Summary box
The COVID-19 response in Mauritius, which is viewed as a success story, benefited
from strong leadership, highest political engagement, and strong involvement of the
WHO, the private sector and other key stakeholders.
Another key success factor lies in clear, transparent and consistent communication,
including feedback mechanisms to understand public perception, the result of which
is good adherence by the population.
Public health measures (quarantine, contact tracing, case investigation and isolation
of contacts, mass testing) have also contributed to the success of the country in
the fight against COVID-19.
The Mauritian success story can be inspiring for other countries, especially regarding
the importance of adapting measures to evolving knowledge and developing a clear and
consistent communication policy so as to buy the adherence of the population.
However, contextual factors (an island has a limited number of entry points) have
also facilitated the implementation and success of these measures.
Not all countries can expect similar results by copy-pasting the Mauritian response
strategy and should probably adopt a comprehensive policy acting on various factors
to fight the pandemic.
Introduction
Mauritius is an island state in the Indian Ocean located within the continent of Africa,
categorised as an upper-middle-income economy. It has an estimated population of 1.27 million
inhabitants, a gross domestic product (GDP) of US$12.2 billion and a per capita GDP
of US$ 9630 in 2021.1
Following the declaration of the COVID-19 outbreak as a public health emergency of
international concern on 30 January 2020, the WHO requested member states to develop
a National Strategic Plan for Preparedness and Response to the Outbreak with nine
strategic pillars.2 Mauritius was identified as the country with the highest risk
of exposure in the African Region, and South Africa, Cameroon and Algeria were the
only large countries among the top 10 highest risk of exposure.3 Using a mathematical
model, stratified by age, to predict the evolution of COVID-19 epidemics, some authors
predicted a median symptomatic attack rate of as much as 42% in Mauritius over the
first 12 months, if the epidemics was unmitigated.4
The first three COVID-19 cases (all imported) were detected in Mauritius on 18 March
2020. On 19 March, the borders were closed. With the escalation of cases, a curfew
was imposed on 20 March, and eventually a complete lockdown was implemented on 24
March.5 According to the national surveillance system, the outbreak quickly evolved
from sporadic cases to clusters and then to local transmission and was contained on
26 April 2020, after 39 days, with no locally transmitted cases until November 2020.
Then, two new community cases were reported, and since 26 November, only imported
cases have been reported in the island. The measures adopted by Mauritius have highly
been praised by international organisations.6
Countries around the world have experienced very different epidemic profiles, with
contextual factors, including social and environmental factors, playing an important
role in shaping the outcomes7—hence the importance of shaping response policies to
local contexts8 and of adapting policies and interventions in light of emerging knowledge
(evidence-based policy-making), engaging in transparent dialogues with stakeholders
and developing appropriate communication strategies that build public trust and support.9
The purpose of this article is to analyse the success factors of Mauritius that could
inspire other countries—if properly adapted to their context—in future outbreaks.
This article adopts a reflexive analytical approach to comprehend the key success
factors of Mauritius in fighting the COVID-19 pandemic. Reflexivity can indeed be
defined ‘as an intentional intellectual activity in which individuals explore or examine
a situation, an issue or a particular object on the basis of their past experiences
to develop new understandings that will ultimately influence their actions’.10 Data
were collected through participative observation of key stakeholders involved in the
fight against the COVID-19 pandemic in Mauritius (WHO, Ministry of Health and Wellness)
complemented by a targeted documentary and literature review. After presenting an
overview of the evolution of the pandemic in Mauritius, we present a number of key
factors that have emerged from our reflexive analysis as major contributors to explaining
the success of Mauritius in the fight against COVID-19.
Overview of the evolution of the pandemic in Mauritius
As shown in figure 1, as of 17 January 2021, the cumulative number of confirmed COVID-19
cases was 556, of which 518 cases had successfully recovered, representing a recovery
rate of 93.2%. Among the 556 confirmed cases, 341 (61.3%) were imported cases and
215 (38.7%) emanated from local transmission. There were 10 deaths in total; the incidence
was 4.4 per 10 000 inhabitants and the case fatality rate was 1.8%.11
Figure 1
Cumulative cases and cumulated deaths, Mauritius, 18 March 2020 to 20 January 2021
(WHO COVID-19 Weekly Situation Report11).
