All 5 international locations confirmed the first COVID-19 case in their respective international locations between February and early March 2020. Most of the first circumstances have been imported from Western Europe. Turkey, Ukraine and Poland have a comparatively giant quantity of cumulative circumstances (8.4 million, 3.2 milion, and 3.2 million), whereas Egypt and Kazakhstan have a smaller quantity of cumulative circumstances (0.3 million and 1.0 million) as of 16 November 2021 [10]. Cumulative circumstances, new circumstances, cumulative deaths, and vaccination protection in Turkey, Egypt, Ukraine, Kazakhstan, and Poland from 1 February 2020 to 15 November 2021 are proven in Fig. 2. The quantity of circumstances, deaths, and vaccination protection, in addition to key health indicators by nation, are summarised in Table 1.
Cumulative COVID-19 circumstances, new day by day circumstances, deaths, and vaccination protection since the starting of pandemic in Turkey, Egypt, Ukraine, Kazakhstan, and Poland. A Cumulative circumstances per million inhabitants in Turkey, Egypt, Ukraine, Kazakhstan, and Poland from 1 February 2020 to 15 November 2021, B New day by day circumstances per million inhabitants in every nation, C Cumulative deaths per million inhabitants in every nation, D Percentage of individuals partially and totally vaccinated in every nation. Solid line exhibits the proportion of complete inhabitants partially vaccinated (acquired at the least one dose). Dashed line exhibits the proportion of complete inhabitants totally vaccinated. Vaccination information in Egypt was not accessible in majority of the time. Vaccination information in Poland was lacking at a number of time intervals. (Data supply: Our World in Data [11] – accessed on 16 November 2021)
Trends in the noticed numbers of circumstances equally had three peaks amongst 5 international locations, though the peaks of transmission have been totally different (see Fig. 2B). The cumulative quantity of deaths in Poland and Ukraine (2.09 and 1.78 per thousand inhabitants) have been larger than in the different three international locations (see Fig. 2C) [10].
Health sector preparedness and response
Health system and health finance
The 5 international locations had developed totally different health programs and health insurance coverage schemes earlier than COVID-19, and health system reforms are ongoing.
Turkey has been implementing health reform initiatives since 2003 [18]. This programme improved governance, health financing, and health service supply considerably, with heavy funding in health infrastructure [19]. The General Health Insurance Scheme (GHIS), funded by a tax surcharge on employers [20], covers 99% of all inhabitants, together with over 3.6 million Syrian refugees. Health providers are supplied each by public and personal sector amenities [19]. The GHIS ensures free therapy for numerous situations, akin to emergency care, occupational sickness, childbirth, and infectious illnesses [21]. Their health system transformation enabled the outbreak response to be efficient and well timed with comparatively restricted pressure on the current health system and capability.
The Egyptian healthcare system is funded and managed by governmental, parastatal, and personal sectors. The Health Insurance Organisation oversees fundamental health protection for 60% of the inhabitants [22]. The Egyptian health system was revitalised in 2014 and improved the high quality of care, health expenditure, availability, and accessibility of illness surveillance. According to the WHO’s evaluation in 2020, Egypt has a strong capability to reply to the outbreak [22].
Ukraine has the weakest health system in the post-Soviet Union international locations [23]. In addition, six years of battle in east Ukraine weakened it additional. Public healthcare continues to be in transition from the extremely centralised health system. Free healthcare is the precept; nevertheless, 58% of sufferers reported having made out-of-pocket funds in 2017 [24]. Unmet healthcare wants are a rising concern in Ukraine [25].
The health system in Kazakhstan is extremely centralised, and public health service is dominant. One of the key challenges in healthcare reform is the appreciable inequity in health financing per capita amongst the totally different geographical areas in the nation. Another problem is that 36% of the health expenditure comes from out-of-pocket funds [26]. Since 2017, all residents are required to take part in employers’ contributions to the healthcare fund. This measure is predicted to increase healthcare spending and usually enhance providers for sufferers [27].
