News of the outbreak of an unknown virus in Wuhan, China, quickly caught the attention of South African disease experts in December 2019. In the event the virus spread globally, those experts understood that the South African government would find itself face to face with two persistent challenges. First, although an upper-middle-income country, South Africa was also the world’s most unequal. Within the country, household access to health care varied dramatically, as did the vulnerability of livelihoods to economic shocks. Second, there were wide disparities in the levels of readiness across the provinces, districts, and cities that would manage the front lines of any response. During mid-March 2020, as the first South African residents fell ill, the government set up a structure for making policy decisions. It vested responsibility for pandemic response coordination in the security services, implemented stringent restrictions on movement, and used the country’s natural disaster management system to try to align policy with the provinces. The Department of Health, already focused on disease surveillance, testing, and other technical functions, cochaired many of the work streams in those institutions. Nonetheless, during the first wave, poorer provinces and districts struggled to respond effectively, and the national government—with external help—surged assistance to those areas. The investment helped contain the spread of infection and return the country to lower alert levels, but disparities in capacity, illness, and deaths persisted in subsequent waves. The country continued to adapt and performed better on several metrics than did a number of similarly situated counterparts. However, the experience pinpointed the difficulties of boosting local preparedness and addressing underlying inequalities amid a crisis.

Jennifer Widner and Andile Cele drafted this case study based on interviews conducted in South Africa during 2021. Tyler McBrien assisted with some of the background research. Case published March 2024.

In mid-2020, Tunisia stood out as a star within its region. The first wave of the COVID-19 pandemic had taken a high toll in the Middle East and North Africa. But by the end of the second week of August, as the first wave ebbed, Tunisia had recorded 149 cumulative cases per million people—compared with more than 800 per million in Algeria, Egypt, Morocco, and most of the rest of the region. Tunisia’s epidemic curve was almost flat. However, the good news was short-lived. By mid-August, the number of COVID-19 cases had started to rise, and by October the number of cases per million in Tunisia matched that of other countries in the area. A year later, Tunisia was a regional hot spot. This case study profiles the difficulty of containing the spread of disease when local governments are new and have limited capacity, when public health guidance from a national government modulates or weakens, and when political distrust runs high.

Mariam Ghanem and ISS staff researched and wrote this case based on research conducted during May, June, and July 2021. Case published January 2022. This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

In early January 2020, when the World Health Organization announced that SARS-CoV-2 had spread beyond Wuhan, China, and represented a public health risk of international concern, Costa Rica was better prepared than other countries in its region. The Central American nation had years earlier developed preparedness and response plans to deal with swine flu, avian flu, Ebola, and other infectious diseases and had updated them in 2018. There was high confidence in both the country’s universal health-care system and the government health-care teams that served even the remotest regions of the country. Doctors had access to an up-to-date database of medical histories that covered more than three-quarters of the population of about 5 million. However, the country also had some vulnerabilities: more than a fifth of the populace lived in poverty; many jobs were associated with international tourism—a sector likely to be hit hard in a pandemic; and the government was wrestling with a fiscal crisis that had started years earlier. Weeks before Costa Rica confirmed its first case of COVID-19, ministries and national institutions began work to procure medical supplies and equipment, set up financial and social assistance programs, and develop a road map to build resilience for the tourism industry. When the virus appeared in early March, the national government declared a state of emergency within days to ensure that every ministry and institution could contribute effectively to the pandemic response. Initial confirmed infections were relatively low in number, but as case numbers grew through 2020, collaborations with partners both national and international led to innovative solutions to avoid a nationwide lockdown and make Costa Rica the first country in Latin America to safely reactivate commercial air travel and international tourism before year’s end.

Miguelángel Verde researched and wrote this case based on interviews conducted during August, September, October, and November 2021. Case published January 2022. This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

When Africa’s most populous country, Nigeria, confirmed its first case of COVID-19, President Muhammadu Buhari tapped the former head of the country’s HIV/AIDS control program, Dr. Sani Aliyu, to design the country’s COVID-response coordination system. Aliyu’s coproduction model partnered Nigerian government experts with United Nations agencies and other organizations that had essential capacities and gave each of them with specific roles. Because Nigeria’s federal system of government endowed the states with major responsibility for public health, Aliyu’s team worked to support governors and state-level emergency operations. The team soon realized that lockdowns were very difficult to maintain in a country where most households depended on income from the informal sector, so it employed a hot-spot strategy in lieu of nationwide lockdowns. To help fine-tune the response, the team conducted weekly national polls to assess residents’ knowledge, perceptions, and behaviors and then adjusted its messages to secure greater compliance with safety measures. Gradually, the government also reached several million vulnerable households with social and economic support. Nigeria ended the first year of the pandemic without repeated surges in serious cases requiring medical care, and it was able to close many of the temporary treatment centers it had set up.

