How well did your country recover from the pandemic?

Published September 29, 2023

Key takeaways:

  • Low vaccine confidence – including in routine childhood immunizations like measles – is a major challenge faced by health systems across the world.
  • Education levels have been profoundly affected by the pandemic, including lower attendance overall and loss of learning.
  • Dr. Emmanuela Gakidou and Dr. Ali Mokdad discuss the results from our new Pandemic Recovery Survey, showing the health and wellness of 21 countries following the pandemic.

Listen to the podcast

Explore the Pandemic Recovery Survey

This transcript has been lightly edited for clarity.

Pauline Chiou: Welcome to the Global Health Insights podcast at the Institute for Health Metrics and Evaluation. I'm Pauline Chiou in Media Relations. It's been more than three and a half years since COVID thrust the world into lockdown.

And we're emerging from this pandemic with new insight from the Pandemic Recovery Survey, which is a health and wellness snapshot of 21 different countries.

Now, the lead investigators on this project and the survey are Dr. Emmanuela Gakidou and Dr. Ali Mokdad, both of IHME. Thank you to both of you for being with us to talk about the survey. 

Dr. Gakidou, let me start with you. Now, the survey asked a variety of different questions, covering different categories. And we should mention that there were many partners for this. People answered questions on Facebook. Meta was a partner with IHME, as well as the University of Maryland and the Ludwig-Maximilians-Universität in Munich.

From a 30,000 foot view, what was the main purpose of this survey?

Dr. Emmanuela Gakidou: Thanks, Pauline. I think, as you said, you know, three and a half years later, a lot of people are wondering what is the state of the world's health and well-being after we've gone through such a massive shock for the last three and a half years?

There is a wide sense that the pandemic has affected many aspects of life well beyond health, and with this project we tried to get a snapshot of where we're at in 21 countries, by asking a variety of different questions on the impacts that people may have felt, not just on health and health care, but also in terms of life satisfaction, food security, income, education, and also some other perceptions related to trust in institutions, governments and other, the scientific community and other organizations.

Pauline Chiou: Yes, it was a wide spectrum of different categories. What, there was so much to dig into, there really is. And people can go to the data visualization tool on our website to see the different categories, but if you had to boil it down, what were the main findings?

Dr. Emmanuela Gakidou: Well, why don’t I start with a couple and then I will let Ali also add here, because there are so many findings, because of the number of different topics that the survey touched on.

I will start by just saying that the impacts of the pandemic are still being felt in all of the countries, all 21 countries that are part of this study. And I'll just mention two noteworthy findings that stood out, particularly to me.

One is a very low level of confidence in vaccines, not specifically COVID-19 vaccines. We asked about routine immunizations, childhood immunizations, and general attitudes towards immunizations.

And across the 21 countries, I would say one of the major challenges that health systems and societies are facing right now is the low confidence towards vaccinations.

And I'll mention one other finding that I think is very important, is the impacts of the pandemic on education. Across the 21 countries, we saw that a lot of learners had to drop out of school, and that the education system, both in terms of just students going to school, but also what they learned and the quality of the schooling, has been profoundly affected.

And I'll pass it over to Ali for additional findings.

Dr. Ali Mokdad: One other interesting finding is people are delaying seeking medical care due to cost, which was surprising for all of us, especially in countries where there is a universal health scheme.

And people are reporting, I'm not seeking medical care and I needed medical care, but because of cost, I wasn't able to get the needed medical care.

We intended in this survey, Pauline, as in any disaster, and this pandemic, which nobody expected, usually prepare a response and you spend a lot of time on recovery. And we looked at this data for recovery in order to put it in front of decision makers to help with recovery from the effects of the pandemic.

And as Emm mentioned, Dr. Gakidou mentioned, there are a lot of things that are coming up here that we feel strongly that this will enable government to better this recovery using the data that we have, especially knowing what they have to deal with.

Pauline Chiou: Well, let's dive into some of the topics that both of you brought up. Dr. Gakidou, you mentioned vaccine hesitancy and this low level of confidence in vaccines.

I mean why, when you consider that the COVID-19 vaccine saves so many people, what would you say is the reason behind the still low level of confidence, and did you see lower levels in certain countries versus other countries?

Dr. Emmanuela Gakidou: Yeah, I think this is a very complicated topic, and this is certainly not the first or only study that is trying to get at both the levels of vaccine confidence, but also some of the reasons behind it. Keeping in mind that this was a survey that was administered through smartphones, we have not been able to go into detail into the reasons why people are feeling hesitant.

But from the questions that we were able to ask, we heard that a lot of people are very concerned about side effects. That was one of the predominant reasons people were quoting, as well as a lot of people raising concerns about vaccines not being compatible with their personal beliefs.

I would say, in terms of the results, that there isn't really one country or any country that stands out as not really having a problem in this area. I think vaccine hesitancy is much higher across the board than we would want it to be.

But there are a few countries, for example, Indonesia, with a very high population of young children, but also countries like Japan, where the rates of hesitancy are very high and the proportion of people that respond that they believe that vaccines are effective and safe are very low.

Fewer than half of the respondents state that, and that is a massive indication that there's a lot of work to be done in these countries to raise confidence in vaccines.

