Health policy and controlling Covid-19 in England: sociological insights

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and well-being in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epidemic and identifies the key sociological and political influences which have shaped these policies. Drawing on the theoretical approach set out in his recent book which lays emphasis on the interplay of powerful structural and economic interest groups, the author will consider the influence of the key players. Government policy has, at least initially, tied itself to scientific and medical evidence and protecting the NHS so the key roles of the medical profession, public health scientific community and NHS management and their respective and relative powerful influences will be discussed. The government needs the support of the public if their policies are to be successful, so how have the government addressed maintaining public trust in this ‘crisis’ and how much trust do the public have in the government and what has influenced it? The strong emphasis on social distancing and social isolation in the national government policy response to Covid-19 has placed an increasing public reliance on the traditional and social media for sources of information so how the media has framed the policy will be considered. One policy aim is for an effective vaccine and the influence of the drug industry in its development is discussed. Finally, the role of the state will be discussed and what has shaped its social and economic policies

MULTI-DIMENSIONAL PROFILING OF CYBER THREATS FOR LARGE-SCALE NETWORKS

Current multi-domain command and control computer networks require significant oversight to ensure acceptable levels of security. Firewalls are the proactive security management tool at the network’s edge to determine malicious and benign traffic classes. This work aims to develop machine learning algorithms through deep learning and semi-supervised clustering, to enable the profiling of potential threats through network traffic analysis within large-scale networks. This research accomplishes these objectives by analyzing enterprise network data at the packet level using deep learning to classify traffic patterns. In addition, this work examines the efficacy of several machine learning model types and multiple imbalanced data handling techniques. This work also incorporates packet streams for identifying and classifying user behaviors. Tests of the packet classification models demonstrated that deep learning is sensitive to malicious traffic but underperforms in identifying allowed traffic compared to traditional algorithms. However, imbalanced data handling techniques provide performance benefits to some deep learning models. Conversely, semi-supervised clustering accurately identified and classified multiple user behaviors. These models provide an automated tool to learn and predict future traffic patterns. Applying these techniques within large-scale networks detect abnormalities faster and gives network operators greater awareness of user traffic.Outstanding ThesisCaptain, United States Marine CorpsApproved for public release. Distribution is unlimited

Hopes, Hesitancy and the Risky Business of Vaccine Development

Recent policy conversations about vaccination programmes primarily target the problem of vaccine hesitancy and the lack of public participation at the level required for community immunity, or herd immunity. In this editorial we will first explore the nature of public vaccine hesitancy, review what is known and demonstrate the significance of understanding vaccine hesitancy in the COVID-19 context. We argue that sociological research indicates that to sufficiently grasp vaccine hesitancy in the twenty-first century it is necessary to consider several aspects: the nature of medical decision-making, trust, risk and social responsibility, and the role of information technology and various forms of media. There are also questions about what influences the (successful) development and provision of a vaccine – issues that have been brought sharply into focus by the COVID-19 pandemic. As such, in the second half of the editorial we move to consider the supply side of vaccination. We examine what shapes this configuration and consider the role of key players such as those who manufacture the vaccines and, in turn, those who regulate development, again with a focus on the COVID-19 pandemi

Healthcare choice: Discourses, perceptions, experiences and practices

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, primarily in the Global North. This special issue aims to explore how choice is perceived and utilised in the context of different systems of healthcare throughout the world, where choice, at least in policy and organisational terms, has been embedded for some time. The articles are divided into those emphasising: embodiment and the meaning of choice; social processes associated with choice; the uncertainties, risks and trust involved in making choices; and issues of access and inequality associated with enacting choice. These sociological studies reveal complexities not always captured in policy discourse and suggest that the commodification of healthcare is particularly problematic

Still elegantly muddling through? NICE and uncertainty in decision making about the rationing of expensive medicines in England

This article examines the “technological appraisals” carried out by the National Institute for Health and Care Excellence as it regulates the provision of expensive new drugs within the English National Health Service on cost-effectiveness grounds. Ostensibly this is a highly rational process by which the regulatory mechanisms absorb uncertainty, but in practice, decision making remains highly complex and uncertain. This article draws on ethnographic data—interviews with a range of stakeholders and decision makers (n = 41), observations of public and closed appraisal meetings, and documentary analysis—regarding the decision-making processes involving three pharmaceutical products. The study explores the various ways in which different forms of uncertainty are perceived and tackled within these Single Technology Appraisals. Difficulties of dealing with the various levels of uncertainty were manifest and often rendered straightforward decision making problematic. Uncertainties associated with epistemology, procedures, interpersonal relations, and technicality were particularly evident. The need to exercise discretion within a more formal institutional framework shaped a pragmatic combining of strategies tactics—explicit and informal, collective and individual—to navigate through the layers of complexity and uncertainty in making decisions

An exploratory study of the role of trust in medication management within mental health services

Objective - To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Setting - Mental health services in the UK. Method - Qualitative methods were applied through focus groups across three different categories of service user—older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Main Outcome - Measure Participants’ views on the key factors influencing trust and the role of trust in safe medication management. Results - The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Conclusion - Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust

Decision making in NICE single technological appraisals (STAs): How does NICE incorporate patient perspectives?

