05/10/22

Health care policy making:

Health services innovations in response to
changing social and health care needs:
Focusing on COVID-19 and COVID-19 vaccination

Dr Daniel CHIU
Specialist in Paediatrics MBBS(HK);FRCP(G&I):DCH(London):FRCPCH(UK)
Hon Clinical Associate Professor, Dept of Paediatrics, CUHK
Member, Scientific Committee on Vaccine Preventable Diseases, HKSAR

OBJECTIVES
Innovative measures in combating COVID-19

Public Healthcare Policy : lessons learnt from COVID

Nurses’ contribution to Healthcare Policy

Epilogue

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WHY INNOVATIVE MEASURES ?

https://www.kcl.ac.uk/news/why-nursing-higher-education-is-essential https://youthrex.com/infographic/covid-19-social-determinants-of-health/

A. HEALTHCARE NEEDS
1. Prevent virus entry
2. Identify at-risk people, isolate, quarantine
3. Reduce community transmission
4. Treat the diseased early and effectively
5. Reduce admission / ICU / death
6. Protect the at-risk subpopulation
7. Protect the hospital / LTRC infrastructure
8. Material and resources
9. Protect people via vaccination
10. Deal with disability after COVID
11. Deal with delayed Non-CVOID diseases
12. Conduct research and predict situation
13. Innovative care (Telemedicine)

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B. SOCIAL NEEDS
1. Communicate with public
2. Deal with poverty / temporary poor
3. Manage obesity, depression, anxiety ..
4. Provide education during school
closure
5. Advise on WFH, travel, gathering,.
6. Collaborate (ALL stakeholders)
7. Monitor social impact (violence)
8. Administration problem
9. Use AI technology effectively
10. Deal with Government mistrust
11. Deal with social and political unrest

WHAT INNOVATIVE MEASURES ?

Translate Research and studies to Healthcare policy

Utilise Genetic Sequencing to combat COVID-19

Create Innovative Vaccines

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Cell biology : Virus characteristics

RNA MUTATION

• single positive-sense stranded

• Largest of RNA viruses (30000 bases)
• (Human double stranded DNA, 300 billion
base pairs).

Lipid bilayer membrane

SARS-CoV-2 is an enveloped virus, which means
that the RNA is packaged within an outer fatty or
lipid membrane, maintain a spherical structure.

Source: https://coronavirusexplained.ukri.org https://ars.els-cdn.com/content/image/1-s2.0-S0300908420301280-gr1_lrg.jpg

Cell biology : Virus characteristics

Spike (S) Protein
This large protein is essential for the virus to attach to and enter uninfected
6. RNA
cells. The individual S proteins are arranged themselves into groups of three
The coronavirus RNA mo
on the outer membrane, giving the coronavirus its distinctive crown or
‘corona’-like appearance.

Envelope (E) Protein

The E protein is found in relatively low numbers in the virus particle and is
thought to have several functions that contribute to virus growth and its
ability to cause disease. These functions are not completely understood but
include: the ability to form small pores that alter the properties of host cell
Membrane (M) Protein
membranes, preventing the M protein from clumping together and the
The M protein is also embedded in the outer lipid
transport and assembly of virus particles within the host cell.
membrane and is the most abundant of all the structural
proteins, giving the virus particle its shape and integrity. M
is also thought to play a role in the final stages of infection,
when new virus proteins are assembled into particles
before they are released and move on to infect new cells.

Nucleoprotein (N)
Multiple copies of the N protein link together to form a spiral that tightly wraps
and coils the RNA. This allows the long RNA molecule to fit into the small virus
particle and forms a protein coat around the RNA that protects it from damage.
The N protein also has an important function in the early stages of infection
when the RNA molecule is first released into the host cell, acting to reduce the
cell’s natural defences against the virus.

