support the development of resilience, increasing children’s ability to manage stress and adversity. Local areas now have an opportunity to increase spaces for play through city infrastructure and land use planning in their Recovery Strategies and Renewal Initiatives. Resilient Cities Network (RCN) explored this topic in a recent webinar. Consider:

• The Reclaiming Play in Cities initiative, which recognises how the “built environment as a critical play and learning resource for children”. Increasing opportunities for play in cities can support communities to build resilience. For example:
  • Barnet, London have taken full advantage of urban regeneration to invest in play infrastructure. Core strategies include “balancing private development with adequate resourcing for the local voluntary and community sector (VCS) to provide play activities for the most vulnerable children in the area”, and the redesign of two local parks
  • Khayelitsha, Cape Town, with the support of the Urban Play Framework (discussed below), began a two-phase intervention to develop a local play culture in the area. With community participation, the first phase upgrades a series of existing courtyards to create a network of designated play spaces. The second phase will link this network to a refurbished nursery which will serve as a central hub to establish a safer, more varied and stimulating environment for play
• The Urban Play Framework which offers guidance on design and ‘placemaking’ in cities:
  • The Urban Play Framework Toolkit which provides methods and tools to support local governments and communities to conduct a play assessment of their area, and identify and co-design play activation initiatives
• The importance of participatory processes and community engagement in the assessment, design, and evaluation of play initiatives so that children are active participants in the process to increase their agency

A recent UN policy brief identified the significant gap in health coverage as a core reason for COVID-19 having such devastating impacts on people's lives. Universal health coverages means that all people and communities can access the health services that they need, with three key priorities; "equity in access, sufficient quality and no undue financial risk". Consider:

• Establish universal provision for "COVID-19 testing, isolating, contact tracing" and treatment
• Ensure protection of essential health services during the critical phases of the pandemic (e.g. services for sexual and reproductive health)
• Through international partnerships, ensure future COVID-19 vaccines are a "global public good with equitable access for everyone, everywhere"
• Protect and invest in core health systems functions that are critical to protecting and promoting health and well-being, known as "Common goods for health"
• Suspend user fees for COVID-19 and other essential health care; reduce financial barriers to service use
• Strengthen local, national and global pandemic preparedness and aim for healthy societies for the future through a whole-of-society approach

Alexander Kreh, MSc and Prof. Dr. Barbara Juen, University of Innsbruck, discuss stressors and challenges faced by healthcare workers, and presents results of a survey of healthcare personnel and the stressors they experience. The authors conclude by suggesting how organisations can build and maintain personal resilience among their frontline workers during COVID-19.

To read this briefing in full, follow the source link below to TMB Issue 28 (p.2-9).

COVID-19 vaccination rollout is taking place in many countries, with many more planning to implement mass vaccination strategies for in the near future. The widespread nature of the pandemic has meant that huge numbers of people require vaccination, and a result, demand for vaccines currently far outstrips supply in some countries[1]. Fear surrounding COVID-19 has led to criminals utilising black markets to develop and sell fake vaccinations on the dark web[2]. The demands on government vaccination programmes has also promoted the online sale of other fake medicines such as the malaria drug hydroxychloroquine and the steroid dexamethasone[3] as these have been associated with COVID-19 treatment. In other cases, some online vendors were claiming to sell vaccinations or medicines that would have never been shipped to buyers[4],

And in the UK, there were incidents of scammers turning up at people’s doorsteps offering a vaccine for payment, following a spate of fake text messages[5].

Vaccines are a financially lucrative commodity, and while the pharmaceutical industry is prepared with regular audits and vetting of supply chains, minimising human contact, stops and handovers during distribution, and real-time digital devices which measure temperature and location, there are other risks. Some of those at risk include:

• Desperate consumers believing they can purchase the vaccine online
• Hospitals and healthcare facilities that have been hit with a barrage of phishing and ransomware attacks which can try to sell fake vaccines
• Vaccination centres which may be points of vulnerability; one supply chain security expert stated “we need to tell people at the vaccine centres that they carry gold”[6].

The rise in fake vaccines and medications requires approaches that protect people, and infrastructure.

Protecting people

• Widespread information campaigns that advise people not to buy any vaccines online, with particular focus on informing people with pre-existing health conditions or those in certain vaccine priority groups as these groups may feel an urgency to be vaccinated
• Remind people that they should consult their registered doctor about vaccination, and only be vaccinated at an official vaccination point[7] and that NHS England will never ask for bank details, Pin numbers or passwords, when contacting you about a vaccination
• Monitor online chatrooms and forums that may be regularly used by vulnerable groups to scan for attempts to sell fake vaccines and medications
• Set up and regulate certification organisations which undertake due diligence on sources of drugs (e.g. pharmacies) and medications e.g. pharmacychecker.com to create a transparent solution for the public to check the sources of their online medications to ensure their legitimacy and safety
• Work with healthcare professionals to build trust in vaccinations. The spread of fake vaccines may deter people from legitimately being vaccinated

