World unprepared for major infectious disease outbreak, says new health security study

• Thailand, South Korea among best-performing countries in index, but Asia still faces significant gaps

No country is fully prepared for the next epidemic or pandemic, according to the first edition of the

Global Health Security Index. 

Released last week, the index shows that only 13 of nearly 200 countries score in the top tier, suggesting that most of the world would struggle to deal with a major outbreak of a deadly infectious disease such as Ebola.

A project of the Nuclear Threat Initiative (NTI) and the Johns Hopkins University Center for Health Security, with research by The Economist Intelligence Unit, the GHS Index is the first comprehensive assessment of epidemic and pandemic threats globally. Built around a framework of 140 detailed questions, the Index assesses each country’s capacity to prevent, detect and respond to health emergencies, as well as the effectiveness of their health systems, their commitment to global norms, and the political, socioeconomic and environmental risk factors that can limit response. The average overall index score is just over 40 out of a possible score of 100, pointing to substantial weaknesses in preparedness. Even among the 60 high-income countries assessed, the average score is barely over 50.

Epidemics have been occurring with greater frequency. The 2014-16 Western Africa Ebola epidemic claimed more than 11,000 lives, and the latest outbreak of the disease, in the Democratic Republic of the Congo, has killed another 2,100 in 2018-19, according to the World Health Organisation. These emergencies and others, including the Zika epidemic in 2015-16, highlight the need to understand how countries can better prepare to face these threats.

The Index, which serves as a barometer for global preparedness, is based on a central tenet: a threat anywhere is a threat everywhere. Deadly infectious diseases can travel quickly; increased global mobility through air travel means that a disease outbreak in one country can spread across the world in a matter of hours. Understanding a country’s readiness to manage an infectious disease emergency is in part a factor of global preparedness.

“Without a way of identifying gaps in the system, we’re much more vulnerable than we need to be,” said Leo Abruzzese, Senior Global Advisor for Public Policy at The Economist Intelligence Unit. “The index is specific enough to provide a roadmap for how countries can respond, and gives donors and funders a tool for directing their resources.”

Findings from the 2019 Global Health Security Index reveal that:

• Stronger health security conditions are not dependent on whether a country is wealthy, but are driven by a multitude of factors, including effective governance and a strong disease surveillance system. Indeed, gross domestic product (GDP) and GDP per head are not strong determinants of global health security. More than 100 high- and middle-income countries score below 50 in the index.
• Even when emergency plans are in place, there is little evidence that countries have tested these capabilities to show they would be functional in a crisis. Eighty-five percent of countries show no evidence of having completed a biological threat-focused simulation exercise with the World Health Organisation in the past year. Fewer than 5% of countries have a national requirement to test their emergency operations centres to respond to a health emergency on an annual basis.
• More than half of countries face major political and security risks that could undermine national capability to counter biological threats. In light of challenges in responding to the Ebola outbreak in the Democratic Republic of the Congo, political and security risks are clear barriers to effective response. Only 23% of countries score in the top tier for indicators related to their political system and government effectiveness, covering only about 14% of the world’s global population.

The GHS Index was developed over a two-and-a-half year period, including a lengthy pilot and refinement phase. The research team consulted with an international panel of experts and other technical advisors to ensure that the index, which is based on publicly available information, adequately covers all of the issues important to assessing global and national health security.

“The index is a treasure trove of information related to health security,” said Priya Bapat, The Economist Intelligence Unit project manager for the GHS Index. “Our team of more than 100 researchers and reviewers assessed regulations and collected information, working in more than 50 languages across 195 countries—and all of this is publicly available. We hope the index will be a tool for leaders to make effective policy decisions."

To ensure the accuracy of the 2019 index data, all countries were provided with an opportunity to review and comment on The Economist Intelligence Unit’s preliminary results.

Recommendations for improving global health security, and a detailed discussion of the GHS Index, are included in a new report from NTI and the Johns Hopkins Center for Health Security, entitled “Building Collective Action and Accountability”. To see the report and other detailed findings from the index, visit http://www.ghsindex.org.