One of the most commonly-asked questions of health care experts is—which country has the best health care system? Radio Advisory's Christopher Kerns sat down with Advisory Board's Vidal Seegobin to try and answer that question by looking at how different countries around the world have handled the Covid-19 pandemic and what that says about the quality of their health care system.
Covid-19 tested national health systems—and they responded largely as designed
Read a lightly edited excerpt from the interview below, and download the episode for the full conversation.
Christopher Kerns: So when I think about the course of the pandemic, I often like to think of things in three acts. There is the initial phase of infection and transmission. There is the second phase of vaccine development, so what do we do once we have gotten to a level of stability in overall infection rates, but we still don't have a vaccine. And then last vaccine deployment. And I'd like to know how each of these different systems and their structural factors impacted performance on each of these.
So let's start at the very beginning. When we think about infection rates, what structures enabled certain countries in your analysis, to do better than others?
Vidal Seegobin: On the infection and transmission spread phase, I think Australia showed that closing borders, putting tight restrictions on people's freedoms and ability to move within the economy and society definitely did have a clear benefit of keeping the transmission and spread of the virus particularly low.
And I would also note pretty early on in the transmission phase Australia, because it had both a public and private health system, were able to structure their approach such that the first line of defense, in case we lost control of community spread, would go to public systems where we had public beds to provide care. A backstop was the private systems.
So the government said, "We will keep you as backup and in case we are overrun on our public side, too many people and not enough beds, we will then sequester private hospital beds to provide additional capacity." They never really needed that, but I think it afforded them a level of comfort to know that if they had to, they could ramp up additional bed capacity pretty quickly.
Kerns: And it's probably fair to say that the federalized system of the United States really prevented the ability to control that spread. There was really no chance that we were ever going to be able to do that, given the inability to restrict people across state borders.
Seegobin: Yeah, and I think that's another major point that's important, that's perhaps not replicable if an American is looking to Australia. So when the community spread was pretty pronounced in Victoria in and around Melbourne in particular, Queensland, New South Wales restricted access from anyone coming from that state into their state, which we know could not happen here in the United States.
Kerns: And that strong and focus on civil liberties is also a factor in the UK as well. I think that's fair to say.
Seegobin: That's true. That's very true.
Kerns: What about vaccine development?
Seegobin: So I think we clearly have to say that U.S. investment in R&D and exposure to market forces where a lot of pharmaceutical companies do recoup a lot of their R&D costs by selling directly to consumers or to many different providers, creates a virtuous cycle by which we saw rapid development of the vaccine, for which I think the world benefited from.
So if I was to give a gold star to one health system or one country for the vaccine side, in terms of its development and quick rollout, particularly to health care workers, we're talking about December and January, I definitely have to give that to the United States.
Kerns: And then finally, what about the vaccine deployment?
Seegobin: So there are two elements that kind of underpin the vaccine deployment. The first is the friction that is either created or removed when I want to access the vaccine. And I'd have to give top marks to England for having very clearly used its primary care doctor or in their terms, general practitioner network, as the first line defense for the public.
So what that looked like, if I was a senior citizen, I got a letter from my GP to tell me what time and what date to show up for my vaccination and that's all I had to do. They took care of all of the scheduling, of all of the ramping up of the and the distribution. And I think when we're thinking about January, February, or even earlier than that, that was a clear win for England.
Kerns: What about the U.S., which also had a generally successful vaccine rollout? Now, we can argue about whether or not it stalled, but I think most would argue that at the very beginning of the vaccine rollout U.S. was making pretty strong progress.
Seegobin: Yes, I think that that's true. Part of the issue, and this is my own heuristic, is that about 50% of the population of any country is really wanting the vaccine as soon as possible. The benefit that the United States had was a very diffused distribution model, where there were multiple openings for you to get your vaccine and that could vary depending on which state.
So for me, I was able to get my vaccine at the Walmart that was really close by. So you're thinking very easy to find, I know exactly what to expect, I got that pretty quickly and pretty easily. So that part of the equation works pretty well.
The second part is how you get past that 50%. So how you start to message to other people who might be reticent for a whole host of reasons, the vaccine is safe, the vaccine works in terms of it's reducing your risk of hospitalization.
And I don't think any one country has perfected that communication strategy where I do think it has worked, comes to that point that I mentioned earlier, which are countries that have or maintain a higher level of faith or trust in their governments, that may not be the same across any two, three countries and are harder to replicate or to improve with any one tactic or policy.
Kerns: Now Australia, from what I understand has a relatively high level of trust in its government, it has centralized decision making, but it also has some distribution diversity as well, but they seemed to struggle a bit with their vaccination rollout. What accounts for that in your view?
Seegobin: There are a couple of factors that I think contribute to why Australia, if I was to be a little bit hard on them, dropped the ball from being one of the early leaders here in terms of very low case rates and pretty few deaths compared to their population size.
So they made a bet that the one vaccine that they were going to dedicate national infrastructure behind was going to be the AstraZeneca vaccine. And when there started to be, or percolate concerns about risks for people around 50, that started to cause a lot more friction in terms of people accessing the vaccine.
The second is that for a lot of people, particularly if you are not in Victoria, where the Melbourne issue was pretty front and center, very little of your life felt different and so there didn't really feel like a lot of pressure to race to get to the vaccine. And when it felt like AstraZeneca might be a little dodgy, they would wait.
And then unfortunately what that required then was Australia to get back onto the market, to purchase Pfizer and Australia as a country while wealthy is not the wealthiest country in the world, and it's not the largest. And so you start to move into the queue when it comes to getting inventory, that of course is limited, and that of course caused additional delays in their ability to access the vaccine.