Challenges to Global Health Emerging from the COVID-19 Pandemic
Mateus F. Carneiro
Round 1
Reviewer 1 Report
The manuscript is interesting and deserves to be published. Some amendments are required for improving clarity for an international reader.
- Many parts of the introduction section and other paragraph need to be adeuately referenced (lines 26-59)
- the sentences "Pressures arising from the uncertainties in the first months of the pandemic triggered a chain reaction of ‘blame- and-shame’ accusations against international organizations (primarily WHO), but also against some national governments. In many countries authorities were facing criticism that pandemic preparedness, which had been a hallmark of activities related to quick response to the new potential epidemic, had not been fit for the purpose of this pandemic situation. Such an intermediate conclusion was proposed given the late response, fragmented actions, and insufficient intensity of response in the very initial stages. " must be accompanied by relevant bibliographic references.
- all the paragraph "Climate change and the pitfalls of globalization " needs to be referenced
- as a minor issue, replace "covid-19" with "COVID-19" throughout the paper.
- the Ottawa and Shanghai declarations must be referenced.
- In the "Future directions" paragraph, the Author could give a perspective on the role of scientific societes.
Author Response
Dear reviewer,
Thank you for your comments. I have uploaded a revised manuscript, which includes the following changes suggested by you:
- Statements in lines 26-59 are referenced now
- The sentences cited are now accompanied by adequate references and the response to the initial criticism is explained.
- The subsection on Climate change and the pitfalls of globalization has been extensively referenced throughout.
- covid-19 was replaced by COVID-19 throughout
- Ottawa and Shanghai declarations are referenced
- Future directions includes the perspective on the role of scientific societies
Thank you again and I believe that the revised manuscript has been greatly improved by incorporating suggestions by the reviewers.
Reviewer 2 Report
A necessary article to bring order to public health, which of course goes beyond mere health interventions.
Congratulations to the author.
Author Response
Dear reviewer,
Thank you very much for your encouraging and positive comments.
Kind regards
Reviewer 3 Report
Comments on “Challenges to global health in a post-covid world meeting with old and unresolved problems”
General Comments:
1. This paper presents an overview of challenges to global health in the post COVID period. The author highlights 5 challenges. Each are briefly described.
2. The paper is a good introduction to the selected challenges. However, it is not a research paper. Each challenge needs to be described in terms of its history and its importance to the future of global health. The information presented here only gives a rather brief overview.
3. This paper would best be seen as an overview for a publication that would provide in-depth research on each of the 5 challenges. There is not enough information provided here to allow the reader to assess the importance of each challenge. Each needs a much more research and information for its role in the future to be properly assessed.
4. This paper does not do justice to the challenges it presents. My suggestion is that a Special Issue of Health Care be devoted to the topic of challenges to global health in a post COVID world. The author could take the lead and request researchers to submit papers on the 5 challenges that have been identified. Or other challenges could be added in a call for papers.
Specific Comments
1.Line 56 For elements are mentioned. However, five challenges are identified. Are the elements different than the challenges?
2. All sections need more references to support the arguments.
3. The linkages between each of the challenges and the impact on global health needs to be greatly expanded.
Author Response
Dear reviewer,
General Comments:
- This paper presents an overview of challenges to global health in the post COVID period. The author highlights 5 challenges. Each are briefly described.
Response: This mistake was corrected.
2. The paper is a good introduction to the selected challenges. However, it is not a research paper. Each challenge needs to be described in terms of its history and its importance to the future of global health. The information presented here only gives a rather brief overview.
Response: The paper was not designed as a research paper, therefore we have followed the instructions for 'Perspective' and it should represent a position paper. Consequently, the succint style. Nevertheless, following the recommendations by the reviewers and the editor, I have greatly expanded references to each of the section. Greater expansion including history would bring the paper to almost twice the suggested length.
3. This paper would best be seen as an overview for a publication that would provide in-depth research on each of the 5 challenges. There is not enough information provided here to allow the reader to assess the importance of each challenge. Each needs a much more research and information for its role in the future to be properly assessed.
Response: That is definitely a possibility and it remains at the discretion of the editor.
4. This paper does not do justice to the challenges it presents. My suggestion is that a Special Issue of Health Care be devoted to the topic of challenges to global health in a post COVID world. The author could take the lead and request researchers to submit papers on the 5 challenges that have been identified. Or other challenges could be added in a call for papers.
Response: I welcome the idea and could elaborate it if adopted by the editors.
Specific Comments
1.Line 56 For elements are mentioned. However, five challenges are identified. Are the elements different than the challenges?
Response: This has been corrected accordingly.
- All sections need more references to support the arguments.
Response: The paper has been extensively referenced throughout.
3. The linkages between each of the challenges and the impact on global health needs to be greatly expanded.
Response: This has been done for each of the challenges and the impact, focusing on the evidence from the studies referenced.
Thank you again for the comments.
Kind regards
Reviewer 4 Report
The proposal of this work is quite interesting, but I believe it gets lost in the development of the text. While trying to list all of the relevant factors in a short text most of those were oversimplified from the used references and I could not understand the contribution from the author. The lack of a discussion of pre-COVID 19 factors, although addressed, collaborates to the simplification of extremely complex issues.
