The World Still Hasn’t Agreed on a Pandemic Playbook

The World Still Hasn’t Agreed on a Pandemic Playbook

A health-care worker in Rio de Janeiro takes a swab sample to test a person for COVID-19.
A health-care worker in Rio de Janeiro takes a swab sample to test a person for COVID-19. Lucas Landau/Reuters

For two years, the world has been battling COVID-19 with masks, vaccines, and lockdowns. There have been impressive results and serious missteps, but countries have failed to channel their shared experiences into a blueprint for action.

February 4, 2022 9:10 am (EST)

A health-care worker in Rio de Janeiro takes a swab sample to test a person for COVID-19.
A health-care worker in Rio de Janeiro takes a swab sample to test a person for COVID-19. Lucas Landau/Reuters
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Current political and economic issues succinctly explained.

Introduction

It’s been two years since the World Health Organization (WHO) declared a public health emergency of international concern (PHEIC) over the outbreak of a new coronavirus disease, COVID-19. In that time, experts have put together a tool kit for how countries should respond to outbreaks, emphasizing that relying on any one tool won’t end the pandemic.

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But the COVID-19 crisis has laid bare the lack of a robust global blueprint for what policies to prioritize, which has resulted in a hodgepodge of national responses with varying results. It has caused more than five million deaths worldwide, though the actual toll is likely much higher. Here’s a rundown of the major strategies countries have used to combat COVID-19 and how successful they’ve been at curbing outbreaks.

Testing and Tracing

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World Health Organization (WHO)

Health officials around the world developed various diagnostic tests to detect COVID-19, which are considered critical for curbing its spread. Both molecular tests (which are typically processed in a lab and are more accurate) and antigen tests (which offer faster results) have become essential resources in understanding the scale of community transmission, though experts stress that tests can only provide a snapshot in time, among other limitations.

Over the course of the pandemic, biotech firms have poured funding into the development of at-home test kits, and many places have broadened the availability of these over-the-counter or vending-machine tests to mitigate overcrowding at doctors’ offices and other care facilities. In mid-2021, the United Kingdom (UK) began providing enough free at-home tests for residents to test weekly. In tandem with testing, health experts urge the use of contact tracing, or notifying people who have come into close contact with someone diagnosed with COVID-19.

Countries that were able to quickly scale up testing and contact tracing kept infections low, while others that lagged saw soaring caseloads. South Korea’s rigorous response in the first days of the pandemic is widely considered a success: the country had applied lessons from earlier outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) to bolster its preparedness for the next epidemic. In 2020, the government worked with the private sector to ensure the availability of tests, and South Korea quickly became the leading country in COVID-19 testing per capita. It also deployed hundreds of contact tracers and opened quarantine facilities to accommodate people with infections. The government never imposed a lockdown, though more recently, it has imposed curfews and other restrictions on gatherings and businesses.

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South Korea quickly became the leading country in COVID-19 testing per capita.

Many other countries have struggled to execute large-scale testing. “Obtaining reliable test results on such a massive scale is difficult and unprecedented,” write University of Queensland’s Tim Mercer and Stanford University’s Marc Salit for Nature Reviews Genetics. Despite being a wealthy nation with some of the world’s best health-care resources, the United States was slow to make tests available in the first wave of the pandemic and has again faced availability issues amid the spread of the omicron variant. At the same time, poorer countries have often lacked the infrastructure, including adequate lab facilities and trained technicians, to undertake mass testing.

Vaccines

Not even a year had passed since the pandemic’s start when the first safe and effective vaccines were developed and rolled out, an unprecedented achievement. This included the landmark emergency approval of genetic-based vaccines by U.S. and German firms; such vaccines had not been authorized for commercial use in humans before the COVID-19 pandemic and are faster to develop than traditional vaccines. Leaders in health and government leaned heavily into the hope that vaccines would put an end to the pandemic.

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Though the vaccines have proved highly effective, particularly at preventing people diagnosed with COVID-19 from suffering severe illness and hospitalization, they have not been made available to everyone equally. At the start of 2022, less than 10 percent of people in low-income countries had received one dose, compared with close to 80 percent in high-income ones. Nigeria, Africa’s most populous country, had fully vaccinated less than 3 percent of its people, largely relying on donated doses from abroad. Continued challenges in supply, distribution, and public hesitancy have amplified concerns that slow, uneven vaccination rates make the world more vulnerable to new variants of the virus.

