Impact of Covid-19 control strategies on health and GDP growth outcomes in 193 sovereign jurisdictions

The Covid-19 pandemic caused approximately 27.3 million excess deaths globally as of June 2024. Despite growing research on pandemic response factors, the effectiveness of different strategic approaches to Covid-19 control remains insufficiently investigated. We aimed to examine associations between Covid-19 pandemic control strategies (including stringent border restrictions) with age-standardized excess mortality and GDP per capita growth outcomes during 2020-2021. We analyzed 193 sovereign jurisdictions with existing Global Burden of Disease Study data. Jurisdictions were classified by implementation of exclusion/elimination strategies reported in published literature, and the level of border restriction measures based on the Oxford Stringency Index. Multivariable analyses adjusted for island status, GDP per capita, and an index of government corruption. Excess mortality was cube root transformed and GDP per capita log transformed for regression analysis. Jurisdictions implementing explicit exclusion/elimination strategies showed the lowest cumulative age-standardized excess mortality (-2.1/100,000) compared to others (166.5/100,000). Island jurisdictions experienced lower mortality (64.8/100,000) than non-islands (194.3/100,000). Duration of border restrictions correlated with reduced excess mortality in islands (Pearson's r = -0.624, p < 0.001; β -0.004, island interaction -0.005, p < 0.001), but not in non-islands. However, this effect weakened when controlling for government corruption in a subsample (lower corruption was associated with lowered mortality). No consistent significant relationships emerged between border measures and GDP growth, suggesting that stringent border restrictions in a pandemic may not significantly harm economies. We concluded that exclusion/elimination strategies and related stringent border restrictions were associated with better health outcomes, particularly for islands. Effectiveness was likely partially mediated by governance quality. Future pandemic planning should consider both control strategy selection and implementation context, both of which are modifiable.