Resilience and Academic Dropout in Ecuadorian University Students during COVID-19

Abstract

The pandemic caused by COVID-19 has had a global impact that has affected all areas of people’s lives. However, people have different capacities to adapt and cope with the adversities and traumatic events that may have occurred during the pandemic with different levels of resilience. One collective affected by this global crisis was university students, who had to face an unprecedented academic situation, resulting in some abandoning their studies. This study aims to analyse whether the resilience of the students could be related to academic dropout. To carry out this research, we assessed the resilience of 1676 university students from 11 universities in Ecuador. To do so, a committee of experts from the Ecuadorian Association of Social Work Education Centres and 11 Ecuadorian universities designed a questionnaire and sent it to the entire sample. Subsequently, we compared the levels of resilience between university students who withdrew from university during the COVID-19 pandemic with those who continued their studies by using a multivariate analysis. The results showed that there were statistically significant differences in all variables analysed. The students who obtained the highest scores were those who continued their studies, and those students who dropped out obtained the lowest scores. In summary, we found that school dropout among Ecuadorian university students during the COVID-19 pandemic was due to low levels of resilience. Therefore, increasing student resilience could improve university retention rates and, in turn, academic performance and future life prospects.

1. Introduction

COVID-19 manifested as atypical cases of pneumonia in China and on 11 February 2020, the WHO considered the illness to be caused by a novel coronavirus [1]. On 11 March 2020, the WHO confirmed that the outbreak was a global pandemic. The virus in question has likely caused the most impact and damage internationally in recent decades [2].

COVID-19 drastically changed people’s lives, and also had global economic, social and political consequences. Such repercussions drastically affected the living conditions of citizens, generating uncertainty, fear, massive disruptions and economic recessions that reorganised the economy’s offer and demand [3]. Regarding the impact of the crisis, other authors have studied conditions that cause distress, mental disorders, and unemployment, which can lead to suicide in many cases [4]. Another factor that affected mental health due to COVID-19 was parents having to work remotely as their workload doubled and new strategies were required to school their children [5,6]. For Pietromonaco et al. [7], the pandemic increased stress levels, affecting couples’ relationships and their individual vulnerabilities, such as insecurity and depression. Furthermore, it has been noted that significant affective, ethical and spiritual values implying emotional bonds hold a binding meaning for elements that are implicit to resilience [8]; as a consequence, and despite mobility and clustering restrictions, the pandemic in some countries increased religious practice and addiction to internet use [9,10], as well as smoking and alcohol abuse and their possible link to SARS-CoV-2 [11].

Education was not spared from the impact of the crisis and it was one of the sectors most affected by the pandemic [3]. The world’s education systems did not foresee systematic actions to mitigate the closure of education facilities, disrupting the education of over one billion learners. This affected learners, teachers, parents and other education-related actors [12]. Authors like Hanushek and Woessman (2020) have connected the impact of learning losses to a lasting economic impact, where the loss of a third of one academic year caused by COVID-19 will affect the students’ income by approximately 2–4% during their working life. The magnitude of these social and economic consequences have been compared to economic crises, environmental disasters, revolutions and terrorist attacks, with the main difference being the considerable risk for public health requiring direct family attention [13].

According to a UNESCO publication (n.d.) [14], some of the harmful effects of school closures due to COVID-19 include learning disruption, malnutrition, digital inequality, greater pressure on schools and social isolation. The World Bank [15] analysed how unemployment and a lack of earnings will be a predominant factor for dropouts, causing more poverty and higher inequality. However, for Schleicher [16], the most affected students will be those who do not have access to digital learning resources and lack the resilience elements required to learn. According to Herrman et al. [17], resilience is a positive attitude towards the ability to maintain or regain mental health in the face of adversity. Resilience can transform life in times of adversity and, although it can be present in other aspects of life, it is during unanticipated times that it can develop with more impetus [18]. For Forés and Grané [19], resilience is strictly related to the ability that an individual has to cope in a situation and change it despite conditions that are detrimental to his or her development.