Source: https://coronavirusexplained.ukri.org https://ars.els-cdn.com/content/image/1-s2.0-S0300908420301280-gr1_lrg.jpg

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CoronaVirus Mask

transmission
Goggles

Cough etiquettes

Gloves
No shared items
Wash hands

https://www.cell.com/trends/immunology/fulltext/S1471-4906(20)30233-7

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https://www.cell.com/trends/immunology/fulltext/S1471-4906(20)30233-7

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https://www.cell.com/trends/immunology/fulltext/S1471-4906(20)30233-7

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https://www.cell.com/trends/immunology/fulltext/S1471-4906(20)30233-7

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Cell biology : Coronavirus transmission

Host factor

Ct
value

Behaviour

https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/ 14

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Reproductive Number (R0)

Early estimate 2.2 (95% CI, 1.4 to 3.9)
Factors
•
affecting Effective Reproduction Number
N Engl J Med 2020; 382:1199-1207
1.Asymptomatic
• Other estimatescases identification,
ranging between tracing, 1.5 isolation
and 3.5
2.Number of susceptible persons in the population
https://labblog.uofmhealth.org/rounds/how-scientists-quantify-intensity-of-an-
outbreak-like-covid-19
3.Environmental
•
factor (population
World Health Organization has estimated the density,
likely Rmobility
0 as between
and
2.0 andtemperature)
2.5, roughly double that of influenza virus
Coronavirus
4.Public disease
health 2019implementation
policy (COVID-19) Situation Report – 46
Omicron variant has an average basic and effective reproduction
5.Country
number of 8.2 from country;
and 3.6. areas from areas
J Travel Med . 2022 May 31;29(3):taac037. doi:10.1093/jtm/taac037
6.Vaccination policy
https://labblog.uofmhealth.org/rounds/how-scientists-quantify-intensity-of-an-outbreak-like-covid-19

= the number of cases, on average, an infected person

15 •
will cause during their infectious period.

IMPLICATION: LOCKDOWN & SLOWDOWN

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https://time.com/5796425/china-coronavirus-lockdown/

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https://www.geekwire.com/2020/washington-state-reveals-contact-tracing-plan-support-phased-opening-business/ 18

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Quarantine to Reduce Transmission

The World Health Organization commissioned a rapid
systematic review on 25 modeling studies and 4
observational studies determined (low quality evidence)
that quarantine to be important in reducing incidence
and mortality during the COVID-19 pandemic, with early
implementation and concurrent implementation of other
public health measures considered important to ensure
effectiveness
https://www.hk01.com/%E7%AA%81%E7%99%BC/443047/%E6%96%B0%E5%86%A0%E
8%82%BA%E7%82%8E-%E4%B8%80%E6%96%87%E7%9C%8B%E6%B8%85-
%E9%A7%BF%E6%B4%8B%E9%82%A8%E9%9A%94%E9%9B%A2%E5%96%AE%E4%BD%
8D%E7%B8%BD%E6%95%B8-
%E9%9A%94%E9%9B%A2%E8%80%85%E5%88%86%E4%BD%88 Cochrane Database Syst Rev. 2020 Apr 8;4:CD013574. doi: 10.1002/14651858.CD013574.

19

http://www.hosp.keio.ac.jp/en/annai/onegai/ https://www.pixtastock.com/illustration/62305638

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Respiratory Hygiene
Clean and disinfect frequently touched
objects and surfaces.
Wash your hands (correctly). 10
Stay at home when you are sick
Call your doctor.
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9b029a24-5ee1-495b-8565-899dec4e44ce.jpg https://www.thesun.co.uk/news/11593283/teachers-demand-pupils-sprayed-disinfectant-
coronavirus/?utm_medium=browser_notifications&utm_source=pushly
https://www.coronavirus.gov.hk/eng/social_distancing.html

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https://www.thesun.co.uk/news/11593283/teachers-demand-pupils-sprayed-disinfectant-
coronavirus/?utm_medium=browser_notifications&utm_source=pushly

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JAMA Apri 21, 2020 Volume 323, Number 15

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Since onset of outbreaks

Cell biology : Coronavirus Infectiousness
l 60% people expose may contract the disease
l Median incubation period to be 5.1 -5.2 days
l 97.5% of those who develop symptoms will do so within 11.5
days (CI, 8.2 to 15.6 days) of infection

l Clinical descriptions of asymptomatic phases after possible

exposure range from 2 to 14 days.
l A 14- day period for monitoring after potential exposure is
generally recommended
Infectious period of Omicron greatly shortened to 3 days
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https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a5.htm

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Nature Reviews Immunology 20, 271-272(2020

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mAb

Interferon
Plasma

HR2 Camostat
Peptide mesylate

Chloroquine Telcopranin

Lopinavir /
Ritonavir

Ribavirin

Remedivir

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V V

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Genome Sequencing

What is Genome Sequencing ?

