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Article ; Online: Towards mission-driven investment in new antimicrobials? What role for Chinese strategic industrial financing vehicles in responding to the challenge of antimicrobial resistance?

Husain, Lewis / Hu, Yajing / Huang, Yangmu

2024 Volume 20, Issue 1, Page(s) 26

Abstract: Background: Antimicrobial resistance (AMR) causes high levels of global mortality. There is a global need to develop new antimicrobials to replace those whose efficacy is being eroded, but limited incentive for companies to engage in R&D, and a limited ... ...

Abstract	Background: Antimicrobial resistance (AMR) causes high levels of global mortality. There is a global need to develop new antimicrobials to replace those whose efficacy is being eroded, but limited incentive for companies to engage in R&D, and a limited pipeline of new drugs. There is a recognised need for policies in the form of 'push' and 'pull' incentives to support this R&D. This article discusses China, a country with a rapidly emerging pharmaceuticals and biotech (P&B) sector, and a history of using coordinated innovation and industrial policy for strategic and developmental ends. We investigate the extent to which 'government guidance funds' (GGFs), strategic industrial financing vehicles (a 'push' mechanism), support the development of antimicrobials as part of China's 'mission-driven' approach to innovation and industrial policy. GGFs are potentially globally significant, having raised approximately US$ 872 billion to 2020. Results: GGFs have a substantial role in P&B, but almost no role in developing new antimicrobials, despite this being a priority in the country's AMR National Action Plan. There are multiple constraints on GGFs' ability to function as part of a mission-driven approach to innovation at present, linked to their business model and the absence of standard markets for antimicrobials (or other effective 'pull' mechanisms), their unclear 'social' mandate, and limited technical capacity. However, GGFs are highly responsive to changing policy demands and can be used strategically by government in response to changing needs. Conclusions: Despite the very limited role of GGFs in developing new antimicrobials, their responsiveness to policy means they are likely to play a larger role as P&B becomes an increasingly important component of China's innovation and industrial strategy. However, for GGFs to effectively play that role, there is a need for reforms to their governance model, an increase in technical and managerial capacity, and supporting ('pull') incentives, particularly for pharmaceuticals such as antimicrobials for which there is strong social need, but a limited market. Given GGFs' scale and strategic importance, they deserve further research as China's P&B sector becomes increasingly globally important, and as the Chinese government commits to a larger role in global health.
MeSH term(s)	Humans ; Anti-Bacterial Agents ; Drug Resistance, Bacterial ; Anti-Infective Agents ; Industry ; Pharmaceutical Preparations ; China
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents ; Pharmaceutical Preparations
Language	English
Publishing date	2024-03-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2185774-X
ISSN	1744-8603 ; 1744-8603
ISSN (online)	1744-8603
ISSN	1744-8603
DOI	10.1186/s12992-024-01030-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Policy experimentation and innovation as a response to complexity in China's management of health reforms.

Husain, Lewis

Globalization and health

2017 Volume 13, Issue 1, Page(s) 54

Abstract: There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the ... ...

Abstract	There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China's reforms; this article argues that these processes have been important in rebuilding China's health system. While China's current system still has many problems, progress is being made in developing a functioning system able to ensure broad population access. The article analyses Chinese thinking on policy experimentation and innovation and their use in management of complex reforms. It argues that China's management of reform allows space for policy tailoring and innovation by sub-national governments under a broad agreement over the ends of reform, and that shared understandings of policy innovation, alongside informational infrastructures for the systemic propagation and codification of useful practices, provide a framework for managing change in complex environments and under conditions of uncertainty in which 'what works' is not knowable in advance. The article situates China's use of experimentation and innovation in management of health system reform in relation to recent literature which applies complex systems thinking to global health, and concludes that there are lessons to be learnt from China's approaches to managing complexity in development of health systems for the benefit of the poor.
Language	English
Publishing date	2017-08-03
Publishing country	England
Document type	Journal Article ; Review
ISSN	1744-8603
ISSN (online)	1744-8603
DOI	10.1186/s12992-017-0277-x
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Understanding China's growing involvement in global health and managing processes of change.

Husain, Lewis / Bloom, Gerald

Globalization and health

2020 Volume 16, Issue 1, Page(s) 39

Abstract: Background: Recent years have seen a rapid change in China's global engagement and a recognition that solving global challenges will need to take the changing role of China into account. The paper discusses China's growing involvement in global health. ... ...