While this crisis required an immediate response, the impact of COVID-19 hit many households in Ecuador, particularly the most vulnerable. At the onset of the pandemic—early 2020—26,336 COVID-19 cases and 1063 deaths were recorded in Ecuador, deaths that were mainly concentrated in a single city (Guayaquil) [20]. For a relatively small country, this figure caused a national state of alarm [21]. Bonilla and Guachamín [22] reported on the reality in Ecuador and indicated that only 37.23% of households had a computer, which was lower in rural areas and deprived neighbourhoods (23.27%). During the first half of 2020, employment dropped by 11.1 %, placing employment at 52.8%, as an additional 643,420 people became unemployed. Of this group, young people aged between 15 and 24 years were the most affected (25.8% reduction), many of whom were students [23]. Furthermore, access to the health system, which was historically believed to be inefficient, was weakened even more, increasing health inequalities, mainly in rural areas [24]. During the first year of the pandemic, Ecuador was ranked eleventh in South America for COVID-19 testing (13,835 tests per million inhabitants), only ahead of Guyana and Suriname. An additional 27,000 deaths were reported compared with the three years before the pandemic [25].

Social and environmental sustainability play an important role in the resilience factors identified in the research. The COVID-19 pandemic deconstructed imposed social and environmental practices and rescued practices recognised for their own cultural identity and worldview. The pandemic was like a laboratory for de-imagining education from the perspective of family and environmental social sustainability [26]. As a consequence, during the health crisis, the family strengthened sustainable development practices through the recovery of memory, such as ancestral health, and the use of medicinal plants to mitigate the effects of COVID-19 or to recover family health in the face of the demand for care in public hospitals; it also recovered, in households, the need to create family gardens, community practices of exchange, intergenerational integration, community work and bartering, which form the basis of the “Sumak Kawsay” [27,28].

In this context, one consequence of the pandemic among the Ecuadorian university population was academic dropout. Tinto [29] described academic dropout as being the process that interrelates academia with the students’ social backgrounds in which different dynamics and conditions interact, including ethnic group, gender, lived experiences, academic achievements, family support and economic status. The paper also indicated that each of these factors will also enhance performance and the impact on those remaining in education. Authors like Greenland and Moore [30] who based their work on Tinto’s [29] theory suggested that dropout or withdrawal was based on the student’s level of commitment and their motivation influenced by friends and social groups that support learning. They further indicated employment as a predominant factor in withdrawal, as well as family and social interrelations. Resilience is related to factors such as dispositional optimism, i.e., the optimism that makes achieving goals and high efficiency possible [31]. To this end, Intriago et al. [32] stated that resilience is characterised by the human condition of being able to push for a goal in the face of defeat, and that “protective factors” will play a fundamental defensive role in goals being achieved. In keeping with these factors, they mentioned that high self-efficacy rates generate a greater ability to face adversity [33,34]. For Pereyra Girardi et al. [35], the self-efficacy construct can have several variables, including a protective factor, whereas Bandura et al. [36] indicated that self-efficacy is directly related to how a person behaves when facing a potentially stressful situation and is what gives human beings the impetus to achieve their goals by applying their skills and abilities, providing the motivation required to reach a goal [37].

1.1. Literature Review

There are studies on resilience that use existing methods and instruments. Levels of individual resilience, according to Jew et al. [38], are measured in three dimensions: optimism, skill acquisition and risk taking. For Doll et al. [39] resilience is measured using interpersonal relationships across four categories: frequency of social interaction, ability to resolve minor disagreements, frequency of prosocial behaviours and ability to resolve conflicts. Authors such as Hjemdal et al. [40] considered an individual’s abilities to adapt when faced with new risky situations, defining the “resilient self” through a 14-item instrument. Other authors such as Wagnild and Young [41], developed a resilience scale based on self-acceptance and personal competence in five dimensions: perseverance, self-confidence, meaning in life, philosophy of life and equanimity. For students, Perry and Bard [42] developed a scale called Resilience Assessment for Exceptional Students (RAES), in which they identified 3 domains of resilience with 11 factors and 54 items. These domains were: knowledge of exceptionality; planning for needs; and alternative thinking for exceptional problem solving. Aspects of resilience such as commitment, burnout and its opposite, engagement, were applied to university students in Spain, Portugal and the Netherlands [43,44]. There are other instruments developed for students, such as the one proposed by Maslach and Jackson [45] that includes three categories: emotional exhaustion, cynicism and low efficacy. Warren and Hale [46] conducted a study of resilience and academic beliefs in students at a public university in the southeastern United States, using a brief resilience scale (BRS). The BRS is a five-item self-report measure developed by Smith et al. [47] that assesses resilience to stress. In Latin America, Salgado [48], developed an instrument to assess five resilience factors, self-esteem, empathy, autonomy, humour and creativity, that responded to Peru’s own reality. In Mexico, Valadez [49] assessed the so-called “Mexican Scale”, 43 items arranged in four categories: (social competences, family support, social support and structure), whereas Palomar and Gómez [50] developed a measurement scale of 25 items grouped in five dimensions.