Applications of Genome sequencing to combat COVID

Vaccine Development

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What is Whole-Genome Sequencing 全基因組測序 ?

Whole-genome sequencing (WGS) is a comprehensive method for providing and
analyzing a high-resolution, base-by-base view of the entire genome.

It detects single nucleotide variants, insertions/deletions, copy number changes,

and large and small structural variants.

It identifies potential causative variants for further follow-up studies of gene

expression and regulation mechanisms

It delivers large volumes of data in a short amount of time to support assembly of

novel genomes.

Therefore, genomic information is instrumental in identifying inherited disorders,

characterizing the mutations that drive cancer progression, and tracking disease
outbreaks.
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Translation of Genomics studies to practice

Phylogenetic study IDENTIFY AGENT AND ORGIN

• Determine timing of outbreak
Molecular • Origin (zoonotic)
diagnosis • Bats natural reservoir
• Pangolin intermediate host
Surveillance • Evolution
• Public health implication
Clinical care • Prevent future outbreaks

Vaccine
development

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TMA Transcription Mediated Amplification; LAMP loop mediated isothermal amplicat

Translation of Genomics studies to practice

• Nucle
Phylogenetic study LAM
• Need
Molecular
diagnosis evolu
a.D
Surveillance ²

²
Clinical care
²
²
Vaccine
development

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Translation of Genomics studies to practice

Phylogenetic study

Molecular
diagnosis

Surveillance

Clinical care

Vaccine
development

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Translation of Genomics studies to practice

Phylogenetic study UNDERSTAND CHARACTERISITCS

• Understand mechanism of viral
Molecular entry
diagnosis • Molecular interaction
• Viral-specific host factors
Surveillance essential for infection

Clinical care

Vaccine
development

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Translation of Genomics studies to practice

Phylogenetic study

Molecular
diagnosis

Surveillance

Clinical care

Vaccine
development

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Create Innovative Vaccines

Immunity, infection and vaccines

COVID-19 vaccines

Variants of Concern

Newer vaccines in the pipeline

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T
B

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Immune response after infection

⾸度感染 次度感染 B
B
抗體濃度
B
T
T
T

B T
45
https://twitter.com/virusesimmunity/status/1297890440478326785

45

Immune response after vaccination

⾸度感染 次度感染 B
B
抗體濃度
B
T
T
T

B T
46
https://twitter.com/virusesimmunity/status/1297890440478326785

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Genomic Organisation of SARS-coV-2

<<<…….Non-structure Protein ……>>> <<<………..Structure & Accessory Protein …….…>>> All curren
protein s
predating
stabilizes
currently
protein, s
furin-site
mutation
mutation
consecut
Virion assembly
Interferon antagonist (MERS-CoV) (Lys986 a
stabilize p
protein. O
the inact
Virus-cell Virion assembly the unmo
Virion assembly
receptor binding
Viroporin (SARS-CoV)
Interferon antagonist (SARS-CoV)
Viral suppressor of RNA silencing (SARS-CoV)
differenc
not only
R. Lu, X. Zhao, J. Li, et al.Genomic characterisation and
epidemiology of 2019 novel coronavirus: implications for formulati
virus origins and receptor binding construct
Lancet (2020), 10.1016/S0140-6736(20)30251-8
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https://www.sandiegouniontribune.com/news/science/story/2020-06-06/race-for-vaccine https://www.nature.com/articles/d41586-020-01221-y

