Controlling the source of infection.

States vary in their methods of case detection, contact tracing, and lockdown. Screening risk in key institutions was adopted by all states except India. During community transmission, Sweden stopped contact tracing while other states continued to do so [11], meanwhile, India and the U.S. released digital tracing apps to assist with tracing [23]. Significant differences existed in the lockdown policies of the four states. Nigeria enforced a strict lockdown in the most affected areas, India implemented a nationwide lockdown, the U.S. implemented only a 15-day voluntary national lockdown, and Sweden did not impose a lockdown [13,23].

Cutting off transmission route.

Regarding case management, Nigeria isolated confirmed cases but the U.S. and Sweden rarely isolated cases but advised people to self-isolate at home. It’s difficult to determine whether India has quarantined patients. Nigeria and India both implemented mandatory mask-wearing protocols in public areas [10,24], while the U.S. had no similar requirements and Sweden only advised mask usage for health care and elderly care settings [25]. Domestic and international travel restrictions were implemented by Nigeria and India, while the U.S. and Sweden focused on reducing international travel [26]. Regarding social distancing, all states aimed to control or cancel mass gatherings, except Sweden, where schools for children up to 16 years and public spaces remained open [26].

Protecting susceptible population.

There have been several ways to protect vulnerable populations. The U.S. focused on health equity issues among disproportionately affected populations, such as racial and ethnic minorities [27]. Sweden prioritized the protection of the elderly and hospitalized individuals by implementing measures such as banning visits to nursing homes and hospitals [28]. The Ministry of Health and Family Welfare in India has published health advice and guidelines for vulnerable groups. Additionally, they have introduced an insurance scheme for health workers fighting COVID-19. In Nigeria, the focus was on the poor and vulnerable, providing food and cash assistance. In order to maintain medical services, the United States and India constructed new hospitals and implemented telemedicine. On the other hand, Sweden and Nigeria did not increase their number of hospitals, and Nigeria failed to establish efficient telemedicine methods.

Collaborative governance.

Governments implemented different policies from the perspective of the whole society to combat infectious diseases. Regarding the leadership form, the U.S. established a public health emergency management system with a vertical hierarchy of “federal–state–local”, and a horizontal division of labour between governments, private sectors, and volunteer groups [5]. The Public Health Agency of Sweden served as the national coordinating body, which had a broad responsibility for public health and regions were autonomous [6]. For India, the state headquarters coordinates technology and resources for local governments, while the local administration operates independently [26]. Nigeria inaugurated the Presidential Task Force (PTF) on COVID-19 to coordinate the state’s multisectoral intergovernmental response [29].

Other aspects.

In terms of basic security, the Food and Drug Administration (FDA) has issued guidance to expand the availability of digital health therapeutic devices for psychiatric disorders in the United States [30], but Nigeria and Sweden have implemented relatively few measures to protect the mental health of their populations. Compared with other states, the United States and India have done more work on COVID-19-related scientific research [5]. We could not find specific information on India’s support for the hard-hit areas. However, other states have made efforts to provide aid to these regions.

Complying with regulations.

When it comes to meeting regulatory requirements, it is crucial to promptly supply information to the World Health Organization (WHO). The U.S. strengthened IHR reporting and recommended people to avoid nonessential travel. Simultaneously, the US implemented border closures with Mexico and Canada and tightened travel restrictions for individuals from other nations with high rates of transmission [13]. Sweden was in continuous communication with the WHO leadership and didn’t recommend non-essential travel to other states. The information we gathered was insufficient to demonstrate that India and Nigeria were able to report information to the WHO promptly.

Sharing information.

Regarding information sharing, Nigeria and the U.S. participated in the China-WHO Joint expert team and conducted field visits in China, the U.S. also analysed the experiences of other states to determine the effectiveness of the surveillance and containment measures [31]. The United States made important contributions in sharing viral genes. Sweden participated in work conducted by the EU Health Security Committee to enhance the sharing of information and coordination. India’s efforts to share knowledge and technology may be limited.

Distributing resources.

