The COVID-19 Global Response Index
From FP Analytics: A country-by-country assessment of government responses to the pandemic.
Updated: Jan. 25, 2021 | Published: Aug. 5, 2020
As governments around the world continue to grapple with the pandemic, FP Analytics has developed the COVID-19 Global Response Index to track countries’ responses to the novel coronavirus according to key metrics. While country rankings have been published by other organizations and publications, the Index is the first effort to track national leaders’ responses in critical policy areas, including public health directives, financial responses, and fact-based public communications—and is doing so on an ongoing basis. Initially released on August 5th, 2020, the Index has been updated periodically. The latest update reflects country-level data as of January 1, 2021, and vaccine-related data as of January 22, 2021.
FPA’s COVID-19 Global Response Index covers 36 countries, including G20 nations as well as several other developing and middle-income countries that experts and epidemiologists have identified as having notable experiences with respect to COVID-19. This group represents an initial set of countries for which there is reasonably robust data availability as well as global geographic distribution and socio-economic and political diversity. While notable gaps in data and reporting remain, this Index endeavors to provide a framework to track government responses across multiple categories and will continue to be refined and expanded as more consistently tracked and disaggregated datasets become available and understanding of the virus can inform further Index weighting.
The Index and associated country profiles are based on global data tracked from December 31, 2019 through January 1, 2021. They are intended to illuminate major actions taken by governments to contain the spread of the virus, identify areas for improvement, and highlight promising practices to inform countries’ ongoing responses. The Index includes policy choices and actions across three (3) categories and produces a composite score that reflects more than containment of the virus, but also financial support for domestic economies amid the global economic shock and commitment to fact-based communication among leaders. Data availability and reporting continues to be a challenge; nonetheless, this project seeks to provide a more holistic view of countries’ responses to the pandemic across variables and inclusive of contextual information. FPA’s COVID-19 Global Response Index will be updated periodically, adding to FP’s international COVID-19 coverage, expert dialogues, and special events that are convening pre-eminent leaders in global health, policy, and security from around the world.
The Index was developed with insights from social scientists, public health experts, and leading epidemiologists working at the forefront of the pandemic response, including those from the Centers for Disease Control and Prevention, the University of Oxford, the University of Michigan, the University of Maryland, the University of Massachusetts, UC-Irvine, and UC-Davis’ collaboration with USAID’s Emerging Pandemic Threats project, among others. We are grateful for their contributions.
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Kenya has a very strong overall policy score, consistently scoring well in all areas, particularly its reliance with respect to facts and science on COVID-19.
Ghana scores very strongly on the Index, due primarily to its proactive public health policy, strong examples set by leadership, and reliance on facts, but its financial response was relatively weak, with a minimal stimulus and little income support.
Despite having relatively weak pre-pandemic capacity, swift action and prevention-based messaging from the government helped mitigate spread early on in the crisis.
New Zealand has had very strong policy, particularly its reliance on science and facts, and its very strong financial response.
Australia is a very strong performer, particularly due to a generous financial response by way of income support, but delayed implementation of its policies pulls down its score.
Argentina’s very strong policy score is mainly due to its strong political response, characterized by clear, fact-based communication and regular press briefings by President Fernandez.
France has greatly improved its public health policy from the early fall with strong restrictions on social gatherings, financial support and a reliance on facts.
India has a relatively high overall score due to its early lockdown and strong financial response.
Japan has a very strong overall score, driven by its generous financial response and a reliance on facts, although its public health policy is slightly below the median.
Taiwan has a relatively strong policy score, but its minimal stimulus and weak debt relief bring it down. However, the data does not accurately measure its advanced contact tracing, which may have diminished the need for more restrictions; this likely results in a score that underestimates Taiwan’s response.
Saudi Arabia has a relatively strong policy response to COVID-19, with a reliance on facts and science, and tight restrictions on public gatherings, although its weak financial response brings its score down.