Table 1 compares the situation of Mauritius with selected countries of the Indian
Ocean Island in terms of COVID-19 confirmed cases and deaths reported in the last
7 days by countries, territories and areas, as of 17 January 2021. It shows that Mauritius
is the country/territory that fares best in the Indian Ocean in terms of almost all
indicators.
Table 1
Comparison of Mauritius with neighbouring countries, selected COVID-19 indicators
Reporting country/territory/area
Cumulative cases
New cases in last 7 days
Cumulative cases per 100 000 population
New deaths in last 7 days
Cumulative deaths
Cumulative deaths per 100 000 population
Transmission classification
Madagascar
18 001
234
65
5
267
1.0
Community transmission
Maldives
14 462
397
2675
–
49
9.1
Clusters of cases
Reunion
9443
196
1055
3
45
5.0
Clusters of cases
Mayotte
6611
379
2423
2
58
21.3
Clusters of cases
Comoros
1577
427
181
23
41
4.7
Community transmission
Seychelles
689
187
701
–
1
1.0
Community transmission
Mauritius
547
8
43
–
10
0.8
Clusters of cases
COVID-19 Weekly Epidemiological Update.11
The key success factors identified are presented below.
Strong governance and leadership
First, the COVID-19 response in Mauritius benefitted from strong leadership and highest
political engagement. A High-Level COVID-19 Committee, chaired by the Prime Minister,
was instituted on 31 January 2020 to monitor the local and international epidemiological
situations and to rapidly share key information among the different ministries. The
committee was composed of ministers in charge of Health and Wellness; Foreign Affairs,
Regional Integration and International Trade; Finance, Economics, Planning and Development;
Tourism; as well as the WHO Representative, the Secretary to Cabinet and Head of Civil
Service, medical technical advisors and other key stakeholders. This whole-of-government
approach enabled a timely and informed decision-making for a coordinated and scaled-up
national response. In addition to this, an intersectoral committee was established
at the level of Ministry of Health and Wellness (MoHW), which monitored the evolution
of the epidemiological situation as well as the daily activities related to the operational
plan. It also elaborated guidelines and standard operating procedures when needed.
Numerous protocols were devised for the different processes of case management, including
transfer to intensive care unit, oxygenation, ventilation, discharge of recovered
patients and taking charge of patients’ family members. Some of the protocols were
the WHO protocols, whereas others were adapted to the local context, taking into consideration
the capacities of the Mauritian healthcare system. Many of them were modified several
times to adapt to the changes in resources and epidemiological context and integrate
the lessons learnt.
The COVID-19 response also benefited from a strong involvement of the private sector.
Business Mauritius, which represents over 1200 local businesses, and the Mauritius
Chamber of Commerce coordinated actions with the Government. For instance, the Mauritius
Chamber of Commerce facilitated the making of food packs distributed by the Ministry
of Social Security to families on the Social Registrar of Mauritius, ensured food
supply chain continuity and contributed to devising the Work Access Permit and the
alphabetical order strategy for shopping during the lockdown.
It is also important to mention the pivotal support provided by the WHO Country Office
since the discovery of the virus. This comprised the sharing and regular updating
of key information and guidelines, and technical assistance to assess preparedness
and strengthen the capacities of country’s response to a health emergency, including
the elaboration of the National Action Plan for Preparedness and Response. The WHO
Country Office sustained its support, as the country prepared to start its vaccination
campaign in January 2021. The purpose of ‘national vaccine table top exercises’ was
to support country to plan, develop and update the national deployment and vaccination
plan for COVID-19 vaccines, including testing and enhancing its planning assumptions.12
Moreover, the WHO Country Office provided technical advice as member of the High-Level
Committee on COVID-19.
Clear, transparent and consistent communication
Another key success factor in the fight against the pandemic of COVID-19 lies in clear,
transparent and consistent communication. Mauritius started with an early intense
sensitisation campaign on COVID-19. As of 23 January 2020, the MoHW started a national
sensitisation campaign through different media (radio, television and written press)
and visuals (posters, pamphlets, banners and billboards), explaining the occurrence
of the novel coronavirus, its mode of transmission, signs and symptoms, and preventive
measures to be taken to avoid the infection. During total lockdown, the National Communication
Committee held press briefings in camera to avoid contact and answered questions from
independent journalists sent on a live platform put in place by the National Broadcaster.