The National Health Fund funds the healthcare system in Poland with the capitation fee system [28]. Citizens pay their health insurance coverage by way of their employer, which is 9% deducted from private earnings and covers core-family members. Healthcare is free for all residents; in specific, the authorities is obliged to present free healthcare to younger youngsters, pregnant ladies, individuals with disabilities, and the aged [29]. A problem in the healthcare system in Poland is that out-of-pocket expenditure accounts for greater than 20% of health expenditure. The quantity of medical staff per 1,000 inhabitants is decrease than the European Union (EU) common, whereas spending for prevention is lower than half of the EU common.
The healthcare expenditure (proportion of GDP) plotted over GDP per capita for the 5 international locations present that the financial system and health funding in every nation assorted (Fig. 3) [16]. Healthcare expenditures per GDP in Egypt, Turkey, and Kazakhstan was decrease than 5%, which is beneath the beneficial degree of health financing. Although GDP in Poland was at the similar degree as for different EU international locations, the health expenditure stayed low (6.2%), which can partly clarify that the life expectancy in Poland is 5 years shorter than the EU common [30]. Ukraine has the highest health expenditure per GDP, and its health infrastructure and human sources are amongst the highest ranges in Europe. However, Ukrainian medical care may not have met the commonplace of care in Europe, and their life expectancy is 9 years shorter than the EU common (Table 1) [25].
![figure 3](https://media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs12889-022-13411-6/MediaObjects/12889_2022_13411_Fig3_HTML.png)
Health expenditure as proportion of GDP versus GDP per capita in 2019 for Turkey, Egypt, Ukraine, Kazakhstan, and Poland. The determine exhibits the relationship between GDP per capita (present US$) and health expenditure as proportion of GDP in Turkey, Egypt, Ukraine, Kazakhstan, and Poland. Among the 5 international locations, health expenditure in phrases of proportion of GDP is comparatively lowest and highest in Kazakhstan and Ukraine respectively. (Data supply: World Bank Database [16])
National coordination of COVID-19 response actions
Turkey established an emergency operations centre instantly after the affirmation of COVID-19 in China and coordinated response actions by way of a Whole-of-Government strategy. Turkey additionally established a scientific advisory board in the early levels [19, 31]. The Ukrainian authorities arrange the Health Emergency Operation Committee in the MoH on 24 January and an inter-sectoral working group on 25 April 2020. Kazakhstan created an interdepartmental fee below the authorities to coordinate actions to forestall the unfold of COVID-19 with all associated ministries on 27 January 2020 [13].
COVID-19 testing capability
Generally, possible circumstances and contacts with confirmed circumstances have been examined by PCR in the 5 international locations. The WHO has famous well-established COVID-19 surveillance programs in Turkey and Egypt [19, 22]. Case definitions of possible and confirmed circumstances have been barely totally different by nation, although they observe WHO or the European Centre for Disease Control pointers.
The 5 international locations have made an effort to improve testing capability during the pandemic. Turkish PCR testing capability, one of the highest in the world, is supported by 453 laboratories, whereas Egypt established 40 laboratories [19, 22]. Ukraine had 96 take a look at centres as of November 2020. PCR assessments have been performed in 9 laboratories at the oblast degree and a nationwide reference laboratory in Kazakhstan as half of the influenza surveillance programme. In Poland, 276 laboratories have been finishing up testing at the finish of January 2021. Total testing capability exceeded 150,000 per day in Turkey, over 80,000 per day in Poland, and round 50,000 per day in Ukraine as of April 2021 [13].
Information about the implementation of contact tracing was largely absent besides in Turkey. Turkey has greater than 100,000 discipline groups conducting contact tracing [19, 22]. Potential contact individuals have been remotely monitored by audio or video name, if potential, in Kazakhstan [13].