Emily Tenenbom and staff drafted this case study based on interviews conducted during August and September 2021. Bunmi Makinwa assisted. Case published January 2022. This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

When the first case of COVID-19 reached Germany in January 2020, the country’s world-class medical and scientific institutions snapped into action to contain—and learn from—an outbreak in Bavaria. As the pandemic escalated, Chancellor Angela Merkel, a scientist by training, based the government’s response on epidemiological models and expert advice. But Germany’s strictly federalized political system reserved power for the 16 states, not the central government. To coordinate the kind of nationwide response needed to curb the spread of the virus, Merkel’s government developed new coordination bodies that harmonized physical-distancing policies across the country. After a nationwide lockdown slowed the initial spread, a response model of federal government guidance and support but with decentralized, local implementation enabled Germany to quickly ramp up both testing and contact-tracing capacities. As a result, from January through October 2020, Germany contained the virus more effectively than any large country in Europe or North America. At year’s end, however, political consensus about how to respond to the virus broke down. With a vaccine on the horizon and the public tired of lockdowns, states hesitated to reimpose restrictions, and new infections surged.

Gordon LaForge drafted this case study based on interviews conducted in February 2021. Case published October 2021.

When SARS-CoV-2 began spreading in Colombia in mid-March 2020, the national government feared the worst: a collapse of the health system. In response, President Iván Duque Márquez ordered the strictest nationwide lockdown in the Western Hemisphere. To implement the lockdown, the national government centralized authority, coordinated a trial run in the city of Bogotá, and relied on epidemiological data from an updated reporting system. The lockdown curbed the initial spread of the virus and bought the government time to increase intensive-care capacity. But the shutdown of the economy threatened to push millions in Colombia’s informal sector into poverty. The government rapidly expanded the social safety net, which nearly doubled the total number of welfare beneficiaries. It also took steps to provide assistance for the highly vulnerable population of 1.8 million Venezuelan migrants in the country. As the lockdown continued into its third month, the high socioeconomic costs of isolation and the government’s lack of consultation with municipalities, which were heterogeneous and were each affected differently by the virus, led to a breakdown in compliance. By the end of the year, new daily infections were at all-time highs, and though the government had kept millions out of poverty, social unrest loomed.

Gordon LaForge drafted this case study based on interviews conducted with the assistance of Miguelangel Verde in May, June, and July 2021. Case published September 2021.This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

Senegal entered the COVID-19 pandemic with what seemed to be grave disadvantages, among them the inability of most households to adjust to prolonged lockdowns, given their dependence on wages they earned day to day. But the West African country also enjoyed an advantage: it was well prepared for an epidemic. In the years following the 2014 Ebola outbreak, Senegal had built a comprehensive health-care emergency response system, and when COVID-19 arrived in March 2020, Senegal moved fast. President Macky Sall declared a state of emergency and announced immediate restrictions to limit the spread of the virus. The country’s emergency operations center became the headquarters for a dedicated COVID-19 Incident Management System, and the Dakar branch of the international Pasteur Institute helped develop a rapid diagnostic test. The government spent 7% of its gross domestic product—more than any other country in Africa—on socioeconomic support measures. The response team credited those measures with the successful containment of community spread during the first wave of the disease. During 2020, the numbers of ill people coming to hospitals and health facilities for treatment remained low, and disease models suggested that subsequent waves were generally of short duration—even after an October religious pilgrimage that had brought thousands together under crowded conditions.