Abstract	Background: Recent years have seen a rapid change in China's global engagement and a recognition that solving global challenges will need to take the changing role of China into account. The paper discusses China's growing involvement in global health. Health is an area where there is broad agreement over global priorities and, potentially, a fertile space to build new forms of collaboration that point the way towards the adaptation of global governance to a rapidly changing context. Results: Drawing on previous analyses of China's management of change in its domestic health reforms and interviews with a range of stakeholders in China, the UK and Switzerland, the paper argues that China's engagement in global health is developing and diversifying rapidly in response to the central government's desire to see a greater role for China in global health. This diversification is part of a pattern of change management familiar from China's domestic reform experience. Explorations underway by a range of Chinese agencies form part of a process of rapid experimentation and experiential learning that are informing China's search for (a) new global role(s). Conclusions: China is undergoing rapid institutional innovation and developing capacity for greater global engagement, including in health; however, substantial, recent leadership commitments make clear Chinese agencies' need for continued exploration, innovation and rapid learning. How China engages globally is of significance to the world, not just China. The challenge for China, other global actors and multilateral organisations is to incorporate new approaches into existing global governance arrangements, including for the management of global health. This will require a willingness on all sides to learn from each other and invest the effort needed to build governance arrangements appropriate for the coming decades. This is not only important as a means of protecting global public health, but also as a demonstration of how governance arrangements can be adapted to the needs of a pluralistic global order in a context of rapid change.
MeSH term(s)	China ; Global Health ; Humans ; International Cooperation ; Investments ; Public Health
Keywords	covid19
Language	English
Publishing date	2020-05-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	1744-8603
ISSN (online)	1744-8603
DOI	10.1186/s12992-020-00569-0
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Deliberation-based learning: strengthening neonatal care in China.

Xiao, Yue / Qiu, Yingpeng / Husain, Lewis / Bloom, Gerald / Shi, Liwei

BMJ global health

2022 Volume 7, Issue Suppl 7

Abstract: This paper presents a case example from China, where detailed deliberations were instrumental in bringing together national and subnational managers to tailor implementation protocols for neonatal care strategies at provincial and county levels. The ... ...

Abstract	This paper presents a case example from China, where detailed deliberations were instrumental in bringing together national and subnational managers to tailor implementation protocols for neonatal care strategies at provincial and county levels. The China National Health Development Research Center (CNHDRC) organised deliberations to support the formulation of strategies for improving early essential neonatal care for rural areas. The aim was to help counties, the lowest level jurisdiction in China, learn what could work locally, and to help provinces and the national government learn what should inform national policy and be disseminated widely in China's decentralised health system. It became clear that central-level stakeholders needed to learn how to help counties support the pilots. CNHDRC staff, national-level experts and academics visited pilot provinces and counties to discuss local policies, initiatives and challenges (including with patients), build a common understanding of the project and identify local support needs including by examining health records and observing health facilities. What followed were county-specific reports with priority interventions and implementation plans, which were further refined through county-level meetings. They helped central stakeholders better understand and address variations in county capacities and needs.
MeSH term(s)	China ; Government Programs ; Humans ; Infant, Newborn
Language	English
Publishing date	2022-09-18
Publishing country	England
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-007934
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Article ; Online: Digital health interventions for COVID-19 in China: a retrospective analysis.

Chen, Mengji / Xu, Shan / Husain, Lewis / Galea, Gauden

Intelligent medicine

2021 Volume 1, Issue 1, Page(s) 29–36

Abstract: Background: The use of digital health technologies was an integral part to China's early response to coronavirus disease 2019 (COVID-19). Existing literatures have analyzed and discussed implemented digital health innovations from the perspective of ... ...