As can be deduced from the previous paragraph, the existing resilience instruments take into account the specific reality of the subjects under investigation, and there is no model that is generally used by the scientific community. For this reason, no methods and instruments were found that were developed and applied under this “new” reality of a global pandemic, nor did they include specific realities, such as the cosmovision of Ecuador’s indigenous peoples and ethnic groups [51].

The Ecuadorian people has a great variety of indigenous ethnicities, peoples and nationalities (14 nationalities and 18 peoples). In this sense, according to Hurtado [52] in his book “Las Costumbres de Los Ecuatorianos” (The Customs of Ecuadorians), personal and family relationships are part of cultural and social relationships; however, these relationships in indigenous communities, Afro-descendants and minority ethnic groups, can be affected by discrimination and communication [53,54]. Family relationships and violence may also affect the personal relationships of students in the coastal region [55].

The existence of various nationalities, ethnic groups and peoples should not be seen as a hegemonic condition that implies superiority of one over another. For Boaventura de Sousa [56], plurinationality is a recognition of the country, which implies respect for its social and cultural rights. However, the culture of these peoples, which is part of their identity, is at risk and influenced by dominant groups and external agents [57]. According to Davalos [58], peoples and nationalities feel that their territory and culture are becoming vulnerable; therefore, they live in constant socio-cultural risk. On the other hand, not only is socio-cultural risk present but, due to natural phenomena, the population also “lives” in constant risk. Its territory is part of the Pacific Ring of Fire and is therefore exposed to constant earthquakes [59], as well as periodic flooding due to high rainfall caused by the influence of the El Niño warm current [60]. Faced with these realities, authors such as Anzola [61] and Páramo [62] consider resilience as a protection factor for people, especially indigenous students in conditions of poverty [63].

1.2. Hypotheses and Objectives

Studying the living conditions and academic dropout of university students became a priority for social work schools at 11 universities in Ecuador. For students, these conditions could generate traumatic situations, which were strictly related to the threat to life and the threat to collective and individual health and how they cope or overcome a crisis, individually or collectively. If they were not able to overcome said crisis, there would be an increasing unmet need, where the following factors should be considered: ethnic group, gender, education level, age, socio-economic and employment situation, etc. [64,65]. In this scenario of unprecedented socio-educational transformation not foreseen by the government, educational institutions or the students themselves, online support networks were created. For Aranda and Pando [66], these transformations arose within the framework of social interrelations and were related to caring and protecting others using support networks. Meanwhile, for Hernández et al. [67] they were informal support networks where identity strengthening is also built upon.

The objective of this study is to analyse if there are significant differences in the resilience of students who continued their studies and those who withdrew from university due to the effects caused by the COVID-19 pandemic in Ecuador.

This study aims to answer questions such as: What resilience factors do university students have because of COVID-19? Does the level of resilience affect university dropout? Is there a difference in the family relationships of those students who drop out because of COVID-19 and those who do not?

This paper is structured as follows: This section reviewed the literature on the health crisis caused by COVID-19 and offered a general overview of the situation and how it affected the population in Ecuador, especially the impact it had on education and academic dropout, which is the main objective of this study. The second section describes the method used for the study and specifies the participants in the sample, the instruments, procedures and the data design and analysis. The third section presents the results obtained from the statistical analysis comparing sample groups of students who continued their studies or withdrew from university. Lastly, the fourth section includes the main conclusions and discusses a possible future study.

2. Method

2.1. Participants

Ecuador has 71 universities (632,541 students), of which 11 universities have a degree in social work. The total number of social work students in the 11 universities is 3775, of which 1695 students participated in this study. These 11 universities are as follows: Central University of Ecuador, Ambato Technical University, National University of Loja, Cuenca University, Catholic University of Cuenca, Civil University Eloy Alfaro de Manabí, Manabí Technical University, Luis Vargas Torres University, Machala Technical University, Milagro State University and Santa Elena Peninsula State University.

