 So, welcome everyone to the session on health governance. We have 45 minutes today and five presentations, let's see, I mean that's the plan. And this panel is looking at the effects of different health governance measures and health seeking behaviours in different contexts. So the first presentation that we have today is pre-recorded, it's by Nayanta Rassama, she's a consultant at the South Asia Chief Economist's office at the World Bank, and working on different topics related to labour inequality, gender immigration and health. Unfortunately, she cannot attend the session today and I believe that the presentation is actually presented by her co-author, Ivan Thore, so yeah, perhaps we, if you want to send them questions afterwards, perhaps you will have access to their email addresses in the attendance list or find other ways of reaching out to them. So yeah, Simon, if you can start the first presentation. Hello everyone, my name is Ivan Thore, I work at the World Bank, and I'm presenting today this paper co-authored with Mauricio Buzolo and Nayanta Rassama, also from the World Bank. In this paper, we intend to explore the effects of government's pandemic response policies on the degree of vaccine hesitancy and vaccine acceptance across the world. Vaccine hesitancy is a critical hurdle in the fight against COVID-19, particularly now as new, more transmissible variants like Delta are emerging. It has never been more important to get as many people vaccinated as possible, also because non-pharmaceutical interventions like lockdowns cannot be prolonged indefinitely given the mental and economic costs they entail. There is an extensive literature on the drivers of vaccine hesitancy at the individual level. Education, personal experience, risk perceptions and demographic factors all play a role in determining the take up of vaccine. Social factors like norms and culture also have an impact. And lastly, policy can play a role. Information campaign, mass mandates and mobility restrictions can also modify individuals' behavior. A recent paper by Glaser and co-authors shows that when local governments left lockdown restrictions, individuals interpret this as a signal that the spread of the disease is low and therefore engage in more risky behavior. Our paper's main research question follows from that literature. If government measures may carry an informational content about the risks concerning the pandemic, up to what point do the government's policy response to the pandemic affect the degree of vaccine acceptance among individuals? Our main data source is a survey run by Facebook covering 67 countries from August 2020 to February 2021. In 18 of these countries, the survey is carried out in a repeated monthly cross-section of a representative sample of internet users. Our main dependent variable is the answer to the question, if available, are you willing to accept a vaccine? Our main independent variable is the Oxford students' index. This is an indicator that summarizes a government's policy response by the degree of stringency. The graph on the left shows that vaccine acceptance is not static. In fact, it has varied considerably in the time period included in our sample. The graph on the right looks at the evolution of vaccine acceptance in Brazil and how it correlates to the evolution of government's stringency. The less stringents are our measures, the lower the vaccine acceptance. Our analysis will look into this correlation in more detail. Social factors like norms and trust also play a role in vaccine acceptance. On the left, you can see that in countries where individuals believe that vaccine acceptance is high in their communities, their own individual vaccine acceptance is also high. On the right, you can see that the more individuals trust government, the more they are individually willing to take the vaccine. With social norms and trust, differently to policy, while they vary considerably across countries, are more sticky from a within-country perspective. In this sense, policy changes can be more relevant to drive changes in vaccine acceptance. This slide shows our main results. Our main empirical equation is a linear probability model in which individual vaccine acceptance is the main dependent variable and where the stringency of government measures is the main regressor. We include a long series of individual controls and also control for the incidence of the pandemic at the time when the survey took place. While our results are purely correlational, controlling for the incidence of the pandemic allows us to be more confident that the partial correlation of the stringency index excludes the variation driven by the pandemic itself. The results on the left show the standardized estimates of the coefficients of the main equation. The stringency is associated with a higher degree of acceptance in the vaccine. For instance, moving from the 25th percentile to the 2075th percentile of the stringency index is associated to a 5.8 percentage point increase in individual vaccine acceptance. Community norms and trust in government have a larger standardized coefficient, but bear in mind that the observed variation in these coefficients is mostly cross-country, remaining even if we include country-fixed effects. The graph on the right shows the partial correlation of stringency and vaccine acceptance across country and you can see that there is