The National Institute for Health and Care Excellence (NICE) provides guidance and recommendations on the use of new and existing medicines and treatments within the NHS, basing its decisions on a review of clinical and economic evidence principally, at least for STAs, provided by the drug manufacturer. The advice provided by NICE is aimed at overcoming the previously ad hoc, discretionary decisions in order to standardise access to healthcare technologies across England based on evidence. A Single Technological Appraisal (STA) is one element of NICE’s decision-making processes in which evidence about a selected technology (often medicines) is evaluated in 3 distinct phases (scoping, assessment and appraisal). In the last phase of this process an independent Appraisal Committee evaluates evidence in a meeting, partly held in public with the latter half taking place in a ‘closed’ session. During the meeting, the Appraisal Committee considers evidence based on clinical and cost-effectiveness, as well as from statements expressed by patients, commissioning experts and clinical specialists. The Institute encourages experts attending the meeting to provide both written and oral commentary about their personal view in the current management of the condition and the expected role and use of the technology – in particular how it might provide benefit to patients. Yet, NICE and its committees find themselves in a potentially incongruous position: how to take on board the experiential evidence from individual experts along with the evidence on cost-effectiveness when reaching a decision, about whether or not to recommend a treatment on cost-effectiveness grounds. This paper considers how NICE committees incorporate the views of patient perspectives in making rationing decisions about STAs. The findings from the study will discuss where points of tension / conflict arise during meetings and how Committee members navigate experiential accounts with scientific data, which types of patient perspectives are regarded favourably and which perspectives are treated with greater caution (tension between representing patients views vs tokenism), and will highlight how Committee members in fact reflect upon their own personal experience and background in the appraisal process, and thereby are at odds with retaining an element of neutrality in decision-making, as they contend with combining their own subjective views alongside considerations of rationing in the STA process. The analysis is drawn from an ESRC funded study which used an ethnographic approach to understand the decision making process within STAs involving three contrasting pharmaceutical products. Data collection methods included analysis of documentary evidence released by NICE, non-participant unstructured observations of nine STA meetings, and qualitative interviews with key informants (n=41) involved in each of the three case studies

Decisions of Value: Going Backstage Comment on “Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis”

Abstract This commentary expands on two of the key themes briefly raised in the paper involving analysis of the evidence about key contextual influences on decisions of value. The first theme focuses on the need to explore in more detail what is called backstage decision-making looking at how actual decisions are made drawing on evidence from ethnographies about decision-making. These studies point to less of an emphasis on instrumental and calculative forms of decision-making with more of an emphasis on more pragmatic rationality. The second related theme picks up on the issue of sources of information as a contextual influence particularly highlighting the salience of uncertainty or information deficits. It is argued that there are a range of different types of uncertainties, not only associated with information deficits, which are found particularly in allocative types of decisions of value. This means that the decision-making process although attempting to be linear and rational, tends to be characterised by a form of navigation where the decision-makers navigate their way through the uncertainties inherent and overtly manifested in the decision-making process

Decision-making in the midst of uncertainty: appraising expensive medicines in England

Decisions need to be made about which services or technologies should be prioritized for provision in the NHS in England .The analysis focuses specifically on the National Institute for Health and Care Excellence (NICE), and on how they appraise expensive medicines. This analysis takes a sociological perspective on decision-making in relation to uncertainty and how uncertainties are managed, drawing on evidence from a scoping study and an ethnographic study. Uncertainties were central to these rationing decisions.Three types of layers of uncertainty -epistemic, procedural and interpersonal – were shown to be salient. Another form of uncertainty was associated with the complexity of the science and that included the level of technicality of the information provided. The analysis highlighted the salience of uncertainties associated with interpersonal relations and the relations between the committees and the drug industry, clinical and patient experts. A key element in these relationships was trust. Decision makers adopted a mixture of formal and informal, collective and individual strategies in making decisions and a need to exercise pragmatism within a more formal institutional framework. The paper concludes by considering more recent policy developments in relation to appraising expensive medicines

All for Vaccination ? Vaccination for All?

It is the purpose of this article to review and assert the utility of sociological knowledge about vaccines. Building on our previous work, we also want to pose a range of, as yet, unanswered questions about COVID-19 vaccination and thus offer an agenda for sociological research. Alongside exploring the social influences on vaccine hesitancy, we also argue that to effectively control the COVID-19 pandemic sociological analysis is also required of the processes of development and regulation of COVID-19 vaccines and of inequalities in the access to and availability of vaccines