Nearly two years after the World Health Organization (WHO) recognized COVID-19 as a Public Health Emergency of International Concern, some lessons from the pandemic are clear:
- Countries’ ability to measure the number of COVID-19 cases and deaths depend on their having public health capacities such as diagnostic and screening tests, which were not adequately established in many countries before the pandemic. For example, the WHO has estimated that six of every seven COVID-19 infections in Africa go undetected due to limited testing capacity. As a result, official country reports of cases and deaths may not accurately reflect the full impact of COVID-19.
- The availability of health security capacities in countries does not automatically translate into protection from illness, death, and economic consequence. Successful outcomes during a pandemic depend on political will and government readiness and flexibility to use available capacities in a way that aligns with evolving evidence-based public health recommendations for disease containment and mitigation. The public must trust advice from health officials and not face hurdles, such as lost income, if protective recommendations are to be followed.
- National risk environments—measured by disorderly transfers of power, social unrest, international tensions, and distrust in medical and health advice from the government— can have an outsized impact on a country’s ability to successfully use its health security capacities to respond to an emerging outbreak. The success of disease-mitigation efforts is contingent upon public trust in government, healthcare institutions, and public health professionals. In the absence of trust, public cooperation and compliance with recommendations—including physical distancing, mask mandates, and shutdowns— are likely to fail and be more vulnerable to corrosive misinformation. Countries with those risk factors must develop strategies to minimize their influence—such as working to foster trust and prevent the politicization of a crisis—to enable a successful response.
- Public health and health system capacities must be coupled with policies and programs that enable all people to comply with public health recommendations. Universal health coverage, paid sick leave, subsidized childcare, income assistance, and food and housing assistance are examples of policies that helped populations comply with protective public health measures of the COVID-19 pandemic. For example, Ghana and Ukraine both provide wraparound services, such as economic or medical support, to infected patients and their contacts to self-isolate or quarantine. New Zealand raised its minimum wage and began providing weekly benefits to support participation of public health measures in society. Portugal extended temporary citizenship to asylum seekers and migrants during the pandemic, thereby dismantling barriers to accessing healthcare among those populations.