Assessing the impact of local context and priorities regarding domestic disease outbreaks and imported risk on early pandemic response: Cross-continental comparisons.

Introduction: Containment and closure policies are effective measures used in the early stages of a highly transmissible global pandemic such as COVID-19 to mitigate the spread and reduce transmissions. However, these policies can have negative impacts on the economy and personal freedom. Governments must carefully consider the necessity of increasing their stringency. Local contexts and priorities regarding domestic disease outbreaks and the risk of imported cases from other countries may vary among different countries, and could influence the decision to increase containment measures. Thus, this study aimed to differentiate the impacts of these affecting factors on the stringency of governmental containment measures through cross-continental comparisons. Methods: This study utilized a zero/one inflated beta (ZOIB) regression model to investigate how domestic epidemic, imported risk, and local context affect government responses to a pandemic. We used a country's weekly confirmed case and death numbers as a measure of its domestic threat. The imported risk was measured using a combination of weekly new cases in each country and the air passenger traffic between countries. Results: The findings indicate that domestic case numbers are a primary concern for governments when deciding to increase policy stringency. Countries with higher development levels tend to implement stricter policies as they can better handle the negative impacts. Additionally, there is an interaction between case numbers and development level, with countries at the second or third highest development level focusing more on domestic outbreaks than imported risks, while those at the highest level have similar concerns for both. Conclusions: We concluded that most countries adjust policies' stringency majorly based on the variation of domestic case number rather than the other pandemic factors and the countries with a high development level tend to implement strict policies since their socio-economical condition could afford such policies. These insights can aid policymakers in improving containment and closure policies for future pandemics.