Gates Package — page 909

level, geography, public policies regarding lockdowns and other steps, and many more factors. None of them reliably predicts how a country will do. A few high-income countries with significant infections managed to keep the deaths from spiraling out of control, for example, while others did not. IHME's data also suggests that a country's success against COVID correlates roughly with how much people there trust the government. This makes intuitive sense, since if you have confidence in your government, you're more likely to follow its guidelines for preventing COVID. On the other hand, trust in government is measured by polls, and if you live under an especially repressive regime, you're probably not going to tell a random pollster what you really think about the government. And in any case, this finding doesn't easily translate into practical advice that can be implemented quickly. Building trust between a people and their government takes years of painstaking, purposeful work. Another good approach to identifying what works is to look at the problem from the other end: Find exemplars that did individual things especially well and study how they did it. A group I fund that's called, appropriately enough, Exemplars in Global Health is doing just that, and they have made some fascinating connections. For example, all other things being equal, countries whose health systems function well in general were more likely to respond well to COVID. If you have a strong network of health clinics that are well staffed with trained personnel, are trusted by people in their community, have supplies when they're needed, and so on, you are in a better position to fight off a new disease. This suggests that any pandemic prevention plan needs to include, among other things, helping low- and middle-income countries improve their health systems. We'll return to this subject in Chapter 8.