Government Responds to COVID-19: A view from within (Part 1 of a 3 part series)
By Evan Lee and Homa Attar Cohen
It is one year since the arrival of COVID-19 has led to profound societal upheaval and affected almost every aspect of our daily lives. Governments across the world continue to be under intense scrutiny and criticism as they bear primary responsibility to direct and organize their national and local responses to COVID-19. The foundation for many of these responses was triggered by work that was done at a global level, but mostly shaped by direct experience with previous epidemics. In this 3-part blog, we provide an informed perspective on the limits and delays in response by governments, based on what we have been able to learn about Switzerland’s perspective. One of us (H. Attar Cohen) serves as an epidemiologist working in a Swiss regional public health office, and the other (E. Lee) has many years of medical and global health experience and has worked with many different countries’ healthcare systems.Although Switzerland has a unique system of government, and a unique cultural context, these learnings may apply elsewhere. For example, many countries, including the US, Brazil, India, and Ethiopia also have federal systems of government, requiring the central authorities to share power on an equal basis with regions, including on matters of health.
The pre-COVID-19 situation
Just over a year ago, it appeared to many that the world was largely prepared for new disease outbreaks. At a global level, following the 2002 SARS epidemic, the 2005 update of the International Health Regulations strengthened the governing framework for international cooperation to prevent and respond to the spread of disease across borders. This work was further strengthened by the creation of the US-initiated Global Health Security Agenda in 2014. In addition, the 2019 Global Health Security Index report which came out just 3 months before the onset of COVID-19 attempted to measure country preparedness to respond to biological events. The Index includes 195 countries and covers 140 different indicators. SARS, and further high profile biological events such as H1N1 (2009), and MERS (2013) had spurred additional efforts in specific regions and countries to be better prepared.
But rather than global recommendations, it was the severity of these events on populations that proved to be decisive for determining the degree of investment in preparedness made by countries. For example, following the SARS epidemic, China established a national public health and research agency — the China CDC and the city of Shanghai went as far as to build its own state of the art clinical and research facility. South Korea, which suffered the largest outbreak of MERS outside of the Middle East, proceeded to create policy frameworks and even gave authorization to the Korean CDC, in the event of a major health crisis, to lead the totality of government response.
By contrast, Europe’s investments in pandemic preparedness appear to have been largely shaped by its experience with H1N1 influenza. Once H1N1 turned out to be less deadly than initially feared, government led efforts to secure large vaccine stockpiles and carry out large-scale vaccination devolved into enquiries and finger-pointing and governments were forced to dispose of their vaccine stockpiles. This experience may have been why efforts to prepare for future pandemics were largely limited to written plans and new organizational charts rather than significant infrastructure investments.
Switzerland had prepared for a variety of scenarios ranging from localized outbreaks to epidemics and even pandemics. A federally led ‘ABC’ commission in the mid-2000s was created to focus on a range of security threats (atomic, biological, chemical). In 2016 the Epidemics Act came into effect, formalizing the country’s response to disease outbreaks. In parallel, regional governments (cantons), also drew up their own plans — consistent with their roles and responsibilities. This effort was supported by specific ordinances covering laboratory testing and a list of pathogens requiring mandatory declaration. As specified by the IHR, a small designated team for crisis management and international collaboration was created, based at the Federal Office of Public Health in Bern.
Thus, there was a patchwork of highly variable degrees of preparation in place around the world when the COVID-19 virus was first identified in December of 2019.
The best laid plans meet the reality of COVID-19
Very quickly, the rapid spread of COVID-19 made it necessary for governments to make urgent, critical decisions that were bound to effect everyday life. There was an urgent need to act and decide in the face of uncertainty as health systems became overwhelmed, despite the many unknowns about the nature of SARS-CoV-2. There was no margin for scientists to methodically study and understand the disease before integrating research findings into government policy recommendations and regulations.
In the next 2 parts of our blog, we focus more deeply on the opportunities and constraints that Switzerland to see what learnings can be drawn. Only publicly available and verifiable information sources have been used.
