In a recent study posted to the medRxiv* preprint server, researchers described the role of local governments in responses to the coronavirus disease 2019 (COVID-19) pandemic across 25 cities.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initially detected in the Wuhan city of China toward the end of December 2019 and has demanded responses from all government strata (including governments of states, provinces, districts, and the nation). Responses to the SARS-CoV-2 pandemic have underpinned the importance of local government involvement in pandemic management.
The substantial societal risks posed by the SARS-CoV-2 pandemic have been recognized by public health communities. Due to the presence of a dense population and high connectivity, cities can be considered a gateway to enhancing or limiting the transmission of infectious organisms. Therefore, understanding infectious disease detection, responses, and management in cities is a key public health concern.
About the study
In the present survey-based study, researchers described the involvement of local governments in 25 global cities in SARS-CoV-2 pandemic responses to improve understanding of the implementation and coordination of activities in cities for responding to the SARS-CoV-2 pandemic.
The study included local public health authorities of cities which were in partnership with healthy cities (PHC) for (i) understanding the government levels that were accountable for particular activities as part of COVID-19 pandemic responses; (ii) documenting the implementation of activities for pandemic response; (iii) characterizing the challenges in performing activities as part of pandemic responses; and (iv) inquiring about preparedness for the pandemic and epidemics.
In particular, seven cities were included to ensure diversity of context, which were: Addis Ababa, Accra, Bandung, Bengaluru, Kampala, London, and Lima. A questionnaire was developed for surveying and characterizing the coordinated efforts in activities performed for responding to the SARS-CoV-2 pandemic, the implementation of response activities for the SARS-CoV-2 pandemic, and the level of challenge in performing pandemic response activities.
The questionnaire comprised 30 questions in several formats such as free-responses, Likert scale-based questions, matrices-based questions, and questions with multiple choices for the answer. The questionnaire was translated to Spanish and French for improved comprehensibility and distributed to local authorities in June 2021.
Responsible, accountable, consulted, and informed (RACI) matrices were used, and descriptive statistical analysis was performed to summarize urban experiences in the COVID-19 pandemic responses. In addition, few study participants were interviewed online from June 2021 to August 2021 to improve the validity of the study findings.
Responsible was defined as the government level in which work required for activity completion was implemented; accountable as the government level which oversewed thorough and correct activity completion; consulted as the government level that engaged in communications (two-way) for providing necessary data for activity completion; and informed as the government level updated in terms of a particular activity.
The cities that completed the surveys were Addis Ababa, Accra, Amman, Athens, Bandung, Bangkok, Barcelona, Bengaluru, Buenos Aires, Cali, Colombo, Guadalajara, Kampala, Kigali, Kumasi, Lima, London, Lusaka, Medellín, Ouagadougou, Rio de Janeiro, Santiago, Santo Domingo, Vancouver, and Yangon. RACI matrices analysis showed several coordinated structures for responses to the COVID-19 pandemic.
In cities like Santo Domingo, Amman, and Kumasi, national-level governments were primarily authoritative. In cities such as Vancouver, Buenos Aires, and Santiago, the primary authority lay with subnational-level governments. For cities like Medellín, Bengaluru, and Kampala, the local governments were primarily authoritative.
National-level government authorities were responsible for most pandemic response activities; however, local-level governments were also responsible for key pandemic response activities, particularly the communication of risks and coordination with civil society organizations and community-setting organizations.
Further, the majority of activities as part of pandemic responses were implemented following the confirmation of COVID-19 in cities, many activities were challenging for local-level governments, and almost all local governments envisioned greater engagement in COVID-19 preparedness and responses to the SARS-CoV-2 pandemic.
Regarding pandemic preparedness, local governments were involved with communication of risks, mandating behavioral changes in individuals, and coordinating with civil society and community-based organizations. Local governments implemented activities such as mandating the closure of schools and businesses, imposing lockdowns, providing diagnostic SARS-CoV-2 testing, providing quarantine services, contact tracing, improving surging care, and conducting vaccination campaigns. Of the activities, mandating the closure of businesses and behavioral changes such as social distancing and facemask use were considered the most challenging. In addition, local governments reported to be open to financial, technical, material, and personnel assistance.
Overall, the study findings highlighted the increasing importance of involving local authorities in managing the COVID-19 pandemic. The findings could be an essential contribution to the expanding literature, which emphasizes improving responses to the ongoing SARS-CoV-2 pandemic and potential future SARS-CoV-2 outbreaks.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.