Leon Schreiber and Matthew Schofield drafted this case study based on interviews conducted with the help of Placide Muhigana in February, March, and June 2021. Case study published August 2021. This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

When SARS-CoV-2 emerged in Wuhan, China, in late 2019, Vietnam’s scientists knew their country was in grave danger. Vietnam, a country of 97 million, shared an 870-mile land border with China, its biggest trade and tourism partner. Adding to the risk posed by the virus, Vietnam was a lower-middle-income nation with limited resources and an already overtaxed health-care system. But in the years after the 2003 outbreak of SARS, a deadly respiratory ailment that traumatized East Asia, Vietnam had built a robust pandemic-preparedness system that swiftly mobilized to confront the threat of SARS-CoV-2. After Vietnam recorded its first case on January 22, 2020, the prime minister declared all-out war on the virus no matter the cost to the economy. The government moved swiftly to implement border closures, extensive contact tracing, targeted lockdowns, and a strict quarantine protocol. Relentless and creative communications based on accuracy, transparency, and timeliness built public trust and compliance with public health measures. After more than three months with no community transmission, the country experienced an outbreak in Da Nang that spread across the nation and threatened to spiral out of control. But Vietnam’s authorities carried out a massive testing, tracing, and quarantine program that halted the contagion. As of December 31, 2020, Vietnam had recorded only 1,465 cases and 35 deaths—and it had posted the highest annual GDP growth of any economy in Asia.

Gordon LaForge drafted this case study based on interviews conducted in March and April 2021. Case published June 2021.This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

As soon as the Republic of Georgia’s National Center for Disease Control and Public Health (NCDC) sounded an alarm about a cluster of unusual pneumonia cases in Wuhan, China, Prime Minister Giorgi Gakharia’s government set its pandemic response into motion.  It was early January 2020, and there was still no hard evidence that the infection had spread across borders, but the country’s health leaders were wary. As outbreaks of the virus, identified as COVID-19, began to appear in other countries, the government quickly created a multisectoral coordination council chaired by the prime minister and then adopted a number of emergency response measures. Working with a network of local public health centers, the NCDC launched a communications blitz, with scientists and physicians at the forefront. The public health campaign encouraged compliance with stringent—and unpopular—lockdown measures. Through the first half of 2020, the weekly number of new cases remained low, even as infections surged in many high-income industrial countries. But it was too early for a victory lap. Pressure grew to open up resort centers during July and August in an economy heavily dependent on tourism. During September, October, and November the number of new cases per day climbed sharply, driven mainly by expansion of the outbreak in Adjara, a vacation destination. Compared to most European countries, the incidence of disease remained low, however, and the number of new infections later plummeted, approaching initial levels by March 2021. This case study highlights how a small, middle-income country with a privatized and decentralized health-care system initially succeeded in its pandemic response, struggled with sharp reversals, and then brought the infection rate close to earlier levels prior to vaccine distribution.

Tyler McBrien drafted this case study based on interviews conducted with Nona Tsotseria, MD, PhD, in January and February 2021. Case published June 2021. This case study was supported by the United Nations Development Programme Crisis Bureau as part of a series on center-of-government coordination of the pandemic response.

The views expressed in this publication are those of the author(s) and do not necessarily represent those of the United Nations, including UNDP, or the UN Member States.

In early 2020, a novel coronavirus spread from Wuhan, China, to almost every corner of the globe. COVID-19 caused devastation in every country where it gained a foothold and was allowed to spread through the population. When the first cases hit New Zealand at the end of February and beginning of March, Prime Minister Jacinda Ardern moved decisively by adopting a “go hard, go early” lockdown strategy to stop the virus from spreading across the island nation. Behind Ardern stood a small cadre of civil servants and infectious disease experts who studied the rapidly evolving science of pandemic response—and the virus itself—and made policy recommendations to Ardern and her cabinet. Behind that response team stood a battalion of police, healthcare professionals, and other essential workers ready to implement the policies. And behind them stood everyday New Zealanders—whom Ardern referred to as “the team of 5 million”—who gave up personal freedoms for the greater good during a mandatory national lockdown. A far-reaching and comprehensive communication effort drove strong public acceptance as the government shifted health directives and policies in response to the fast-changing situation. After May 1, the country went 102 days with no locally transmitted cases of the virus. However, a new outbreak of cases in August plunged Auckland, New Zealand’s largest city, back into lockdown and made clear that extreme vigilance was necessary to protect New Zealanders from the pandemic raging abroad.

Blair Cameron drafted this case study based on interviews conducted in Wellington, New Zealand, in July and August 2020. Case published September 2020.