These early messages placed emphasis on physical distancing, use of face masks, hand
hygiene and cough etiquette, and encouraged the public to call the hotline for further
information or to signal suspected cases. Pamphlets were distributed at the port and
airport; in educational institutions, community halls and centres at the level of
town municipalities; in village and district councils; and in all health facilities.
Clear and consistent communication was facilitated by the creation of the National
Communication Committee on COVID-19 as a unique, central communication mechanism.
It is entitled to transmit decisions taken by the High-Level Committee on COVID-19
to the Mauritian population and to address the key issues during daily press briefings.
In addition, members of the National Communication Committee on COVID-19 also participated
in special live television programmes on COVID-19 on the national television and radio
channels. These enable to provide more details on the different response measures
and to answer questions raised by the general public. It has proven to be a very effective
strategy to ensure an accurate, transparent and trustworthy stream of communication
directly from the decision-makers to the general public and to reassure the population.
To expand the dissemination of information on COVID-19 and to achieve a maximum reach,
several media platforms were created: a website, http://www.COVID-19.mu; a Facebook
page ‘Coronavirus Moris’ dedicated to COVID-19 in Mauritius; and a mobile application,
‘beSafeMoris’.
Communication goes both ways, and henceforth, several feedback mechanisms to understand
public perception on COVID-19 were established—namely, a hotline dedicated to COVID-19,
the monitoring of social media platforms and live radio shows, and regular feedback
from the Mauritius Police Force and MoHW. These mechanisms helped to monitor the populations’
behaviours with respect to the different measures implemented as well as their beliefs,
fears and concerns which were consequently addressed during the regular press conference.
As the outbreak progressed in Mauritius, the National Communication Committee on COVID-19
indeed observed that the population was more adherent to precautionary measures such
as physical distancing and wearing masks while shopping and more respectful of the
sanitary curfew in general.13
The National Communication Committee on COVID-19 also addressed rumours, misinformation
and fake news with clear and correct clarifications with a view of halting their propagation.
The committee condemned the spreading of fake news on social media—notably about the
prevalence of COVID-19 cases in Mauritius, the number of deaths, the reliability of
tests and treatments, and the reclosure of supermarkets—characterised such behaviour
as antipatriotic and highlighted their negative impact such as installing a climate
of fear or panic.
Last but not least, the government was also engaged to reassure the population that
the country is COVID-safe since 26 April 2020. The people were encouraged to remain
alert and maintain recommended sanitary measures as the prevalence of COVID-19 is
on the rise in foreign countries. This regular and transparent communication has proven
to be highly effective. A considerable decrease in rumours and fake news was observed
among the population and on social media. The population also reacted in a responsible
and disciplined way when a cluster of two locally transmitted cases of COVID-19 were
identified in November 2020. According to the reports from the COVID-19 testing centres,
the Mauritius Police Force, media and social media, the population showed no behaviours
expressing panic on the announcement of local cases. ‘The population is now better
prepared and when there is a local transmission they understand that the authorities
took the needful measures did the contact tracing … there was no panic, the population
reacted responsibly and in discipline’—said Dr Joomaye Zouber, Senior Adviser to the
Prime Minister in Mauritius, during his interview at the WHO Inter-Action Review exercise
on 18 December 2020. There was also no indication of other behaviours such as panic
buying and people not wanting to go to their workplace or sending their children to
school.
Population adherence to physical distancing measures
During the COVID-19 community transmission phase in March to May 2020, high-level
governmental commitment and good communication resulted in strong adherence of the
population to physical distancing measures in place. These include, for example, the
fact that while supermarkets opened 6 days a week, Mauritians were only allowed to
shop twice a week in alphabetical order using family names: A to F on Mondays and
Thursdays, G to N on Tuesdays and Fridays, and O to Z on Wednesdays and Saturdays.
One person per household was allowed to shop for 30 min, and the wearing of protective
masks was compulsory. Customers had to bring an identification document that was verified
at the entrance of the supermarkets. The elderly, being more vulnerable, were dissuaded
from shopping, whereas younger adults of the family were encouraged to do so. However,
a special morning slot from 9:00 to 10:00 was created for elderly persons who had
to shop for themselves. These measures were very well respected.