Moreover, vaccine manufacturing is concentrated in just a handful of countries. The COVID-19 wave caused by the delta variant devastated India in 2021, leading one of the world’s top vaccine producers—and the intended primary supplier for the global COVAX initiative—to temporarily halt deliveries of much-needed doses abroad.

More recently, wealthy countries have moved to administer booster shots to provide their populations with increased protection, especially given the wildfire-like spread of omicron. In January, for example, Cambodia and Israel began offering a fourth COVID-19 vaccine dose to more vulnerable groups. However, the WHO and other health bodies have criticized this strategy, arguing that first doses in low-vaccinated regions should be prioritized.

We’ve identified that in a truly global crisis, nations have been unwilling to share.
Thomas J. Bollyky, Senior Fellow for Global Health, Economics, and Development and Director of the Global Health Program

To improve vaccination rates in this pandemic and better prepare for future crises, many experts advise the expansion of production capacity, particularly in regions such as sub-Saharan Africa and South America. “We’ve identified that in a truly global crisis, nations have been unwilling to share,” says CFR Senior Fellow Thomas J. Bollyky. “Around areas such as vaccine manufacturing and early stage R&D, countries are setting up infrastructure to do those things differently in the future, mostly to be able to do it independently and be less reliant on others.”

Masks

Among the first measures taken by health officials was asking or requiring people to wear face coverings to prevent COVID-19 transmission, which occurs predominantly by inhalation of respiratory droplets. There is growing evidence that respirator masks, such as N95s and KN95s, are the most effective at preventing the spread of the virus, far more so than single-layer and loosely woven cloth masks. Face coverings have also been found most effective when they are widely used in a community; the prevalence of asymptomatic infections in this pandemic underscores the importance of universal mask wearing.

Yet, national policies on masks vary widely, with some making no such recommendation and others mandating the use of particular types of masks nationwide. For example, the U.S. government’s policy has shifted several times. Initially, amid concerns about the mask supply for frontline health workers, it recommended masks only for sick people or those caring for someone who is sick. Now, there is a federal mandate for mask wearing on public transportation and in federal buildings, but policy is otherwise left to states and local governments, and there is no specification about the type of mask. This has led to a patchwork of guidelines and enforcement across U.S. states.

Taiwan’s early and broad mask mandate, part of a crisis response strategy crafted in the wake of the SARS epidemic, has contributed to the island’s success at managing the pandemic.

At the same time, Germany and several other European countries have required people to wear medical-grade masks in certain public settings to combat omicron, pointing to the findings on the greater effectiveness of such masks. Taiwan’s early and broad mask mandate, part of a crisis response strategy crafted in the wake of the SARS epidemic, has contributed to the island’s success at managing the pandemic.

But regions such as North America and Northern Europe, where face coverings were not already part of societal norms to prevent disease transmission, have seen pushback. “Communication, community engagement, and trust matter an enormous amount in terms of the willingness of the public to adopt these behaviors that could be protective of their health,” says Bollyky. Researchers have found that low-cost interventions such as providing free masks and modeling by community leaders help to increase mask usage.

Social Interventions

Officials have also employed a variety of social interventions to keep people with COVID-19 from transmitting it to others, such as quarantines, social-distancing guidelines, and lockdowns.

Health experts advise that any person with COVID-19 isolate away from others, but health agencies around the globe differ in their guidelines or mandates for the length of isolation and precautions to take after exiting isolation. Experts also recommend quarantines for people who are exposed to someone with COVID-19. (The U.S. Centers for Disease Control and Prevention (CDC) uses the term “isolation” for people who are sick with COVID-19 or another contagious disease and “quarantine” for people who were exposed.) 

Alongside quarantining are other strategies around social interactions, such as social distancing (maintaining a certain amount of space between oneself and others) and restrictions on gatherings. But the intensity of these policies, as well the extent to which they’re enforced, differs dramatically around the world. The WHO, for example, recommends people maintain a distance of at least one meter (about three feet), while other health agencies advise at least six feet.