Abstract	Background: The use of digital health technologies was an integral part to China's early response to coronavirus disease 2019 (COVID-19). Existing literatures have analyzed and discussed implemented digital health innovations from the perspective of technologies, whereas how policy mechanisms contributed to the formulation of the digital health landscape for COVID-19 was overlooked. This study aimed to examine the contexts and key mechanisms in China's rapid mobilization of digital health interventions in response to COVID-19, and to document and share lessons learned. Methods: Policy documents were identified and retrieved from government portals and recognized media outlets. Data on digital health interventions were collected through three consecutive surveys administered between 23 January 2020 and 31 March 2020 by China Academy of Information and Communication Technology (CAICT) affiliated to the Ministry of Industry and Information Technology (MIIT). Participants were member companies of the Internet Health alliance established by MIIT and the National Health Commission (NHC) in June 2016. Self-report digital interventions focusing on social and economic recovery were excluded. Two hundred and sixty-six unique digital health interventions meeting our criteria were extracted from 175 narratives on digital health interventions submitted by 116 participating companies. Thematic analysis was conducted to describe the scope and priority of policies advocating for the use of digital health technologies and the implementation pattern of digital health interventions. Data limitations precluded an evaluation of the impact of digital health interventions over a longer time frame. Results: Between January and March 2020, national policy directives promoting the use of digital technologies for the containment of COVID-19 collectively advocated for use cases in emergency planning and preparedness, public health response, and clinical services. Interventions to strengthen clinical services were mentioned more than the other two themes ( Conclusions: The contextual factors and key enabling mechanisms through the use of policy instruments to promote digital health interventions for COVID-19 in China include pathway of policy directives influencing the private sector using a decentralized system, the booming digital health landscape before COVID-19, agility of the public sector in introducing regulatory flexibilities and incentives to mobilize the private sector.
Language	English
Publishing date	2021-04-28
Publishing country	China
Document type	Journal Article
ISSN	2667-1026
ISSN (online)	2667-1026
DOI	10.1016/j.imed.2021.03.001
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Development of innovative tripartite partnership for China's engagement in global health: recommendations from China-Tanzania Cooperation Project on Malaria Control.

Ma, Xuejiao / Lu, Shenning / Ding, Wei / Deng, Shanying / Wang, Duoquan / Xiao, Ning / Mlacha, Yeromin / Husain, Lewis / Zhou, Xiaonong

Infectious diseases of poverty

2024 Volume 13, Issue 1, Page(s) 22

MeSH term(s)	Global Health ; Tanzania ; China
Language	English
Publishing date	2024-03-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2689396-4
ISSN	2049-9957 ; 2049-9957
ISSN (online)	2049-9957
ISSN	2049-9957
DOI	10.1186/s40249-024-01178-4
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The China-UK Global Health Support Programme: looking for new roles and partnerships in changing times.

Husain, Lewis / Bloom, Gerald / McPherson, Sam

Global health research and policy

2020 Volume 5, Page(s) 26

Abstract: China's engagement in global affairs has changed substantially in the 2010s. One aspect of the country's global reorientation has been its increased interest in, and willingness to play a role in, global health. In the early 2010s, the UK Department for ... ...

Abstract	China's engagement in global affairs has changed substantially in the 2010s. One aspect of the country's global reorientation has been its increased interest in, and willingness to play a role in, global health. In the early 2010s, the UK Department for International Development (DFID) initiated a collaboration with the Chinese government on a programme to support the country to play a greater and more effective global role in health and explore how the UK and China could work together on issues of key concern and contribute to improved global development outcomes. The programme worked with key Chinese agencies to carry out capacity building, support analysis of China's approaches to engagement in global health governance and assistance, and provide support to government decision making. It also trialled several small-scale interventions in third countries through which Chinese agencies gained experience of working on health programmes overseas. The article reports on the main findings of an evaluation commissioned by DFID to learn from the programme. The programme provided support at a key time in China's global reorientation; however, there is a need for continued development of capacity and systems for China to play the role envisaged by the country's leadership. There is also a need for continued exploration on the part of China and partners of how to effectively collaborate to support improved global outcomes.
MeSH term(s)	Capacity Building/organization & administration ; China ; Delivery of Health Care/methods ; Global Health/standards ; Health Promotion ; International Cooperation ; United Kingdom
Keywords	covid19
Language	English
Publishing date	2020-06-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2397-0642
ISSN (online)	2397-0642
DOI	10.1186/s41256-020-00156-1
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Evaluation and learning in complex, rapidly changing health systems: China's management of health sector reform.

Xiao, Yue / Husain, Lewis / Bloom, Gerald

Globalization and health

2018 Volume 14, Issue 1, Page(s) 112

Abstract: Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China's healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present ... ...