Distributing resources is another important aspect of international governance. The United States provided support to Centres for Disease Control and Prevention (CDC) offices in affected states and set aside funds for international aid. Sweden donated COVID-19 vaccines to low- and middle-income states and contributed both political and financial support to the WHO and other multilateral organizations [32]. At the same time, Sweden made efforts to improve the functioning of the European single market and lift newly imposed export restrictions [33]. Except for Sweden, other states have taken less action to reduce trade barriers and maintain trade. India donated masks and other medical supplies to China and pledged nearly 100 million hydroxychloroquine tablets to Russia [10]. Nigeria has done relatively little to share resources.

Strengthening cooperation.

The U.S. participated in therapeutic and vaccine clinical trials and broadened global respiratory surveillance activities with the WHO [34]. Sweden supported the UN appeal and the "Team Europe" approach to support partner states and worked with the EU and other actors to combat rumours and disinformation. India has partnered with AstraZeneca to produce large quantities of COVID-19 vaccine for the COVID-19 Vaccines Global Access (COVAX) program. Additionally, a fund named the COVID Fund for South Asian Association for Regional Cooperation (SAARC) States has been established [35]. Nigeria led infection prevention and control training in Africa in collaboration with the Africa COVAX [36].

Controlling infection source.

In terms of controlling the source of infection, ’detection’ and ’lockdown’ are two important aspects. The United States faced many challenges with testing, including delays in test reporting, shortages of testing kits and supplies, and disproportionate distribution of testing sites [5,40]. The limited availability of tests nationwide may be due to the CDC’s unsuccessful attempt to develop its own test and stringent government regulations on third-party test approval [41,42]. Similarly, India lacked sufficient risk monitoring at crucial sites, and Nigeria also faced issues with inadequate testing [43,44]. India and the United States used Internet technology to develop apps that can track close contacts to reduce the burden of manpower. However, these apps raised legitimate public concerns about privacy, data protection, and civil liberties [23]. Sweden did not implement a formal compulsory lockdown or state of emergency during peacetime due to constitutional limitations. However, despite the lack of a mandatory lockdown, many Swedes followed the government’s recommendations and changed their behaviours to prevent the spread of COVID-19, resulting in what was referred to as a ’virtual lockdown’ [6,25]. Although the lockdown was only implemented in the three most affected areas, Nigeria did not effectively implement it due to the fact that many Nigerians are self-employed and were unable to cope financially [43]. Nigeria reopened before the outbreak was fully under control, and so did the United States and India [45]. In the United States, the effective implementation of containment policies was hindered by the lack of manpower in both federal and local governments. Additionally, American communities were sparsely populated and rarely walled, which further complicated the situation [46]. When it comes to India, it may be counterintuitive that the containment strategy with nationwide lockdown has not achieved the desired results, which may be closely related to factors such as high levels of poverty and mobility, low levels of education of the population, and inadequate healthcare systems. These are common challenges faced by developing states like India and Nigeria [39].

Cutting off transmission route.

The next step is cutting off the transmission routes of the virus. For Nigeria, the supervision of self-isolation of people was too lax [47] and there were cases of neglect and even rejection of patients in health facilities [43], which may be related to the backward economic foundation and lack of health resources in developing states [48]. Although Nigeria implemented strict policies, compliance with preventive guidelines was reportedly zero in some states due to the nonchalant attitude of both ordinary people and public figures [43]. Unlike Nigeria, Sweden, being a developed state, has sufficient medical resources to control the spread of infections, even during a pandemic like COVID-19 [28]. In regards to personal protection monitoring, India and Nigeria have stricter regulations, followed by Sweden. The United States, on the other hand, has more lenient regulations. The lack of personal protection supervision, such as mask mandates in the United States and Sweden increased the risk of infection in the population and hindered efforts to cut off transmission routes.

Protecting susceptible population.

