The COVID-19 Global Response Index

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:

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
Switzerland	$70,989	60.7%
Norway	$66,832	66.4%
United States	$65,118	182.8%
Iceland	$60,061	63.7%
Australia	$53,320	225.1%
Taiwan	$53,270	84.0%
Canada	$51,342	453.1%
Saudi Arabia	$48,909	4.3%
United Kingdom	$48,710	270.3%
EU	$46,467	177.1%
New Zealand	$43,953	226.0%
Japan	$43,236	114.6%
South Korea	$43,029	64.4%
Russia	$29,181	0.2%
Turkey	$27,875	32.3%
Argentina	$22,947	52.0%
Mexico	$20,411	55.8%
China	$16,785	3.5%
Brazil	$15,259	46.1%
Iran	$14,536	0.0%
South Africa	$12,999	1.3%
Indonesia	$12,302	74.1%
India	$7,034	10.9%
Kenya	$4,509	0.0%
Senegal	$3,536	0.0%
Ghana	$5,637	0.0%
Ethiopia	$2,312	0.0%

Sources: World Bank, World Economic Outlook, Duke University, Iceland Ministry of Health, New York Times, Reuters

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.

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.

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.

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.

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.

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..

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.