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-70 C

Chemically modified mRNA

encoding the S protein bound
to ionizable lipids is
encapsulated inside a layer of
mixed lipids (BNT162b2 and
mRNA-1273).
Distinct advantages of the
mRNA-LNP technology in rapid
prototyping and
manufacturing on a large scale.
Good (not from cells; just
need a sequence; safe
because less procedures; fast;
initially -80 , now stable for
weeks to months in fridge;
Bad (reactogenicity; cold
storage)
50
https://www.sandiegouniontribune.com/news/science/story/2020-06-06/race-for-vaccine

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AstraZeneca 亜斯利康
phase II trial of
CanSino’s inhaled ChAdOx
vaccine found that,
when given as a CanSino Ad5
booster, the vaccine
raised blood-serum Sputnik-V rAd26 rAd5
antibody levels
significantly more
than did a boost
J&J Ad26
from an injection.
This suggests that
Good : greater stability; no freezing
the inhaled vaccine
requirements; good immune response
will offer protection
But pick a safe virus
that is as good as,
Bad: rare but serious consequence;
or better than, that
vaccine-induced immune thrombotic
provided by the
thrombocytopenia syndrome (VITT)
shot.

https://www.sandiegouniontribune.com/news/science/story/2020-06-06/race-for-vaccine
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Novavax
諾⽡⽡克斯

produced by incorporation of
purified recombinant S
protein into polysorbate 80
micelles with the addition of
the saponin-based adjuvant
Matrix-M (NVX-CoV2373).
Cannot cause infection.
Preliminary trial demonstrate
robust humoral and cell-
mediated immunity.

https://www.sandiegouniontribune.com/news/science/story/2020-06-06/race-for-vaccine 52

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Effectiveness of CoronaVac in Adults

https://chp-dashboard.geodata.gov.hk/covid-19/zh.html
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Effectiveness of Coronavac 3-7 years old

Seroconversion after 2
doses: > 96%

Neutralising Antibodiy
(induced at 3.0 µg dose)
GMT
Ø < 18 yo 142.2
Ø ≧ 18yo 44.1
Ø ≧ 60yo 42.2
https://chp-dashboard.geodata.gov.hk/covid-19/zh.html
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Effectiveness of Coronvac under 3 years old

6-3 MONTHS OLD AFTER 6-35 MONTHS OLD AFTER
2 DOSES OF CORONAVAC 2 DOSES OF CORONAVAC
安慰劑組 疫苗組 接種前 接種後
1139

6
100
73.03

68.97
58.62

44
234.38

189.75
5.38

接種前 接種28天後 接種前血清陰性 接種前血清陽性

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Effectiveness of BioNTech

Age Effectiveness
>= 16 91%
12-15 100%
5-11 91%

Nature Microbiology | VOL 6 | September 2021 | 1140–1149

57

Effectiveness of BioNTech 5-11 yo

Children 5-11 yo Efficacy
l 2268 children
• 1/3 Placebo
• 2/3 received 2 shots, 21 days apart
• Each dose 10 μg (1/3 adult dosage)
• Seroconversion 90.7%
• Antibody GMT similar to adolescents
16-25 years old Among hospitalized adolescent patients, two
l Study extended to 4500 children doses of the BNT162b2 vaccine were highly
effective against Covid-19-related hospitalization
l No safety concern and ICU admission or the receipt of life support.
l No major adverse event
l No myocarditis excess

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Seroconversion % GMT
120 1.4

100 1.2

1
80
0.8
60
0.6
40
0.4
20 0.2

0 0
6-23月 2-<5歲 16-25歲 6-23月 2-<5歲 16-25歲

59

Which vaccine should I choose?