Health infrastructure
The 5 international locations quickly elevated the mattress capacities to accommodate COVID-19 sufferers with the onset of the pandemic. Turkey has 563 hospitals devoted to treating COVID-19 circumstances as of November 2020; up to 1,200 hospitals partly supplied the look after COVID-19 circumstances. Over 25,000 ICU beds have already been accessible in Turkey. In addition, Turkey constructed two new pandemic discipline hospitals with a capability of 1,000 beds [13]. Egypt has 750 COVID-19 designated hospitals with 35,152 beds, 2,218 ventilators, and 3,539 crucial care beds. Ukraine elevated the accessible beds for COVID-19 sufferers from 12,000 at the starting of the pandemic to 53,445 in 582 designated hospitals as of 24 November 2020. In Kazakhstan, a cellular hospital in Nur-Sultan was assigned to take care of COVID-19 sufferers completely. Poland ready at the least one devoted hospital in every province for case administration [19, 22, 32, 33]. As of October 2020, roughly 8,000 beds and over 800 respirator beds have been ready in Poland [13].
The quantity of hospital beds in every nation earlier than the pandemic is summarised in Table 1. The quantity of assessments, hospitals, and beds after the pandemic as of April 2021 is summarised in Table 2.
Healthcare workforce
Maintaining the healthcare staff for routine health providers and COVID-19 responses was the largest problem in the 5 international locations. The methods to preserve the workforce in 5 international locations have been process shifting, monetary incentives, and offering psychosocial look after them.
In Turkey, medical and dental residents have been repurposed for the COVID-19 response. Poland mobilised non-specialised personnel, retired individuals, medical college students, and troopers and assigned them sure duties in line with their capability. Ukraine reserved medical college students to be employed as a surge capability [13].
Turkey, Ukraine, and Poland elevated the wage for many who work with COVID-19 sufferers by 100–300%. In Poland, the earnings loss was compensated for medical employees who have been restricted to work out of their hospitals due to potential contacts with COVID-19 sufferers. Overtime funds and day without work obligation have been ensured by legislation. Quarantined or remoted docs acquired 100% of their wage in Poland and Ukraine. Turkey and Poland supplied lodging for healthcare staff who didn’t need to put their households at potential threat of an infection [13].
In Ukraine, the MoH required healthcare personnel to cross WHO on-line programs on medical administration and an infection prevention and management. WHO led coaching at 200 designated therapy hospitals and shared data on COVID-19 therapy measures by way of video conferencing [13].
Medical provide
Due to the shutdown of factories in China, provide chains have been significantly disrupted [34]. Many important medical medication have been produced in China. Shortages of masks, gloves, and private protecting gear (PPE) have been reported worldwide [35]. Turkey, Egypt, Ukraine, and Poland reported a scarcity of PPE in the early levels of the outbreak [19, 22, 36]. Turkey had strategized for the manufacturing and stockpile of medication and PPE at a nationwide degree. Ukraine has acquired greater than 65,000 objects of PPE from WHO [37]. Poland has joined the EU’s medical gear procurement mechanism for the buy of gloves, goggles, face protectors, surgical masks, and clothes [38].
Physical distancing and non-pharmaceutical interventions
The 5 international locations imposed regional or nationwide quarantines, “lockdown” measures, between March and May 2020, and steadily lifted them in June 2020 or later. Business workplaces, eating places, retail outlets, and leisure venues have been closed. Public entities, parks, and seashores have been closed. Mass gatherings and non secular worship have been usually prohibited [19, 22, 23, 33, 39]. Egypt has banned the two largest non secular occasions in the nation [22].
In Turkey, curfews have been imposed on those that have power diseases or are aged both over 65 or below 20 years [19]. In Egypt, a night-time curfew was put in place, however no day-time lockdown was imposed [22]. The “partial lockdown” was later questioned as a result of the lockdown interval was extended with out sufficient suppression of illness transmission.
Ukraine, Kazakhstan, and Poland took strict restriction insurance policies for all residents. Ukraine and Poland divided international locations into pink, yellow, or inexperienced zones in accordance to their native epidemic standing [13]. Ukraine and Kazakhstan prohibited home journey from crossing regional borders in addition to worldwide journey [23, 33, 39]. This measure is known as an “interstate lockdown,” which restricted the motion of individuals in a bigger space than at family or particular person degree.
