International researchers set out to compare different countries' COVID-19 responses

Reviewed by Emily Henderson, B.Sc.Sep 17 2020

The typical measures of the efficacy of a country's response to COVID-19 are the contagion curve and the number of deaths from the disease. Indeed, the frequently expressed aim of "flattening the curve" refers to a perceived need to slow the rate of transmission so that healthcare systems are not overwhelmed. An international group of researchers have set out to go beyond these indicators by discussing how and why the strategies implemented by countries to deal with the pandemic succeeded or failed.

The study is supported by FAPESP and coordinated by researchers at Getúlio Vargas Foundation (FGV) in São Paulo, Brazil, and the University of Michigan in the United States. A book will be published with comparative analyses of countries and regions. The project also calls for primary data collection during the pandemic, and for the creation of a repository as a basis for future studies, with news stories and data on political leaders, government communication, and public policies.

I'm going to contribute to the comparative analysis of countries and the chapter on how Brazil has addressed the crisis. Brazil was very well positioned to deal effectively with the pandemic but unfortunately failed to do so. Its research and health infrastructure is relatively robust, and it has a strong track record in combating epidemics such as AIDS and zika. One of the main problems may have been science denialism, which was already advancing in response to climate change."

Elize Massard da Fonseca, professor in FGV's Department of Public Administration and principal investigator for the project, told Agência FAPESP

According to Fonseca, the Brazilian government's actions in the sphere of international relations and its reaction to the disclosure of deforestation data had already pointed to a degree of science denialism. "It's possible to discern similarities between the response to the pandemic and environmental policy," she said. "There was already a great deal of climate denial, and with regard to the Amazon, more importance has been placed on economic development than conservation. The emphasis is on contempt for science and a hypothetical opposition between these factors and the economy, which is groundless in both cases."

Data is another issue and one that has become crucial. "Trustworthy data and information are essential for the planning and transfer of resources in the healthcare sector," Fonseca said. "In the case of COVID-19, this is even more important. You need data almost in real-time for fast decision making on matters such as whether to end lockdown or buy equipment."

Since Brazil restored democracy after the end of the military dictatorship (1964-85), the country has had reliable epidemiological and health surveillance data, Fonseca added. This is a sound basis for mapping regional differences and needs, including policies and programs to combat diseases such as AIDS.

"Brazil has various regionalized infectious disease monitoring systems that include planning information, so there was no doubt which regions would face the greatest difficulties in dealing with the pandemic and it was possible to formulate specific public policies for these regions," she said.

It is very hard to obtain data, she continued, but one of the advantages of doing research in Brazil is the reliability of the data available. "In the case of the Health Ministry, this period is an exception. Since redemocratization, the ministry has been staffed by highly qualified professionals, although it also has many political appointees. That isn't just an impression. It's one of the findings from our group's research, which includes profiling ministers, executive secretaries, and divisional heads since the 1980s. They've almost all been medics or other kinds of health professionals who know the health system well and understand the importance of having good data."

Eye of the storm

A first paper with findings from the research project is published in the journal Global Public Health, arguing that the different responses to COVID-19 and their effects cannot be understood without an in-depth analysis of policy and politics in the various countries concerned. The authors propose four key focuses to understand the reasons for COVID-19 responses: social policies to manage the economic crisis and recovery, political regime (democracy or authoritarianism), formal political institutions including subnational governments, and state capacity, especially control of health care systems and public administration.

"The measures taken to deal with the pandemic tend to be similar because of the profile of the disease, the recommendations of the World Health Organization [WHO] and observation of what worked in the first countries affected, such as lockdown in Wuhan, or mass testing and tracing in South Korea," Fonseca said. "We're going to look at the fit between what worked well and the characteristics of the countries concerned, in a comparative analysis focusing on regional and institutional variables."

Countries that suffered signal failures in the past are now displaying higher levels of efficacy. "South Africa, for example, responded very wrongly to the AIDS epidemic. The president at the time actually denied the importance of public policy to deal with it. Now, however, all these years later in a different epidemic the country's response has been relatively effective," she said.

Analyzing the response to a pandemic, including possible resurgences and fresh waves, requires a certain temporal distance, but at the same time, there is an urgent need to collect primary data and find explanations for successes and failures in combating COVID-19.

"It's a very hard time to do analysis of any kind. We're in the eye of the storm. Everything is happening at once. Any attempt to analyze crises and do research in social science requires distancing. So this project is a daunting challenge," Fonseca said. "The phenomena we're studying are highly dynamic and change constantly, but collecting primary data is very important and we're one of the first groups in Brazil to undertake a comparative study of this kind with the aim of explaining what's happening."