COVINFORM - Baseline report: Public health responses

This report provides a cross-country synthesis of pandemic preparedness plans and evaluations of specific COVID-19 public health responses. Based on insights from 15 countries, it analyses the extent to which lessons learned about best practices and missed opportunities have been documented in formal evaluations and other relevant documents. In line with the COVINFORM project’s focus, the analysis pays particular attention to how COVID-19 responses have been adapted or diversified to meet the needs of groups in society that have been disproportionately impacted by the crisis.

Prior to the outbreak of the COVID-19 pandemic, 14 out of 15 countries had a publicly available pandemic preparedness plan. However, there is considerable variation in the scope and approach of the plans, as well as the extent to which they have been updated over time. Comparison of countries’ pandemic preparedness plans highlighted that many plans lacked specificity with regards to the need to tailor pandemic responses to different groups in society. When plans mentioned the disproportionate impact a potential pandemic would likely have on specific groups, they often focused heavily on medical vulnerability.

Available evaluations of COVID-19 responses suggest that pre-existing pandemic preparedness structures were not adequate to manage the global shock posed by the COVID-19 pandemic. Responsibilities were not clearly defined, and insufficient resources and other structural factors hampered implementation of the actions outlined in national plans. In addition, the plans were not designed for the broad and long-term impact posed by the COVID-19 pandemic. Many countries are currently planning or carrying out changes to their pandemic preparedness structure based on the lessons learned during the COVID-19 pandemic. At a national level, changes to pandemic preparedness structures typically involve alteration of the division of responsibilities for emergency preparedness, and an increased focus on capability development, simulations, and promoting institutional memory.

The analysis also found that the extent to which testing & tracing efforts have been formally evaluated differs significantly between national contexts. Available evaluation documents typically have a heavy focus on technical and logistical aspects of testing and tracing, rather than a focus on broader lessons learned and societal considerations. Common challenges and lessons learned identified across documents related to capacity; compliance; contact tracing apps; (de)centralisation and local expertise; improvisation and agility. Diversification and specific actions for vulnerable groups received limited attention across available evaluations of testing and tracing strategies. However, a key lesson learned across COVINFORM countries is the importance of the combination of national oversight and local expertise to adapt testing and tracing strategies to the needs of different groups in society.

Finally, the cross-country analysis compared evaluations of COVID-19 vaccination campaigns. Although most countries have (technical) reports available that document vaccination progress, only a few countries have published evaluations that go beyond reporting quantitative coverage outcomes. A review of the available evaluations showed that key challenges and lessons learned relate to mandatory COVID-19 certification; vaccination hesitancy; and coordination between stakeholders at different geographical levels. Vaccination campaigns were structured and diversified to reach different population groups at different time points and in various ways, particularly when initial scarcity concerns subsided and sufficient vaccines became available for the entire population. Available evaluations and strategy documents highlight the need to prioritise not just accessibility of vaccination (in terms of distance, time, cost, and administrative barriers), but also acceptability (perceptions of need, relevance and risks) and trust in the vaccine and the wider healthcare system. Finally, the analysis showed that despite efforts to adapt and target COVID-19 vaccination strategies to specific groups, vaccination uptake remains heterogeneous. Continuous efforts to address these inequities are required.