Preparing for the Next Pandemic…That Is Already Here

While we may be tempted to say the COVID-19 pandemic is unprecedented, we would be wrong. Epidemiologists and historians have pointed out that global health crises, pandemics included, are not new. The effects of COVID-19, from economic destruction to the human toll, feels unprecedented, to be sure. But those effects are the consequence of poor planning, a lack of preparedness and flawed responses by societies and governments around the world.

Unfortunately, we do not have the time to reflect and ready ourselves for the next pandemic. The next pandemic is already here, in COVID’s coming second wave, and for many countries, continued exponential increases in infection rates amidst the current wave.

There are many lessons to be learned from the COVID-19 pandemic. Chief among them is the fact that beating the coronavirus does not require terribly sophisticated responses.

The COVID Comparative Project at the Munk School of Global Affairs and Public Policy features 16 country case studies conducted by University of Toronto undergraduate students, under the supervision of Professor Joseph Wong. The case studies are short, readable and digestible. They highlight countries that have struggled to contain the COVID-19 virus and illuminate what has worked in many countries. One of the key findings in the case studies is that successfully addressing COVID-19, from containment to recovery, requires relatively simple interventions. We’re not talking rocket science here; this isn’t science fiction.

Communicating clear, concise, consistent and science-based information is imperative. Access to testing, ideally for symptomatic and asymptomatic patients, as well as contact tracing, allow public health authorities to get a handle on how and where the virus is spreading, important when it comes to containment. Wide distribution of personal protective equipment (PPE) for frontline workers as well as for face masks is critical. Rationing scarce supplies, rather than hoarding supplies, is important. Physical distancing is effective in reducing transmission.

Early implementation of all of these interventions, we know, is vital, as just a few weeks delay can result in exponential increases in transmission rates. We know that tens of thousands of COVID-related deaths could have been prevented had governments responded earlier. Lockdowns are not ideal, given the economic costs of shutting down the economy, and can be avoided or truncated if the virus is contained sooner rather than later.

Confronting COVID-19, in terms of interventions and responses that work, is easy. The challenge – and the lessons we must learn from the current first wave in anticipation of a coming and potentially more brutal second wave – is ensuring the optimal institutional and structural conditions are in place for governments to effectively respond. The 16 case studies offer important insights.

First, regime type – democracy or authoritarianism – is less consequential than one might think. Democracies and autocracies have both performed well and not-so-well in the fight against COVID. More important is that governments are strong, authoritative, consistent in their messaging, and have the capacity to implement emergency regulations.

Second, the case studies presented in the Munk series suggest that federal institutions (i.e. decentralized authority to provinces and states) have an advantage in containing COVID-19, allowing sub-national authorities to implement locally-specific responses. Decentralized power, however, has to be coordinated by a strong federal center. Germany is a good example of where states responded locally, but where the federal government played an important coordinating role. The United States, on the other hand, demonstrates the problem of strong states and the lack of central coordination.

Third, trust in government is critical. In some societies, trust in governing authorities tends to be higher due to the technocratic nature of the government or national culture. In our case studies, trust is not an a priori given; trust in government is earned. Governments that communicate clear and consistent information tend to be more trustworthy. In contrast, governments that flip-flop in their messaging and policy responses, such as in the UK and Sweden, generate less trust. Societal trust in the government and public health authorities is important because effective responses to COVID-19 require compliance among citizens, and people are more likely to comply with measures, such as physical distancing, quarantine, wearing face masks and testing, when they trust the government. Extreme politicization and partisanship, such as in the US, undermine trust.

Fourth, countries that have a strong social safety net in place, including access to health services, are more likely to successfully respond to the COVID pandemic. Access to healthcare is critical to ensuring people are tested and treated. Social safety nets more generally soften the blow of COVID responses by allowing people to work from home, to provide an income floor for families, continued access to social programs, to facilitate the transition back to work and to prevent households from becoming impoverished. When citizens are assured of a social safety net, they are more willing to comply with public health regulations.

Fifth, the global community must address the problem of structural inequality and marginalization. Most of the case studies highlight communities (within country) that are especially vulnerable to COVID-19 and excluded from government responses to the pandemic, including: foreign migrant workers in Singapore, Canada, Sweden and many other countries; elderly populations in most countries; Muslims in India; Arab Israelis in Israel; those who are employed in the informal sector, especially in less developed countries; and so on. Addressing structural inequality and marginalization is an ethical imperative, in that no one should be left behind or excluded. However, it is also a public health imperative, because those who are socially, politically or economically marginalized and thus more susceptible to COVID present a viral threat to everyone. The global response to next pandemic must be truly inclusive.

Read the case studies:

• German pandemic efficiency: fiscal capacity, logistical coordination, and infrastructure (by Zoë Johnson)

• Contradictory messaging and uncoordinated response has skyrocketed COVID-19 cases in Brazil (by Purushoth Thavendran)

• COVID-19 federalism: disparate government responses in Canada (by Marium Nur Vahed)

• Overcompensation or necessary precaution? Tracing China's response to COVID-19 (by Hui Wen Zheng)

• India in the pandemic: successful states vs flailing central government (by Aryan Dhar)

• Ghana: testing innovations against economic limitations (by Andrew Yin)

• Amidst political and economic turmoil, Iran's COVID-19 response signals the dangers of deprioritizing public health (by Hui Wen Zheng)

• Israel's response to COVID-19: pitfalls of a political pandemic (by Astrid Ling)

• Just one step behind: analyzing the Italian government's response to COVID-19 (by Martina Facchin)

• Setting the precedent in unprecedented times: the "Taiwan Model" for combatting COVID-19 (by Elizabeth Shaw)

• Pandemic in the land of a thousand hills: Rwanda and COVID-19 (Cheikh Ameth Tidiane Diop)

• Efficiency and its limits: Singapore's COVID-19 response (by Katie Kwang)

• From MERS to COVID-19: the South Korean journey (by Emma Rogers)

• Abandoning the vulnerable: unequal impacts of Sweden's COVID-19 response (Abhayjeet Singh Sachal)

• No country is an island, but the UK insists otherwise (by Naomi Butterfield)

• A political pandemic: partisanship and chaos in the American COVID-19 response (by Liam Keating)