Major collaborative study shows preparedness made largest difference in COVID-19 pandemic

Nations with the best capacity to prevent, detect and respond to disease threats weathered the COVID-19 pandemic with lower overall mortality rates than less prepared nations, according to a new study from partners at the Brown University School of Public Health, Bill & Melinda Gates Foundation and the Nuclear Threat Initiative (NTI).

While the study considered both the age of countries’ populations and their capacity to diagnose COVID-19 cases and deaths, it was the latter that proved the difference. The results, published in BMJ Global Health last week, may have seemed fairly straightforward – better prepared makes for less danger – but this marked the first comprehensive analysis and proof of the comparative mortality ratio as well. By accounting for age, it was able to factor in the possibilities of older population nations having higher baseline mortality rates and those with weaker health systems under-reporting COVID cases and deaths.

Undertaken without those factors, the data could have come out distorted. This particularly flies in the face of data widely touted during the pandemic, which appeared to show countries with high scores on preparedness and on charts like the Global Health Security Index, were experiencing the worst overall COVID outcomes and highest death rates. At the time, the aforementioned extra factors were not brought in, merely raw available body counts.

“Our analysis confirms what you would expect, which is that preparing for pandemics before they occur means we can save more lives during a global health emergency,” Dr. Jennifer Nuzzo, director of the pandemic center at the Brown University School of Public Health and the senior author of the study, said. “Countries that took significant action before the pandemic to invest in capacity to prevent, detect and respond to these types of events were much more effective at protecting the health of their populations and had much better outcomes overall.”

Pre-pandemic investment, according to the authors, could therefore be proven to save lives. In fact, most highly prepared countries appeared to have used their capacities well during the pandemic. Therein, the U.S. was something of an outlier. It ranked highest in the GHS Index, yet 62 countries, with everything factored in, had lower comparative mortality ratios. This, the researchers added, showed that the way a country uses it tools and resources also impact performance – and throughout the early days of the pandemic, the U.S. was frequently critiqued for a waffling, indecisive and inconsistent approach to dealing with the health crisis.

“It is crucial to get the details right when analyzing the relationship between pandemic preparedness capacity and outcomes,” Dr. Jaime M. Yassif, vice president of global biological policy and programs at NTI, said. “As countries evaluate their COVID-19 performance, we can now point to clear evidence of the immense value of building essential pandemic preparedness capacity and the deadly consequences of failing to do so.”