The constant split using HIC as reference leaves aside all of the major structural diferences existent within that group, e.g. a comparison between the USA and China shows in itself can show an absurdly different preparedness, actions and results. Sentences like "Offsetting the impact of these measures and even their introduction was easier for the HICs" (line 177) are far from addressing the material reality, and using income as the main factor of the analysis leave the nuances out and there's a clear failure in being able to point solutions in the text.
The comments about the war in Ukraine seem to disregard several different conflicts that has been ongoing for decades in the world now, it also seems to ignore the internal conflict in Ukraine previous to 2022. That is also the impression when the text mentions a refugee crisis without mentioning the already ongoing crisis previous to 2022.
The last three sessions are a collection of statements that often appeal to common sense without adding much to what was already said. In several points the author seems to blame individuals for problems that obviously systemic (like vaccination numbers). Unfortunately I cannot recommend this work for publication in its current status.
Author Response
Dear reviewer,
Thank you for your comments.
The paper presented was not intended to be a research paper but a 'Perspective' as the typology selected suggests.
- References: These have been extensively added throughout the text and have been accompanied by additional topical explanations.
- US and China: I do not quite understand what is implied here. US showed serious shortcomings, followed by the big loss of lives and unmasking an otherwise discriminating (not universal) health system. China pursued strict policies of zero covid. This was accompanied by vaccinations using mostly their own vaccine which has evidently been the least efficient. Outbreaks and spreads during the omicron soars were therefore expected. The economic cost was dramatic and all the implications on mental health have not been evaluated. All this should be assessed as well but it might prove to be difficult also because the registration of cases has stopped in China.
- The HIC were in the advantage of seizing the vaccines soon even to the exaggeration which caused shortages for LMICs and this is clearly a fact.
- Subsidising own economy and the social pressures was clearly (supported by evidence) much easier for HICs than LMICs.
- Other military conflicts of the recent period - the last 15 years were added and their impact exemplified.
- I did not imply anywhere in the text that it was the individual's 'fault' or 'guilt' for not having been vaccinated. The mention of no-vax movement and promoted scepticity were actually successful because of insufficient organised approaches at the system level. This has now been underlined and predictors of success and hesitancy referenced.
Kind regards
Reviewer 5 Report
This paper discussed the challenges that need to be tackled in a post-covid world. The
author highlighted several perspectives including military conflicts, climate change, ageing
and inequality. I suggest accepting it for publication.
I have one comment: when an abbreviation is used at the first time, please also provide the spelled-out version for readers to understand the content. For example, USAID in the discussion part.
Author Response
Dear reviewer,
Thank you for your positive and encouraging comments.
The USAID was explained when mentioned in the text in the revised manuscript.
Kind regards
Round 2
Reviewer 3 Report
This paper is much improved. I understand it is a perspective. However the expanded references enable readers to seek more information to support the findings. Before publication, I recommend minor revisions. The title could be changed to "Challenges to global health emerging from the COVID-19 pandemic". This would provide a more focused expectation for the reader. The section untitled "Conclusion" should be put at the very end of the paper. It wraps up the entire argument including "Future Directions".
Author Response
Dear reviewer,
Thank you for your positive comments in this round.
- I have changed the title of the article according to your suggestion.
- I have swapped place between Future Directions and Conclusions.
Kind regards,
Reviewer 4 Report
Dear Author,
Thank you for your answers.
Let me address your comments individually:
1. Thank you. With the new references and topical explanations I can see this paper as a 'Perspective' work.
2. The extra nuances the author show in the comment, are examples of what I tried to imply in my review. The plain use of HIC as a category without addressing the internal structure of the group produces statements, and conclusions, that are too nonspecific to be useful.
3. My apologies, I don't understand how my comments triggered this line, but (again) the author's note show a more realistic analysis than the article's text. The article does not contain an explicit comment on the relation between vaccination shortage and the exaggerated seize of them by HICs, it only mentions the shortage superficially (line 96) with no references.
4. I don't disagree with the statement but, again, I don't understand how it addresses my review. It's also another case of a comment by the author that bring an analysis that is not present in the article text.
5. Thank you for addressing that comment. To be clear, when I mentioned conflicts in Ukraine starting in 2014 I meant the conflict in the Donbas area, not the annexation of Crimea (that is arguably irrelevant to the discussion presented).
6. Thanks for adding the discussion about antivax movements. Apologies if I've seemed to accuse the authors of "blaming" individuals for not being vaccinated. My comment was related to how the author conflates individual aspects with systemic problems. The vaccination numbers were one example, but the use of terms like "lifestyle" (line 319) give the impression that individual choices are relevant to what is being discussed.
Again, thank you for your comments and for the new version of the text. My opinion is that this work could be improved. The current version presents a good collection of references, but the discussion is oversimplified and produces sessions 4 and 5 that are too generic to be useful.
