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Overview

A central puzzle of COVID-19 is why some nations have so successfully contained the virus while others have failed. Even more puzzling is how nations with similar systems of government and demographics have experienced the pandemic in such different ways.

To understand what drives divergent outcomes, Schmidt Futures partnered with the National Science Foundation to support teams at Harvard, Cornell, and Columbia universities examining how public trust, leadership, and political culture have impacted 23 nations’ COVID-19 responses, including the first major intra-African study. This research, undertaken by 78 researchers from 47 institutions, pinpoints key variables to determine why some nations’ COVID-19 responses succeeded while others struggled. The findings will help public health authorities and policymakers mount a more effective response to COVID-19 and better prepare for future pandemics.  

With support from Schmidt Futures, Georgetown University’s Center of Global Health Science and Security is also releasing Health Security Net, an online, searchable library containing over 1,200 global reports chronicling 25 years of pandemic preparedness policy. This collection of reports, testimony, and expert advice will become the most comprehensive repository of its kind ever published.

23 Nations Studied in the Comparative Research

Pandemic Response in Africa

Researchers

Public health and policy research teams at Columbia University and the Brenthurst Foundation examined the actions taken in response to COVID-19 in five major economic and cultural hubs in Africa.

Countries

Egypt, Ethiopia, Kenya, Nigeria, South Africa

Core Findings

Multilateral Coordination: Many African countries benefited early in the pandemic from swift action by central governments to reduce the spread of COVID-19, enabled in part by recent multilateral coordination and capacity-building efforts to stem the flow of Ebola and other diseases. Institutions such as the Africa CDC provide a model for more effective multilateral cooperation in crisis via a continent-wide health governance structure. Looking ahead, the Africa CDC may consider setting up regional branches in order to serve the member states of different parts of the continent.

Leadership: These five countries illustrate how rapid action to recognize and respond to the crisis at the top of government can help reduce early levels of transmission of a disease and enable health systems to catch up to the threat.

Trust: Public trust, particularly in vaccines, remains a problem, but some innovative approaches on display in the studied countries may have potential to further scale.

Testing: Limited testing and medical capacity remains a major issue for these five countries, making it difficult to construct a complete understanding of the spread of COVID-19, and forcing large-scale, economically-restrictive measures rather than more targeted interventions.

Economic Impact: The economic impact of those economically-restrictive measures has been largely unsustainable, forcing a more nuanced approach.

Comparative COVID-19 Response

Researchers

Grounded in the field of Science & Technology Studies, and incorporating interdisciplinary expertise from law, public policy, and the social sciences, teams at Harvard and Cornell universities studied the COVID-19 response across 18 countries.

Countries

Australia, Austria, Brazil, China, France, Germany, India, Indonesia, Italy, Japan, Netherlands, Peru, Singapore, South Korea, Sweden, Taiwan, United Kingdom, United States

Core Findings

Pre-Existing Conditions: Underlying societal conditions have significantly affected countries’ abilities to respond to COVID-19. In particular, the virus found and revealed three “pre-existing conditions,” or structural weaknesses in each system that obstructed effective policy response: 1) weak or decentralized public health infrastructure, including data collection; 2) economic inequality; 3) political alienation and lack of trust in government. In contrast, in countries that had effective policies in place in response to prior public health emergency experiences, the result was as if antibodies were activated to help fight off a new infection faster and in more targeted ways.

Social Compact: The social compact matters. Countries with traditions of acting in concert against social problems and countries with histories of deference to public authorities fared better on compliance than countries lacking either or both.

Public Health Policy: Broad lessons are emerging from the comparative study about ways in which public health policies must change to produce better integrated global responses across highly divergent health, economic, and political systems. Politics did not not take a backseat to policy during the pandemic. Future policy guidance from national and global institutions must account for the ways in which political divisions and biases will impact implementation and compliance.

Economic Impact: Job protections, rather than unemployment assistance, most effectively reduced economic dislocation during the pandemic, at least in the short-term.

Multilateral Coordination: The pandemic made clear the need for integrated, international institutions. Looking ahead, individual national approaches without global coordination will not be effective at containing a future health emergency, and international collaboration is needed to ensure effective measurement, capacity-building, and sharing of best practices.

Researchers

Georgetown University’s Center of Global Health Science and Security built an online, searchable library, containing over 1,200 reports chronicling 25 years of pandemic preparedness policy, the most comprehensive repository of its kind. 

Purpose

This historical collection of reports, testimony, and expert advice at the international level will help scholars study what was known and unknown, and acted upon and not acted upon, in the years before COVID-19.

Content

The resources include 873 reports, 263 government actions, 118 journal papers, and 9 simulations and exercises. The majority of resources emphasize medical preparedness and emergency response, with a focus on Ebola, followed by influenza and COVID-19.

Key Questions Health Security Net Can Help Answer

To what degree was information about pandemics known and to what extent were recommendations acted upon, or not, either for reasons of competing priorities or other judgements made by decision makers?

How did these decisions materially affect U.S. and global preparedness for COVID-19? 

To what degree did the literature on pandemic preparedness in its totality translate to success or failure in effective response?