There has been a great deal of variation in the proportion of COVID-19 cases and deaths across states throughout the world during the pandemic. The United States, on the one hand, along with Western European states such as Britain, Italy, and Spain, and Latin American states such as Mexico, Brazil, and Argentina (along with various other countries throughout the world), had high levels of infection and death rates early on. Asian nations such as China, South Korea, Singapore, and Vietnam, and Pacific island nations such as Australia and New Zealand, (again, along with various other countries throughout the world), had low levels of infection and death rates. What accounts for such variation?
Both structural and individual-level factors have affected COVID-19 case counts and death rates. At the structural or macro-level, some countries went into the pandemic more favorably predisposed to containing it than others. At the micro-level, how individuals in positions of leadership, as well as those within the mass public, have reacted, has mattered. Here are 10 important factors that have impacted transmission and death rates.
DemographyGiven that COVID-19 is more likely to cause severe illness and death among the elderly, regions with youthful populations are less vulnerable to COVID-19. Africa, where the median age is (slightly) under 20 years old, has had an advantage here, whereas Europe, which has an aging population, has not.
GeographyCountries that have natural boundaries that are difficult to cross (such as Australia as an island nation), are better able to control their borders to prevent those who might be infected from coming in from abroad. Here again, Europe has been at a disadvantage given the close proximity of countries that share land borders on the continent (and free movement within the EU). States with rural populations are less vulnerable given natural distancing, compared to highly urbanized areas where citizens are crammed into city centers.
SizeThere are fewer logistical hurdles to providing relief and distributing vaccines in smaller countries. It is unsurprising that small countries such as Malta have been near the top in vaccination rates while large nations such as India have had a harder time vaccinating their citizenry.
General healthThose who are obese and/or have preexisting health conditions are at increased risk of hospitalization and death from COVID-19 compared to those who are healthier. This leaves states such as Mexico, for example, where there are high rates of obesity and diabetes, more vulnerable than those states with healthier populations, such as Japan, which has the lowest obesity rate of countries in the OECD (an international organization of developed nations).
State capacityIt might be tempting to conclude that authoritarian countries have had an advantage in containing the spread of COVID-19 due to a centralization of decision-making, an enhanced ability to impose draconian lockdown measures, and the Chinese Communist Party’s observed success in limiting the damage from COVID-19 within China. But as Harvard’s Francis Fukuyama has pointed out, there has not been a clear trend between the type of political system that a state has (democratic vs. authoritarian) and its handling of the pandemic. Some democracies, such as Japan and South Korea, have fared relatively well, while other democracies, such as the United States and India, have not. Authoritarian states have similarly had varying levels of success in containing the virus.
More important than whether or not a state is democratic, is state capacity. Unsurprisingly, countries with better developed and more efficient health care services and bureaucratic systems have fared better during the pandemic (such as Israel) than nations with weak and disorganized healthcare services and government systems.
Economic developmentEconomically-advanced nations are better able to protect their citizens from the economic fallout caused by COVID-19 (as observed in the United States, for example, through the passage of massive economic relief bills), and have had better access to, and are better able to afford, COVID-19 jabs. And white-collar workers (who are more abundant in developed nations) are more likely to be able to work remotely (at desks, using phones and computers to communicate), putting themselves less at risk than blue-collar workers (such as those in manufacturing or in providing essential services) and those who work in the informal sector (selling goods independently on the street, for example), which typically requires one’s physical presence.
LeadershipSome leaders have been more effective than others in responding to the pandemic. In general, nations with populist leaders who are distrustful of “experts” or the “elite”, such as the presidents of the United States, Brazil, and Mexico through the initial phases of the pandemic, have fared poorly. This has partly been the result of such leaders downplaying, ignoring, and even in some cases, deriding the advice of public health officials.
Political cultureAlong with how leaders have responded, how individuals in the mass public have responded has mattered as well. The United States fared poorly early on in the pandemic perhaps partly due to a deeply ingrained individualistic culture and longstanding skepticism of government authority, making it less likely for there to be compliance with lockdown measures. Nations with high levels of societal trust, such as South Korea and elsewhere in Asia, fared better.
Vaccination ratesDeveloped nations have better access to approved vaccines, though some, including the United States, have been held back by vaccine hesitancy.
Prior exposure to pathogensThis is somewhat speculative, but some have suggested that death rates from COVID-19 were initially lower in places such as Vietnam and India due to prior exposure to pathogens that provided some cross-immunity.
Identifying the factors that affect the likelihood of the spread of COVID-19 is important so that the “lessons” of COVID-19 can be applied to the next pandemic. Some factors are more difficult to control than others. Countries cannot easily alter geographic realities, for example. But when it comes to factors that we have more control over, such as whether or not we comply with lockdown measures and mask mandates, hopefully the next time we will all be a little bit more like South Korea and other nations that have managed the pandemic well, and less like those who have learned the lessons of the pandemic the hard way.
David R. Dreyer is a political science professor at Lenoir-Rhyne University.