A mixture of smaller countries led by New Zealand, Vietnam, Taiwan, Thailand, Cyprus, Rwanda and Iceland led the world's top 10 countries to manage their COVID-19 response well, according to a new study.

In the study, published in BMJ, lead researcher Flinders University's professor Fran Baum joined experts from around the world to reflect upon the Global Health Security Index (October 2019) predictions for a public health emergency. Along with Australia, Latvia and Sri Lanka among the best responders, the list highlights some of the 10 key causes of why some countries were successful or not in containing COVID-19 pandemic over the past year.

The U.S., UK, Netherlands, Australia, Canada, Thailand, Sweden, Denmark, South Korea, Finland (France, Slovenia and Switzerland) were ranked as 'most prepared' on the index.

And while high-income countries report an average score of 51.9 (out of 100), the index shows that collectively, international preparedness for epidemics and pandemics remains very weak, the study noted.

"Now we know that ten factors contributed to the index failing to predict country responses, including overlooking the power of political, economic, and social contexts and the role of civil society - notably in western developed countries like the U.S. and UK," says Baum, from the Southgate Institute for Health, Society and Equity at Flinders University.

"Our study builds a strong case for these 10 factors to be used in future assessments of pandemic preparedness to take into account a systems approach which enables a focus on critical system components," the 15 authors say in the new article published in a special analysis series 'COVID-19: The Road to Equity and Solidarity'

The 10 variables identified in the new study are:

1. Limited consideration of globalization, geography, and global governance. For example, island nations such as Australia, New Zealand and other Pacific countries could prepare manage better than regional organizations such as the EU.
2. Bias to high income countries. The pandemic exposed contrasts between biosecurity measures in high-income countries and their actual ability to rally community participation in prevention and control measures.

3. Failure to assess health system capacity.

4. Role of political leadership. Under pandemic conditions, do leaders understand and garner trust in evidence-based infectious disease management? For example, New Zealand Prime Minister Jacinta Ardern's leadership was clear and emphatic - resulting in a far better outcome than foreseen in the index.

5. Context of countries' political, social, cultural and financial systems. For example, the US, Belgium, Australia and South Africa are federated responses but separately had quite different responses and outcomes to the pandemic.

6. Limits of national health systems did not always correlated as a predictive factor. For example, lower income countries such as Rwanda and Vietnam had better results perhaps due to better allocation of limited resources for maximum national effect.

7. The pandemic highlighted pre-existing health and social inequities in some high-income countries, such as the UK and US, where minority ethnic groups experienced a higher burden of the COVID-19 disease.

8. The index didn't foresee the effects of differences in social security provisions for an extended epidemic.

9. The civil capacity for a response was not assessed. For example, South Africa's Cape Town community action networks are working to both ameliorate the consequences of lockdown and reduce local transmission..

10. Gaps between capacity and its application. For example, political intervention in the U.S. blocked the Centers for Disease Control and Prevention rolling out advanced epidemiology training programs in a more timely and uniform fashion

"The crucial lesson from the COVID-19 pandemic is that an effective response does not rely just on a strong public health system but also requires a society that is fair and offers all its citizens and residents social and economic security," the study concludes.

Reference: "Explaining COVID-19 performance: what factors might predict national responses?" (2021) by Fran Baum, Toby Freeman, Connie Musolino, Mimi Abramovitz, Wim De Ceukelaire, Joanne Flavel, Sharon Friel, Camila Giugliani, Philippa Howden-Chapman, Nguyen Thanh Huong, Leslie London, Martin McKee, Jennie Popay, Hani Serag, Eugenio Villar' (2021) by and F Baum has been published in BMJ 2021; 372 doi: 10.1136/bmj.n91

Source: Flinders University