And especially in countries that we surveyed, like Indonesia, with one of the largest population of under-five children in the world, it's very important to keep high rates of immunization for the routine vaccines,

So that not just for current health, but also for the future health of the upcoming generations in these countries.

Pauline Chiou: And wasn't Italy a country that was kind of interesting, Dr. Mokdad, in terms of vaccines and the levels of vaccination there, yet the parents thinking towards vaccinations.

Dr. Ali Mokdad: Unfortunately, as Dr. Gakidou mentioned, we've seen a wide range between countries. But if you put it into perspective and, again, we don’t have all the detailed information to explain why, but we have seen the vaccine confidence has been declining even before COVID-19.

And you've heard about outbreaks here in the United States, measles in Europe, for example, and what has happened during COVID-19, because unfortunately, it was the spread of many rumors against COVID-19 vaccine, it has spilled over to other vaccines.

And we are very much concerned about vaccination. Vaccines save lives. And we are so concerned that the decline in confidence in vaccine, in many countries, and that could be true in other countries that we did not survey, that that will lead to an increased mortality from the vaccine-preventable diseases in the future.

And yes, Italy has a unique characteristic when it comes to vaccine coverage, Brazil as well, for example, a country that has high vaccination rate also has a surprising high hesitancy as well, or no trust in vaccines.

So there is a lot of work to be done ahead. Building trust, and health education, to tell parents how important it is to get their kids their vaccines.

Pauline Chiou: And speaking of trust, the trust in government question was very interesting as well. And overall, when you looked at the answers among the 21 countries, scientists and health officials got the thumbs up in terms of being trustworthy.

Yet government was considered the least trustworthy. Looking ahead to the next public health crisis, that's going to be a big problem if people aren't trusting the government.

So, Dr. Gakidou and Dr. Mokdad, what do you think governments need to do right now to start building trust? Either of you can take it.

Dr. Ali Mokdad: OK, you know, unfortunately, when you have trust and you lose it, it's very hard to get it back again. But it's not impossible. And what we have seen before in many countries, they spend a lot of time in health education, reaching out to parents, showing people why vaccines are important.

But the most important part is to roll your sleeve and get the vaccine yourself and to lead by example.

And sometimes people, you know, in different countries when they don’t trust the vaccine, or they feel a vaccine is provided for free, in a country where services, usually you have to struggle to get it and pay for it. We need to overcome that and say these vaccines are for free because it saves a lot of lives and money.

And to build that trust will take time, and it will involve not only the government but academia.

As you said, people trusted academia, people trusted physicians to involve them in this. Community leaders, religious leaders, everybody has to be part of this, sports figures, anybody who's trusted in a locality, and public health is local.

You need to work with them in order to build that confidence in vaccines. And it's a long road ahead, but we need to start today, and it's doable, it's not impossible.

Pauline Chiou: That's such a great line that you just mentioned. Public health is local. It starts at the local level. Dr. Gakidou, do you have any thoughts in terms of building trust?

Dr. Emmanuela Gakidou: Yeah, I totally agree with everything that Dr. Mokdad said, and I would encourage governments and local leaders to also explore our results.

What we found across the 21 countries was different levels of trust. So the institutions or individuals that people trust in each country varies. And so I would start by looking at who does the local population, find the most trustworthy source, and engage them in a campaign to regain the trust, keep consistent messaging.

I think something that hurt trust throughout the pandemic was inconsistent messaging across various stakeholders, and so another thing that potentially governments could do would be to bring all the institutions and organizations that people turn to for advice and insights, and have a consistent message.

Some countries were very good at doing that during the pandemic and others were not. And I think, in this phase of rebuilding and regaining trust, it will be very important if local populations hear the same message across different sources.

Pauline Chiou: And if the public or policymakers want to learn more about this survey, they can go to our website, where they can access country briefs from the 21 countries and also dive a little deeper into some of the other categories, like education, as well as health care, and why people had delayed their health care.

There's a lot of data, a lot of information and a visualization tool people can use to compare countries.

Dr. Emmanuela Gakidou and Dr. Ali Mokdad, thank you so much for fleshing this out for us.

Dr. Ali Mokdad: Can I add one thing for vaccine confidence and building trust that, we need to do more on health education when it comes to vaccines. For example, many vaccines, especially childhood vaccine, will prevent the disease.

Get a vaccine for measles, you don't get measles, and you will never die from it because you don't get it. Polio, for example.

Whereas a vaccine like COVID-19, you get the vaccine that was designed to prevent severe illness and hospitalization.

And what has happened during COVID-19 is that many people who got COVID vaccine got COVID, and they now lost the trust in vaccines.

And we need to explain that and say, you know, I got a COVID vaccine personally not to prevent me from getting COVID, I didn't want to end up in a hospital, in an emergency room or in intensive care. And I don't didn't want to die from COVID-19.

Whereas, for childhood vaccination it’s totally different, and that's very important to distinguish for the public in order to build their trust in vaccine.

Pauline Chiou: And people can see the data when they go onto the website to see the childhood vaccination rates and what parents are thinking in different countries.

Thank you so much for this important message. We really appreciate the conversation.