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Safety, immunogenicity, and efficacy of COVID-19 vaccines in adolescents,

children, and infants: A systematic review and meta-analysis
Yuxuan Du, Long Chen, Yuan Shi

Inactivated vaccines have a more
satisfactory safety profile
l initial (RR 1.40, 95% CI 1.04–1.90, P =
0.03)
l booster (RR 1.84, 95% CI 1.20–
2.81, P = 0.005)
The risk of adverse reactions was
significantly increased after first and
second doses
No significant difference between the
first two doses (RR 1.00, P = 0.60).
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021290205
2 doses vs 1 dose:
l neutralizing antibodies (RR 144.80, P <
0.00001)
l RBD-binding antibodies (RR 101.50, P =
0.001)
l Cellular immune response seemed not
to be further enhanced.
Older children and adolescents were at
significantly increased risk of adverse
reactions after vaccination, with either
mRNA or inactivated vaccines,
accompanied by a stronger immune
response.

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Evolution of the SARS-CoV-2 omicron variants BA.1 to BA.5: Implications for immune escape and transmission

Mutation and Variants of Concern

Reviews in Medical Virology, First published: 20 July 2022, DOI: (10.1002/rmv.2381)

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67 HKU Presentation of Prof Lau Yu Leung 2022/8

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3 劑是基礎療程 “S” + M + E + N

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Effectiveness against Omicron

FIGURE : Age-adjusted rolling 14-day SARS-CoV-2 cumulative incidence* (A) and hospitalization
rates (B), by vaccination status — LA, California, 20211107-20220108 during Omicron surge

2.0

3.6 5.3x
23.0x

https://www.cdc.gov/mmwr/volumes/71/wr/mm7105e1.htm?s_cid=mm7105e1_w

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Reaction
CoronaVac after
safe for kidsCoronaVac
100

90 6-35 months
80

70

60

50

40
33.7 32.7
30 25.7
22.7
20
12.8 12.8
10 6.9
4.95
0 0
0
總反應 ≥ 3級反應 全⾝反應 發燒 針⼝痛
安慰劑組 疫苗組

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Reaction after BioNTech

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Myocarditis and BioNTech

Between 14 June 2021 and 4 September 2021

33 Chinese adolescents ( 29 males 4 females )
Median age of 15.25 years.
Overall : 18.52 per 100,000 persons vaccinated.
Dose 1 6 (18.18%) 3.37 100,000 persons
Dose 2 27 (81.82%) 21.22 100,000 persons
Males Dose 1 : 2 = 5.57 : 37.32 per 100,000 persons vaccinated.
All cases are mild and required only conservative management

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Reduced dose of BioNTech (30 >>10 >> 3 mcg)

https://chp-dashboard.geodata.gov.hk/covid-19/zh.html

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Reactions after BioNTech

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我的孩⼦適合打針嗎？

W Fever, acute diseases >>>> WAIT

HK incidence of anaphylaxis 0.22 cases per 1,000,000 doses administered

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NO COVID-19 VACCINE FOR < 6 MONTHS

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18 x
25.1 x
33.7 x
54.5 x

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A fourth dose of a COVID-19 vaccine restores

antibodies to levels observed after the third dose but
provides only a modest boost in protection against
infection, according to a small trial carried out in
Israel, suggesting that current mRNA vaccines hit a
“ceiling of immunity” after the third dose.

“The third dose is really, really important,” but people

who are young and healthy and don’t have risk
factors will probably not benefit much from a fourth
dose” Fourth dose raised participants’ levels of
‘neutralizing’ antibodies but did not surpass those
observed shortly after the third dose.
This additional protection could make a large
80
difference for high-risk groups during a surge,”
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Should we wait for Omicron-specific vaccine?

l Omicron ca
plummet b
manufactu
finalize the
l it’s difficult
whether th
CoV-2 varia
like Omicro
l Milder dise
l short term
weeks afte
92 to 83%)
l No human
l Fourth dos
vaccine be
Omicron sp

81
https://health.gvm.com.tw/article/90786

81

https://www.thelancet.com/action/showPdf?pii=S2352-3964%2822%2900025-1

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How Well Do Vaccines Protect Against Long COVID?

