While researchers and institutions all over the world are gathering an increasing amount of data and evidence on the evolution of the COVID-19 pandemic in general, the situation in small countries is being analyzed to address their distinctive needs in this respect. To find a long-term solution, one of the crucial questions to be answered is “how can we design health and economic systems that will be more resilient to future pandemics?” To discuss the issue, a panel of experts gathered on 2 September 2020 for a webinar organized by the WHO Collaborating Centre on Health Systems and Policies in Small States (University of Malta) (which provides support to the WHO Small Countries Initiative), with input from the Islands and Small States Institute (ISSI) of the University of Malta.
Are small countries more exposed or protected than larger countries?
The situation related to COVID-19 in small countries is complex and diverse. They do not all face the same challenges; both disadvantages and assets can be identified as regards their exposure to the virus and their capacity for response. Therefore, researchers and policy-makers are looking into a complex set of social and economic interaction patterns, as well as the specific qualities of local health systems. Small countries might benefit, for instance, from a more cohesive community approach, which in turn would make it easier to coordinate and implement various measures, particularly those aimed at surveillance and control. As Dr Natasha Azzopardi Muscat, Director Country Health Policies and Systems, WHO Regional Office for Europe, mentioned, “a small jurisdiction makes it easier for the government to identify and address shortcomings”.
On the other hand, small countries might be more exposed. For example, Professor Lino Briguglio, a researcher at the University of Malta, sees “travel connectivity”, for both tourism and business, as crucial to the transmission of the virus. He argues that “due to the increasing ease and affordability of air travel and mobility of people, transmission of airborne, food-borne and vector-borne infectious diseases have become an important public health issue”.
Ensuring access to equipment- and vaccine-supply chains
Another topic that increased the attention of public health authorities, particularly during the crucial early stages of the pandemic, is the global procurement of equipment (such as personal protective equipment (PPE) or hospital and laboratory equipment). There is a recognized requirement for supply-chain management to tackle the most urgent needs of the population and health personnel. This issue could very well extend into the future when vaccines start to be produced and become available.
While virtually every country in the world was competing at the same time for essential goods (gloves, masks, etc.), several of the small countries were struggling to keep up. They lacked both the infrastructure to produce the goods and the capacity to challenge larger countries in accessing the limited stocks. Therefore, concerned international organizations stepped up their support to small countries: WHO, for example, is currently developing a new initiative, namely the Access to COVID-19 Tools (ACT) Accelerator, which involves global collaboration to “accelerate development, production, and equitable access to COVID-19 diagnostics, therapeutics, and vaccines”. This initiative, and specifically its COVAX (vaccine) Pillar, is likely to be extremely significant when vaccines start to be mass-produced. More joint effort is required, however, to facilitate access to this innovation at affordable prices.
Building resilience
Other researchers, such as Dr Stefano Moncada, Director of ISSI and focal point of the Climate Change Platform at the University of Malta, have sought to underline the necessity for small countries to build up their resilience to health pandemics. This is particularly relevant in the context of climate change, which affects them disproportionately compared to larger and possibly more resilient economies. As Dr Moncada alleges: “There is an argument, especially at international level, to build a system that promotes and funds the building of resilience, since in small countries this comes at a much higher cost”. For instance, some small countries cannot rely on having several hospitals to provide a custom-built response to a pandemic, something which larger countries have been able to do by creating dedicated COVID-19 facilities and networks.
If there is one key lesson to be learned from the pandemic, it is, as Dr Natasha Azzopardi Muscat puts it, that “stronger multilateralism for health must be developed to benefit those that are most vulnerable”. Synergies among national and international actors are needed to address complex social, economic and environmental patterns to understand how pandemics affect small countries and how appropriate responses can be designed and implemented.