Senegal’s COVID-19 policy response has been relatively strong across the board, buoyed by a high degree of preparedness and a reliance on facts and science.
Iceland has a relatively strong score, having substantially improved its public health and financial policy since the early fall.
Canada’s scores above the median, due to a generous financial response and a reliance on fact-based communications, but is hurt by a relaxed lockdown, poor contact tracing, and little emergency healthcare spending.
Hungary scores above the median, but limited testing, efforts to limit press freedom, and modest financial support have weakened its score over time.
Denmark scores slightly above the median, due to a robust healthcare system and to fiscal responses that safeguarded employment. Limited public health directives bring its score down.
Belgium scores just above the median, with its generous income support and strong testing and contact tracing countered by limited public health directives.
Overall, South Africa scores near the median with vigorous policy implementation - particularly with respect to lockdowns - offset by its relatively meager financial response.
Norway scores just above the median, pulled down by its weak public health score, countering its semi-strong financial response and reliance on facts and a free press.
Indonesia scores near the median, with its poor financial policy bringing its score down.
Clear, fact-based communications and a generous stimulus package have been instrumental factors in Finland's COVID-19 response, but its poor public health policy keep its score near the median.
Germany’s pandemic response has been praised around the world for its rapidly implemented contact tracing strategy and science-based leadership, although its public health policy declined significantly since the fall, bringing its overall score near the median; however, the data does not adequately account for Germany's contact tracing.
Brazil scores near the median, primarily due to its poor public health policies, especially its very low levels of testing, coupled with President Bolsonaro’s spreading of misinformation about the virus.
The U.K. scored near the median for overall policy, due to a relatively strong financial policy, although its weak initial lockdown hurt its score; the new strain is causing a huge uptick in cases, resulting in stricter lockdowns.
South Korea scores around the median, largely due to its very weak financial policy; its public health score is likely underestimated here, given the data’s limitations to adequately account for the impacts of the country’s advanced contact tracing.
While hit hard by COVID-19, Italy’s reliance on facts and relatively strong public health policies helped slow the spread; however, its public health score has dropped significantly since the early fall, as it is now facing another wave of the pandemic.
Switzerland's reliance on facts and an open media drove its score up to the median, helping to counter weak financial support and limited restrictions on social interactions.
Spain scores below the median, with limited restrictions on public interactions contributing to consistently high case rates and minimal stimulus support bringing down its score.
Mexico score has deteriorated over time, due primarily to its extremely weak financial response and relatively weak public health policy, including very limited testing.
The United States’ policy has been relatively weak, given the federal government’s limited use of facts and science, limited emergency healthcare spending, and limited debt relief.
The Netherlands’ overall policy is relatively weak, driven by its limited lockdown and restrictions, low testing levels, and minimal financial response.
Turkey has relatively weak policy. In addition to limited restrictions on movement, officials have provided little emergency spending, stimulus, or debt relief. They also have limited press freedom and have conducted minimal testing.
Despite being known for a relatively strong public healthcare system, Sweden has been hit hard with cases; the country’s lack of stay-at-home orders and school closures, limited testing, and few gathering restrictions overshadowed its financial support and a reliance on facts and accountability with an open press.
Russia has a relatively weak score, with strong public health policy undone by weak financial support, limitations on press freedom, and spread of misinformation about the pandemic.
China’s aggressive lockdowns played a key role in controlling case and death rates. China’s low score is driven by multiple factors, including the country’s minimal financial response, low scores on press freedom and fact-based communications. China’s failure to report testing data drag down its scores and obscure understanding of actual COVID-19 dynamics within the country.
Iran has an extremely low policy score, due largely to very weak public health policy, driven by a severe lack of testing, and substantial misinformation and press limitations by the Iranian authorities.
Hope and Frustration Characterizing Initial Vaccine Rollout
Findings from the Index and supplementary research indicate:
As of January 2021, there have been over 85 million cases and close to two million deaths from COVID-19 around the globe. A second wave of the pandemic has resulted in a substantial increase in cases, severely straining even the strongest health care systems. The recent mutations of the virus, first reported in Britain, which may be more contagious than the original strain, compound the urgency with which nations must act.
