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4 February 2022

The Public Health Governance of the COVID-19 Pandemic: A Bibliometric Analysis

and
1
Institute of Economics, Tsinghua University, Beijing 100084, China
2
One Belt-One Road Strategy Institute, Tsinghua University, Beijing 100084, China
3
The New Type Key Think Tank of Zhejiang Province’s “Research Institute of Regulation and Public Policy”, Zhejiang University of Finance and Economics, Hangzhou 310018, China
4
China Institute of Regulation Research, Zhejiang University of Finance and Economics, Hangzhou 310018, China
Healthcare2022, 10(2), 299;https://doi.org/10.3390/healthcare10020299
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Abstract

The 2019 global outbreak of COVID-19 has had a huge impact on public health governance systems around the world. In response, numerous scholars have conducted research on public health governance in the context of the COVID-19 pandemic. This paper provides a bibliometric analysis of 1437 documents retrieved from the Web of Science (WoS) core collection database, with 49,695 references. It analyses the research directions, countries of publications, core journals, leading authors and institutions and important publications. The paper also summarises research trends by analysing the co-occurrence of keywords, frequently cited documents and co-cited references. It summarises the global responses to COVID-19, including public health interventions and a range of supporting policies based on the features and impacts of the COVID-19 pandemic. The paper provides comprehensive literary support and clear lines of research for future studies on the governance or regulation of public health emergencies.

1. Introduction

In December 2019, a new coronavirus (SARS-CoV-2) emerged, triggering an outbreak of human acute respiratory syndrome centred in Wuhan, China [1]; this pandemic has become known as the 2019 coronavirus disease (COVID-19) pandemic. According to data from the World Health Organisation (WHO), by the end of October 2021, there were more than 200 million confirmed cases of COVID-19 worldwide, including more than 5 million deaths (available online: WHO Coronavirus (COVID-19) Dashboard, https://covid19.who.int/, date of access 1 December 2021). The COVID-19 pandemic has led to a massive global public health campaign, with government departments and public health agencies advocating increased hand washing, wearing masks in public places and social distancing to slow the spread of the virus. The outbreak of COVID-19 has highlighted the importance of having strong public health governance systems in place to safeguard public health.
Public health governance has a multifaceted role. For example, Helgesen (2014) argues that public health governance has two main roles: ‘health promotion’ and ‘disease prevention’ [2]. Carlson et al. (2015) defined six functions of public health governance: ‘policy development’, ‘resource stewardship’, ‘continuous improvement’, ’partner engagement’, ‘legal authority’ and ‘oversight of a health department’ [3]. In the case of infectious diseases, widespread prevalence will cause enormous economic and political damage to society. Effective public health governance can prevent and control this damage through health promotion, disease prevention and control, improved resource allocation, oversight of the public health sector and other activities. Thus, questions such as how to develop governance policies for catastrophic public health emergencies and which factors need to be taken into account deserve in-depth discussion and research.
In this period of intense scrutiny of disease prevention and control, how to take a long-term view, draw lessons from experience and build resilient public health systems have become hot topics of global concern. In the past two years, scholars around the world have published 1437 documents on public health governance during the COVID-19 pandemic; this is a clear indication of the importance of the field. Based on existing literature, we found that although there are many studies on public health governance policies for the COVID-19 pandemic, there are few articles that systematically analyse the overall lineage and direction of these studies. This article reviews the valuable experiences and research currently shared by scholars and institutions around the world. It provides a more comprehensive analysis for academics and practitioners to grasp the current status and shortcomings of public health governance during the COVID-19 pandemic. Furthermore, it also provides a useful exploration of further improvements to institutional mechanisms for catastrophic public health emergency governance and the public health regulatory system.
The following article consists of four parts in total. Section 2 presents the methodology and data. Section 3 provides an analysis of the distribution of the 1437 citing sources, includes the distribution of research direction, journals, countries or regions, institutions and authors. Section 4 is an analysis of research trends. Section 5 includes the discussion and conclusions.

2. Methodology and Data

2.1. Method

The methods used in this paper are bibliometric analysis and mapping of knowledge domains. Bibliometrics is a statistical and mathematical method to analyse the development of literature in a given field [4], helping researchers to understand current research trends, their distribution and core themes [5]. Mapping knowledge domains is a quantitative and visual research method that reveals knowledge about the structures of and connections and interactions between activities [4,6]. We used science mapping tools for the mapping analysis.
There are various mapping tools, including Bibliometrix, BibExcel, CitNetExplorer, HistCite, Leydesdorff Toolkit, SCI of SCI, Network Workbench, VOSviewer and CiteSpace [7,8]. We used VOSviewer (version 1.6.16) to execute our bibliometric analysis. VOSviewer was developed by van Eck and Waltman [7] at the Centre for Science and Technology Studies at Leiden University in the Netherlands, and it provides clear visualisation of knowledge mapping networks.

