The Heterogeneity of National Responses to the COVID-19 Pandemic: a Mixed-method Study

Abstract

Background: COVID-19 has quickly spread to all corners of the world since its emergence in Wuhan, China in December of 2019. The disease burden has been heterogeneous across regions of the world, with Americas leading in cumulative cases and deaths, followed by Europe, Southeast Asia, Eastern Mediterranean, Africa and Western Pacific. Initial responses to COVID-19 also varied between governments, ranging from proactive containment to delayed intervention. Understanding these variabilities allow high burden countries to learn from low burden countries on ways to create more sustainable response plans in the future.Methods: This study used a mixed-method approach to perform cross-country comparisons of pandemic responses. The chosen countries for this study were the US, Brazil, Germany, Australia, South Korea and Thailand; they were selected based on their income level, relative COVID-19 burden and geographic location. To rationalize the clinical variability between these six countries, a list of 14 indicators was established to systematically assess the countries’ preparedness, actual response, and overall socioeconomic and demographic profile in the context of COVID-19.Results: As of December 1st , 2020, the US had the highest cases per million, followed by Brazil, Germany, Australia, South Korea and Thailand. The same ranking was observed for the countries’ deaths per million statistics. Cross-national comparison suggests that there were nine indicators to explain epidemiological differences between the countries, and they were 1) leadership, governance and coordination of response, 2) communication, 3) community engagement, 4) multisectoral actions, 5) public health capacity, 6) universal health coverage, 7) medical services and hospital capacity, 8) demography and 9) burden of non-communicable diseases.Conclusion: The COVID-19 pandemic manifests varied outcomes due to differences in countries’ vulnerability, preparedness and response. Our study rationalizes why South Korea, Thailand, Australia and Germany performed better than the US and Brazil. By identifying the strengths of low burden countries and weaknesses of hotspot countries, we elucidate specific factors constituting an effective pandemic response that can be adopted by leaders in preparation for re-emerging public health threats.