The recent approval and initial distribution of 10 different COVID-19 vaccines, and development of nearly 100 more that are currently in trials, offer hope for more effective management and an eventual end to the pandemic. As of this publishing, there are two vaccines approved for widespread use, eight in early or limited use, and 20 in large-scale efficacy Phase 3 testing. Currently:
- Pfizer: Approved in Saudi Arabia, Bahrain, Switzerland, and in emergency use in 16 countries and EU
- Moderna: emergency use in Canada, US, EU, UK, Switzerland, Israel
- Oxford: emergency use in Mexico, El Salvador, Dominican Republic, Brazil, Argentina, Morocco, Britain, India, Pakistan, Nepal, Bhutan, Bangladesh, Maldives
- Sputnik: emergency use in Russia, Hungary, Belarus, Serbia, Algeria, Turkmenistan, Palestinian Authority, Venezuela, Bolivia, Paraguay, Argentina
- China is producing two vaccines, Sinovac and Sinopharm. Sinopharm is approved in China, the UAE, and Bahrain, and in emergency use in Jordan and Egypt, while Sinovac is in emergency use in China, Indonesia, Turkey, and Brazil
23 countries have a vaccine in use as of January 22, 2021.
Despite the initial rollout of vaccines, COVID-19 cases are still increasing rapidly. Three unique challenges associated with all of the approved vaccines could stall crisis management and must be addressed to hasten widespread inoculation across countries.
Supply Chain Bottlenecks Hampering Vaccine Production and Deployment
Several issues with COVID-19 vaccine supply chains could stall management of the pandemic. First, supply chains for COVID-19 vaccines are still under development: historically, pharmaceutical companies have established supply chains after drugs have been fully tested and approved. The unprecedented rate of vaccine development has exceeded the development of robust supply chains and, not surprisingly, affected rollout. Pfizer, for example, discovered that some raw materials in its supply chain didn’t meet its standards, and a late-stage trial took longer than expected, slowing vaccine production. These complications resulted in Pfizer halving its expected supply for 2020. Given the rushed process for all COVID-19 vaccine manufacturers, others may face similar issues in their supply chains, slowing vaccine production and distribution.
Countries also need clearer plans for supply chain integration, particularly with respect to vaccine distribution and individual administration. In the U.S., inconsistent messaging from leaders about the facts of the vaccine, lack of coordination between federal and state authorities, and communication and information gaps among officials, healthcare providers, and patients continue to impede rollout and slow uptake. These hurdles stand to be higher in poorer countries, where governance, government coordination, and disparities between rural and urban health facilities tend to be more severe, making “last mile” delivery and widespread vaccination harder.
Developing Countries Facing High Costs and Limited Supplies
The pandemic has wreaked havoc on economies across the globe, causing serious slowdowns and economic contractions, straining the ability of developing countries’ governments, which already have minimal public healthcare spending and healthcare capacity, to secure costly vaccines. On average, wealthier countries moved early and secured limited supplies, severely constraining access in the developing world. None of the African countries in the Index, for example, has secured vaccine supplies, and barring any change with this, they will have to rely on international financial institutions and other partners to fill gaps to keep the pandemic from worsening. Incidentally, the countries listed have relied on very aggressive policy, notably stay-at-home orders, early school shutdowns, and restricting public gatherings, to limit COVID-19’s impact, but it is unclear how long they can keep it up without increased international assistance, most notably for vaccines.
Significant funding commitments will be required. A full treatment of the Pfizer or Moderna vaccine costs $40 or more, which becomes very expensive for poorer nations needing to purchase hundreds of millions of doses. In addition, indirect costs to store, transport, and administer the vaccine are substantial. All the vaccines require cold temperatures, in particular the Pfizer vaccine, which requires specialized freezers. As such, delivery will require refrigerated vehicles, temperature-monitoring devices, and adequate roads to transport vaccines to rural locations. Glass vials, syringes, and needles and other critical supplies add to the costs.
