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Thomas J Bollyky, Erin N. Hulland, Ryan M Barber, James K Collins, Samantha Kiernan, Mark Moses, David M Pigott, Robert C. Reiner, Reed J D Sorensen, Cristiana Abbafati and 75 more
BACKGROUND: National rates of COVID-19 infection and fatality have varied dramatically since the onset of the pandemic. Understanding the conditions associated with this cross-country variation is essential to guiding investment in more effective preparedness and response for future pandemics. METHODS: Daily SARS-CoV-2 infections and COVID-19 deaths for 177 countries and territories and 181 subnational locations were extracted from the Institute for Health Metrics and Evaluation's modelling database. Cumulative infection rate and infection-fatality ratio (IFR) were estimated and standardised for environmental, demographic, biological, and economic factors. For infections, we included factors associated with environmental seasonality (measured as the relative risk of pneumonia), population density, gross domestic product (GDP) per capita, proportion of the population living below 100 m, and a proxy for previous exposure to other betacoronaviruses. For IFR, factors were age distribution of the population, mean body-mass index (BMI), exposure to air pollution, smoking rates, the proxy for previous exposure to other betacoronaviruses, population density, age-standardised prevalence of chronic obstructive pulmonary disease and cancer, and GDP per capita. These were standardised using indirect age standardisation and multivariate linear models. Standardised national cumulative infection rates and IFRs were tested for associations with 12 pandemic preparedness indices, seven health-care capacity indicators, and ten other demographic, social, and political conditions using linear regression. To investigate pathways by which important factors might affect infections with SARS-CoV-2, we also assessed the relationship between interpersonal and governmental trust and corruption and changes in mobility patterns and COVID-19 vaccination rates. FINDINGS: The factors that explained the most variation in cumulative rates of SARS-CoV-2 infection between Jan 1, 2020, and Sept 30, 2021, included the proportion of the population living below 100 m (5·4% [4·0-7·9] of variation), GDP per capita (4·2% [1·8-6·6] of variation), and the proportion of infections attributable to seasonality (2·1% [95% uncertainty interval 1·7-2·7] of variation). Most cross-country variation in cumulative infection rates could not be explained. The factors that explained the most variation in COVID-19 IFR over the same period were the age profile of the country (46·7% [18·4-67·6] of variation), GDP per capita (3·1% [0·3-8·6] of variation), and national mean BMI (1·1% [0·2-2·6] of variation). 44·4% (29·2-61·7) of cross-national variation in IFR could not be explained. Pandemic-preparedness indices, which aim to measure health security capacity, were not meaningfully associated with standardised infection rates or IFRs. Measures of trust in the government and interpersonal trust, as well as less government corruption, had larger, statistically significant associations with lower standardised infection rates. High levels of government and interpersonal trust, as well as less government corruption, were also associated with higher COVID-19 vaccine coverage among middle-income and high-income countries where vaccine availability was more widespread, and lower corruption was associated with greater reductions in mobility. If these modelled associations were to be causal, an increase in trust of governments such that all countries had societies that attained at least the amount of trust in government or interpersonal trust measured in Denmark, which is in the 75th percentile across these spectrums, might have reduced global infections by 12·9% (5·7-17·8) for government trust and 40·3% (24·3-51·4) for interpersonal trust. Similarly, if all countries had a national BMI equal to or less than that of the 25th percentile, our analysis suggests global standardised IFR would be reduced by 11·1%. INTERPRETATION: Efforts to improve pandemic preparedness and response for the next pandemic might benefit from greater investment in risk communication and community engagement strategies to boost the confidence that individuals have in public health guidance. Our results suggest that increasing health promotion for key modifiable risks is associated with a reduction of fatalities in such a scenario. FUNDING: Bill & Melinda Gates Foundation, J Stanton, T Gillespie, J and E Nordstrom, and Bloomberg Philanthropies.
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Bollyky, T. J., Hulland, E. N., Barber, R. M., Collins, J. K., Kiernan, S., Moses, M., Pigott, D. M., Reiner, R. C., Sorensen, R. J. D., Abbafati, C., Adolph, C., Allorant, A., Amlag, J. O., Aravkin, A. Y., Bang-Jensen, B., Carter, A., Castellano, R., Castro, E., Chakrabarti, S., … Dieleman, J. L. (2022). Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. The Lancet, 399(10334), 1489–1512. https://doi.org/10.1016/s0140-6736(22)00172-6
Bollyky, Thomas J, et al. "Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021." The Lancet, vol. 399, no. 10334, 2022, pp. 1489–1512, https://doi.org/10.1016/s0140-6736(22)00172-6.
Bollyky, Thomas J, Erin N. Hulland, Ryan M Barber, James K Collins, Samantha Kiernan, Mark Moses, David M Pigott, et al. "Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021." The Lancet 399, no. 10334 (2022): 1489–1512. https://doi.org/10.1016/s0140-6736(22)00172-6.