2.2. Data

The data were retrieved from the Web of Science (WoS) core collection database on 31 October 2021. From 1st January 2020 to 31 October 2021, 1437 documents have been published on the public health governance of COVID-19, with 49,695 references and a total of 12,959 citations. The 1437 documents that were retrieved from WoS can be recognized as citing sources. Their types include articles, editorial materials, letters, data papers, conferences, etc. According to the statistics of WoS, there were 1154 articles among them. The search query method mainly concerns the screening steps in Chen’s work [9]. That is, we combined multiple topical search queries to generate the data; the queries included keywords related to health public governance and COVID-19. Our search strategy was as follows:
(1)
TS=(‘COVID19′ OR ‘COVID-19′ OR ‘COVID-2019′ OR ‘coronavirus disease 2019′ OR ‘SARS-CoV-2′ OR ‘sars2′ OR ‘2019-nCoV’ OR ‘2019 novel coronavirus’ OR ‘coronavirus disease 2019′ OR ‘coronavirus disease-19′ OR ‘novel coronavirus’ OR ‘SARS-CoV-2019′ OR ‘SARS-CoV-19′ OR ‘COVID’ OR ‘nCoV’)
(2)
TS=(‘public health governance’ OR ‘public healthcare governance’ or ‘public health care governance’ or ‘global health governance’ or ‘public health polic*’ or ‘public healthcare polic*’ or ‘public health care polic*’) or TS=(‘public health’ NEAR governance) OR TS=(‘public healthcare’ NEAR governance) OR TS=(‘public health care’ NEAR governance) or TS=(governance NEAR ‘public health’) OR TS=(governance NEAR ‘public healthcare’) OR TS=(governance NEAR ‘public health care’) OR TS=(‘public healthcare’ NEAR polic*) OR TS=(‘public health care’ NEAR polic*) or TS=(‘public health’ NEAR polic*) or TS=(polic* NEAR ‘public health’) OR TS=(polic* NEAR ‘public healthcare’) OR TS=(polic* NEAR ‘public health care’)
(3)
We combined the foregoing sets through the command (#1) AND (#2).

3. Bibliometric Analysis Results

3.1. Distribution of Research Directions

According to the WoS research directions, research related to public health governance during COVID-19 covers a total of 131 areas. We list the 10 areas with the highest number of publications below (see Table 1). The most productive research areas are public, environmental and occupational health (58.66%), followed by infectious diseases (57.97%), health care sciences services (46.49%) and the respiratory system (30.55%). The other areas in the top 10 are mainly related to social sciences and human behaviour, such as sociology, psychology, behavioural sciences, business economics, law and public administration. These areas also suggest that public health governance is closely related to socio-economic development, legal regulation, public administration and human psychological development.
Table 1. Top 10 research directions.

3.2. Journal Distribution

According to WoS statistics, a total of 949 journals published COVID-19-related public health governance research. Table 2 reports the top 10 journals in terms of number of publications. The journal that has published the most papers is the International Journal of Environmental Research and Public Health (IJERPH). The main reason for its high number of publications is the journal’s focus on various aspects of public health topics and the journal’s efficiency in publishing articles. However, the average citation rate of publications is 7.9, which is not high compared to the top journals. This is due to the high volume of publications and the large number of articles published in 2021. Newly published papers are not yet able to receive much attention in a short period of time. Therefore, it is safe to assume that the productive journals have published many points of view and research contributions in the public health governance of COVID-19. Healthcare, which has the same publisher (Multidisciplinary Digital Publishing Institute, or MDPI, available online: https://www.mdpi.com/, accessed on 1 December 2021) as IJERPH, also has a high number of articles, ranking seventh among the top 10 journals. The second most published journal is Frontiers in Public Health, followed by PLOS One, Journal of Medical Internet Research and Public Health.
Table 2. Top 10 most productive journals.
Citations can lend insight into the influence or popularity of an article, and the top 10 journals in terms of total citations were thus further analysed (see Table 3). The most cited journals were JAMA—Journal of the American Medical Association, followed by Annals of Internal Medicine and Lancet. These journals are the top journals in their respective disciplines. Papers published in these journals received great attention during the time period covered by this paper.
Table 3. Top 10 journals with high citations.
The most cited paper in JAMA—Journal of the American Medical Association is from Pan et al. (2020) and is entitled ‘Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China’ (citations = 621). This paper quantifies the relationship between public health interventions and prevention and control of the COVID-19 pandemic in China [10]. The most cited paper in Annals of Internal Medicine is ‘Diagnostic testing for severe acute respiratory syndrome-related coronavirus 2: A narrative review’ (citations = 277). This article reviews research on the global disparity in diagnostic testing capabilities and is a study of public policy approach [11]. The paper with the highest number of citations in The Lancet is ‘Dementia prevention, intervention, and care: 2020 report of the Lancet Commission’. This article, written by the Lancet Commission, reports on the impact of the COVID-19 pandemic on a specific group of people with dementia and suggests appropriate public health precautions [12].

