Hindsight: Reflections on Responses to COVID
COVID-19 has revealed key lessons about how the global community responds to crisis. Despite some remarkable examples of determination, cooperation and innovation, most countries struggled with at least some aspects of crisis management—and the world has not yet come together to mitigate the fallout. While it is too early to draw definitive lessons, this chapter distils some early observations across different response areas.
If the lessons drawn from this crisis inform decision-makers only how to better prepare for the next pandemic—rather than enhancing the processes, capabilities, and culture for galvanizing effort around other major concerns—the world will have fallen into the familiar risk management trap of planning for the last crisis rather than anticipating the next (see Box 6.1).
Box 6.1: Pandemics and Crisis Response in the Global Risks Report Series
The Global Risks Report has frequently discussed the risk of pandemics to health and livelihoods. The 2020 edition flagged how health systems across the world were generally stretched; the 2018 and 2019 editions highlighted biological threats and antimicrobial resistance; and the 2016 edition stressed that the Ebola crisis would “not be the last serious epidemic” and that “public health outbreaks are likely to become ever more complex and challenging”.
The report has also explored aspects of managing risk and building resilience to crises: the 2018 and 2019 editions, for example, looked at the impacts of complexity and cognitive bias on risk assessment and response. The experience of COVID-19 so far offers an opportunity to update our understanding.
In a connected world, an outbreak anywhere is a risk everywhere—and, on average, a new infectious disease emerges in humans every four months, with 75% of these new diseases coming from animals.1 This section takes stock of global preparedness by looking at four key areas of the COVID-19 response: institutional authority, risk financing, information collection and sharing, and equipment and vaccines.
Response to risks like a pandemic requires effective global cooperation, information sharing and coordination. The H1N1 and Ebola outbreaks in the 2010s highlighted the need to strengthen the World Health Organization (WHO)’s competencies,2 yet some areas of weakness have intensified. The WHO lacks independent investigative powers and also lacks the ability to sanction non-compliant member states (by design and charter); its authority has been further challenged in recent years by nationalist behaviours in many countries. Throughout the crisis, the WHO’s advice at times competed with that of several governments. This conflict reiterated the challenges that, at times of urgency, the multilateral system faces to function in a way that is commensurate to the scale of global crises.
Beyond the WHO, other international actors struggled to mount a coordinated response to the global health, societal and economic crisis. For example, the United Nations Security Council was slow in reaching a resolution to support the Secretary-General’s call for a global ceasefire.3 The G7 and the G20, hampered by domestic and bilateral political issues, also failed to mount a collective response commensurate with the scale of the impacts, although they had been able to do this in previous crises.4 This was seen in an initial failure to increase available resources for international finance organizations and to suspend debt repayments.5
The WHO’s annual budget—US$2.4 billion6—is far outweighed by the economic and development costs of the pandemic so far. In the early stages of the pandemic, delivery of supplementary crisis funding proved to be a slow process. It took two months to meet an initial funding goal of US$675 million.7 International finance organizations were faster to mobilize to help low- and middle-income nations prepare healthcare services and support households during lockdowns. However, here too greater preparedness is needed:8 although funding was available in March or April when pre-determined triggers were in place, in the absence of those triggers relief took longer to disburse (see Figure 6.1).
Figure 6.1: Approved International Finance Institute Financing by Month
Source: Segal, S., Henderson, J. and Gerstel, D. 2020. CSIS Economics Program, data from a collection of international finance institutions press releases. 24 November 2020, https://www.csis.org/analysis/international-financial-institutions-covid-19-funding-rebounds-september-remains-below
Based on the dire economic and development consequences of the pandemic thus far and experience from previous infectious diseases, the benefits from investing more in preparedness globally would have been a valuable investment especially if also coupled with the enhancement of health systems. This will continue to be the case and is true across different types of disasters.9
Information collection and sharing
Early response efforts were hampered by the lack of robust data-sharing systems that would enable large-scale and near-real-time analysis on information such as testing and infection rates, fatality numbers, personal mobility, and viral genome sequences.10 Although such systems were rapidly developed, they were often restricted by a lack of open data standards.
Collaboration between the private and public sectors did work well in some cases. For example, in March 2020, the World Economic Forum launched the COVID Action Platform and communicated weekly updates from governments, the World Health Organization, and vaccine manufacturers with more than 1,800 executives and leaders. The platform has helped channel the supply of essential equipment through the Pandemic Supply Chain Network.
Technology companies also provided mobility data that helped authorities understand the potential spread and better target responses.11 Scientists sequenced and shared more than 32,000 viral genomes, enabling researchers to trace more quickly the origin of outbreaks and laying the foundation for more robust pandemic surveillance in the future.12 Information on the relative success of medical treatment options was rapidly disseminated by medical professionals and pharmaceutical companies, improving outcomes across the world.
