A novel, scenario-based approach to comparing non-pharmaceutical intervention strategies across nations

Comparing COVID-19 non-pharmaceutical intervention (NPI) strategies across nations is a key step in preparing for future pandemics. Conventional comparisons, which rank individual NPI effects, are limited by: 1) vastly different political, economic, and social conditions among nations, 2) NPIs typically being applied as packages of interventions, and 3) an exclusive focus on epidemiological outcomes of interventions. Here, we develop a coupled epidemiological-behavioural-macroeconomic model that allows us to transfer NPI strategies from a reference nation to a focal nation while preserving the packaged nature of NPIs, controlling for differences among nations, and quantifying epidemiological, behavioural and economic outcomes. As a demonstration, we take Germany as our focal nation during Spring 2020, and New Zealand and Switzerland as reference nations with contrasting NPI strategies. We show that, while New Zealand’s more aggressive strategy would have yielded modest epidemiological gains in Germany, it would have resulted in substantially higher economic costs while dramatically reducing social contacts. In contrast, Switzerland’s more lenient NPI strategy would have prolonged the first wave in Germany, but would have also have increased relative costs. Our results demonstrate that Germany’s intermediate strategy was effective in quelling the first wave while mitigating both economic and social costs. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by the Helmholtz Association (HGF; Helmholtz Gemeinschaft) under the framework of the "Coping capacity of nations facing systemic crisis - a global intercomparison exploring the SARS-CoV-2 pandemic" COCAP project with the grant nr. KA1-Co-10. This work was partially funded by the Center of Advanced Systems Understanding (CASUS), which is financed by Germany's Federal Ministry of Education and Research (BMBF) and by the Saxon Ministry for Science, Culture, and Tourism (SMWK) with tax funds on the basis of the budget approved by the Saxon State Parliament. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data used in the manuscript are available online at