3.3. The Distribution of Countries/Regions

Table 4 reports the top 10 countries or regions in terms of their number of publications. The highest number of articles were published by scholars from the USA, with 561 publications in two years. The second most productive country is England, and China is third with 170 publications. Of the 10 countries, seven are developed, while three (China, Brazil and India) are emerging market countries. Scholars from these 10 countries have made relatively large contributions to public health governance research during the COVID-19 pandemic.
Table 4. The top 10 productive countries/region.
Furthermore, we used VOSviewer to build a collaborative network between countries. The network is mainly composed of countries that published more than one article, with 111 nodes in total. The size of the nodes indicates the number of publications, the colour of the nodes represents the clusters (16 clusters) and the thickness of the lines between the nodes represents collaboration strength. The cluster categories are mainly implemented by VOSviewer based on association strength.
According to Figure 1, the 10 countries in Table 4 are core nodes in their respective categories. Scholars from the USA have strong collaborative partnerships with scholars from China, Canada, France, Australia and Switzerland. Scholars from England have extensive collaborations with scholars from Scotland, Germany and Switzerland. China has strong collaborative partnerships with developed countries such as Australia, the USA and Canada. In terms of the link strength, the strongest and most collaborative relationships are between the USA and China.
Figure 1. The co-authorship network of countries/regions.

3.4. The Distribution of Institutions

This section presents a statistical analysis of the author affiliations of the 1437 citing sources and lists the top 10 productive institutions. The University of London is the most prolific publisher with 64 documents, and it has the second highest citation rate after Harvard University. Harvard University is the second most productive institution, followed by the University of California System. Among the top 10 institutions, most are from the USA (five schools or university systems).
We also carried out an in-depth analysis of institutional co-authorship. We used VOSviewer to construct a collaboration network. The network consisted of 134 institutions with five or more articles and was divided into 12 clusters based on association strength. The network map is shown in Figure 2. As shown, the node of University of London is the largest and is at the core of each linkage. Combined with Table 5, it has the strongest total link strength, followed by Harvard University and the University of California System. This suggests that academics have played an important role in the area of public health governance during the COVID-19 pandemic.
Figure 2. The co-authorship network of institutions. Note(s): The colours refer to cluster, node size refers to publication number and line thickness refers to cooperative strength.
Table 5. Top 10 productive institutions.
The collaborative networks in Figure 2 show strong geographical clustering. For example, the University of London, which has the highest number of publications, has stronger collaborations with institutions mainly from the UK, such as the University of Oxford, Imperial College London, University New South Wales and so on. The green and yellow clusters are more likely to be US-based institutions, with thicker link lines within these clusters that indicate stronger collaborative relationships. Among the core nodes, there is a strong partnership between Harvard University and the University of Oxford.

3.5. Author Distribution

Table 6 reports the top 10 productive authors. These authors have an average of around five publications and have a relatively similar total link strength. According to Figure 3 and Figure 4, there is a strong collaborative relationship between the eight authors in Table 6. With the exception of Greer and Khunti, the remaining eight authors have co-authored five papers, as reported by the WoS citation report.
Table 6. The top 10 productive authors.
Figure 3. The co-authorship network of authors (publications). Note(s): Node size represents the number of publications. Node colour refers to clusters. The links refer to co-authorship.
Figure 4. The co-authorship network (this is based on citations).
Most of these papers were published in 2021 and focus on monitoring the transmission characteristics of COVID-19 around the world, including in Central Asia [13], the USA [14], Canada [15], Europe [16], the Middle East and South Africa [17]. All five papers apply the dynamic panel data (DPD) model approach proposed by Oehmke et al. (2020). The DPD model was mainly used to derive surveillance metrics [18]. These dynamic surveillance indicators can provide an important factual basis for public health policy regarding COVID-19.
Figure 3 shows a visualisation of the author collaboration network. The figure includes 253 authors with two or more publications. The most dominant collaborative network in the graph consists of the eight authors in Table 6. The remainder of the authors present multiple collaborative teams, although these teams produced a relatively low number of publications.
The network composition in Figure 5 is the same as in Figure 3. The only difference between the two is that the node sizes indicate different meanings. Node size in Figure 5 represents the total number of publication citations for an author’s publications. The core authors in Figure 5 are mainly Qi Wang, An Pan, L. Gostin, R. Katz, Yan Li and others. Although these authors have published fewer articles, their papers have had a greater impact. Among these highly cited authors, we investigated the h-index (see Table 7) and found that Qi Wang’s research during the COVID-19 pandemic may have had the highest impaction in the fields of COVID-19 public health governance.
Figure 5. The co-authorship network of authors (citations). Note(s): The node size represents the frequency of citations. The colours of nodes refer to clusters. The links refer to co-authorship.
Table 7. The top five authors with highest citation.