In more extreme cases, usually amid acute outbreaks, governments have imposed lockdowns. This typically means the closure of public spaces, schools, and nonessential businesses. Some places, including Singapore and the UK, have experimented with so-called circuit breakers, or temporary, localized shutdowns. Others, such as Australia and New Zealand, maintained broad lockdowns for months at a time. The tight restrictions helped the two countries keep COVID-19 cases low, but by late 2021, both began to shift away from their lockdown strategy despite the spread of omicron, citing the need for a more sustainable approach.

The Chinese government aimed to create a virus-proof bubble.

China’s pandemic response, which government officials say has been among the most effective but which critics say has been among the most oppressive, has involved a slew of controversial measures as part of its zero-COVID policy ahead of the 2022 Winter Olympics in Beijing. The Chinese government aimed to create a virus-proof bubble by isolating thousands of staff and volunteers from the general public months before the games opened, and by January, it had locked down several cities (altogether home to some twenty million people). Though experts acknowledge that Beijing’s strategy limits the virus’s spread, many say that its harsh tactics go unnecessarily far.

Ultimately, social interventions can be highly effective, but they’re not foolproof. And as the pandemic drags on, writes CFR’s Yascha Mounk for the Atlantic, leaders are less likely to implement such measures as people grow exasperated.

Travel Restrictions

The rapid spread of the original strain of the coronavirus in early 2020 sent governments into a frenzy, many of them imposing widespread travel bans. The moves prompted harsh criticism from the WHO, which warned that travel restrictions have been found in many cases to be ineffective and that they could divert resources from other public health interventions.

Experts say such restrictions produce mixed results at best, because by the time bans are implemented, a virus has usually already spread enough that they will not prevent it from reaching across borders. Still, the emergence of the omicron variant in 2021 led to a similar response, with countries barring visitors from southern Africa, where the new strain was first reported. Japan, which has maintained stringent border controls throughout the pandemic, went further than most by temporarily barring all international visitors. Tokyo says the restrictions are working, as the jump in COVID-19 cases has been relatively small, and most Japanese favor the policy.

South African researchers were unable to acquire necessary supplies to study the variant because their delivery was blocked by travel restrictions.

Meanwhile, the repercussions of travel bans can be severe: they can drive tourism and other sectors of business to a halt, as well as generate stigma and act as a disincentive for governments to report new strains to the WHO and other countries. “We still don’t know if omicron truly originated in South Africa,” says Bollyky. “But South Africa paid for it.” For instance, South African researchers were unable to acquire necessary supplies to study the variant because their delivery was blocked by travel restrictions. The bans likewise obstructed the sharing of virus samples with other countries.

However, “travel measures can be effective,” writes Simon Fraser University’s Kelley Lee for Foreign Affairs, “if they are internationally coordinated, informed by scientific evidence, and politically transparent.” Lee writes that early timing is important, but that having robust testing and quarantine measures already in place also matters for such restrictions to work.

Crafting a New Playbook

Governments have poured billions of dollars into trying to contain and end this pandemic, and some nations have proved to be quite nimble as the health crisis has thrown new challenges their way.

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But on the whole, experts say the world remains woefully unprepared to effectively handle future pandemics, or even unexpected variables in this one. “Countries tried to institute policies in real time that should have been in place much earlier,” writes John Nkengasong, director of the Africa Centers for Disease Control and Prevention, for the New York Times. In the case of COVID-19, the consequence has been the wide-scale infection of tens of millions of people and the shift toward endemic COVID-19. Now, the world has to prepare to manage this virus for the foreseeable future. 

The path forward, many experts say, requires rethinking the current playbook. On the national level, this means investing heavily in robust health-care systems that can deal with crises, as well as boosting community engagement and trust to get people on board with public health policies. 

On an international scale, countries should strengthen cross-border monitoring and surveillance networks and put their full support behind resource sharing and equitable distribution. But the current crisis has revealed that the world is sorely lacking a leader to galvanize these efforts. Although member states continue to look to the WHO for technical guidance and assistance, it has proved to be an insufficient mechanism for affecting the behavior of countries, particularly more powerful ones. 

“We have thought about this with the same playbook that we use to pursue a lot of global health measures, in which we donate funds and donate vaccines,” says Bollyky. “We really need to think about this in the way that we think about other national security or trade arrangements, where there’s an exchange of benefits and you capitalize on the mutual reliance of countries to advance the policy goals of everyone.”

Will Merrow and Michael Bricknell created the graphics for this article.

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