Before the advent of the COVID-19 pandemic, several countries had their preparedness for pandemics assessed via the Global Health Security Index (GHSI).1 The USA and the UK were identified as two countries most prepared. Experiences with COVID-19 have shown that in-depth assessments of outbreak preparedness need to go beyond publicised plans.
Prior assessments of countries such as Vietnam (ranked 50th on the GHSI) and New Zealand (35th on the GHSI)1 are inconsistent with actual performance.2 In practice, it is better to benchmark countries during a pandemic in ways that allow information on outcomes and performance to be obtained, analysed, reported, and used in real time. In its April, 2020, COVID-19 Strategy Update WHO recommended that every country implement a comprehensive set of measures to slow down transmission and reduce mortality.
Assessment of the performance of COVID-19 response systems in implementing these measures is key to relaxing lockdowns and opening of borders between and within nations. It requires an understanding of public health capacities, government actions, and community behaviours, recognising that people, communities, and nations everywhere are learning to live with COVID-19.
Making decisions about border closures or lockdown status without such an assessment gives insufficient attention to the extent to which communities are capable of living with the virus; simply put, actions are taken without some of the essential factors being considered. To try to keep cases of COVID-19 sustained at zero while waiting for a vaccine to become available is a naive option and will result in enormous social and economic harm and isolation for an indefinite period. There are no guarantees that an effective vaccine will be available soon and have high community uptake. The other extreme of accepting uncontrolled transmission leads to excess all-cause mortality and overwhelmed health systems. As people everywhere make sense of the threats posed by COVID-19, they expect decision makers to help them limit both risks to their health and any restrictions on their lifestyles and livelihoods.