While it has been well documented Australia is one of the shining lights when it comes to its handling of the coronavirus pandemic, our nation was in fact one of those predicted to perform well.
The Global Health Security Index (GHSI), which measures preparedness for pandemics or epidemics, published its scores in October 2019 months prior to the pandemic, ranking Australia in its top 10 nations, all of which are "most prepared".
Yet of those 10, only two feature in the top 10 of rankings measuring how well a nation has managed Covid-19, according to research by Flinders University.
Thailand is the only other country alongside Australia to feature in the top 10 of performing nations who had been touted to succeed. They are joined by New Zealand, Vietnam, Taiwan, Cyprus, Rwanda, Iceland, Latvia and Sri Lanka.
Yet there was no place for the US, UK, Netherlands, Canada, Sweden, Denmark, South Korea and Finland who have not – some more than others – lived up to their expectations outlined by the GHSI.
US and UK head the Covid failures
The first two, the US and UK, have notably had catastrophic health and economic repercussions from the virus. The two Covid-hit nations have contributed more than 620,000 deaths during the pandemic - about 25 per cent of all deaths globally.
Sweden initially drew praise for a herd immunity approach that appeared to be working until a surge in cases meant its government backflipped on lax restrictions.
South Korea was another country which was deemed to have been performing well, however a spike in December which routinely saw more than 1000 cases a day scuppered that reputation.
Research, led by Flinders University’s Professor Fran Baum, reflects on the GHSI's predictions for a public health emergency and identifies 10 factors that contributed to failures in the rankings.
“Now we know that 10 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 US and UK,” Professor Baum, from the Southgate Institute for Health, Society and Equity, said.
“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 British Medical Journal analysis series ‘COVID-19: The Road to Equity and Solidarity’.
10 reasons why pre-pandemic predictions failed
Limited consideration of globalisation, geography, and global governance. For example, island nations such as Australia, New Zealand and other Pacific countries could prepare and manage better than regional organisations such as the EU.
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.
Failure to assess health system capacity.
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.
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.
Limits of national health systems did not always correlate 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.
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.
The index didn’t foresee the effects of differences in social security provisions for an extended epidemic.
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.
Gaps between capacity and its application. For example, political intervention in the US blocked the Centres 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.
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