Friday, October 25, 2019

The Inaugural Global Health Security Index

Introductory Video (4 min)


In 2005 the World Health Organization adopted new IHR (International Health Regulations) which – among other things - requires countries to develop mandated surveillance and testing systems, and to report certain disease outbreaks and public health events to WHO.
Although this well-intentioned agreement went into force in 2007 - and member states were given until mid-2012 to meet core surveillance and response requirements - most nations have yet to meet even those standards.
While often these failures are due to a lack of resources or political instability, it is no secret that some countries - whether for political, economic, or prestige reasons - continue to deliberately drag their feet when it comes to reporting disease outbreaks.  
Shortcomings and policy decisions that put the world at risk.  
One of the realities of life in this highly mobile, interconnected, 21st century is that oceans and vast distances no longer protect against the spread of infectious diseases, and that without extensive surveillance and timely reporting from all countries, we can easily be blindsided by the next pandemic threat.
A month ago, in the WHO/World Bank GPMB Pandemic Report : `A World At Risk' we saw the latest in a long string of warnings (see WHO: On The Inevitability Of The Next Pandemic and World Bank: The World Ill-Prepared For A Pandemic) that the world remains woefully unprepared to deal with a severe pandemic.
Most countries self-report their progress in meeting the IHR, and there are few (if any) penalties for misrepresenting that progress or ignoring IHR rules (see 2015's Adding Accountability To The IHR), making it almost impossible to know how prepared (or unprepared) we really are.

That is, until yesterday, when the first Global Health Security (GHS) Index - a joint project of the Johns Hopkins Center for Health Security (JHU) and the Nuclear Threat Initiative (NTI), with research from The Economist Intelligence Unit (EIU) - was unveiled.
The results of this 324 page PDF report are sobering, to put it mildly.
First stop, some excerpts from the Johns Hopkins press release.
Inaugural Global Health Security Index Finds No Country Is Prepared for Epidemics or Pandemics
—Even high-income countries are found lacking and score only in the average range of preparedness

A new Global Health Security Index released today, the first comprehensive assessment and benchmarking of health security and related capabilities across 195 countries, suggests that not a single country in the world is fully prepared to handle an epidemic or pandemic. The GHS Index is a joint project of the Johns Hopkins Center for Health Security and the Nuclear Threat Initiative (NTI), with research by The Economist Intelligence Unit (EIU). The Center for Health Security is a part of the Johns Hopkins Bloomberg School of Public Health.

The inaugural GHS Index finds severe weaknesses in countries’ abilities to prevent, detect, and respond to significant disease outbreaks. The average overall 2019 GHS Index score is slightly over 40 out of a possible score of 100. Among the 60 highest-income countries assessed, the average score is 51.9.

Jennifer Nuzzo, associate professor at the Bloomberg School and senior scholar at the Center for Health Security, said the GHS Index, developed with guidance from an International Panel of Experts from 13 countries, can be used by health ministers and international organizations, philanthropists and funders, academics and researchers.

The GHS Index finds that no country is fully prepared for naturally occurring, intentional, or accidental infectious disease outbreaks,” Nuzzo said. “Knowing that there is work to do, countries can use the index to identify gaps, build preparedness and best practices, and track progress over time.”

“Whether they be natural, accidental, or deliberate, infectious disease outbreaks can cause significant harm to health, peace, and prosperity if countries are not adequately prepared,” said Center for Health Security director Tom Inglesby. “It is important for national leaders to understand the risks that infectious diseases pose and commit to making improvements in preparedness for these events.”

The GHS Index assessed countries across six categories, 34 indicators, and 140 questions, using only open-source information and data from international organizations, including the World Health Organization, the World Organisation for Animal Health, the Food and Agriculture Organization of the United Nations (UN), and the World Bank.
Top findings

The Index found that:
  • Fewer than 7 percent of countries score in the highest tier in the category assessing the prevention of the emergence or release of pathogens.
  • Only 19 percent of countries receive top marks (scoring a 66.7 out of 100 or higher) in the category assessing early detection and reporting of epidemics of potential international concern.
  • Fewer than 5 percent of countries score in the highest tier in rapid response to and mitigation of spread of an epidemic.
  • With an average score of 26.4 out of 100, having a sufficient and robust health sector to treat the sick and protect health workers was the lowest-scoring category.
The GHS Index findings and recommendations for addressing significant gaps in global health security come amid an ongoing Ebola outbreak in the Democratic Republic of Congo and five years after the UN Security Council met in crisis over the Ebola epidemic in West Africa.

At a time when risks are magnified by a rapidly changing and interconnected world and rapid technology advances make it easier to create and engineer pathogens, knowing the risks is clearly not enough. Political will is needed to protect people from the consequence of epidemics, to take action to save lives, and to build a safer and more secure world.
        (Continue . . . )

At 325 pages, I haven't had time to read the full report, but you can get an excellent overview from the GHS Home page, which includes an interactive world map that allows you to drill down into preparedness on a range of topics.

If you grade on the curve, a handful of countries get a `passing grade', but no country (including the United States) is truly prepared. Again, from the home page:
The average overall GHS Index score is 40.2 out of a possible 100. While high-income countries report an average score of 51.9, the Index shows that collectively, international preparedness for epidemics and pandemics remains very weak.
If you live in the United States (ranked #1), the UK (#2), the Netherlands (#3),  Australia (#4), or Canada (#5) you may be somewhat relieved to see that you are among the most prepared nations today.

But these are overall scores, and each country has one or more Achilles heel. Canada ranks #5 globally, but drops to #78 when it comes to preventing zoonotic diseases.  Australia, which ranks #4 overall, falls to 17th in its ability to respond to a pandemic.
Once you start digging into the data, you come to realize just how vulnerable we really are.
This is a massive report, and highly detailed interactive website, that cannot be digested in a single bite, so plan your visits accordingly.  Hopefully it will spur more action on the part of world leaders.

But the clock is ticking, and we'll need action on a wide variety of fronts if we are to be even marginally prepared for the next severe pandemic.