considerable heterogeneity, with a few countries having a negative correlation. These results suggest that the effect that government measures may have on vaccine hesitancy may be context-dependent. To conclude, government's management of the pandemic has varied and so has public reception to these policies. Individual and social factors drive vaccine acceptance, but they are difficult to change as they depend on social histories and culture. Government policies have the potential to convey information on the risk of contracting the disease and in this way they can shift vaccine acceptance. Our results show that this effect is potentially sizable. We are currently extending our analysis to whether understand this effect and in particular we are looking at whether individual risk perceptions change when governments announce new restrictions. We expect to have new results in the coming months. Thanks again for giving us the opportunity to present at this conference. All right, thank you for the presentation and hopefully there will be an opportunity to ask questions or give feedback at some point. I don't see the next presenter. Simeon, do you see Shuku Uedoji Acero somewhere? No, no, I didn't see. No? Okay, so then I think we should just move on to the third presentation by Amani Hussain, who has joined us already. She's an independent urban researcher and she's going to present a paper on towards a place-based approach for managing the impacts of COVID-19 on Egyptian households. Amani, the floor is yours. Good morning. My research towards a place-based approach for managing the impacts of COVID-19 on Egyptian households. The main objective of this research is to analyze the efficacy of policy responses to the pandemic in Egypt. It consists of three parts. The first part is a brief discussion of vulnerabilities in the urban health and socio-economic context in Egypt. The second part is an investigation of the health and socio-economic impacts of the pandemic on Egyptian households by using qualitative research methods and analyzing the publicly available data and surveys conducted by the Central Agency for Public Mobilization and Statistics between 2015 and September 2020. The third part is recommending a resilient place-based approach for managing the impacts of the pandemic in Egypt. The urban system in Egypt has many vulnerabilities that can exacerbate transmission rates of COVID-19 and make containment measures more difficult. More than 40% of the urban areas in Egypt are on-planet and have high population density. More than 31 million people in Egypt are poor and about 6 million are living in extreme poverty. Only 7% of the population used with sub-lion ICT infrastructure and 63% of the working force are informal workers. The health sector has many vulnerabilities due to the low government sub-denture and medical personnel per 1,000 people are very low and hospital beds per 1,000 people also. Since the 4th of March 2020, the government had many measures to limit the community spread of the virus, counseling all public events, dedicating hospitals for isolating COVID-19 cases, halting all air travel, closing schools and universities, and nighttime curfew. But by the 1st of August 2020, the government announced lifting all restrictions. By the 1st of September 2021, only 3% of the population have been fully vaccinated in Egypt. And this is considerably low in the region. The government announced stimulus policies in $6 billion package, about 50% for tourism sector and 0.6% for health sector and 0.4% for regular workers support. The targeted cash transfer program includes only half of the first injections. The second part of the research about the impacts of COVID-19 in Egypt, I used the publicly available data to calculate excess mortality in 2020 due to the pandemic. In the Peace Corps method, excess mortality is calculated as a percentage difference between the number of deaths in 2020 and the average number of deaths in the same period over the last five years. By comparing the Peace Corps of Egypt and several countries, we can notice that the mortality rate in Egypt is higher than USA and close to Italy and Brazil. After calculating the Peace Corps for the urban and rural areas of Egyptian government rates, we find that the excess mortality was higher in urban areas than in rural areas. Especially in the cities of Aswan and Luxor and Krena tourist destinations. By mapping variations in mortality rates across European areas of Egyptian government rates, we can notice that the first cluster of infections emerged in Aswan and Krena and is spread to other government rates due to laxity in implementing social distancing measures. By comparing the locations of the first Fushi with the locations of the first isolation hospitals, it's clear that the Egyptian authorities were efficient in monitoring and isolating the first cases. By mapping variations in mortality rates across rural areas, we can notice that the infection rate was lower than the urban areas. Socioeconomic impacts of COVID-19, about 62% of the working population have been negatively affected by the pandemic. 