5. Discussion and Conclusions

5.1. Discussion

We used an analytical framework to summarise the research directions and trends of public health governance of COVID-19 (see Figure 10). The aim of the framework is to provide a more intuitive research overview for scholars and to support future research on the governance of catastrophic public health emergencies.
Figure 10. An analytical framework for research on public health governance during the COVID-19 pandemic.
Figure 10 shows that the focus of research on public health governance during the COVID-19 pandemic encompasses three aspects. The first is to study the features of COVID-19 and its effects. In catastrophic public health emergencies, the most important aim of public health governance institutions or researchers is to use technology and scientific experiments to study the epidemiological features and impact effects of the emergency itself. The second is to study and propose public health governance regulatory interventions and supporting systems for COVID-19 that can be used to regulate or eliminate public health risks. The third is to evaluate the effects of the policies. By evaluating and comparing policy effects, more appropriate public health governance policies will be promoted to improve the efficiency of public health governance system. These three aspects follow the basic paradigm of public health governance, namely the discovery-to-control paradigm. Existing research on public health governance has focused on providing effective responses and regulatory policies at each stage of the discovery-to-control process.
However, at the beginning of the 21st century, some scholars pointed out that a simple discovery-to-control paradigm would require huge governance costs and cause resource scarcity problems [52]. Neubauer (2005) argued that the discovery-to-control governance paradigm should be shifted to a ‘research-to-prevention-to-discovery-to-control’ paradigm. [52]. Prevention is also an important element of public health governance, and scholars and institutions in various countries have been making efforts in this regard by exploring the causes of epidemics, the history of the emergence of coronaviruses and so on [53,54]. However, there are fewer studies examining the causes and prevention of infectious diseases such as COVID-19 from a public health governance perspective (see Figure 9). This is an area that deserves further exploration. At the same time, public health governance also involves multifaceted institutional support, including a coordinated and effective public health governance system, professional staffing, special clinical systems and public infrastructure systems. These are also areas where public health governance needs further improvement and research.

5.2. Conclusions

In this paper, we used VOSviewer and Excel to analyse the distribution of publications and research trends on public health governance during the COVID-19 pandemic. We advance three main conclusions.
First, we summarised the main research directions in the field of public health governance related to the COVID-19 pandemic. The research direction that has attracted the most publications is “public, environmental and occupational health”.
Second, we identified the journals, countries (or regions), institutions and authors that have made major contributions to the field. The journal with the most publications was the International Journal of Environmental Research and Public Health, while JAMA—Journal of the American Medical Association had the highest number of average citations. The country with the most articles was the United States. The institution with the most publications was the University of London. The most influential authors were Wang Qi, Pan An, Gostin, Katz, Li Yan.
Third, we identified research trends in public health governance during COVID-19. These trends include the features and impacts of COVID-19, interventions and supporting policies, and the effectiveness of the policies.
This paper has important implications for researchers and regulators in understanding how the public health sector responds to public health emergencies. The summary in Figure 9 shows the elements that should be taken into consideration to develop and implement public health policies. It also provides empirical support for future research on improving public health governance systems and helps public health researchers to understand possible future research directions.
This paper has several limitations. The WoS Core Collection was used as the data source to obtain high quality research, which may lead to a significant amount of literature being excluded, such as the literature from Scopus, PubMed/Medline and others. There could be other bibliometric analyses of other databases in the future. Furthermore, as public health governance is a global topic and varies from country to country, the content of the research may also vary. In the future, country samples can be selected to conduct comparative studies.

Author Contributions

Conceptualization, K.Y. and H.Q.; methodology, H.Q.; software, H.Q.; validation, K.Y.; writing—original draft preparation, H.Q.; writing—review and editing, K.Y.; supervision, K.Y. All authors have read and agreed to the published version of the manuscript.

Funding

This research is funded by the Key Project of the National Social Science Foundation of China, grant number 21AGL025.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

No data statement.

Conflicts of Interest

The authors declare no conflict of interest.

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