August 08, 2022

"The best way not to have long COVID is not to have COVID at
all," says Leora Horwitz, MD, a professor of population health and
medicine at New York University's Grossman School of Medicine.
"To the extent that vaccination can prevent you from getting
COVID at all, then it helps to reduce long COVID."
And just as vaccines reduce the risk of severe disease,
hospitalization and death, they also seem to reduce the risk of
long COVID if people do get breakthrough infections. People with
more serious initial illness appear more likely to have prolonged
symptoms, but those with milder disease can certainly get it, too.
"You're more likely to have long COVID with more severe disease,
and we have ample evidence that vaccination reduces the
severity of disease," Horwitz says. "We also now have quite a lot
of evidence that vaccination does reduce your risk of long
COVID – probably because it reduces your risk of severe disease."
There is little consensus about how much vaccines can lower the
risk of long-term COVID symptoms, but several studies suggest
that number lies anywhere from 15% to more than 60%.
https://www.medscape.com/viewarticle/978864

83

• Previous SARS-CoV-2 infection had a protective

effect against BA.5 Protection was maximal for
previous infection with BA.1 or BA.2.
• Immunity after infection wanes after few months
• Breakthrough infections with the BA.5 subvariant
were less likely among persons with a previous
SARS-CoV-2 infection history in a highly vaccinated
population

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Should vaccines be given after infection ?

https://www.nature.com/articles/s41586-021-03696-9

85
a–d, Plasma IgG antibody binding to SARS-CoV-2 RBD (a) and N protein (b) shown as area under the curve (AUC; numbers
in red are mean geometric AUC), and plasma neutralizing activity (NT50) in unvaccinated (c) and vaccinated (vac) (d)
individuals 12 months after SARS-CoV-2 infection (n = 63). n = 63 individuals, 37 convalescent unvaccinated (black) and 26
convalescent vaccinated (blue) individuals. a, b, Two-sided Kruskal–Wallis test with subsequent Dunn’s multiple
comparisons. c, d, Lines connect longitudinal samples from the same individual. Two-sided Friedman test with
subsequent Dunn’s multiple comparisons. Two individuals who received their first dose of vaccine 24–48 h before sample
collection
Effects areof
represented
Vaccinationin purple.
ande, Plasma neutralizing
Previous activity against
Infection indicated SARS-CoV-2
on Omicron Infectionsvariants of concern
in Children
(n NEJM
= 30, 15DOI:
convalescent and 15 convalescent vaccinated individuals). The B.1.526 variant used here contains the E484K
10.1056/NEJMc2209371
substitution. Substitutions, deletions and insertions in S variants used here are described in Methods. Two-tailed Mann–
Whitney test. Red numbers in c–e indicate the geometric mean NT50 at the indicated time point. All experiments were
performed at least in duplicate.

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Omicron variants partially escapes T-cell

response induced by SARS-CoV-2 vaccines

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Common Myths

1. Pregnancy not suitable for covid vaccination?

2. Affect sperms and fertility?
3. Natural immunity better than vaccination
4. Vaccine being developed too fast, not safe?
5. Change my DNA?
6. mRNA attacks the body?
7. Vaccine many serious side effects ?
8. Reinfection, why bother vaccination ?
9. Children are spared from COVID ?
10.Omicron is the last variant and the disease will fade out

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Summary on COVID-19 vaccines

Not 100% effective

Keep NPI Not lifelong
protection
HIGHLY effective in
reducing serious illness,
Hospitalisation and death.
Mild reaction
common; serious
event rare
91

https://www.covidvaccine.gov.hk/zh-HK/

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Public Healthcare Policy : lessons learnt from COVID

Basics of Public Healthcare Policy

Policy Process

Lessons learnt

101

Basics of Public Healthcare Policy

Defined as a law, regulation, procedure, administrative action, incentive, or voluntary practice of
governments and other institutions aiming to reduce sickness, promote health and well-being.

4 common types : public policies, organization policies, functional policies and specific policy.

Important because they help establish guidelines that benefits patients, healthcare organizations
and healthcare system.

Might include a bunch of sub-policies, for example Isolation policy, quarantine policy. Mandatory
testing policy, school policy, public premises policy, drug policies, vaccine policy, vaccine pass
policy and infringement policy.

Might need to be modified in the light of new information and changing needs.

