Analytical observational study evaluating global pandemic preparedness and the effectiveness of early COVID-19 responses in Ethiopia, Nigeria, Singapore, South Korea, Sweden, Taiwan, UK and USA

BMJ Open. 2022 Feb 2;12(2):e053374. doi: 10.1136/bmjopen-2021-053374.


Objectives: An analysis of early country-specific COVID-19 strategies and the impact of policies, healthcare resources and cultural influences on their effectiveness.

Design: Analytical observational study.

Setting: USA, UK, Sweden, South Korea, Singapore, Taiwan, Ethiopia and Nigeria.

Main outcome measures: OxCGRT indices were used to quantify variations in governments' responses, and effectiveness was measured by the number of deaths as a proportion of the population. Hofstede's cultural dimensions, and the availability of healthcare resources, were analysed for their potential impact on effectiveness.

Results: Effective strategies reflect factors such as speed of governmental intervention, cultural norms, population demographics and available resources. While biases, confounders and lack of data at the beginning of the pandemic make inferences challenging, publicly available data suggest that South Korea, Singapore and Taiwan were most successful through rapid identification and isolation of cases, and effective contact tracing systems.

Conclusion: The rapid spread of the highly transmissible SARS-CoV-2 virus took many countries by surprise and the delayed global response contributed to the severity of the COVID-19 pandemic. The speed at which strategies were implemented is highly correlated to the number of deaths. Factors such as cultural norms and healthcare resources impact effectiveness significantly, implying that implementation of a global 'one size fits all' approach is challenging. Global preparedness should focus on effective surveillance and preparedness strategies to enable timely identification and containment of future threats.

Keywords: COVID-19; public health.

Publication types

  • Observational Study

MeSH terms

  • COVID-19*
  • Ethiopia
  • Humans
  • Nigeria
  • Pandemics* / prevention & control
  • Republic of Korea / epidemiology
  • SARS-CoV-2
  • Singapore
  • Sweden
  • Taiwan
  • United Kingdom