Bollyky T. J., Hulland E. N., Barber R. M. [и др.] Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021 // The Lancet. — 2022. — Vol. 399, № 10334. — P. 1489–1512. — URL: https://doi.org/10.1016/s0140-6736(22)00172-6
@article{bollyky2022pandemic,
title = {{Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021}},
author = {Thomas J Bollyky and Erin N. Hulland and Ryan M Barber and James K Collins and Samantha Kiernan and Mark Moses and David M Pigott and Robert C. Reiner and Reed J D Sorensen and Cristiana Abbafati and Christopher Adolph and Adrien Allorant and Joanne O Amlag and Aleksandr Y Aravkin and Bree Bang-Jensen and Austin Carter and Rachel Castellano and Emma Castro and Suman Chakrabarti and Emily Combs and Xiaochen Dai and William James Dangel and Carolyn Dapper and Amanda Deen and Bruce B Duncan and Lucas Earl and Megan Erickson and Samuel B Ewald and Tatiana Fedosseeva and Alize J Ferrari and Abraham D Flaxman and Nancy Fullman and Emmanuela Gakidou and Bayan Galal and John Gallagher and John R Giles and Gaorui Guo and Jiawei He and Monika Helak and Bethany M Huntley and Bulat T. Idrisov and Casey Johanns and Kate E LeGrand and Ian D Letourneau and Akiaja Lindstrom and Emily Linebarger and Paulo A Lotufo and Rafael Lozano and Beatrice Magistro and Deborah Carvalho Malta and Johan Månsson and Ana Maria Mantilla Herrera and Fatima Marinho and Alemnesh H Mirkuzie and Ali H Mokdad and Lorenzo Monasta and Paulami Naik and Shuhei Nomura and James Kevin O'Halloran and Christopher M Odell and Latera Tesfaye Olana and Samuel M Ostroff and Maja Pasovic and Valeria Maria de Azeredo Passos and Louise Penberthy and Grace Reinke and Damian Francesco Santomauro and Maria Inês Schmidt and Aleksei Sholokhov and Emma Spurlock and Christopher E Troeger and Elena A. Varavikova and Anh T Vo and Theo Vos and Rebecca Walcott and Ally Walker and Simon Wigley and Charles Shey Wiysonge and Nahom Alemseged Worku and Yifan Wu and Sarah Wulf Hanson and Peng Zheng and Simon Iain Hay and Christopher J L Murray and Joseph L Dieleman},
journal = {The Lancet},
year = {2022},
volume = {399},
number = {10334},
pages = {1489--1512},
doi = {10.1016/s0140-6736(22)00172-6},
url = {https://doi.org/10.1016/s0140-6736(22)00172-6}
}TY - JOUR AU - Bollyky, Thomas J AU - Hulland, Erin N. AU - Barber, Ryan M AU - Collins, James K AU - Kiernan, Samantha AU - Moses, Mark AU - Pigott, David M AU - Reiner, Robert C. AU - Sorensen, Reed J D AU - Abbafati, Cristiana AU - Adolph, Christopher AU - Allorant, Adrien AU - Amlag, Joanne O AU - Aravkin, Aleksandr Y AU - Bang-Jensen, Bree AU - Carter, Austin AU - Castellano, Rachel AU - Castro, Emma AU - Chakrabarti, Suman AU - Combs, Emily AU - Dai, Xiaochen AU - Dangel, William James AU - Dapper, Carolyn AU - Deen, Amanda AU - Duncan, Bruce B AU - Earl, Lucas AU - Erickson, Megan AU - Ewald, Samuel B AU - Fedosseeva, Tatiana AU - Ferrari, Alize J AU - Flaxman, Abraham D AU - Fullman, Nancy AU - Gakidou, Emmanuela AU - Galal, Bayan AU - Gallagher, John AU - Giles, John R AU - Guo, Gaorui AU - He, Jiawei AU - Helak, Monika AU - Huntley, Bethany M AU - Idrisov, Bulat T. AU - Johanns, Casey AU - LeGrand, Kate E AU - Letourneau, Ian D AU - Lindstrom, Akiaja AU - Linebarger, Emily AU - Lotufo, Paulo A AU - Lozano, Rafael AU - Magistro, Beatrice AU - Malta, Deborah Carvalho AU - Månsson, Johan AU - Herrera, Ana Maria Mantilla AU - Marinho, Fatima AU - Mirkuzie, Alemnesh H AU - Mokdad, Ali H AU - Monasta, Lorenzo AU - Naik, Paulami AU - Nomura, Shuhei AU - O'Halloran, James Kevin AU - Odell, Christopher M AU - Olana, Latera Tesfaye AU - Ostroff, Samuel M AU - Pasovic, Maja AU - Passos, Valeria Maria de Azeredo AU - Penberthy, Louise AU - Reinke, Grace AU - Santomauro, Damian Francesco AU - Schmidt, Maria Inês AU - Sholokhov, Aleksei AU - Spurlock, Emma AU - Troeger, Christopher E AU - Varavikova, Elena A. AU - Vo, Anh T AU - Vos, Theo AU - Walcott, Rebecca AU - Walker, Ally AU - Wigley, Simon AU - Wiysonge, Charles Shey AU - Worku, Nahom Alemseged AU - Wu, Yifan AU - Hanson, Sarah Wulf AU - Zheng, Peng AU - Hay, Simon Iain AU - Murray, Christopher J L AU - Dieleman, Joseph L TI - Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021 JO - The Lancet VL - 399 IS - 10334 SP - 1489 EP - 1512 PY - 2022 DA - 2022/02/01 DO - 10.1016/s0140-6736(22)00172-6 UR - https://doi.org/10.1016/s0140-6736(22)00172-6 ER -
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