26% of them became unemployed and 73% suffered from income decline. We can notice that rural areas are more affected than urban areas, despite that infection rates were much lower. According to the same survey, more than 60% of them indicated that containment measures are the principal reason for income decline. We can, according to another survey, the percentage of households with insufficient income decreased after lifting the containment measures. The beneficiaries of a regular worker's aid were only 4% of the Egyptian households. And this is very low percentage compared to 63% of the working population. Conclusions, we can notice that COVID-19 and the pandemic have deeply affected the Egyptian people on the health sector and the socioeconomic sector. The Egyptian government was very late in undertaking initial containment measures, such as halting air travel. The public health and social measures were delayed and couldn't prevent the community spread of COVID-19 in Egypt, in addition to affecting the Egyptian households livelihoods negatively. The economic measures were insufficient to mitigate the economic impacts on Egyptian households. And the government must accelerate the pace of vaccination. Recommendations, as the daily infection rate is high, a comprehensive combination of containment processes is needed to reduce the spread of the virus, strike planning of gatherings, physical distancing measures in schools or workplaces. Use special data collection techniques can enable local authorities to assess the real-time spread of COVID-19 and develop area-based responses, such as localized lockdowns in most affected areas instead of lockdowns or curfews for the entire country. Using special mapping techniques to identify communities that can be hotspots of local transmission. And the geographic targeting of these communities would help local authorities to target emergency efforts to the poor and informal workers with cash transfers or food distribution and waive utility bills for the duration of the pandemic and bright rising vaccination for these low-income areas. Once the daily infection rate has been lowered, the comprehensive form of tests and contacts for tracing policies is the most effective strategy in this situation. Thank you for listening. Thank you very much, Amami, that was very interesting and very rich in detail in the presentation. So I am not sure if we have other presenters. There's technically three more presentations. Simon, did you... were you able to... Yeah, no. We cannot find them. So I think this gives more time for discussion. Some attendees want to even share audio and discuss it. It's also possible. Yeah, let's do that. I will just read out the titles of the other presentation so that if people are interested in the work, they can get in touch with the presenters. So the one presentation was on the Peace Paradox and Pandemic, a natural experiment of COVID-19 effects of African jihadi groups by Larissa Navau and Henry Nanjiang. Larissa Navau is an assistant lecturer at the University of Jiang. So it's a very interesting paper. Please look them up if you want to give feedback or get in touch with them. And then there is another presentation by COVID-19 time-varying reproduction numbers worldwide and empirical analysis of mandatory and voluntary social distancing. I think the presenter was Alessandro Ribucci from the Johns Hopkins University Carey Business School. It's a very interesting, very comprehensive paper. So possibly another area of interest for people attending the panel. And then I think we were missing also the presentation by... Let me double-check. There's one more, I believe. I guess, Spatial Appraisal of the Health Care Seeking Behaviors of People with Chronic Health Conditions during the COVID-19 pandemic in South Africa by Shukwe Dozi Acero, who's a senior research fellow at the Environment for Development Initiative and Associate Professor in the Department of Geography at the University of Nigeria. So if some of these topics are close to your own research, just, yeah, you can find the names in the conference program and feel free to get in touch. Okay, so I do not see any questions in the Q&A tab or in the chat, I think, no. So I would have a few for Amani, but please feel free to also join us on the, I guess, stage. I think you can do that if you share your audio and video. And then perhaps, Amian, can put you up for us to discuss with or I'm happy to have a very open session talking about related research or other questions that you may have. So, yeah, thank you again, Amani, for your presentation. Now, you could have taken more time, we didn't know, but you won't be the only live presenter today. I wanted to ask you because you said that the vaccine rates are very low in Egypt if you have any insights as to where this is mainly because of rollout or if you observe a similar topic as we saw in the first presentation on vaccine hesitancy as well and what may be the reasons for that. And then also because you draw on different information from different surveys, so maybe you can give us some information about which data sources you consult and when they were conducted, just interested in that as well because a lot of the data collection efforts actually have been suppressed by COVID containment measures and so forth. And yeah, you also mentioned the unemployment rates who have, as a result of the pandemic, I was wondering if you have some insights as to which sectors were particularly affected by that or which population groups as well. Yeah. The research has many details more than the presentation and the vaccination was very late because only 7% of the population have fixed the ICT