Discussion
In an era where countries are prone to in-country and cross-border health emergencies, there is the need to augment existing quantitative preparedness measures with lived actions and practices in the response to pandemics. Our scoping review highlights the relatively newer strategies employed by the countries that are not explicitly included in existing quantitative preparedness tools. The COVID-19 crisis was different in length from previous health emergencies and needed unique interventions in addition to those that were done previously for which preparedness indicators exist. Countries used all strategies in their reach, including following and adapting the WHO’s guidance (online supplemental material 2) to respond and control the spread of COVID-19. Though there are similarities in both the COVID-19 and Ebola responses strategies to previous epidemics, there were strategies in the response that countries employed that had not been extensively used in previous pandemics.
We found that countries leveraged experiences and lessons from previous outbreaks to respond to COVID-19. Lessons were not limited to outbreaks that happened within their countries but also experiences from other countries. These lessons continue to shape and reshape how countries respond to disease outbreaks. For example, adaptation of previous pandemic response plans shortened planning for the COVID-19 response and ochestrated the use of previous pandemic surveillance for timely reporting of cases,16 17 and Ebola experiences from West Africa inspired the development of new technology tools for COVID-19 contact tracing in Taiwan.18 Though such a tool may not replace the traditional contact tracing, it improves effectiveness and requires less resources compared with traditional contact tracing. A country’s ability to learn and use experiences from previous epidemics that occured either within or outside its boundaries would improve efficiencies in the response. It is, therefore, important to archive after-action review reports and to integrate past epidemic response strategies into countries preparedness and response plans.
Some countries leveraged the prevailing trust in leadership, role models and community champions to rally the population to take up testing, vaccination and adhere to prevention measures, although the hardships that were involved. For example, community health workers who were initially rejected by communities in Liberia during the Ebola outbreak because of their linkage to health facilities and community mistrust in health facilities, with time built relationships with the communities that helped to address trust and stigma around Ebola. They eventually conducted community engagement and social mobilisation on EVD control and prevention.19 Following experiences from the Ebola response, mistrust in the government of Sierra Leone negatively affected the COVID-19 testing, vaccination and adherence to preventive measures.20 Trust in the leadership, role models and community champions as well as in the healthcare system should be evaluated and leveraged during the pandemic response.
Some epidemic control measures such as prolonged lockdowns, negatively affected economic activities in countries. Our findings show that governments took economic and social actions to not only minimise secondary effects of COVID-19 response measures but also strengthen adherence to quarantine during the peak of the pandemic. Families and businesses were impacted and some countries intervened by providing subsidies to business enterprises and in some cases providing stimulus cheques directly to their citizens.21 22 Citizens spent these funds majorly on food items. This helped cushion both the businesses and the citizens from the effects of a prolonged pandemic. On a microeconomic level, the Chinese government increased investment and issued targeted loans to enterprises to boost the economy and improve household incomes.23 The shutdown of businesses, loss of jobs and the impact of countermeasures such as lockdowns suggest that during a prolonged pandemic, citizens need protection measures such as unemployment insurance that can be sustainable for a long period of time. Global standards on social protection during a prolonged pandemic would guide countries on how to support their citizens in such crises.24
With restrictions on movement and social distancing countermeasures, countries adapted and exploited the use of information technology (IT) in various forms. Our findings show that countries were able to develop technology solutions on the go and used them to engage the public during the pandemic. Technology was used in infection detection through information transfer, to assess risk of infection, tracking infected individuals and interventions and during postintervention as telemedicine.25 Phone applications using distance points were used to not only notify users if they were getting close to a person infected with COVID-19 but also used for contact tracing.26 27 Countries’ ability to develop and use technology on the go during COVID-19 demonstrated their potential to integrate technology into future disease outbreaks responses.
As countries grappled with controlling the pandemic, it was important to protect the vulnerable population, especially the elderly and those with chronic diseases from COVID-19 infection.28 Vulnerable populations are at increased risk because of their conditions, limited preparedness planning for them, increased risk of exposure and service disruption.29 Telemedicine and telepharmacy were used to review patients who did not need urgent care or invasive procedures and deliver medication, shielding them from the high risk of COVID-19 infection at health facilities.30 31 These experiences indicate the need for countries to consider the vulnerable groups when responding to disease outbreaks.29
We also found that a country’s ability to scale up and adapt existing platforms to respond to the outbreak was handy to control the epidemic. There was creativity in repurposing existing infrastructure to respond to COVID-19. To increase the uptake of testing for COVID-19, countries like South Korea and Israel implemented drive-through testing.32 33 This increased the volume of individuals tested and treated despite the limited number of PPE used by health workers.34 In UAE, field hospitals were set up to reduce the patient load in major hospitals.35 As countries develop or revise their emergency contingency plans, the inclusion of infrastructure that can be repurposed such as hotels, treatment centres is very important in the event of surge capacity.
