A macro study published in ’The Lancet’ discovers the notable importance of the credibility of governments and citizen solidarity to explain the differences in infections between countries and discards medical and technical aspects.
Pandemic and COVID-19 Preparedness : An exploratory analysis of infection and mortality rates, and contextual factors associated with preparedness in 177 countries, from January 1, 2020 to September 30, 2021 Background National COVID-19 infection and death rates have varied dramatically since the start of the pandemic. Understanding the conditions associated with this variation between countries is essential to guide investment in more effective preparedness and response to future pandemics. Methods Daily SARS-CoV-2 infections and COVID-19 deaths for 177 countries and territories and 181 subnational locations were extracted from the Institute for Health Metrics and Evaluation modeling database. Cumulative infection rate and infection-fatality rate (IFR) were calculated and standardized for environmental, demographic, biological, and economic factors. For infections, we included factors associated with environmental seasonality (measured as the relative risk of pneumonia), population density, gross domestic product (GDP) per capita, the proportion of the population living below 100 m and a indicator of previous exposure to other betacoronaviruses. For IFR, the factors were population age distribution, mean body mass index (BMI), exposure to air pollution, smoking rates, surrogate for prior exposure to other betacoronaviruses, density of population, the age-standardized prevalence of chronic obstructive pulmonary disease and cancer, and GDP per capita. These were standardized using indirect age standardization and multivariate linear models. Standardized national cumulative infection rates and IFRs were tested for associations with 12 pandemic preparedness indices, seven health care capacity indicators, and ten other demographic, social, and political conditions using linear regression. To investigate the pathways by which important factors could affect SARS-CoV-2 infections, we also assessed the relationship between interpersonal and governmental trust and corruption and changes in mobility patterns and COVID-19 vaccination rates. 19. Results The factors that explained the greatest variation in cumulative SARS-CoV-2 infection rates between January 1, 2020 and September 30, 2021 included the proportion of the population living below 100 m (5· 4% [4·0–7·9] variation), GDP per capita (4.2% [1.8–6.6] variation) and the proportion of infections attributable to seasonality (2.1% [95% uncertainty interval 1.7– 2·7] variation). Most of the variation between countries in cumulative infection rates could not be explained. The factors that explained the greatest variation in the COVID-19 IFR during the same period were the country’s age profile (46.7% [18.4–67.6] variation), GDP per capita (3.1 % [0·3–8·6] variation) and the national average BMI (1·1% [0·2–2·6] variation). 44.4% (29.2–61.7) of the cross-country variation in IFR could not be explained. Pandemic preparedness indices, which aim to measure health security capacity, were not significantly associated with standardized infection rates or IFRs. Measures of trust in government and interpersonal trust, as well as lower government corruption, had larger and statistically significant associations with lower standardized infection rates. High levels of government and interpersonal trust, as well as lower government corruption, were also associated with higher COVID-19 vaccine coverage among middle- and high-income countries where vaccine availability was more widespread, and lower Corruption was associated with greater reductions in mobility. If these modeled associations were causal, an increase in trust in governments such that all countries would have societies that achieved at least the amount of trust in government or interpersonal trust measured in Denmark, which is at the 75th percentile across of these spectrums, it could have reduced global infections by 12·9% (5·7–17·8) for government trust and by 40·3% (24·3–51·4) for interpersonal trust. Similarly, if all countries had a national BMI at or below the 25th percentile, our analysis suggests that the global standardized IFR would be reduced by 11.1%. Interpretation Efforts to improve pandemic preparedness and response for the next pandemic could benefit from greater investment in risk communication and community engagement strategies to increase the trust people have in public health guidance. Our results suggest that increasing health promotion for key modifiable risks is associated with reduced deaths in such a setting. Funding: Bill and Melinda Gates Foundation, J Stanton, T Gillespie, J and E Nordstrom and Bloomberg Philanthropies. |
Implications of all available evidence
Existing metrics for health system capacity and national pandemic preparedness and response have been poor predictors of pandemic outcomes, suggesting that other areas may deserve greater weight in future preparedness efforts.
Not all correlates that explain some variation in per capita infections and infection-to-mortality ratios, such as age structure, the altitude at which a population lives, and environmental seasonality, are easy for formulators to control. of policies.
However, other factors are within the scope of policy, including preventive health measures focused on the fundamentals of population health: promoting healthy body weight and reducing smoking could be useful in avoiding morbidity and mortality in future pandemic scenarios.
Furthermore, the level of trust is something a government can prepare for and gain in a crisis, and our analysis suggests that doing so may be crucial to mounting a more effective response to future pandemic threats. The large unexplained variation in differences in SARS-CoV-2 infections between countries speaks to the importance of further research in this area.
Uncertainty about the conditions that contribute to cross-country variation in COVID-19 outcomes undermines efforts to convince global partners and policymakers to invest in preparedness for future pandemics. The large unexplained variation in infection differences between countries speaks to the importance of further research in this area.
More social cohesion and solidarity, more trust with others, makes us have better health.
Researchers in The Lancet study noted that low interpersonal trust is highly correlated with socioeconomic inequality. “Although sometimes not considered a key health policy, improving social cohesion through efforts to reduce income inequality could have an impact on improving outcomes in the next pandemic”
Meanwhile, this analysis identifies factors that explain some of the variation in the COVID-19 pandemic and suggests areas for potential investment to prepare for the next pandemic threat. Governments should invest in risk communication and community engagement strategies to increase people’s trust in government guidance in public health crises, especially in settings with historically low levels of interpersonal and governmental trust. Furthermore, health promotion to address key modifiable risks could be an important condition for reducing deaths in some pandemic settings.