International journey was prohibited partially or totally in the 5 international locations. Negative PCR outcomes have been required earlier than entry, and travellers have been quarantined at the border.
Health communication
Clear and clear communication with the public is a crucial half of the pandemic response and for avoiding panic and misinformation, which can impinge on efficient response actions. The official web sites, on-line streaming, and social media turned the major communication channels during the COVID-19 pandemic.
The MoH in Turkey established a public web site and up to date the quantity of circumstances and different info, e.g., pointers, posters, and Q&A (questions and solutions). Turkey used social media, together with Twitter, Facebook, and Instagram accounts, to share info with the public. In Ukraine, an official suggestion of hand hygiene and respiratory etiquette was posted on a number of social media channels and the MoH web site. Regular brief day by day briefings about the COVID-19 response have been organized and streamed on-line on the MoH web site and tv. Weekly briefings about the COVID-19 scenario have been distributed by textual content message or video. In Kazakhstan, visible posters have been put at borders or transportation stations, and loudspeakers and mass media have been used to disseminate COVID-19 prevention measures to the public recurrently. In Poland, info was transmitted by web site, Twitter, and Facebook by way of the official account of MoH or the Primary Health Office. A chatbot on the WhatsApp software additionally supplied details about COVID-19.
Digital communication performed a major function in mass communication during the pandemic in Turkey, Ukraine, and Poland. Their funding in digital health had began prior to the pandemic.
Impact on non-COVID-19 health providers
Healthcare entry to non-COVID-19 providers, together with important health providers, was diminished by each demand-side and supply-side constraints. In Ukraine, 14% of households couldn’t entry healthcare during the pandemic due to busy hospitals, scarcity of treatment, suspension of common providers, and lack of transportation [40]. In Poland, regardless of the vital development of telemedicine, the complete quantity of providers supplied at major care centres between March and November 2020 decreased by 9.6% in contrast with the similar interval of 2019 [33]. Home visits by midwives have been minimised, and college nurses had no duties as colleges have been closed [33].
Telemedicine was promoted in Turkey, Ukraine, Kazakhstan, and Poland to preserve important health providers [13]. Ukraine, Kazakhstan, and Poland continued to present routine medical help to pregnant ladies and youngsters, sufferers receiving most cancers therapy, in addition to different life-threatening illnesses whereas suspending routine screening or examination.
A hotline was created in Turkey, Ukraine, Kazakhstan, and Poland for COVID-19-related session or screening. These 4 international locations supplied free healthcare providers associated to COVID-19, together with testing, therapy, and vaccination [13].
Turkey, Ukraine, and Poland diminished the quantity of admissions to the hospital, particularly for elective surgical procedure, although they continued to provide emergency surgical procedure. Poland tentatively stopped routine childhood vaccination, although it resumed in April 2020. Ukraine noticed a major declining pattern of routine vaccination in March–April 2020, however efficiency improved by July 2020 [13].
In Poland, coaching for resident docs was stopped at the hospitals devoted to COVID-19 sufferers. Some docs in these hospitals have left their jobs as they might not proceed their specialised observe, regardless of their wage being elevated by the governmental compensation. There is a priority that the perform of these hospitals may not be maintained even after the COVID-19 pandemic [13].
Impact on the financial system
COVID-19 is the greatest problem that the international financial system has skilled in the post-Second World War period. Because of the lockdown measures taken, home consumption declined by 40% in Kazakhstan [41]. Except for Turkey, the annual GDP development fee declined in 2020 in comparability to the earlier 12 months for Egypt, Ukraine, Kazakhstan, and Poland (Table 3) [40,41,42,43,44]. Despite the well-diversified financial system with superior digitalisation, Poland skilled the first output contraction for over 20 years [44].
