AuthorDirectorate-General for Health and Food Safety (European Commission)
The organisation of resilient health and social care
following the COVID-19 pandemic
The current pandemic caused by coronavirus SARS-CoV-2 poses a threat to every
country i n th e world. The argument fo r a concerted international response to
microorganisms can be summarised as “germs do not respect nationa l borders”. Early in
the COVID-19 pan demic, on the 27th of March 2020, members of the EX PH argued in a
blog in BMJ Global Health, for greater European solidarity and cooperation in the
response to COVID-19 (De Maeseneer J, Barros P et al . 2020). Its impact, measured by
numbers i nfected an d d ying, has varied enormously among and within countries. Some
of this was luck. Those countries, such as Italy, that were among the first to receive
infected individuals had little time to develop a comprehensive response (Boccia, Cascini
et al. 2020). Yet others that saw their fi rst cases sometime later also struggled to control
the disease. In the second wave, many EU countries saw higher number of infections,
beyond what they experienced in the first wave.
Even the most superf icial i nspection of the geographi cal distribution of infections
worldwide identifies clusters of coun tries that have performed well and others that have
performed poorly. Most obviously, countries and territories in East Asia, such as Hong
Kong, Korea, Taiwan (Han, Chiou et al. 2020), and Vietnam, have done well (Legido-
Quigley, Asgari et al. 2020). However, despite limited resources, some countries in
Africa, such as Rwanda (Binagwaho 2020) and Liberia, have also managed to avoid the
experience of countries that are much weal thier. Both of these groups of countries have
one thing in common. They have recent experience of dealing with highly infectious
disease outbreaks, in the former case SARS or MERS and the latter Ebola. Consequently,
they had put in place a range of measures that meant that they could respond effectively
to another serious threat from a novel infectious agent. As some commentators have
noted, countries can be divided into those that based their r esponse on a SARS
paradigm, in which the goal is elimination of infection, and those that employed an
influenza paradigm, based on an acceptance that the disease would ultimately spread
through the population with relatively little that could be done. Many of the “SARS
countries had implemented wide-rangin g changes to their health systems, including
investment in disease surveillance and r edesign of health facilities to reduce cross
infection. It is now clear that the former have been much more successful than latter.
Some other countries have also been successful in controlling the pandemic. The small
island states and the Pacific have an obvious advantage by virtue of their ability to
control th e relativel y low volume of international travel. In some cases, such a s Samoa
(Thornton 2020), they share with countries in East Asia and Africa the recent experience
of threats from i nfectious diseases, especiall y measles. In others, political scientists have

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