Almost all states have neglected vulnerable groups, including the United States and Sweden, which we focus on as examples because the challenge is more severe in developing states. Though equity is a fundamental principle of Swedish social systems [28], mitigation policies required mild patients to isolate at home [11], which made people living in poor conditions difficult to separate from other family members [6,11,28]. Similarly, in the United States, ethnic minorities face a higher risk of contracting the virus. Additionally, some states did not adequately protect their health workers, allowing them to continue working even after testing positive [5,23]. The inequalities may be due to limited access to health services, difficulty adhering to physical distancing recommendations, underlying health disparities, and intersecting stigmas [49]. In India, prenatal care and childhood immunizations were reduced, and the virus spread rapidly among the poor [10,39]. Moreover, the vaccination rate in India has been sluggish, with just about 2% of the population having received both doses of the vaccine even after four months since the launch of the vaccination campaign. Many states like India and Nigeria implemented strict transportation limitations or even a complete shutdown of transportation, affecting the satisfaction of necessary medical needs, especially for chronic patients [50] and leading to avoidable spread of COVID-19 [10], which highlighted the advanced nature of Sweden’s sustainable policy.

Collaborative governance.

At the macro level, the U.S. government pursued a competitive, private-sector approach, leaving states and localities to fend for themselves. Unfortunately, there has been no coordinated implementation of policies [23], which has caused the price of medical resources to rise [45]. Federal and local conflicts were largely due to the fact that the U.S. Constitution places local responsibility for public health, while the federal government is primarily responsible for the spread of disease between states and internationally [37], and so is Sweden [38]. Therefore, achieving a high degree of coordination and unity in epidemic prevention and control is challenging for Sweden. However, Swedish experts, rather than politicians, have a voice, which has made Sweden’s prevention and control policy more scientific [11]. The issue of state incoordination was also present in Nigeria, which worsened the movement of people between states [43]. In India, the Ministry of Health and Family Welfare was responsible for overseeing national awareness and guideline implementation, while individual states managed local information dissemination independently. Districts coordinated with departments to streamline efforts in pandemic control, resulting in a structured approach that optimizes coordination [26,39]. Overall, India’s decision-making during the pandemic has been focused on the national level. India’s leadership model has demonstrated effective decentralized control in the pandemic response [13], but national-level management needs further harmonization.

Basic security.

In terms of basic security, while the United States utilized the Defense Production Act to guarantee the production and distribution of essential goods, the implementation was limited in scope and duration, which failed to meet the demands [23]. Simultaneously, Nigeria faced a severe shortage of medical resources and other essential materials, resulting in panic hoarding [43], which was caused by inadequate funding and bureaucracy [44]. All states provided palliative support to individuals and enterprises. However, for the United States, additional stimulus funding was not passed between April and November 2020 [23]. Although Nigeria implemented palliative policies, the eligibility criteria were so strict that the scheme was largely ineffective [47,51]. Medical personnel in India have faced reduced salaries and have been victims of discrimination and violence, causing them to quit their positions [39,51], which has had a negative impact on medical capacity.

Social mobilization.

Regarding social mobilization, there was a lack of transparency and empathy in the information provided in the United States [52], which led to public confusion and an underestimation of the virus’s efficacy [42]. Additionally, the slow response of the federal government has weakened the ability of local governments to respond, putting federal and state leadership at odds [52,53]. Some scholars believed that the slow dissemination of relevant information in the United States was mainly to prevent an economic downturn and satisfy public sentiment [42]. Preventive and control measures are difficult to implement in India due to common mass gatherings for religious events and inadequate education about the epidemic. Similarly, in Nigeria, rumours and stigma were widespread, creating barriers to promoting mask-wearing and vaccination. This led to the stigmatization of patients and health workers, as well as causing fear and rejection of isolation among Nigerians [29,43,54].

Control of international traffic and trade.

Regarding the international governance of COVID-19, the United States, Sweden, and Nigeria have faced criticism for their lax management of international travellers. The United States and Sweden were hesitant to enforce strict entry restrictions on Europeans [25,42], while the Nigerian government refused to impose a travel ban on flights originating from severely affected regions, thereby contributing to the expansion of the pandemic [47]. The absence of a travel ban may be due to economic considerations, as disrupting normal communication can harm society as a whole [42].

Sharing information and resources.