Unemployment elevated in Egypt, Ukraine, and Poland [40, 44, 45]. The quantity of individuals dwelling beneath the poverty line (US$ 5.50 per day for middle-income international locations) elevated in Turkey by 1.6 million, in Egypt by 0.2 million, in Ukraine by 2.7 million and in Kazakhstan by 1.1–1.5 million (Table 3) [40, 42,43,44].
Emergency funds have been established to help home enterprises in the 5 international locations to mitigate the economic fallout. Countries took comparable measures, akin to [41,42,43,44, 46, 47]: (i) reasonably priced financial institution loans at discounted rates of interest for companies, (ii) monetary help/money transfers to poor households and affected people, (iii) help for companies’ funds akin to short-term working capital or unpaid go away or subsidised salaries, and (iv) exemption from tax or social contributions, tax deferrals and subsidised loans for companies or focused sectors.
These authorities insurance policies have supported the financial system to keep afloat, whereas Turkey and Egypt confronted excessive inflation [42, 43]. Kazakhstan’s inflation was first pushed by elevated meals costs, however later, the weak exterior demand, low oil costs, and subsequent alternate fee depreciation led to larger inflation [41]. The impact on the financial system and its mitigation measures in every nation are summarised in Table 3.
Impact on training, gender, and civil liberties
The COVID-19 pandemic has negatively affected training for youngsters. Schools have been closed fully in the 5 international locations for between 19 and 49 weeks as of 16 November 2021 [3]. E-learning or distant studying, akin to video-based instruction, matching the expertise of the educating drive to the new vary of duties and actions, may improve the efficiency of colleges. However, distance studying was difficult due to restricted entry to digital applied sciences in the 5 international locations. The refugees and migrants in Turkey and Ukraine and common college students in Kazakhstan have reported vital issues with the infrastructure of the web [48,49,50,51]. Therefore, modified education and a greater social safety system have been additionally warranted.
In Turkey, ladies have been extra probably to lose their jobs and perform home labour in addition to working remotely during the pandemic [4]. Uneven division of family labour by gender has continued and even aggravated. In Ukraine, ladies are disproportionately affected by the illness as a result of ladies account for 82% of all health and social staff in contrast with the 70% worldwide common [40]. The pandemic and lockdowns have additionally led to a rise in home violence by 30% in Ukraine [40].
The scarcity of PPE imposed a excessive threat of an infection on healthcare staff. Medical professionals who identified the scarcity of PPE and coaching for themselves have been arrested in Egypt. Over 70 individuals, together with health staff, journalists, and legal professionals, have been detained in Egypt between March and June 2020 [52]. One-sixth of the COVID-19 infections occurred in medical professionals in Poland as of April 2020. The Ministry of Health in Poland tried to forestall medical personnel from commenting on the pandemic concerning the scarcity of PPE [36]. Censorship of speech in Egypt and Poland has highlighted the significance of balancing public health measures and civil liberties [36, 52].
COVID-19 vaccination
Various varieties of COVID-19 vaccines have been rolled out globally, together with 23 vaccines in totally different international locations, of which eight have been accepted to be used by WHO (as of 15 November 2021) [53, 54].Turkey and Poland primarily used the vaccine made by Pfizer in the United States of America, Egypt used the Sinopharm vaccine from China, Ukraine used the Astra Zeneca vaccine made in India, and Kazakhstan used the Sputnik V vaccine from Russia. In Turkey, Poland, and Kazakhstan, 66%, 54%, and 45% respectively of the complete inhabitants have acquired at the least the first dose as of 15 November 2021. On the different hand, in Egypt and Ukraine, solely 20% and 28% of the inhabitants have accomplished the first dose as of 15 November 2021 (Table 1, Fig. 2D).
Vaccine hesitancy in communities poses critical challenges in reaching sufficient protection. Ukraine and Egypt reported excessive vaccine hesitancy in each the common inhabitants and amongst healthcare professionals [55, 56]. The underlying causes of vaccine hesitancy have been reported to be the lack of belief in the government-led healthcare sector in Ukraine [55]. Egyptian medical college students talked about {that a} lack of details about the adversarial results of the vaccine was the major purpose for vaccine hesitancy [56].