COVID-score: A tool to evaluate public perception of countries' response to the pandemic
The Barcelona Institute for Global Health (ISGlobal), a center supported by the "la Caixa" Foundation, in coordination with the City University of New York Graduate School of Public Health & Health Policy (CUNY SPH) and other international institutions, has developed an easy and reliable tool to evaluate the public perception of governmental response to the COVID-19 pandemic.
According to an analysis of the first results obtained across 19 countries, the COVID-SCORE questionnaire can help public health officials and other decision makers identify and correct weaknesses in key aspects of a country's response, and track trends as the pandemic evolves.
Government response to the COVID-19 pandemic has varied considerably between countries. Although most governments have implemented a series of common measures such as mobility restrictions, closure of businesses, places of worship and schools, or shelter-at-home orders, the timing and approach have differed. One key element that determines the course of a pandemic is a society's compliance with such measures, which in turn depends on several factors such as trust in government or the clarity of the information that government sources provide.
"We need basic tools to help us assess the public perception of government responses in key aspects such as communication, or access to health services and social welfare," says Jeffrey V Lazarus, researcher at ISGlobal. Together with international colleagues, Lazarus coordinated the development of COVID-SCORE with 10 items related to key aspects of the government response, to be rated by the interviewees.
The study Lazarus and his colleagues published in PLOS ONE validates the tool and presents the first results from a survey conducted in June 2020 with over 13,400 participants from 19 countries heavily affected by the pandemic. The average score varied considerably between countries—from 35.76 out of a maximum of 100 for Ecuador to 80.48 for China, the country whose response was rated most positively. Countries in Asia tended to have higher scores, while Latin-American and European countries were among those with lowest scores.
As expected, the average score for a country was strongly associated with the level of trust in government, as reported in this survey and measured independently by the Wellcome Global Monitor.
"We know that public compliance with preventive measures greatly depends on the trust in public health experts, health systems and science," says Ayman El-Mohandes, Dean of CUNY SPH. Higher COVID-19 mortality or a greater percentage of respondents directly affected by the disease correlated with a lower score for the country, the researchers found.
The average score for the United States, with 773 respondents, was 50.57. Highest rated (3.16 out of 5) was the government's assistance with income, food, and shelter during the pandemic: this finding corresponds with the timing of the survey, which took place soon after initial emergency funds were distributed last spring. Notably, the US ranked seventeenth among the 19 countries surveyed with regard to government cooperation with other countries and international organisations such as the WHO (3.03 out of 5).
Spain, with 748 respondents, obtained an average score of 44.68. The highest-rated item was relative to the government's cooperation with other countries and international organisations such as the WHO (3.46 on a 1 to 5 scale), while the lowest-rated item was access to free and reliable COVID-19 testing in case of symptoms (2.09).
In all countries, questions about protection and assistance to vulnerable groups and help in meeting daily needs for income, food and shelter rated poorly, which underscores the need to give particular attention to the most vulnerable. Provision of mental health services was the lowest-rated item across all countries.
"This tool is easy to implement and can guide researchers and authorities in designing measures to better control the pandemic," says El-Mohandes. In addition, it can be done at different moments to assess the response as the pandemic evolves.
Average Score by Country
- China 80.48
- South Korea 74.54
- South Africa 64.62
- India 63.88
- Germany 61.32
- Canada 61.00
- Singapore 57.55
- Italy 51.71
- United States 50.57
- France 49.20
- Russia 48.85
- United Kingdom 48.66
- Mexico 46.48
- Nigeria 46.32
- Spain 44.68
- Sweden 42.07
- Poland 41.28
- Brazil 36.35
- Ecuador 35.76