Just before the pandemic, a coalition of major foundations published a Global Health Security Index (GHSI) that ranked countries’ capacity to prevent, detect, and report an infection, and to respond rapidly to disease outbreaks. “Unsurprisingly,” a data journalist with Statista observed at the time, “higher income countries tended to record better scores in the index.” Topping the list of “countries best prepared to deal with a pandemic” were the United States and the United Kingdom.
One year later, those rankings appear farcical. According to a study published in September, “The 10 countries worst affected with COVID-19 in terms of deaths per million are among the top 20 countries in terms of their overall GHSI scores.”
Of course, it is too early to trumpet a “successful model” for dealing with the pandemic. New epidemic waves are bearing down even on countries that thought they had the virus beat. But it is clear that some governments have deployed their resources, skills, and institutions much more effectively than others. Particularly interesting are three countries that ranked among the lowest on the GHSI.
Consider Senegal. With a population of just over 15 million and per capita GDP of around $1,500, it ranked 95th on the GHSI with a score of 37.9 (the US, in first place, scored 83.5). Yet in January 2020, when the World Health Organization first declared an international public-health emergency, Senegal was already preparing.
When Senegal detected its first COVID-19 case on March 2, it deployed mobile testing units (with results in 24 hours), established a contact-tracing system, and set up isolation facilities in clinics, hospitals, and hotels. The government also immediately banned public gatherings, imposed a nightly curfew, restricted domestic travel, and suspended international commercial flights. By April, face masks had been declared mandatory in all public spaces. As of October, the country had recorded around 15,000 cases and 300 deaths.
It was not all smooth sailing, of course. Rioting in June led to an easing of restrictions. But the country adapted quickly. Its Health Emergency Operations Center remained committed to openness and transparency. Through the media, religious groups, village and community leaders, and other channels, it kept the public informed about the evolution of the epidemic, having learned the importance of clear and direct messaging during the 2013-16 Ebola crisis.
Another country to beat expectations is Sri Lanka. With a population of 21.5 million, it ranked 120th on the GHSI, but it responded quickly to early reports about the virus. Deploying the military to help, the government rolled out locally developed rapid tests (with results in 24 hours) and random polymerase-chain-reaction (PCR) testing in densely populated areas. It established a stringent contact-tracing regime, provided support for those in isolation, mandated face masks in public, restricted and screened travelers, and set an island-wide curfew. And, as in Senegal, the Sri Lankan government launched a massive public-communications campaign. As of November 2020, the country had reported only 13 COVID-19 deaths.
A third country to stand out is Vietnam. With a population of 95 million and an under-developed health-care system, it was ranked 50th on the GHSI, but it moved with impressive speed on the first news of the virus in neighboring China. Shortly after logging its first cases, it had prepared laboratories and tests, and imposed restrictions on all visitors from China. These measures were followed by rapid testing, contact tracing, hospitalization for all infected people, and isolation for all contacts of suspected cases. By October, the country had reported only 35 deaths.
If these poor countries could manage so well, why did the US and the UK fail? Recent experience with contagious diseases clearly played a role in country-level preparedness. Just as Senegal had experienced Ebola in 2013-16, Vietnam and Sri Lanka had absorbed the lessons from SARS (2003) and MERS (2012). Each had created an infrastructure to manage outbreaks (and some populations may have developed immunity to coronaviruses).
But history alone doesn’t explain why these three countries fared so much better than the US and the UK. Why didn’t these wealthier countries roll out rapid-result testing, contact tracing, and isolation procedures for suspected cases? Why didn’t they mandate face masks and do more to prevent travel and in-person gatherings? Long after the data had shown these measures to be effective, the US and the UK continued dithering.
There are deeper lessons about governance. In Senegal, Sri Lanka, and Vietnam, each government unified behind a strategy, focused on clear public communications, and partnered with community networks. By contrast, neither the US nor the UK proved capable of mobilizing its world-leading institutions behind a coherent national strategy. Instead, both countries’ governments succumbed to feuding among elites.
When it came to strategy, the divisions within the US Republican Party and the UK Conservative Party caused their respective leaders to veer from one approach to another. The experts advising them competed for attention and influence, promoted their own models and research, and often lacked the humility to reach out for advice to frontline workers and other countries with relevant experience.
When it came to delivery, the US Centers for Disease Control and Public Health England each insisted that it alone should develop and control the testing regime for its jurisdiction. That approach failed in both countries, while a more collaborative approach worked in others. Instead of building local networks for contact tracing (which would be useful for future pandemics), the UK government outsourced the task to the corporate giant Serco and a company called Sitel. The result was a national call-center and online track-and-trace system that has failed to perform anywhere near as well as local health-protection teams in more successful countries.
In the end, COVID-19 exposed the weakness of strategies aimed at political popularity rather than at the pandemic. Equally, it has exposed the folly of attempting to govern by centralized command rather than collaboration and cooperation. The UK prime minister’s office ended up at loggerheads with the mayor of Manchester, and the US president with the governor of Michigan. Resources did not flow from the center to the areas where they were needed most.
The pandemic has revealed the urgent need to build connective tissue across governments and between national and sub-national institutions in the US and the UK. This is as crucial for fighting the pandemic as it is for ensuring a successful post-pandemic recovery.
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