Strong public health measures
Capitalising on decades of experience in successfully fighting communicable diseases,
Mauritius’ public health measures have also contributed to the success of the country
in the fight against COVID-19. Contact tracing, case investigation and isolation of
contacts were established under the supervision of the Communicable Diseases Control
Unit. Once a positive COVID-19 case was notified by the Central Health Laboratory,
the Communicable Diseases Control Unit contacted every person tested positive for
case investigation following their transfer to the COVID-19 treatment centres. Key
information about how long they had been sick, the people they stayed with, the people
they had been in contact with and whether their contacts were sick, and the places
they visited is collected. A list of all of the patient’s contacts is elaborated,
and each of them is contacted, asked for symptoms and instructed to self-isolate while
waiting to be visited by the contact tracing team.
On 27 April 2020, a mass rapid testing campaign for COVID-19 targeting frontliners
was initiated by the MoHW. By 7 July 2020, 160 315 rapid tests were carried out among
health personnel from both public and private institutions, including members of the
police force, prison detainees, expatriates living in dormitories, pharmacies’ personnel,
scavenging and cleaning services, supermarkets personnel, personnel working for port
and airport authorities, private sector staff, staff from various ministries, members
of religious and sociocultural organisations, public transport workers and athletes,
among others. This campaign was designed to ensure that there was no case of COVID-19
in Mauritius in preparation for the phased ease of lockdown. No positive case was
subsequently found, and the testing campaign was stopped.
Laboratory testing has also been a priority from the start of the pandemic. The total
number of tests conducted as of 17 January 2021 was 319 242, comprising 158 927 PCR
tests and 160 315 rapid antigen tests. A 14-day quarantine is mandatory for those
entering Mauritius, with entrance conditioned on the presentation of a negative PCR
test 7 days before travel to Mauritius and three tests during the quarantine on day
1, day 7 and day 14. All positive cases are treated in dedicated treatment centres
until they get two consecutive negative tests at an interval of 24–48 hours. Mauritius
is now elaborating the COVID-19 National Deployment and Vaccination Plan with a goal
of re-opening borders.
Conclusion
On 19 January 2021, the High-Level Committee chaired by the Prime Minister met for
the 101st time. It took note that while the number of cumulative cases compare with
other African countries, the situation changed drastically because Mauritius, which
was one of the most heavily hit African countries in April 2020, was the lowest affected
country in the African region in January 2021.11
Like many other countries, Mauritius faced an unprecedented situation because it had
never experienced a pandemic of that scale and responded promptly by actions initially
taken on an ad hoc basis. However, the government learnt throughout the national response
and improved its management of the pandemic accordingly. Overall, it is estimated
that measures implemented to prevent widespread community transmission of COVID-19
may have saved the country 837 human lives worth international US$258 080 991. This
evidence, conjointly with human rights arguments, calls for increased investments
to bridge the existing gaps for achieving universal health coverage by 2030.14
We have identified governance and leadership, and communication, coupled with proactive
contact tracing and test-and-treat measures as key factors contributing to the success
of Mauritius. Other authors have also pinpointed the rapid response by the Mauritian
Government, and appropriate and strong support and compliance from the public as key
factors towards the control of the pandemic.5 A retrospective study using inferential
statistical methods identified a number of factors that have contributed significantly
in controlling the propagation of the novel coronavirus in Mauritius; in particular,
the sanitary curfew/lockdown, sanitisation and sensitisation campaigns, and safe shopping
guidelines have helped to curb down, by a large extent, the number of COVID-19 cases.
Hence, such preventive and proactive measures, with the main focus on sanitisation
measures at grocery stores and in busy public places, should be maintained even after
lifting lockdown orders. Quarantine centres for all incoming passengers have also
significantly helped in timely containment of the novel coronavirus, eliminating to
a great extent the risk of spreading in the local community.6
The Mauritian success story can be inspiring for other countries. However, it should
be noted that contextual factors have also facilitated the implementation and success
of these measures. The fact that Mauritius is an island, with a limited number of
entry points, has obviously facilitated the identification of arriving persons and
the follow-up of their quarantine. The fact that Mauritius is a close-knit society
has also perhaps facilitated social control and adherence to governmental measures.
Therefore, not all countries can expect similar results by copy-pasting the Mauritian
response strategy—and most countries should probably adopt a comprehensive policy
acting on complementary social, economic, physical and environmental factors to improve
the health stock of the population and to curb the COVID-19 mortality.7 Nevertheless,
Mauritius illustrates well the importance of adapting measures to evolving knowledge
and developing a clear, transparent and consistent communication policy so as to buy
the adherence of the population.