Comparing COVID-19 pandemic health responses in two high-income island nations: Iceland and New Zealand

Abstract

Aims: We aimed to compare COVID-19 control measures, epidemiological characteristics and economic performance measures in two high-income island nations with small populations, favorable border control options, and relatively good outcomes: Iceland and New Zealand (NZ).

Methods: We examined peer-reviewed journal articles, official websites, reports, media releases and press articles for data on pandemic preparedness and COVID-19 public health responses from 1 January 2020 to 1 June 2022 in Iceland and NZ. We calculated epidemiological characteristics of the COVID-19 pandemic, as well as measures of economic performance.

Results: Both nations had the lowest excess mortality in the OECD from the start of the pandemic up to June 2022. Iceland pursued a mitigation strategy, never used lockdowns or officially closed its border to foreign nationals, and instead relied on extensive testing and contact tracing early in the pandemic. Meanwhile, NZ pursued an elimination strategy, used a strict national lockdown to stop transmission, and closed its international border to everyone except citizens and permanent residents going through quarantine and testing. Iceland experienced a larger decrease in gross domestic product in 2020 (relative to 2019) than NZ (-8·27% vs. -1·22%, respectively). In late 2021, NZ announced a shift to a suppression strategy and in 2022 began to reopen its border in stages, while Iceland ended all public restrictions on 25 February 2022.

Conclusions: Many of Iceland's and NZ's pandemic control measures appeared successful and features of the responses in both countries could potentially be adopted by other jurisdictions to address future disease outbreaks and pandemic threats.

Keywords: COVID-19; Iceland; New Zealand; SARS-CoV-2; pandemic; policy.

Figure 1.

Epidemic curves of monthly newly notified confirmed cases and cumulative total confirmed cases in Iceland [8,9] and New Zealand [11,19] up to 1 June 2022 (includes cases identified at the border in both nations).

Figure 2.

Pre-Omicron variant epidemic curves of monthly newly notified confirmed cases in Iceland [8,9] and New Zealand [11,19] up to 1 October 2021 (includes cases identified at the border in both nations).

Figure 3.

COVID-19 Containment and Health Index from 1 January 2020 to 1 June 2022 in Iceland and New Zealand [58]. The Containment and Health Index is a composite measure based on 13 policy response indicators rescaled to a value from 0 to 100 (100 = strictest) [58].