City Research Online

Macro level influences on strategic responses to the COVID-19 pandemic – an international survey and tool for national assessments

Ahmad, R. ORCID: 0000-0002-4294-7142, Atun, R. A., Birgand, G., Castro-Sanchez, E. ORCID: 0000-0002-3351-9496, Charani, E., Ferlie, E., Hussain, I., Kambugu, A., Labarca, J., McKee, M., Mendelson, M., Singh, S., Varma, J., Zhu, N., Zingg, W. and Holmes, A. H. (2021). Macro level influences on strategic responses to the COVID-19 pandemic – an international survey and tool for national assessments. Journal of Global Health,


Background: Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning.

Methods: A cross-sectional electronic survey of health and non-healthcare professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains – Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks.

Results: 928 respondents from 66 countries (57% healthcare professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains.

Conclusions: The tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.

Publication Type: Article
Additional Information: This work is licensed under a Creative Commons Attribution 4.0 International License .
Subjects: G Geography. Anthropology. Recreation > GE Environmental Sciences
G Geography. Anthropology. Recreation > GF Human ecology. Anthropogeography
H Social Sciences > HN Social history and conditions. Social problems. Social reform
J Political Science > JS Local government Municipal government
Q Science > QR Microbiology > QR355 Virology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: School of Health Sciences > Healthcare Services Research & Management
Date Deposited: 23 Mar 2021 15:13
Text - Accepted Version
Available under License Creative Commons: Attribution International Public License 4.0.

Download (1MB) | Preview



Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login