As shown in

Table 1. Descriptive statistics for participants’ age by gender.

Gender	N	Min Age	Max Age	Age Avg.	Age Std. Dev.
Female	1111	18	46	22.25	2.977
Male	584	18	47	21.83	3.263
Total	1695	18	47	22.10	3.084

, the average age of the participants was 22 years, and their ages ranged from 18 to 47 years.

2.2. Instruments

The global pandemic caused by COVID-19 has created a new social problem scenario for which there is no evidence of methods and instruments that specifically measure resilience in this type of context. Under this new reality, experts from the 11 Ecuadorian universities (sociologists, psychologists, social workers and anthropologists) developed a measurement instrument with four factors/categories and resilience items during the pandemic (period of maximum impact) taking into account the realities, socio-cultural and family realities from the worldview of the peoples and communities of Ecuador [51,68].

We designed a social resilience assessment questionnaire (

Table 2. Resilience questionnaire.

I apologise when I feel like I’ve made a mistake I share my problems with my friends I think one needs to tell the truth and be respectful to have friends I feel proud of the person I am When something difficult happens in my life, I get over it quickly It’s important for me to have people that support me during difficult times of life If another person bothers me, I ask them to change the way they behave towards me I feel uncomfortable when people tell me about sad situations If someone asks me for help, I listen to them I find it hard to put myself in someone else’s place when they’re telling me about something that happened to them I feel like I receive support from my family when I have problems and/or needs Among my family and the people I live with, we talk and share our problems My family and the people I live with accept and support my decision to pursue new activities My family and the people I live with express their affection and respond to my emotions, such as anger, sadness and love My family and the people I live with spend time together in different parts of the house In my neighbourhood or community, we are prepared to face any type of situation The people in my neighbourhood or community are supportive of one another when there is a need In my academic preparation, I have received training about skills and strategies on how to face this situation I trust the educational institutions’ responses to propose strategies to deal with the emergency situation The state institutions in my neighbourhood or community care about the well-being of my family or my neighbours I feel like state institutions respond to the needs of my neighbourhood or community The measures currently adopted by the State improve my family’s quality of life Feeling like I belong in the place where I live allows me to develop emotional bonds of identity to face this crisis As citizens, strengthening national identity is important to face a crisis situation Customs and traditions are important resources to make us stronger during difficult times I didn’t believe that the situation would reach the magnitude it has I try to take something positive from the country’s situation I try to not think about the country’s situation so as not to worry I feel defenceless and unable to do anything to change the situation

) using the Delphi method to find out how the participants coped during the COVID-19 health crisis. The research instrument included 29 items grouped in four categories of semantic units of resilience: interpersonal resources, family resources, sociocultural resources and coping with the risk situation.

To this end, we asked participants to answer the questions in Table 1, stating to what degree the statements described them by selecting one of the following four options from a Likert-type scale ranging from 4 to 1: always, almost always, almost never, never.

The questionnaire was approved by ten professionals based on the expert judgement method. Following the expert judgement, the Aiken’s V coefficient was 0.96 and Cronbach’s alpha was 0.80 for the whole scale.

2.3. Procedure

We conducted this study in response to 11 Ecuadorian universities deciding to take part in a study within the context of the COVID-19 health crisis. All universities offer degrees in social work and are members of the Ecuadorian Association of Social Work Education Centres (ANUATSE is its acronym in Spanish). The study was based on the principles of voluntary group participation. After the Association announced a student support project (called “COVID-19 support network”) to its members, the heads of the degrees in social work agreed to be part of the study to consider the social problem of university students under this “new” reality throughout Ecuador.

The study started with ANUATSE formally communicating with authorities from the participating universities and the Council for Higher Education (the Council for Higher Education (CES) is an Ecuadorian institution that plans, regulates and coordinates the higher education system, and connects the different education actors with society to guarantee citizens a quality education and boost growth in the country [69]). Certification of the research project and informed consent (ethical considerations) for the application of the survey was issued by ANUATSE, and the research was carried out with the endorsement of the CES.

We then confirmed the data protection protocol, ensuring that participants had given their informed consent and that the data would be used appropriately. A database was created on the Eloy Alfaro de Manabí University’s (ULEAM) virtual platform. Due to confidentiality and data protection, access to this database is restricted except for researchers from the participating universities. The method was developed by the Central University of Ecuador (UCE), and all participating universities created the analysis and instrument design.

