In the current crisis, the extent and quality of infrastructure related to health such as hospitals, water, and sanitation have proven to be important for the effectiveness of responses. Furthermore, there may be scope to consider where infrastructure can play a role more generally in support of healthcare value chains, for example through more efficient trade and transportation infrastructure to support delivery of essential goods. The importance of broader social and economic infrastructure, such as transport systems and communication infrastructure, was also demonstrated.
Notably, the crisis has brought renewed focus on social or “soft” infrastructure, which is sometimes overshadowed by hard infrastructure like energy and transportation in the context of resilience. These infrastructures that maintain the economic, health, education, cultural and social standards of a population are critical elements of modern societies. Hospitals were at the frontlines of impact and response to the pandemic yet are part of healthcare systems that only function well when all aspects are resilient. Preparation and response to the crisis was demonstrated in a number of areas, including setting up temporary hospitals in some jurisdictions to handle the influx of patients, prioritising care, or even “telehealth” solutions where care and information can be administered remotely through telecommunication services.
Besides impact in healthcare, education was also widely impacted during the pandemic. Education services have demonstrated remarkable resilience and flexibility, having established strategies for education continuity, in extremely challenging conditions. While education has been disrupted, a number of creative solutions have been implemented to continue learning, with observations from many jurisdictions, particularly in the use of technologies for distance learning (OECD, 2020l).
Yet the ability and capacity of government response has been uneven across countries or among regions and municipalities within countries. The capacities of emerging and developing economies to invest in the health response have been limited, given tighter borrowing constraints as a result of the spill overs of the crisis. Critical support is needed in some parts of the world in order to bolster health response and limit the spread of the virus. Despite increased mobilisation after the 2014-2016 Ebola crisis, investment in pandemics preparedness and response has been insufficient. In light of the “global public good” nature of such spending, it is in countries’ own interest to spend more and better on infrastructure that supports pandemic preparedness in other countries, as controlling the spread of the virus everywhere can help to lower risks of resurgence (OECD, 2020j).
Within countries, COVID-19 affects the populations and economies of regions and cities differently, with the ability of subnational governments to respond also differing. In most countries, regional and local governments are tasked with critical aspects of healthcare, social services, economic development and public investment, putting them at the frontline of COVID-19 crisis management. Across OECD countries, subnational governments are responsible for nearly 60% of public investment, including investment in infrastructure. Ensuring that subnational governments have what they need to meet this (e.g. improved procurement or planning capabilities, needed fiscal transfers), and other responsibilities, can minimise generating or further entrenching disparities in regional resilience to shocks and crises (OECD, 2020k).