102

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Principles of Public Healthcare Policy

GOALS Vision? clear? Foresight?
IDEAS Open? Transparent? Evidence-based? Humility? Empirical?
DESIGN
Realistic? Practical? Feasible? Efficient? Effective? Ethical? safe? Value-
added? Past experience? Alignment? Equitable? Financial? Rights?
EXTERNAL
All stakeholders? Consensus? Non-medical impact? Epidemiological?
Behavioural? Legislative? Economic? Demographic? International?
COMMUNICATION Clear? Timely? Understood? Ethnic? Trust ? Writing?
IMPLEMENTATION Capacity? Sustainable? Political? Resources? Manpower?
APPRAISAL
Thorough? Robustly assessed? All aspects (Covid, non-Covid and
socioeconomic) ? Metrics used? Cost-effective? Risk assessment?
ROLES Accountabilities? Committees? KISS? Uniformity? Right people?
FEEDBACK AND Mechanism effective? All stakeholders? Periodic review? One-off
EVALUATION event? Continuity?

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Policy making process

1. Problem identification /
Agenda setting
2. Policy formulation and
prioritization
3. Strategy and policy
development
4. Policy enactment
5. Logistics, monitoring
and implementation
6. Policy Evaluation

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1. Problem identification / Agenda setting

a. Clarify and frame the problem in terms of the effect on

population health.
b. Collect, summarize, and interpret relevant information (what,
why.)
c. Define the characteristics (e.g., frequency, severity, scope,
human behavior and attitude, economic, social and budgetary
impacts)
d. Identify gaps in the data and synthesize historical context
(global and local) social)
e. Goal setting: targets, indicators and time frames

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2. Policy formulation and prioritization

a. Activation of emergency response system https://www.sb.gov.hk/eng/emergency/ers/ers.htm
b. Formation of relevant committees including different key stakeholders (medical
and non-medical, supporters and opponents, government officials and NGOs)
c. Review literature, conduct an environmental scan, Identify different options
d. use quantitative and qualitative methods to evaluate different options as
regards health impact (morbidity and mortality), political and operative factors
affecting feasibility, and economic and budgetary impacts
e. Assess relevant characteristics (knowledge, attitudes, needs and barriers)
f. determine the most effective, efficient, and feasible option. (prioritize)
g. Connect with decision makers, partners, those affected by the policy and the
general public; solicit input and gather feedback

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3. Strategy and policy development

a.Identify how the policy will operate

b.Identify the strategy for getting the policy adopted
c.Define strategy for engaging stakeholders and policy
actors
d.Identify the resources needed for enactment
(jurisdictional, capacity)
e.Draft the policy (law, regulation, procedures, actions, etc.)

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4. Policy enactment

a.Follow internal or external procedures for getting policy enacted

or passed.
b.Assess whether enactment is consistent with the best available
evidence and findings of the policy analysis.
c.Identify facilitators and barriers to enactment.

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5. Logistics, monitoring and implementation

a. define implementation standards and accountabilities

b. Coordinate resources and build capacity of personnel to implement policy
c. Implement regulations, guidelines, recommendations, directives and
organizational policies. Translate into action.
d. Identify indicators and metrics to evaluate implementation and impact of the
policy
e. Assess implementation and ensure compliance with policy. Consider
²Disscentives
²positive incentives
f. Support post-implementation sustainability of policy

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Policy Evaluation

a. Define the purpose of the evaluation, who is requesting the information, why
the information is needed and how it is to be used.
b. Collect and analyze systematically the appropriate steps of the policy cycle to
make judgements about contexts, activities, characteristics, impact and
outcomes (short term, intermediate and long term) of the policy.
c. Evaluate whether principles of healthcare policy are met
d. Disseminate evaluation results and facilitate use to relevant parties
e. Build the capacity of others to evaluate policy and invite feedbacks
f. Use evaluation results to improve policy development, adoption,
implementation, and effectiveness, and builds the evidence base for policy
interventions and future directions
g. Evaluation might be needed periodically or permanently deleted

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NURSES’ CONTRIBUTION to HEALTHCARE POLICY