The research was carried out in two stages: firstly, it was planned to survey university students and, secondly, the community in general. These surveys were carried out with the collaboration of students in the final stages of their social work degree courses. The students were mostly at home due to the suspension of face-to-face classes, but because connectivity in rural areas does not have total coverage [70], it was not known whether or all students had telephone or internet connectivity [71]. However, to use the research instrument, we considered the socio-economic conditions of each province (there are 24 provinces in Ecuador), a map and geo-referencing of each actor. We conducted the questionnaire from May 2020 until September 2021 via telephone calls (mobile or landline) or by sending a questionnaire link via email. The phone calls and student emails were carried out by students who were studying social work, a total of 220 students. Before starting the questionnaire, we informed the participants that they were participating voluntarily and asked them to consent to their data being recorded via the tool Kobo Collect.

2.4. Data Analysis and Design

To obtain the students’ profiles, we assessed the students’ resilience level during the COVID-19 pandemic.

We later conducted a statistical analysis in which we compared the resilience profiles of students who continued their studies and those who withdrew from university during the pandemic. We compared the groups using the general linear model (GLM) in the SPSS statistics package (version 24) along with a multivariate analysis of variance (MANOVA) and an analysis of variance (ANOVA), which is the procedure commonly used to analyse profiles. The approach to repeated measures designs offers several advantages over the traditional univariate approach. It does not make the assumption of sphericity that is so rarely met by psychophysiological data or in the behavioural sciences in general [72]. In said analysis, we used resilience variables as within-subject variables and the student groups (those who continued and those who withdrew) as between-subject variables. A t-analysis was used when it was necessary to analyse variable-by-variable behaviour.

3. Results

The result from the evaluation of assumptions of this analysis using Box’s M test showed that there was homogeneity in the variance-covariance matrices (F = 1.525 and p = 0.123) being considered equivalent groups for the study. However, Mauchly’s sphericity test did not show sphericity for the matrix of dependent variables (DVs) (W = 0.753, χ² = 480,899, gl = 5 and p = 0.000).

Since the matrix shape of the dependent variables was not spherical, the degrees of freedom for the intra-subject tests were corrected for the effects of “flatness” (resilience effect) and parallelism of profiles (effect of interaction resilience * withdrawal from university COVID), with the epsilon correction values calculated in accordance with Greenhouse–Geisser procedures ε = 0.853, Huynh–Feldt ε = 0.854, and lower bound ε = 0.333. The result of the intra-subject effect analysis with the corrected degrees of freedom showed that the profiles were not flat but they were parallel. The variations in the DVs were significant for all statistics in the flatness tests (F = 354,980; p =0.000 and η² partial = 0.173). These profiles are displayed in graph form in Figure 1. The variations in the resilience variables for each group in all statistics corresponding to the parallelism test were not significant (F = 2123; p > 0.05 and η² partial = 0.001).

To analyse if there were significant differences in the resilience level of students who withdrew from university during the pandemic compared to those who did not, we conducted a level test (see

Table 3. Test of inter-subjects effects.

Source	gl	F	p	η2 Partial	Obs. Power a
Intersection	1	15,156.523	0.000	0.900	1.000
Withdrawal from university COVID	1	20.150	0.000	0.012	0.994
Error	1693	(59.493)

^a computed using alpha = 0.05.

). The results showed that the average resilience of one group differed from the other (F = 20,150; p = 0.000; η² partial = 0.012); however, the effect size showed that the two groups were not so far apart.

Lastly, we conducted a t-test for difference of means to determine which variables showed differences between the two groups of students (

Table 4. t-test of independent samples of students who withdrew from university and those who continued their studies.

Variable	Difference of Means	T	Sig.
Interpersonal resources	−2.5	−2.497	0.000
Family resources	−7.2	−3.685	0.000
Sociocultural resources	−3.6	−2.274	0.000
Coping with the risk situation	−4.4	−2.991	0.000

). The results showed that there were significant differences in all variables (interpersonal resources, family resources, sociocultural resources and coping with the risk situation).

4. Discussion

This research led us to identify that those university students who withdrew from education during the COVID-19 pandemic were less resilient. Resilience included significant differences in all the factors we studied (interpersonal, family, sociocultural and coping with the risk).