Author Response
Dear reviewer,
Thank you for your positive and constructive comments. Here are answers to your comments and suggestions:
- Thank you. With the new references and topical explanations I can see this paper as a 'Perspective' work.
Response: Thank you. I am glad I have been able to demonstrate that.
2. The extra nuances the author show in the comment, are examples of what I tried to imply in my review. The plain use of HIC as a category without addressing the internal structure of the group produces statements, and conclusions, that are too nonspecific to be useful.
Response: Thank you. I expanded greatly on your suggestions and brought the proposed reflection in context.
3. My apologies, I don't understand how my comments triggered this line, but (again) the author's note show a more realistic analysis than the article's text. The article does not contain an explicit comment on the relation between vaccination shortage and the exaggerated seize of them by HICs, it only mentions the shortage superficially (line 96) with no references.
Response: There have been studies referenced that demonstrate the differences as well as delays in availability of vaccines in HICs compared to LMICs.
4. I don't disagree with the statement but, again, I don't understand how it addresses my review. It's also another case of a comment by the author that bring an analysis that is not present in the article text.
Response: There is a reference from an IMF analysis addressing the financing of the economic impact of COVID-19 in HICs compared to LMICs. The impact is also demonstrated through the approaches taken by the different HICs in addressing the crisis.
5. Thank you for addressing that comment. To be clear, when I mentioned conflicts in Ukraine starting in 2014 I meant the conflict in the Donbas area, not the annexation of Crimea (that is arguably irrelevant to the discussion presented).
Response: I understand that this is just a comment and not a request for amendments.
6. Thanks for adding the discussion about antivax movements. Apologies if I've seemed to accuse the authors of "blaming" individuals for not being vaccinated. My comment was related to how the author conflates individual aspects with systemic problems. The vaccination numbers were one example, but the use of terms like "lifestyle" (line 319) give the impression that individual choices are relevant to what is being discussed.
Response: Vaccine hesitancy and the potential future approaches have been referenced with various studies.
Again, thank you for your comments and for the new version of the text. My opinion is that this work could be improved. The current version presents a good collection of references, but the discussion is oversimplified and produces sessions 4 and 5 that are too generic to be useful.
Response: The text of the Discussion section has been extensively amended and referenced and the final points have been expanded.
The revised text now includes references for all key statements and the five key challenges it proposes.
Round 3
Reviewer 4 Report
My last review was mostly not addressed in the new text. The final work still lacks relevant discussions and recommendations.
Author Response
Dear reviewer,
In response to both your 2nd and 3rd comments, I have done the following:
2. The extra nuances the author show in the comment, are examples of what I tried to imply in my review. The plain use of HIC as a category without addressing the internal structure of the group produces statements, and conclusions, that are too nonspecific to be useful.
Response: Thank you. I expanded with additional references on the experiences of the LMICs and brought the proposed reflection in context.
- My apologies, I don't understand how my comments triggered this line, but (again) the author's note show a more realistic analysis than the article's text. The article does not contain an explicit comment on the relation between vaccination shortage and the exaggerated seize of them by HICs, it only mentions the shortage superficially (line 96) with no references.
Response: There have been studies referenced that demonstrate the differences as well as delays in availability of vaccines in HICs compared to LMICs and the effects these delays had on the latter.
4. I don't disagree with the statement but, again, I don't understand how it addresses my review. It's also another case of a comment by the author that bring an analysis that is not present in the article text.
Response: There is a reference from an IMF analysis addressing the financing of the economic impact of COVID-19 in HICs compared to LMICs. The impact is also demonstrated through the approaches taken by the different HICs in addressing the crisis as well as examples from LMICs.
5. Thank you for addressing that comment. To be clear, when I mentioned conflicts in Ukraine starting in 2014 I meant the conflict in the Donbas area, not the annexation of Crimea (that is arguably irrelevant to the discussion presented).
Response: I understand that this is just a comment and not a request for amendments. However, the origins of the Ukrainian conflict were added to the discussion.
6. Thanks for adding the discussion about antivax movements. Apologies if I've seemed to accuse the authors of "blaming" individuals for not being vaccinated. My comment was related to how the author conflates individual aspects with systemic problems. The vaccination numbers were one example, but the use of terms like "lifestyle" (line 319) give the impression that individual choices are relevant to what is being discussed.
Response: Vaccine hesitancy and the potential future approaches have been referenced with various studies. Lifestyles have been removed entirely. Vaccine hesitancy and no-vax are not a new movement but they had been significantly enhanced harming also the previously existing immunisation programmes.
Again, thank you for your comments and for the new version of the text. My opinion is that this work could be improved. The current version presents a good collection of references, but the discussion is oversimplified and produces sessions 4 and 5 that are too generic to be useful.
Response: The text of the Discussion has been revised, additionally referenced, reorganised and partly rewritten so as to follow the indicated five topical areas. Similar expansions and reorganisations were made for the Future perspectives and Conclusions sections. The text now uniformly follows the logic of the five topics, which had been previously neglected and partly fuzzy because of the different orders. Generic and simplified statements were either removed or rewritten.
The revised text now includes references for all key statements and the five key challenges it proposes.