Based on our findings, India and Nigeria have not engaged in significant information and resource sharing. This suggests that developing states may face challenges in providing assistance and support to other nations during global health crises due to their lower levels of economic development. However, the United States, as the most developed state, provided little medical assistance to other states. This situation changed after Joe Biden took office. It implies that a state’s global health governance policies may be closely related to its leader [55]. Maintaining normal trade is crucial during an epidemic as it affects the global supply chain. However, it can be challenging to achieve. India prohibited the export of protective equipment, 26 active pharmaceutical ingredients, and their medicines [10]. The vaccine is the most crucial tool in curbing the pandemic, but its distribution has been inequitable. Low- and middle-income states have not received the necessary vaccines, while developed states have hoarded them instead of disseminating them to those in need [56].

Cooperation.

Achieving substantive results can be challenging due to the non-binding nature of inter-state cooperation modalities, such as partnerships. Although cooperation is necessary to respond to the pandemic, it is important to acknowledge that human beings are not always rational actors. As stated by one source, ’Instead of acting collectively to save the world, the superpowers fell into a trap of meaningless competition and wasted efforts fighting the virus’ [57]. The United States government politicized and stigmatized public health issues instead of taking full measures to control the epidemic. President Trump repeatedly referred to the coronavirus as the ’Chinese virus’ [58] and portrayed everything related to China as evil. The United States not only criticized China but also announced its withdrawal from the WHO and ended its financial support for the organization. This move has seriously undermined the unity and stability of global health governance [45].

Suggestions.

When managing infectious diseases, governments should firstly consider unique cultural, social, and economic factors within each state while prioritizing global health due to the borderless nature of viruses.

Before outbreak, it is crucial to strengthen infectious disease surveillance and early warning systems domestically to prevent large-scale outbreaks. This entails establishing robust monitoring networks that integrate data from healthcare facilities, laboratories, and community-based surveillance systems. These systems should employ advanced analytics and machine learning algorithms to detect unusual patterns and provide real-time alerts, enabling rapid response mechanisms. Furthermore, investing in research and development for diagnostic tools and vaccines tailored to local disease profiles can significantly enhance preparedness.

When an infectious disease outbreak occurs, coordinated leadership systems and intermediate strategies maybe effective. Governments should establish multi-sectoral task forces comprising health experts, policymakers, and community leaders to ensure a unified and efficient response. Implementing containment measures such as targeted lockdowns, enhanced hygiene protocols, and social distancing guidelines can mitigate the spread of diseases. Governments should improve risk communication in a timely and transparent manner, based on scientific evidence. This includes regular updates through official channels, clear guidelines for the public, and addressing misinformation actively. To strengthen source control, governments should augment testing capabilities by expanding laboratory networks and utilizing rapid testing technologies. Enhancing hospital capacity, including increasing bed availability, procuring essential medical equipment, and training healthcare workers, is crucial. Implementing necessary closures, such as schools and non-essential businesses, should be done in a phased and strategic manner to balance public health with economic impacts. Additionally, governments should prioritize the protection of vulnerable groups, including the elderly, immunocompromised individuals, and those living in densely populated or underserved areas, by providing them with prioritized access to healthcare services and supplies. Moreover, addressing health inequalities requires a comprehensive approach. Governments should invest in strengthening primary healthcare systems, promoting health education, and improving sanitation and hygiene infrastructures, particularly in rural and marginalized communities.

Internationally, adherence to laws, timely information sharing, and collaboration with organizations such as the WHO are crucial. Developed nations should support developing regions through knowledge transfer, capacity building, and the equitable distribution of vaccines and medical supplies. This includes establishing technology transfer agreements, providing financial aid, and facilitating access to advanced medical research. Efforts should also be made to combat vaccine nationalism and ensure that no country is left behind in the global vaccination drive. To effectively combat infectious diseases and achieve global health goals, it is important for all countries to prioritize cooperation, actively participate in multilateral partnerships, and resolve conflicts diplomatically. This includes refraining from harmful competition, such as hoarding medical resources or engaging in vaccine diplomacy that undermines global solidarity. Instead, fostering a spirit of global citizenship, where nations work collaboratively towards a common health security agenda, is essential for sustainable global health governance.