Protecting infrastructure

• Regularly assess cyber security and train staff in recognising and reporting any phishing scams or malware attacks
• Train staff and volunteers administering vaccinations in the safe and careful disposal of empty vaccine vials which could be stolen and used to package fake vaccines that look authentic[8]
• If required, consider security at vaccination centre sites, especially those which have been set up in temporary locations or do not have adequate security systems

References:

[1] https://www.swissinfo.ch/eng/swiss-regulator-warns-of-fake-covid-19-vaccines-online/46279734

[2] https://www.japantimes.co.jp/news/2020/11/27/asia-pacific/covid-19-vaccine-china-black-market/

[3] https://iea.org.uk/will-there-be-a-black-market-in-covid-vaccines/

[4] https://www.ft.com/content/8bfc674e-efe6-4ee0-b860-7fcb5716bed6

[5] https://www.bbc.co.uk/news/uk-england-london-55577426

[6] https://www.ft.com/content/8bfc674e-efe6-4ee0-b860-7fcb5716bed6

[7] https://www.swissinfo.ch/eng/swiss-regulator-warns-of-fake-covid-19-vaccines-online/46279734

[8]https://www.dw.com/en/officials-warn-of-fake-covid-19-vaccines/a-56123830

There is much concern about the combination of coronavirus with winter flu and the effects on transmission rates and a recent report outlines concerns and plans. It recommends to plan for coronavirus during winter months by:

• Analysing current COVID-19 data to develop prevention and mitigation strategies for winter, considering the rise in other illnesses during colder weather
• Considering how mitigation strategies should protect, and pose no further disadvantages to high risk patients or communities
• Engaging with patients, carers, public and healthcare professionals with enhanced coordination, collaboration and data sharing between central and local initiatives

It also suggests considering:

• Minimising community SARS-CoV-2 transmission and impact through:
  • developing effective policies to maximise population engagement in essential control measures e.g. participation in test, trace and isolate (TTI)
  • extensive autumn public information campaigns co-produced by communities and professional organisations
  • guidance for commercial, public and domestic properties on temperature, humidity and ventilation to reduce virus transmission indoors
  • consideration of those most vulnerable to COVID-19 who are least able to heat their homes adequately in winter
• Maximise infection control and ensure that COVID-19 and routine care can take place in parallel by:
  • prioritising system-wide infection prevention and control measures
  • o providing training to use personal protective equipment (PPE) and other infection prevention and control measures
  • maximising remote consultations for hospital and community care
  • testing and quarantining patients being discharged into the community or care
  • prioritising the backlog of clinical care by clinical need, not waiting times
• Improving public health surveillance for COVID-19, influenza and other winter diseases through:
  • comprehensive, population-wide, near-real-time, health surveillance systems
  • conducting large-scale population surveys comparable data collected from hospitals and the community
  • overseeing and coordinating data centrally
• Minimise influenza transmission and impact by maximising influenza vaccination uptake

There is research being done on most conceivable topics related to COVID-19. Many projects are looking to expand the range of governments, cities, organisations and individuals that will get involved in the project to contribute information into the project and provide a testbed for their work. Participation may enable you to influence the project towards your priorities, get early access to project findings that could change the ways you deliver, get funding to support your involvement, and provide access to a wider network that can help you in your job. Consider whether to:

• Identify what knowledge gaps you have in your organisation that research could usefully help to fill
• Identify the information that you can feed into projects and other contributions you can make to a project
• Approach local universities and research institutes to partner on research or mutual interest
• Talk to national bodies on what research they have funded
• Contact national and overseas researchers to request participation and/or early notice of their emerging findings
• Joining research webinars, research network email-lists, and research observatories to receive notification of project results
• Join advisory boards of projects to direct their focus
• Search databases of funded projects to find those that align with your interests

Consider:

• That systems are not always focused on all the needs of people but rather on specific health conditions. Support for people and their overall health is vital rather than the restoration of specific services.
• That there will be challenges about aligning all the different health and care activities that are required in each place. Central government organisation may mean a lack of alignment at a place level depending on the department. For example, health systems, local resilience forums and environmental infrastructure are all different in England. We have learned that effective partnerships need to be developed 'bottom up' at place level, and many of these have worked well during COVID-19 response.
• Partnerships between organisations and between and in communities have worked well because of relaxation of information governance, financial constraints, central guidance and regulation. Careful consideration must be given to the extent to which these are reinstated and the timing of this.
• New processes that have been established during response, and the extent to which they can and should be continued. IN particular, remote consultations between health care providers, both in hospital and primary care, currently comprise the vast majority of interaction. Reverting to the pre-COVID method of primarily face to face will have both positive and negative consequences, which will differ across society. Careful thought needs to be given to the equality impact of retaining these changes.
• The power of each part of the health system - including that of the large health service providers (hospitals) but also the power of the people who live in each place. The longer-term consequences of e.g. establishing COVID-free (cold) hospital sties must be considered from a population perspective.

TMB Issue 10 brings together the reflections of our learning from the first 10 weeks of gathering lessons on recovery and renewal from COVID-19. Follow the source link below to read all of the reflections from our team (p.9-15).