No single set of numbers is a fair measure in a pandemic that has evolved so quickly, demanding different responses at different moments from countries with different contexts (and luck). Do you stop at hospitalisation and mortality rates or consider who managed the economic and social fallout best too? Do you give more weight to testing rates, our main window into how the virus has taken hold in a country, or vaccination, now our main defence against it?
“There’s no magic recipe,” says Lemahieu. “It was a perfect storm. It was about learning at speed, being flexible and communicating well. This might not be a popular opinion, but politicians the world over do deserve some credit for adapting on the fly.”
Indeed, what worked before vaccines (and more infectious variants of the virus Delta and Omicron) often won’t work now. China’s then-unprecedented decision to lock down more than 10 million people in Wuhan in January 2020 may have largely stamped out the virus where it first emerged (as a fast national lockdown did soon after for New Zealand). But China’s dogged pursuit of such an elimination strategy in 2022, with cases soaring, and Omicron on the loose, is sending whole cities into crisis as people are sealed inside their homes or dragged to crowded quarantine centres. (In recent days, the World Health Organisation has urged Beijing to abandon the strategy.)
Of course, back in 2020 when Lowy calculated its index, caseloads were still the main metric, Lemahieu says. Wealthy and poor countries had found themselves on a fairly level playing field at the start of the pandemic – the virus had overwhelmed even the healthcare systems of the developed world as it carved a path out of China through Europe and the main arteries of globalisation such as New York and London.
Nations sharing a border with hotspots fared worse, those with smaller, spread-out populations, particularly island states (such as Australia), had an advantage. The developed world had better systems and resources, but also older populations more vulnerable to the virus. Poorer countries with people living in squalid or remote places faced the usual healthcare headaches but many, including across Africa, also had “more muscle memory” and experience handling deadly outbreaks such as HIV and Ebola, says epidemiologist Professor Mike Toole of the Burnet Institute, who has worked with the WHO and America’s Centre for Diseases Control and Prevention to manage outbreaks all over the world.
“COVID is still something of an epidemiological mystery in how it’s hit some countries harder than others,” says health economist Associate Professor Joseph Dieleman at the University of Washington. When he teamed up with epidemiologists to examine the responses and preparedness of more than 170 nations, no advantage stood out as making a big difference to how their first 20 months of the pandemic unfolded (including population density and GDP) save one: trust. Not just in government – our officials and institutions – but in each other. In fact, Dieleman and the team estimate that there would have been about 13 per cent fewer infections globally if every nation’s population had at least as much trust in their government as Denmark’s did (Denmark being one of the high scorers on trust).