Effect of government intervention in relation to COVID-19 cases and deaths in Malawi

The COVID-19 pandemic prompted diverse government interventions globally, including lockdowns, social distancing, and mask mandates. The effectiveness of these measures remains debated. This study focuses on Malawi, examining the impact of government stringency measures on COVID-19 cases and deaths. Malawi, despite initial plans for a nationwide lockdown, implemented various non-pharmaceutical interventions. The study aims to determine if these measures contributed to lower-than-expected COVID-19 mortality and high recovery rates, considering Malawi's developmental goals and the disruption caused by the pandemic. The research employs an instrumental variable (IV) approach to address potential endogeneity issues, focusing on a single country to mitigate spatial heterogeneity challenges often found in cross-country studies. The study's methodological contributions lie in its use of an IV approach to overcome endogeneity concerns and its focus on a single country case study (Malawi) to reduce issues stemming from spatial heterogeneity in COVID-19 dynamics present in cross-country studies.

Existing literature on the effectiveness of government stringency measures in curbing COVID-19 presents conflicting findings. Some studies demonstrate a significant inverse relationship between stringency measures and COVID-19 incidence rates, emphasizing the effectiveness of these measures across multiple pandemic waves. These studies highlight the importance of timing and strictness of interventions and the influence of economic status on a country's susceptibility to the disease. Conversely, other research finds no quantifiable evidence supporting the effectiveness of these measures in reducing case prevalence and mortality. Some research suggests effectiveness depends on timing and the wave of the pandemic. This study aims to contribute to this ongoing debate by focusing on the Malawian experience.

The study utilizes data from the Oxford University COVID-19 Government Response Tracker (OxCGRT), covering daily data from February 20, 2020, to April 25, 2022. The primary outcome variables are COVID-19 confirmed cases and deaths. The main independent variable is the OxCGRT stringency index, a composite indicator encompassing nine different government intervention metrics. Control variables include dummy variables for planting and harvesting seasons and an election dummy to account for potential seasonal variations and election-related gatherings. An instrumental variable (IV) approach is employed to address potential endogeneity between the stringency index and the outcome variables. The date of the constitution of the COVID-19 task force in Malawi serves as the instrument. First-stage tests are conducted to ensure instrument relevance, using the Stock and Yogo test. The analysis uses ordinary least squares (OLS) and IV regression models to estimate the impact of the stringency index on confirmed cases and deaths.

Descriptive statistics reveal a 97% survival rate among confirmed COVID-19 cases in Malawi (85,747 confirmed cases and 2,633 deaths). The correlation analysis shows a significant inverse relationship between the stringency index and both confirmed cases and deaths (-0.408 and -0.418, respectively). The first-stage IV test confirms the instrument's relevance (F-statistic = 465.27, p<0.01). IV regression results indicate that a one-unit increase in the stringency index is associated with a decrease of 179 confirmed cases and 6 deaths (both statistically significant at the 1% level). OLS results, while showing the same qualitative effect, yield quantitatively different results. The IV estimates suggest that the government's stringency measures effectively reduced COVID-19 cases and deaths.

The study's findings demonstrate the effectiveness of Malawi's government stringency measures in mitigating the COVID-19 pandemic, despite the absence of a complete lockdown. The results align with studies showing a negative relationship between stringency measures and COVID-19 mortality across various countries. The significant reduction in COVID-19 cases and deaths in Malawi, despite resource constraints, highlights the potential impact of well-implemented non-pharmaceutical interventions. The study's findings contrast with situations like Brazil, where government responses were linked to higher mortality rates. The mechanisms through which the stringency measures impacted the pandemic involved restrictions on movement, gatherings, and public transport, creating a deterrent effect through fear of enforcement.

This study provides the first empirical evidence of the positive impact of Malawi's government stringency measures on COVID-19 cases and deaths. The results show that a multisectoral approach, despite limitations, led to significant achievements. The study underscores the importance of timely implementation and public adherence to such measures in managing future outbreaks. Future research could explore district-level data to analyze spatial heterogeneities and decompose the stringency index to assess the relative effectiveness of individual interventions.

The study's main limitation is the use of an aggregate stringency index, which obscures spatial heterogeneities in the implementation and effectiveness of interventions. The inability to disaggregate the index prevents a detailed assessment of the contribution of each individual measure. Future research should investigate district-level data and decompose the stringency index to provide more nuanced policy recommendations.