Of all the resilience factors we analysed, the main difference was found in the variables related to family resources (−7.2 points). These differences could be related to worldview (the age-old view of the relationship between humankind and our natural surroundings) [73] as well as the social and cultural values typical of Latin American families, which together form a protective factor for its members. Culturally, most university students are influenced by their cultural traditions and live with their families until they complete their academic studies, or even later, in some cases. Based on this, we can assume that family resources will have an important repercussion on the students’ daily lives.

The next most significant resilience factor was “coping with the risk situation” (the difference between student groups was −4.4 points). This factor requires students having access to effective protective factors for them to continue their university studies and are dependent on the lack or limitation of effective protective mechanisms that may expose them to withdrawal or affect their academic performance.

The resilience differences concerning sociocultural resources among the students who continued their university studies compared to those who withdrew were also significant (−3.6 points). Even though at a community level, strategies are developed to cope as a response to the need for health services, food, housing and working conditions in the population, these responses do not seem to have been enough to alleviate the situation that university students had to face during COVID-19.

Lastly, the interpersonal resource variable showed a significant difference between the two student groups (−2.5 points). These differences could be due to the initial lockdown situation experienced by families in Ecuador, and later, by the social distancing measures put in place due to the pandemic, such as the need for online classes, which gave way to other ways of interacting with others, (which were not new for the students, however). In this sense, the analysis suggests that general resilience strategies should be developed for the public, but with a greater emphasis on the resilience of students’ family resources. Although we identified family resources as an important protective factor for university students, this factor requires care, family monitoring, prevention, support and comprehensive coping strategies. According to Zambrano et al. [74], family members suffered the effects of the health crisis and were left unprotected, so older adults had to go out to look for work while students abandoned their studies due to lack of resources.

The study shows certain limitations with respect to the techniques used. Since these techniques depended on technology (telephony and internet), and this in turn depended on the economic level of the students, there was a bias in access to the study. Students living in rural areas who did not have these services could not be interviewed. Another limitation was the lack of personal information that the universities had about their students (home addresses, telephone numbers and mailing addresses). Moreover, the main weakness was due to the extreme situation created by COVID-19 in which the research itself was carried out, since the social work students who carried out the surveys were going through situations of risk and family affectation, to which were also added the mobility restriction measures. This meant that the data could not be collected in situ, and the opportunity to collect qualitative information based on direct observation and dialogue (in-depth data) was lost. However, despite these limitations, the strength of the research lies in the large amount of data collected, high student participation, the inclusion of diverse regions and cultures, and the integration of academically dispersed social work programmes.

5. Conclusions

COVID-19 is a social phenomenon that has led to devastating consequences on global, regional and local scales. We analysed the impact of resilience on university students in Ecuador during this new scenario. However, there are studies linking the pandemic and the right to education, its impact on schooling and state obligations, as well as the closure of education facilities in Latin America [75].

In summary, we found that academic dropout in Ecuadorian university students during the COVID-19 pandemic was due to low resilience levels. To this end, calling for new legislation considering the ethics and politics that would benefit university students should be made a priority. Trying to increase students’ resilience could improve university retention rates, and in turn, their academic performance and future life prospects.

To improve resilience capacities in the interest of academic improvement, student welfare departments should implement an online care system as an initial action because, as Vargas [76] mentions, the increase in family violence caused by the pressure of a lack of employment can influence negative aspects in students, such as alcohol consumption, smoking and unauthorised drug use.

In the future, we plan to study the COVID-19-related resilience factors that could affect academic performance to a greater or lesser extent and examine how these factors evolve following the pandemic. We will also analyse other social factors that could cause academic dropout, such as domestic violence, the use of psychotropic substances, the use of alcohol and unemployment caused by COVID-19.

We also plan to conduct further studies aimed at developing participation and planning strategies for higher education public policy to improve the overall health of students and their return to university. Although these policies are medium- and long-term, emerging assessments for students at risk in the short term could facilitate learning in conditions of equality that produce, as mentioned by Camargo-Velastegui et al. [77], a formative education, autonomy and self-regulation of students as well as the commitment of a teacher as an empowering agent. In this sense, we also hope that this further study will encourage authorities to create social policies or recommendations to minimise the impact of future pandemics or other serious crises.