Trust is key for a successful COVID-19 response

The COVID-19 Data Dispatch largely focuses on U.S. news. This country’s response to the pandemic has been so chaotic and confusing that it is a full-time job just to keep up with major developments. But sometimes, to truly understand COVID-19 in America, we need a global perspective. More specifically: seeing how other nations have succeeded in mounting a robust public health response—with actual support from the public—can show us how we have failed.  

I got the opportunity to gain that perspective this week, by attending the (virtual) Futures Forum on Preparedness, hosted by tech nonprofit Schmidt Futures. At the forum, a diverse group of health, science, and policy leaders presented research on the global COVID-19 response and discussed how to better prepare for future public health crises.

One cornerstone of the forum was a comprehensive comparison of how 23 countries responded to COVID-19. Researchers at the Harvard Kennedy School, Cornell University, and other partners—including teams in each of the 23 countries—analyzed politics, policies, and social conditions in order to figure out what actually constitutes success in protecting a nation’s citizens from a public health threat.

The researchers classified countries into three major categories: control, consensus, and chaos. A nation in control exhibits public health authority—uncontested by political leaders or the general public—to actually contain the coronavirus (with border controls, contact tracing, etc.) without needing to disrupt daily life. A nation in consensus exhibits cooperation between the political system and the public health system, with citizens agreeing to some disruptions in their lives in order to more broadly keep people safe and keep the economy working. A nation in chaos fails to heed public health advice, fails to find agreement between political parties, and fails to preserve overall public safety at the expense of individual freedoms.

Speakers at the Forum provided examples for each category: Taiwan is a nation in control, Germany is a nation in consensus, and as for chaos… of course it’s the U.S. (Brazil, India, Italy, and the U.K. also fall into the chaos category.)

Now, some particularly nerdy readers might remember an index touted last winter, when we were just beginning to recognize the gravity of the threat posed by COVID-19. The 2019 Global Health Security Index bills itself as “the first comprehensive assessment of global health security capabilities in 195 countries.” It rates nations based on their ability to prevent public health threats, set up epidemiological surveillance, communicate risk, give citizens access to healthcare, and other similar metrics.

The U.S. is ranked number one. It seems laughable now, right? All the measures that were supposed to help us deal with these crises—our monitoring systems, our highly trained scientific workforce, our massive national GDP—have completely failed in the face of partisan fighting and a broad lack of trust in public health measures.  

I remember hearing about this index at the American Association for the Advancement of Science last February, what seems like a million years ago. I pitched a story on the index to my colleagues at Stacker—we could rank countries on how prepared they are for this new coronavirus, I thought. My boss questioned the pitch, saying that the index was entirely prospective and couldn’t predict how countries would actually respond. Plus, the U.S. had already started to fuck up, via the complete lack of testing and the Trump administration downplaying how severe a threat COVID-19 might pose. We did not produce the story. (Sam, if you’re reading this: thank you.)

America was supposed to be great at this, but we failed. That’s not really news. I like the Comparative Covid Response report, though, because it highlights this failure in stark, neon lighting—and tells us exactly what we need to improve on, systematically, before the next crisis hits. At their Futures Forum on Preparedness talk, the researchers behind this report showed that a nation’s score on the Global Health Security index doesn’t correlate at all to the nation’s COVID-19 death rate. But then, they showed one property that does correlate: trust in the government.

Figure from presentation at the Futures Forum on Preparedness.

Countries where people actually trusted their governments to provide public health guidance, such as Thailand, New Zealand, and Germany, were able to institute those control or consensus measures I mentioned earlier and prevent widespread tragedy while keeping the basic functions of the country going. The U.S. needs to get to this point if we are to actually take advantage of all our money and resources in response to future public health crises.

One last note: I have to give credit to the Global Health Security index where credit is due. They did get one ranking right—the U.S. scored only 25 (of 100) points for healthcare access, ranking at 175 of 195 nations.

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