infrastructure and the vaccination registration system requires for online registration on our website. So little percentage of the population can register for this vaccination. According to regarding the unemployment, I'm not sure but I think that I have read about this information that the most affected sector is the tourism sector because all airlines were halted in the first wave and the service sector also, restaurants and gyms and all the service industry have affected. And regarding the service that you're talking about where they were able to conduct them during the pandemic and who were they mainly reaching? Was it via phone interviews? I'm sorry, I couldn't understand. You were saying like the information that you draw on in your presentations coming from multiple surveys, right? So I was wondering if you know a bit more about when they were conducted or by whom? These surveys were conducted by the Central Agency for localization and administration in Egypt. This is a governmental authority. The surveys were conducted in May 2020 and September 2020 and I think July 2020. During the first wave when the curfew was implemented and after lifting all restrictions and lockdowns so they measured the impacts of the pandemic on the population in three stages. Okay, thank you for the additional insights. So I don't see, wait, let me see if there are some questions by now, no? Is there anyone else who'd like to ask a question directly, live? To Amani or regarding the present? We want to discuss something of the earlier presentation. Perhaps people are still in the morning hours. Okay, is there something else that you would like to discuss Amani or something else? I have just noticed that the presentation was too small. I think it wasn't clear enough on something. No, no, I think it allows you to go into presentation mode when you are in the PowerPoint. But if you go to full screen mode, it was actually possible to see the slides quite well. But if there's something, for example, that you discuss briefly, that you would elaborate a little bit more, we still have some time if you want to. It's your panel basically. Okay, I think that the second part is the most part of the research. I conducted an analytical research for this part. I have gathered data about the number of deaths for each governorate, all the cities and urban areas and rural areas in every governorate for the last five years. I calculated the police court to identify the most affected areas that had the most number of deaths in the country. So we can determine where the infection rate is higher than other places. This is the main objective of this research. And I discovered that Aswan and Luxor, very famous locations in Egypt, are the first fushi for the pandemic. I think that if the government applied special techniques and digital tools to determine the first infections and cases, the government would handle the pandemic or its consequences better than letting the infection spread everywhere. So they didn't have different measures for different locations, right? And did you look into why certain locations have a much higher death toll or spread of the virus? I think that is the first cases where we are in these places. Because they are tourist destinations, especially in winter for foreign tourists. So the pandemic started from there and the government was very late in halting air travel. They halted air travel in about 19 March. It's very late. And they were inefficient in their policy responses. Also, the urban areas were very high in their mortality rates than the rural areas. But the rural areas were more affected by the socio-economic implications of the pandemic than the urban areas. So if the government was aware of the geographic distribution of the pandemic in Egypt, it could apply a place-based approach for managing the pandemic instead of affecting all people. Yes, I guess there were very different approaches in different countries and different delays. And so it's a very interesting point to make. I think it would have been nicely for you to discuss also with the other presentation that looks at the rate of the reproduction numbers across different countries and see how it sits within a larger debate and a global perspective. But unfortunately, we won't have the panelists attending today. OK, I mean, I think it's almost 35 past now. So I think if there are no other questions, we can end this panel a bit earlier. So you can see what I think there's like immediately some sessions afterwards on if I recall correctly on some capacity building sessions that are discussing different data sets and so forth. So thank you very much, Amani, for your presentation. And it was very interesting. Thank you for attending. Also, yeah, also to our other presenters who sent us the pre-recorded video, Eventore and Nayantara Sama, I hope that there will be some follow up discussions or contacts or if you find people that are doing basically related research to your topic, feel free to reach out to them. Yeah, yes. And as we see in the chat, if you and we close the session, you can move to a coffee break room. Or I guess I can also leave it open if people want to have discussions on other topics. Or yeah, you can you can also use the other forums of the conference for that. OK, then thank you, everyone. Thank you, Sumion, for the support. And then I will see you in the other forums. Thank you.