Equipment and vaccines
Early competition to secure personal protective equipment (PPE) and medical supplies made it harder to optimize their development and distribution. Governments requisitioned masks that had been ordered by foreign buyers, and, in some cases, stock was reportedly sold to higher bidders on airport runways.13 As of October 2020, more than 90 jurisdictions had implemented export controls (see Figure 6.2).14 On a more positive note, innovative public-private partnerships emerged as supply chains were rapidly reconfigured to meet demand.15
Figure 6.2: Export Controls on Medical Supplies and Medicines
Source: World Bank. “COVID-19 Trade Policy Database: Food and Medical Products.” Brief. https://www.worldbank.org/en/topic/trade/brief/coronavirus-covid-19-trade-policy-database-food-and-medical-products
Vaccine development progressed rapidly through collaboration among private companies and universities facilitated by government funding, although it is still unclear how concerns about intellectual property rights, pricing and procurement will be handled.16 Initiatives to deploy vaccines equitably to low- and middle-income countries, such as the G20’s COVID-19 Tools Accelerator, have been hampered by funding and distribution challenges. More than 180 countries have signed up to take part in the WHO’s COVAX initiative to facilitate lower-cost bulk purchases of vaccines. However, low- and middle-income countries may receive only a small fraction of their doses for frontline workers until advanced economies have achieved a vaccine coverage of 20%.17
Other implementation challenges for vaccine programmes still require resolution—for example, distribution (cold chain requirements, global glass vial availability and supply logistics for low-density areas) and application (defining priority groups, recording doses given and countering vaccine hesitancy). As vaccine rollouts begin, rapid dissemination of challenges and best practices will be key for successful iteration across economies.
National-level responses have varied given different starting points: income level, health system maturity, geographic and demographic characteristics, culture and type of political regime. Nonetheless, early lessons can be drawn in five areas: governmental decision-making, public communication, health system capabilities, lockdown management, and financial assistance to the vulnerable. These areas are interdependent: a weak performance in one area has spill-over effects elsewhere.
In the early days, with imperfect and evolving information, all governments understandably struggled to balance health security with economic impact and community sentiment.18 However, some countries subsequently proved more able than others to formulate clear strategies and adapt them as new information became available.19 Countries that already had a pandemic high on their risk registers could appreciate the different dimensions of the risk, the key considerations and mitigation options, and the evidence needed to inform decisions. While some were able to put the lessons from stress tests and table-top exercises into practice, others failed to apply previously developed response strategies.20 Some also failed to appreciate lessons learned in other countries once the pandemic had begun, losing valuable time to build capacity, understand vulnerabilities and develop contingencies.21 This lack of understanding grew more complicated as strains mutated and emerged with higher levels of transmissibility.22
Separately, concern has also grown about the scope and duration of new emergency powers and the consolidation of a less-consultative mode of leadership.23 In some countries, the side-lining of key public servants, soured relationships among government actors, and the failure to heed expert advisory body recommendations have exacerbated challenges to a successful response.24
Communication with populations
Governments that most successfully sustained popular confidence in 2020 were typified by regular and consistent public reporting, transparency about the limits of knowledge at any given time, and visible alignment between politicians and experts in areas such as epidemiology and behavioural science.25 Behaviour tended to be more chaotic where governmental messaging lacked clarity, measures seemed discriminatory, national and local leaders espoused different agendas, and competing narratives sowed doubt26—exacerbated by misinformation on social media (see Chapter 2, Error 404).27
Health system capabilities
Many countries made extraordinary efforts to expand health system capacity in the first wave of the pandemic—for example, by delaying elective care, reallocating medical professionals, and building whole new temporary hospitals. However, in addition to PPE shortcomings discussed above, health systems also often overlooked the challenge of controlling infections in high-impact facilities such as care homes, where age and poor health gave rise to high numbers of deaths (see Figure 6.3). In many cases, there was also insufficient forethought paid to chronic exhaustion among health system personnel, as subsequent waves of the pandemic coincided with the need to attend to other conditions that had worsened during lockdowns28—e.g. for the 41% of adults in the United States who delayed or avoided medical care.29 Health workers have already begun leaving the profession (see Chapter 1, Global Risks 2021). Mental health issues across populations—including anxiety, depression and post-traumatic stress—are also set to increase (see Chapter 1, Global Risks 2021 and Chapter 3, Pandemials).
Many countries struggled with testing, tracking and contact tracing,30 even though these were seen as critical to keeping outbreaks under control and economies open.31Such systems were often slow to identify where infections were spreading: from international travel, meat packing facilities, large social gatherings, or accommodation for migrant construction workers.32
National lockdowns had some successes: for example, the shielding of vulnerable individuals often worked well in advanced economies, with public-private collaboration ensuring delivery of food supplies. However, disruption of schooling and workplaces caused a wide range of impacts in countries of all income levels (see Chapter 3, Pandemials),33including an exacerbation of digital divides (see Chapter 2, Error 404). Box 6.2 compares the characteristics of lockdown responses across regions.
After the gradual opening up of economies caused cases to rise again, many governments were reluctant to revert to extended nationwide lockdowns, instead trying short (two-to four-week) “circuit breakers” or more nuanced local restrictions (such as curfews, hospitality closures, bans on inter-household mixing, and travel constraints).34 The timing and conditions for the deployment of these measures, and their prospects of success in controlling the spread of the virus, generated fraught policy discussions, and mixed outcomes resulted in some governments returning to more restrictive national approaches.35
Financial assistance for individuals
Lockdown measures caused a sharp downturn in economic output, endangering jobs and businesses. Wealthier countries sought to define and deliver relief packages (see Chapter 1, Global Risks 2021) for the most-affected groups and supported employers in their efforts to retain employees.36 However, the phasing out of support will leave many businesses with difficult employment decisions (see Chapter 5, Imperfect Markets). Rapidly rising unemployment in the second half of 2020 began to put additional pressure on other welfare system provisions and exacerbated mental health challenges. Developing economies with limited public finances often faced the difficult choice between lockdowns with no or little financial assistance for those who lost their livelihoods and keeping their economies open at the risk of rapid spread of the virus and overwhelmed health systems. In many economies, informal markets also complicated the distribution of financial assistance.
Box 6.2: Responding to COVID-19: Regional Characteristics
Note: Please see Appendix B for a more detailed description of the methodology.