Via JAMA Network: Suboptimal US Response to COVID-19 Despite Robust Capabilities and Resources. Excerpt:
Several factors may help explain why the US has struggled more than many other countries to suppress COVID-19, and the GHS Index may provide some possible insights. Despite its top overall ranking on the index, the US received a low score on a key factor that can determine how well a country is able to react to a pandemic: public confidence in the government.
The US is one of only a small number of high-income countries in the Index that received the lowest possible score on public confidence in the government. Poor confidence in the government can undermine the public’s adherence with disease-control measures, such as wearing masks or stay-at-home recommendations, and has been reported among the existing challenges to the US COVID-19 response.
In addition, the US received low scores on important indicators pertaining to the strength of its health system and the ability of its people to access health care without barriers. For example, among the 60 high-income countries in the GHS Index, the US ranked 38th for its number of physicians per capita and 40th for its number of hospital beds per capita. On access to health care, the US was ranked 175th globally due to its absence of laws mandating universal health care coverage and large numbers of underinsured and uninsured individuals. A lack of guaranteed access to health care for all citizens leaves many individuals vulnerable during times of emergency. In 2020, the US Congress passed legislation to remove cost barriers for SARS-CoV-2 testing, but testing costs remain and have been cited as a barrier to expanding the number of tests performed in the US.
Overall, the US was well poised to respond to COVID-19, but it has lacked strength in key areas. Although the US established a national stockpile of medicines, personal protective equipment, and ventilators, when signs of a new outbreak surfaced, calls by federal officials to replenish and augment these supplies were ignored.
The US also failed to harness its own technical expertise, such as that within the CDC. Although the US has a world-class network of public health and clinical laboratories that had the capacity to develop their own assays to test for SARS-CoV-2, federal restrictions initially prevented these laboratories from doing so. This severely constrained the number of tests the US could conduct (and likely allowed the virus to spread around the country undetected) until these restrictions were eventually lifted. Even now, the lack of a national testing strategy and unaddressed shortages in testing supplies continue to limit the country’s ability to suppress SARS-CoV-2.
What is most puzzling is that the US has been significantly involved in helping other countries to amass their own capacities to prepare for events like COVID-19. During the Obama administration, the US launched the Global Health Security Agenda and has contributed financial and technical support to help countries develop public health capacities to prevent, detect, and respond to infectious disease outbreaks. Thailand’s epidemiological capabilities were developed with large contributions of funding and expertise from the US. Even though the US lacks a national strategy for testing and conducting surveillance for COVID-19, it has previously helped other countries develop such strategies for other diseases.
International experts agree that the COVID-19 pandemic as a test case of the capacities as assessed by the GHS Index remains highly relevant. However, going forward, the Index should include new or stronger metrics about additional capacities, such as medical supply chains and a better understanding of national leadership. The strength of a country’s leadership and the confidence of its people in their government and their leaders is just as important (if not more important) than technical capacities. Future versions of the Index will give greater weight to these factors.
During the years to come, the US undoubtedly will undergo national-level reviews to understand how its strong capabilities were squandered when the country needed them the most. In the meantime, the country’s health and economic security will continue to be adversely affected until national leaders change course.
