Curtailing COVID-19 on a Dollar-a-Day in Malawi: Implications for the Ongoing Pandemic

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Utilizing population-based data from the COVID-19 phone survey (N=2,262$) of the Malawi Longitudinal Study of Families and Health (MLSFH) collected during June 2nd--August 17th, 2020, we investigate behavioral, economic and social responses COVID-19 and focus on the crucial role that community leadership and trust in institutions play towards shaping these responses. We argue that the effective response of Malawi to limit the spread of the virus was facilitated by the engagement of local leaders to mobilize communities to adapt and adhere to COVID-19 prevention strategies. Village heads (VHs) played pivotal role in shaping individual's knowledge about the pandemic and the adaption of preventive health behaviors and were crucial for mitigating the negative economic and health consequences of the pandemic. We further show that trust in institutions is of particular importance in shaping individuals' behavior during the pandemic, and these findings highlight the pivotal role of community leadership in fostering better compliance and adoption of public health measures essential to contain the virus. Overall, our findings point to distinctive patterns of pandemic response in a low-income sub-Saharan African rural population that emphasized local leadership as mediators of public health messages and policies. These lessons from the first pandemic wave remain relevant as in many low-income countries behavioral responses to COVID-19 will remain the primary prevention strategy for a foreseeable future.