Pharmaceutical companies, among other entities, have stated that they would make low-cost doses available for poorer countries. However, with high-income countries already having purchased over four billion doses (out of approximately eight billion total available), and no evidence of direct deals between vaccine manufacturers and low-income countries, poorer countries will have to rely entirely on the approximately 20 percent of supplies purchased through global vaccine initiatives such as the World Health Organization’s (WHO) COVAX – a collaboration between governments and manufacturers which seeks to provide equitable access to COVID-19 vaccines. Even if these are all provided at discount prices, they only amount to 1.4 billion doses, enough for just the populations of Indonesia, Pakistan, and Brazil, for example. While the COVAX initiative is seeking to provide equitable access to both rich and poor countries, it faces serious funding concerns: COVAX currently estimates it needs to raise another $6.8 billion for 2021, $6 billion of which could facilitate supply and delivery to developing countries.
In addition to the aforementioned challenges, geopolitical tensions could affect select countries’ finances, limiting their access to vaccines. Iran, currently the lowest-scoring country in the Index, is a prime example. U.S. sanctions on Iran place severe restrictions on that country’s banking system that add additional administrative hurdles that are complicating its access to humanitarian and medical goods. The U.S. Treasury Department only recently allowed Iran to transfer money from its banks to the COVAX fund to purchase vaccines.
Vaccine Nationalism Further Hampering Global Distribution
Vaccine nationalism (when, according to RAND, countries “push to get first access to a supply of vaccines, and potentially hoard key components for vaccine production”), has characterized production and initial rollout. Countries have largely financed vaccine research independently, instead of pooling resources multilaterally, resulting in over 100 disconnected efforts around the globe to bring effective vaccines to market. Even with the multilateral COVAX initiative, which seeks to provide equitable access to vaccines, richer countries are negotiating side deals to obtain exclusive doses from pharmaceutical companies. Barring an exponential increase in doses produced, this almost certainly will result in substantial delays for poorer countries to secure adequate supplies of vaccines.
Even suppliers that regularly provide vaccines and drugs to the developing world, notably the Serum Institute in India, will face serious challenges. As the largest vaccine manufacturer globally, Serum will be critical to the provision of COVID-19 vaccines to the developing world. It is planning to provide one billion doses to poorer nations, in partnership with AstraZeneca. However, the Institute has stated that half its production will be for India, where the coronavirus caseload trails only that of the United States globally, significantly limiting availability for other developing countries.
Further, vaccine nationalism could be extremely costly to the global economy at large: a RAND study puts the economic damage of unequal COVID-19 vaccine allocation at $1.2 trillion per year, with losses coming predominantly from contact-intensive sectors, like tourism, travel, and transportation, compared to equitable global vaccine distribution. Conversely, according to the Eurasia Group, equitable distribution could generate an estimated $153 billion in economic benefits by the end of this year, which could triple to over $460 billion by 2025 when accounting for just 10 major economies. The transnational reality of the virus and stark costs of vaccine nationalism make greater multilateral collaboration on global vaccine deployment an imperative as gaps in distribution will allow for further spread and increase the risk of additional mutations. Failure to address these gaps multilaterally will also create opportunities for ‘vaccine diplomacy’ and exertion of soft power — particularly in lower-income countries.
Comprehensive Policies Remain Critical to COVID-19 Management
The range of challenges noted above will play heavily into the overall recovery from the pandemic. The Index highlights the differences among countries’ responses and will incorporate more vaccine-related data as it becomes available. As countries continue to work to mitigate the many negative effects of COVID-19 with aggressive policies—including contact tracing, appropriate limitations of social interactions, and financial support—greater, more equitable distribution of vaccines will be needed to emerge from the crisis. In the meantime, countries must maintain vigilance and continue to implement a range of policy and financial measures to contain the spread.