Why?
l Professionalism
l Evidence based
l Critical thinking and analytic skills
l Information technology skills
l Leadership
l Social esteem

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NURSES’ CONTRIBUTION : HOW

l Frontline workers including hospital staff, l Innovative measures
Community nurses, School nurses, ² Telemedicine
Health departments and universities ² Contact tracing
² Professional care ² Quarantine camps, hotel isolation
² Early identify problem, diagnosis, management
treatment ² Systems thinking
² professional feedback on challenges, ² Research
quality … ² Policy suggestion, amendment and creating
² Vaccination ² Building professional trust (Communities with
² public education and myth clarification higher levels of trust and reciprocity, such as
Denmark, have experienced lower rates of
² Training and teaching
hospitalization and death from COVID-19. )
² Address non-Covid needs….
² Promote proscociality

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What we have learnt

² Timely
² Evidence based
² Immediate clarify misinformation and disinformation
² Distrust in the government
² Not to forget again after pandemics
² Change of mindset to prepare for endemic
² Defining the next normal (redefining risk level)
² Tracking progress
² Limiting illness and death
² Slowing transmission

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Defining the next normal (New risk level)

1.Developing a set of vital signs to track the health of society.
Evaluating the public-health system
a.current key COVID-19-related measures (excess mortality, hospitalization,
case fatality, and transmission rates for the specific disease.
b.broader societal healthcare outcomes (such as maternal and infant health,
behavioral health, communicable disease, chronic disease, and
environmental health)
c.Factors that affect health (such as childhood lead exposure)
d.socioeconomic indicators (such as schooldays and workdays lost
because of health issues, changes in employment rate, and demographic
differences across various metrics).

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Defining the next normal (New risk level)

2. Engaging a diverse range of stakeholders to create the vital signs. Including
stakeholders across different demographic and socioeconomic groups.
3. Maintaining an evidence-based approach.
a.better understanding
b.interact with one another and affect daily life
c.emphasis may begin to shift away from case rates and toward the number of
hospitalizations, deaths, and acute-care access, in addition to tracking
variants.
4. Communicating the reasoning with clarity and empathy : what, why, shared
goals.

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TRACKING PROGRESS
1. Communicating vital signs simply. Also provide access to data
and allow persons to determine their own risk appetites.
2. Reinforcing health data infrastructure and public-health
surveillance systems.
a.Public-health surveillance, with tracking and early
intervention of any new variants
b.Early detection and monitoring
c.A broader set of bioinformatics tools (such as genomic
sequencing to detect variant mutations and wastewater-
monitoring systems to detect community transmission).

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LIMITING ILLNESS AND DEALTH

1.Vaccines
2.Treatments
3.Health system robustness
4.High-risk populations
5.Health equity
6.Neglected subpopulation

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Potential risk factors for severe disease —

• Infants <1 year of
• Chronic pulmonary disease (including moderate to
severe asthma)
• Cardiovascular disease
• Immunosuppression (eg, related to cancer,
chemotherapy, radiation therapy, hematopoietic
cell or solid organ transplant, high doses of
glucocorticoids)
• Others (Chronic kidney disease, chronic liver
disease, diabetes mellitus and severe obesity

https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/ 119

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Slowing transmission
l Fundamental principles for enabling a robust public life:
n maximize ability to detect disease outbreaks, public-health surveillance to be always on
by continuously monitoring for outbreaks (prioritize more passive surveillance
approaches that minimize impacts on individuals) through a broad set of tools (such as
wastewater surveillance and sampled testing).
n minimize the time needed to coordinate and mobilize resources (Agile rapid-response
teams, include testing, therapeutic interventions, securing hospital and staffing
resources , and developing safe interaction policies). Governments could work with
community stakeholders (such as schools, employers, and faith-based organizations) to
develop scenarios
n Promoting NPI that reduce local transmission. (Mask use in crowded areas; Social
distancing; outdoor dining). Investing in infrastructure that reduces disease transmission
(such as air quality infrastructure in schools and workplaces) is another consideration.

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