11 global reflections on local COVID responses
Among the damage and disruption, some positives to reflect on
Coverage of global COVID responses often focuses on which countries did ‘best’ and ‘worst’. Or whether a particular country ‘beat’ their neighbours.
But even countries that had a ‘good’ response under certain metrics have things that they would ideally have improved, and even countries that did ‘badly’ often had aspects of their response that other countries would have liked to reproduce. If we want to plan for the next major outbreak, we therefore should be learning from the best the world has to offer, rather than just picking one country as a template.
Last week, I sat on a panel at the Hong Kong Immunity Conference that featured prominent researchers and advisors from across eleven territories. We were encouraged to reflect on the positives as well as the weaknesses of the responses in our respective locations. Below is a summary of some examples that emerged from each presenter (shared from East to West).
New Zealand: A clear strategy delivered with high public support. The aim from spring 2020 onwards was elimination, with control focused at the border, and strict lockdown measures introduced early to keep this status, before an eventual transition to a vaccine-led reopening during the Omicron era. As a result of declines in other infections (e.g. influenza) following lockdowns and border closures, excess mortality actually declined during the pandemic.
Australia: Point of care testing in remote and first nations communities. Like many countries, Australia has substantial health disparities across different communities. From May 2020, remote testing programmes were therefore set up to help improve detection and reduce transmission in at risk groups.
Hong Kong SAR: Prolonged suppression without a full lockdown. Like New Zealand and parts of Australia, Hong Kong had long periods of local elimination with measures focused on borders, as well as tightening of local measures to retain this status. (On a personal note, I found some of analysis of interventions by HKU – such as combined mask mandates and social distancing – very informative during the pandemic).
Israel: Early vaccine rollout and effectiveness studies. Thanks to an early deal with Pfizer, Israel had an early and widespread rollout of mRNA vaccines in 2021. As well as protecting their population, this meant a lot of early data that provided valuable information on vaccine characteristics for other countries.
South Africa: Prompt insights into local epidemiology. Thanks to high quality genomic analysis and ongoing community studies like PHIRST-C, South African researchers provided crucial real-time insights into the local epidemic as well as emerging variants. (On a personal note, I really liked how South Africa gave detailed live scientific briefings to the public, giving in-depth information on new concerns like the Beta and Omicron variants.)
The Gambia: Locally-led scale up of testing capacity and training. The MRC Unit The Gambia played a key role in helping expansion of testing capacity and training, as well as generating multiple scientific insights from genomic sequencing. In terms of sequences per case identified, The Gambia ended up with a high ratio as a result.
Norway: Capitalising on structural advantages. From relatively low population density to strong welfare and healthcare, Norway build on its pre-pandemic advantages to keep disease burden lower than in many other European countries. In particular, data on the proportion of genomic variants over time in 2020 shows that, unlike in many countries, they didn’t each sweep through on an ongoing transmission wave; instead, new chains of transmission typically fizzled out eventually.
Switzerland: Mass serological testing. As a result of early development of a cheap antibody test, Switzerland was able to generate good situational awareness on the . (On a personal note, I found the early seroprevalence study in Geneva a useful benchmark for under-ascertainment of infection and clustering of infection within households.)
France: Repurposing of highspeed trains to ease hospital load in first wave. The early COVID epidemic in France was spatially variable, with most infection concentrated in the northeast of the country. To ease the resulting hospitalisation burden, TGV trains were repurposed as mobile medical units to rapidly transfer patients from hard-hit regions to hospitals in lesser-hit areas.
UK: Scientific studies and trials to inform policy and practice. In my short presentation, I highlighted the numerous observational studies and trials that gave crucial insights into how to treat and tackle COVID, both in the UK and further afield. (One of the things that kept me going as a researcher during the pandemic was the knowledge that even if the UK government didn’t always make most effective use of the insights we and others were generating, the findings would often be helpful for many other countries too.)
USA: Resources poured into accelerated vaccine development. In May 2020, the US announced a public-private partnership dubbed ‘Operation Warp Speed’ to accelerate vaccine development. Initial funding was around $10bn, which went to eight companies. By the end of 2020, several had announced successful trial results, with roll-out following shortly afterwards.
The above are just some brief examples from eleven individuals. And there are, of course, many things that did not work so well in the above countries, including early approaches to control strategies, vaccine uptake, and post-vaccination reopening. But among all the negatives, it can also be useful to reflect on what worked well, and how we can learn from these experiences when planning for the next disease threat.
(Cover image: Jpatokal via WikiCommons)
Although difficult to apply elsewhere, the Norwegian experience of the benefits of lower population density stands out for me.
One of my ongoing concerns, is that lessons are quickly being forgotten or swept under the carpet (I suspect because they are too left-leaning to be palatable to many governments). Are there any countries that are actively applying the lessons (mostly related to social determinants of health) for the long term?