Abstract	Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China's healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation, innovation, and learning. Multiple mechanisms exist within the government structure to allow and encourage flexible implementation of policies, and tailoring of reforms to context. These limit the risk of large-scale policy failures and play a role in exploring new reform directions and potentially systemically-useful practices. They have helped in managing the huge transition that China has undergone from the 1970s onwards. China has historically made use of a number of mechanisms to encourage learning from innovative and emergent policy practices. Policy evaluation is increasingly becoming a tool used to probe emergent practices and inform iterative policy making/refining. This paper examines the case of a central policy research institute whose mandate includes evaluating reforms and providing feedback to the health ministry. Evaluation approaches being used are evolving as Chinese research agencies become increasingly professionalised, and in response to the increasing complexity of reforms. The paper argues that learning from widespread innovation and experimentation is challenging, but necessary for stewardship of large, and rapidly-changing systems.
MeSH term(s)	China ; Delivery of Health Care/organization & administration ; Health Care Reform/organization & administration ; Humans ; Learning ; Organizational Innovation ; Policy Making
Language	English
Publishing date	2018-11-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	1744-8603
ISSN (online)	1744-8603
DOI	10.1186/s12992-018-0429-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: China's long march to malaria elimination: a case of adaptive management.

Wang, Duo-Quan / Liang, Xiao-Hui / Lu, Shen-Ning / Ding, Wei / Huang, Jing / Wen, Xin / Lv, Shan / Xiao, Ning / Husain, Lewis / Zhou, Xiao-Nong

Malaria journal

2022 Volume 21, Issue 1, Page(s) 38

Abstract: Since the 1950s, China has transitioned from a malaria pandemic country with tens of millions of annual cases, through phases of local control and elimination, to sustained national malaria elimination efforts. This marks the first time a country in the ... ...

Abstract	Since the 1950s, China has transitioned from a malaria pandemic country with tens of millions of annual cases, through phases of local control and elimination, to sustained national malaria elimination efforts. This marks the first time a country in the World Health Organization (WHO) Western Pacific region has been certified malaria-free in more than 3 decades. This article provides an innovative approach to understanding China's malaria elimination journey. A number of articles and commentaries have analysed the effectiveness of specific technical approaches implemented in China. Our argument is that we need to look beyond these, and consider the ways in which policy development and implementation capacities have been fostered to support the dynamic change management. The article makes a number of arguments. First is the pragmatic adaptiveness of policies and strategies-and implementation capacities. Second, China has invested in building systems as well as capacities to support the elimination of parasitic diseases, including malaria. Third, the country has both benefited from, and contributed to, global health collaboration on malaria elimination. The ongoing work by the authors is identifying a number of key factors.
MeSH term(s)	China/epidemiology ; Global Health ; Humans ; Malaria/epidemiology ; Malaria/prevention & control ; World Health Organization
Language	English
Publishing date	2022-02-08
Publishing country	England
Document type	Case Reports ; Letter
ZDB-ID	2091229-8
ISSN	1475-2875 ; 1475-2875
ISSN (online)	1475-2875
ISSN	1475-2875
DOI	10.1186/s12936-021-04038-w
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: How effective are face coverings in reducing transmission of COVID-19?

Robinson, Joshua F. / Rios de Anda, Ioatzin / Moore, Fergus J. / Gregson, Florence K. A. / Reid, Jonathan P. / Husain, Lewis / Sear, Richard P. / Royall, C. Patrick

medRxiv

Abstract: In the COVID-19 pandemic, among the more controversial issues is the use of face coverings. To address this we show that the underlying physics ensures particles with diameters (> 1 micron) are efficiently filtered out by a simple cotton or surgical mask. ...

Abstract	In the COVID-19 pandemic, among the more controversial issues is the use of face coverings. To address this we show that the underlying physics ensures particles with diameters (> 1 micron) are efficiently filtered out by a simple cotton or surgical mask. For particles in the submicron range the efficiency depends on the material properties of the masks, though generally the filtration efficiency in this regime varies between 30 to 60 % and multi-layered cotton masks are expected to be comparable to surgical masks. Respiratory droplets are conventionally divided into coarse droplets (> 5-10 micron) responsible for droplet transmission and aerosols (< 5-10 micron) responsible for airborne transmission. Masks are thus expected to be highly effective at preventing droplet transmission, with their effectiveness limited only by the mask fit, compliance and appropriate usage. By contrast, knowledge of the size distribution of bioaerosols and the likelihood that they contain virus is essential to understanding their effectiveness in preventing airborne transmission. We argue from literature data on SARS-CoV-2 viral loads that the finest aerosols (< 1 micron) are unlikely to contain even a single virion in the majority of cases; we thus expect masks to be effective at reducing the risk of airborne transmission in most settings.
Keywords	covid19
Language	English
Publishing date	2020-12-03
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.12.01.20241992
Database	COVID19

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