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IMPORTANCE Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low-and middle-income countries and in urban areas, where most people with depression now live.OBJECTIVE To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. DESIGN, SETTING, AND PARTICIPANTS This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019.EXPOSURES Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. MAIN OUTCOMES AND MEASURESIncident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. RESULTSOf 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [

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and colleagues believe that there is much to learn from the experiences of low and middle income countries in co-producing knowledge and working with communities to find feasible and acceptable solutions to healthcare concerns on 21 February 2021 by guest. Protected by copyright.

Any country thinking of easing COVID-19 lockdowns must be confident that they have a robust system in place to find, test, trace, isolate and support new cases. This is essential if they are to minimise the risks of a second wave going out of control. The theory is simple. Anyone with symptoms is tested and, if positive, their contacts are traced and advised or instructed to isolate. The reality is somewhat different. It requires a complex system with many interlinking components, demanding rapid and effective communication between different organisations, some of which are newly created, while others may be combining their day-today work with a major expansion in capacity. Even the best resourced public health system would struggle given the scale of the pandemic. For many, especially those whose capacity has been diminished as a consequence of sustained underinvestment, the challenges are enormous. To help those who are facing these challenges, we have examined what countries across Europe are doing, seeking where possible lessons that can be learned from their experiences. This analysis uses information gathered from the COVID Health System Response Monitor, created by the European Observatory on Health Systems and Policies, 1 the World Health Organisation European Regional Office and the European Commission. A network of national correspondents from 50 countries has prepared a series of structured reports on national responses to the pandemic, regularly updating them as events develop. Conceptually, we can consider a find, test, trace, isolate and support programme as a complex adaptive system, with the individual being tested passing along a non-linear route involving multiple paths, each with feedback loops and with their speed and direction influenced by a multiplicity of factors, many

Israel has led the world in rolling out its COVID-19 vaccination program. This experience provides lessons that others can learn from. It is, however, necessary to consider some national specificities, including the small size of the country, its young population, and the political imperative to drive this program forward. Israel also has a number of other advantages, including a strong public health infrastructure. The lessons that can be learnt include the importance of coordinating delivery mechanisms with the inevitable prioritisation of groups within the population, timely deployment of a skilled cadre of health workers, a recognition that not everyone in the population shares in the benefits of digital connectedness, the need to reach out to disadvantaged groups, based on an understanding of the barriers that they face, and the importance of placing COVID-19 vaccination within a comprehensive response to the pandemic.

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