Wealthier Countries Locking Up Limited Vaccines
|Country||GDP Per capita||% Of population fully covered by purchased vaccinations|
European Union Countries
Sources: World Bank, World Economic Outlook, Duke University, Iceland Ministry of Health, New York Times, Reuters
Findings from the Index and supplementary research indicate:
Countries Imposing Restrictions Again as Case Numbers Continue to Rise
The latest round of data on COVID-19 cases and reopening of some economies illustrates a key point: the world is still facing challenges with COVID-19, and many countries have had to re-impose restrictions to contain further spread. As expected, as the weather became colder in many of the pandemic’s worst-hit countries, case rates have risen, as more people are indoors. While countries with higher Index scores continue to have generally managed cases more effectively, even they have seen increases in the virus within their borders. This indicates that, until the vaccines reach a large share of the world’s population, countries are unlikely to eliminate COVID-19. However, it also shows that those with stronger policies and practices are likely to more effectively minimize the damage. The restrictions have helped mitigate coronavirus spread. Seen notably in France, Denmark, Belgium, and Switzerland, serious restrictions helped all these countries reverse skyrocketing case rates.
- Level 1: Officials recommend not leaving the house
- Level 2: Officials issue stay-at-home orders requiring that people not leave the house with exceptions for daily exercise, grocery shopping, and ‘essential’ trips
- Level 3: Officials issue stay-at-home orders requiring that people not leave the house with few exceptions (e.g. people are allowed to leave once a week or only one person can leave at a time); in some cases, monitoring of civilians is enforced
Early and Targeted Policies, Better Outcomes
Countries with higher index scores generally have better in-country status of COVID-19, including lower death and case rates, and positive test results. Preparation, targeted testing, and quick action have had impacts. However, several outliers skew the data. Lack of transparency in reporting likely boosts some countries’ outcomes, while early contact tracing and management—such as in Taiwan and South Korea—aren’t sufficiently captured, due to lack of disaggregated data. Contextual information enriches our understanding of each of these countries and will continue to inform and augment our analysis as additional data becomes available.
OVERALL COVID-19 INDEX SCORE AND IN-COUNTRY COVID-19 STATUS
Circle colors reflect categories on the vertical axis
Crisis Planning Has Enabled Rapid Response
Planning and preparation for health-related crises have enabled rapid response and COVID-19 containment. Notably, lessons learned from H1N1 and Ebola have informed crisis planning and preparedness in Kenya, Ghana, Ethiopia, and Australia, among the best performers in the Index.
Clear Policy Directives Matter
Countries’ socio-economic and health security—and investment to those ends—strengthen capacity to respond but are insufficient to manage the crisis. Clear healthcare directives and early, targeted actions seem to have significantly impacted outcomes in many of the highest-scoring countries—notably Ghana, Kenya, India, Ethiopia, and New Zealand. On average, countries with strong public health directives managed to limit COVID-19 spread. While some wealthy countries with strong pre-COVID healthcare capacity were able to mitigate total deaths without strong directives, countries with stronger health directives minimized COVID-19's impacts even more.
PUBLIC HEALTH DIRECTIVES AND IN-COUNTRY COVID-19 STATUS
Circle colors reflect categories on the vertical axis
Early Investment in Emergency Healthcare Cushioned Impact
Early investment and strategic stockpiles of medical supplies and personal protective equipment have helped enable healthcare response, notably in France, Kenya, Japan, and New Zealand.
Close Coordination with State and Regional Governments Remains Key
Close coordination and clear communication among federal, state, and regional entities have been critical to resource allocation and policy directive implementation, notably in Australia, Canada, and Germany.
Testing and Contact Tracing Have Been Game Changers
Contact tracing has been key to managing the crisis, notably in Taiwan, Germany, and South Korea, though data regarding the degree of tracing and efficacy is not yet sufficient or differentiated to reflect the full importance and positive impact of these measures. In the case of Taiwan, utilization of data and analytics has enabled the country to effectively manage the crisis and avoid strict lockdowns. Widespread availability of testing has enabled countries to quickly identify new outbreak clusters and effectively implement quarantine protocols to prevent spread.
