‘Traditional measures of pandemic preparedness don’t explain highest or lowest COVID-19 infections, mortality rates’

A new study published in The Lancet journal this month looks at trust in the government, interpersonal trust and corruption and the impact it has on COVID-19 infections and infection-fatality ratio (IFR) among other factors. It found statistically significant associations with lower standardised infection and vaccination rates.

The study describes COVID-19 as an ‘epidemiological mystery’, underlining the importance of looking at contextual factors that impact mortality and infection so as to plan for the long term against the pandemic.

Other factors influencing case load and IFR included per capita gross domestic product, age profile, mean body mass index, altitude and environmental seasonality.

Down To Earth spoke with Erin Frame, predoctoral research associate in Global Health Metrics and Implementation Science at the University of Washington, United States and the lead author of the study.

DTE queried Frame on the findings of the research, why COVID-19 was termed an epidemiological mystery and what the key takeaways are. Edited excerpts: 

Taran Deol (TD): What are the reasons for calling COVID-19 an epidemiological mystery?

 

Erin Frame (EF): COVID-19 has been called an epidemiological mystery given that the reported incidence and mortality from COVID-19 hasn’t really followed the pattern of a lot of other communicable diseases. Which is to say that lower-income countries with fewer healthcare resources in general have a higher burden.

That is not the case for COVID-19. We’ve seen that a lot of wealthier countries with higher resources and in some cases, higher preparedness scores too, like the United States and the United Kingdom, have actually faced a higher burden. So it’s a mystery, compared to the pattern of other communicable diseases that we’ve studied. 

TD: How does the impact of trust in a government on caseload and IFR differ between a democratic and non-democratic country?

EF: We had an index of democracy as one of the variables we studied. We found that actually didn’t have a relationship on COVID-19 infections or mortality. It wasn’t a dichotomous variable.

Essentially, it wasn’t a yes or no, but it did have an index of a scale which was not found to be related to COVID-19. Whereas, as we mentioned, trust in the government, trust in other people and government corruption were found to be significantly related. 

TD: You have placed Denmark to be the benchmark country when it comes to interpersonal trust and trust in the government. How did you arrive at this conclusion?

EF: We use Denmark as an exemplar country. What we actually did in our analysis was just measure it against what is called the 75th percentile.

So essentially, if a country had trust (in the government) at the 75th percentile of all countries — so the higher end, at the three quarters — that was what could have resulted in a 13 per cent reduction in infections.

Denmark just happened to be the country that was right there and is a really good example. But there are several other European and other countries in the world that do have high interpersonal trust. These include Switzerland, Sweden, Luxembourg and Finland.

Another good example is Japan, which was at the three quarter metric mark that would have been related to the 40 per cent fewer infections at the 75th percentile.

There are several countries that have trust at 75th percentile or higher, in which case, the reduction in infection would have been even bigger. But in this study, we just focused on that 75th percentile as a kind of reasonable improvement.

We did not look at the United States individually, but their government trust was quite a bit lower than Denmark. It was kind of in the middle, if not on the lower end of governmental trust. We didn’t really look into the reasons why trust might have differed among these countries. 

TD: How did African nations fare on this front?

EF: Trust in Africa is really variable. Unsurprisingly so because it’s a really diverse continent. Some countries ranked highly, or relatively highly and then other countries ranked relatively lowly.

So there was not really one clear trend in either personal trust or governmental trust. Rwanda was on the higher end, as was Ethiopia while Gabon and South Sudan were on the lower end.

We must note that this information is among countries that had this data. We used survey data and there were a handful of countries for which this was not available. 

TD: What are the key factors that we need to understand to formulate a long-term plan against COVID-19?

EF: In our paper, we conclude that a lot of the traditional measures of pandemic preparedness — the two that we look at are the joint external evaluation and the Global Health Security Index, which are measures of preparedness, capacities, response, prevention and communication — did not explain the highest or lowest COVID-19 infections and mortality rates.

But most importantly, trust has been shown to be valuable in keeping COVID-19 infection rates relatively low. That was throughout the whole pandemic.

We looked at two different time periods — before and after variants and vaccines, with October 2020 being the break-off point — and the trust factor was consistent through both. Moving forward, we believe that fostering trust can help governments prepare for the next wave of this pandemic and future pandemics. 

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