*Given data limitations with respect to contact tracing, Taiwan’s and South Korea’s successes are not adequately captured in the Index, but both are notable leaders in this regard and in overall management of the pandemic. Several countries that employed advanced and aggressive contact tracing or other measures mitigated their need to implement other major COVID-19-specific policies, as seen in their low case rates. The Index adjusts for these outliers. Please refer to the methodology for further detail.
Overall Funding and Mechanism of Financial Support Matters
Financial support to companies—enabling them to keep workers on the payroll—and relatively strong worker wage support have helped to mitigate COVID-19’s economic fallout, notably in Australia, Ethiopia, France, Ghana, Kenya, and New Zealand. These countries took both assertive action on the public health response and also passed considerable economic support to mitigate economic shocks, elevating their scores overall. On average, countries that have had relative success managing COVID-19 impacts have provided more robust financial support during the crisis.
FINANCIAL POLICY AND IN-COUNTRY COVID STATUS
Circle colors reflect categories on the vertical axis
Misinformation and Press Limitations Associated with Poor COVID-19-related Outcomes
While not causal, the majority of countries whose leaders have engaged in the spread of misinformation and have limited press freedom with respect to COVID-19 are among those with the highest case rates, notably the U.S., Iran, Hungary, Brazil, Mexico, and the U.K..
COUNTRIES WITH LOW COMMUNICATION POLICY SCORES AND OVERALL INDEX AND POLICY SUBCATEGORY SCORES
Bar color indicates rank on overall index or within policy subcategories
Challenges with Data from China
While China scores near the top in terms of COVID-19 status, having relatively low case and death rates, as reported by the Central Government, it scores near the bottom in the Index in terms of policy. Failure by Chinese authorities to consistently report data on key metrics, such as testing, as compared with other countries, as well as limited transparency on other metrics, results in data gaps contributing to a low overall policy score. The gap is exacerbated by China scoring particularly low on the fact-based communications measure, which includes measuring press limitations on covering the pandemic. This inconsistency also should make it clear that the Index policy score aims to evaluate a country’s range of policies. While that is often tied closely to the current status of COVID-19 in a country (the number of cases), it is not always so, as policy and capacity and other factors, including proximity to countries with major COVID-19 outbreaks, all impact the state of coronavirus in a country.
Disproportionate Socio-economic Impacts Warrant Further Study
Countries with significant shares of migrant workers and large informal economies—including India, Brazil, and Kenya—face unique challenges, due to workers’ limited access to healthcare and mechanisms for extending financial support, putting these populations at exceptional risk.
FPA would like to acknowledge those working on the front lines of the pandemic and to thank the public health and policy experts who contributed to this study. We would also like to thank all of those working to systematically track and report COVID-19-related data, including the University of Oxford, the Johns Hopkins University, the Centers for Disease Control and Prevention, and a range of international institutions, such as the IMF, the World Bank, and the United Nations. FPA’s COVID-19 Global Response Index will continue to be updated with the help of these and other globally available databases.
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Statistics and government response factors available on each country profile include:
- Debt to GDP ratio
- Infant mortality rates
- Hospital beds per 1,000 people
- Gini coefficients measuring inequality
- Health access and quality
COVID-19 Public Health Directives:
- Stay-at home orders
- School-closing policy
- Public-gathering restrictions
- Cancellation of public events
- Testing policy and rates per 1,000 people
- Emergency healthcare spending per capita
- Travel restrictions
- Contact tracing
COVID-19 Financial Response:
- Stimulus package as a share of GDP
- Income support
- Instances of misinformation by leadership
- Limitations on press freedom, censorship
Current/Historic In-Country COVID-19 Status:
- Death rates per 1 million
- Case rates per 1 million