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Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.

The Global Health Security Index: We're Not Where We Need to Be

NOV 04, 2019 | SASKIA V. POPESCU
How well prepared are we for an epidemic? What about a pandemic? Moreover, how prepared do you think other countries are?

In the world of global health security and pandemic preparedness, we are only as strong as our weakest link. Identifying and working to strengthen a country’s ability to prevent, detect, and respond to biological threats and disease outbreaks is a critical part of enhancing global preparedness. To address this issue, a new index has been released that provides a detailed assessment of dozens of countries. 

The Global Health Security Index is a joint project by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security, which is also supported by the Economist Intelligence Unit (EIU). Countries were assessed across 6 categories (prevention, detection/reporting, rapid response, health system, compliance with international norms, and risk environment), with 34 indicators, and 140 questions, utilizing only public information. Acting as a benchmark for health security and providing context so that we can address weaknesses, the results were both astounding and deeply concerning. 

“The results are alarming: All countries—at all income levels—have major gaps in their capabilities, and they aren’t sufficiently investing in biological preparedness,” said Ernest J. Moniz, co-chair and chief executive officer of NTI in a statement. “The bottom line is that global biological risks are growing—in many cases faster than health systems, security, science, and governments can keep up.  We need to ensure that all countries are prepared to respond to these risks.”

To truly understand what they found though, we need to get into the weeds a bit. Overall, the average score was 40.2 out of a possible 100, and even the 60 high-income countries had an average score of 51.9. This means that no one is doing particularly well at addressing infectious disease response and prevention.

In total, 195 countries were assessed and across those 6 categories, they found that fewer than 7% of countries had a high-tiered score for prevention, while only 19% of countries score high for detection and reporting. The United States’ score came in at 83.5, followed by the UK with 77.9.

The lowest-scoring category was for health system indicators, with an average of 26.4. From the infection prevention perspective, this is particularly worrisome as this category includes components like health capacity in clinics and hospitals, medical countermeasures, health care access, infection control practices and availability of equipment, and communication with health care workers during public health emergencies. It is also reported that only 11% of countries have established practices for engaging the private sector to assist with outbreak emergency preparedness and response. 

The Index also pointed to components that go beyond just medical countermeasures and surveillance efforts, but include aspects of biological risks and new technology, pointing to the Canadian horsepox synthesis. Another example is that that small island nationals need special support and resources, referring to the Zika outbreak that hit Yap Island particularly hard, infecting 70% of the population. 

The report also provided 33 recommendations to help address the identified failures. Some recommendations suggest that public and private organizations should invest a percentage of their sustainable development and health security portfolio in the area of biosecurity, health security financing, evaluations, and planning should prioritize functional capability and regular exercises, and countries should test their health security capacities and public after-action reviews, at least annually. 

Overall, the Global Health Security Index found that no one is particularly prepared for epidemics or pandemics and that every country has health security gaps. More than half of countries face major political and/or security risks that could undermine the nation’s capacity to counter biological threats. Moreover, a majority of countries significantly lack foundational health systems capabilities that are critical for epidemic and pandemic response.

The Global Health Security Index is not only a detailed account of how the collaborative effort provided their findings but ultimately, what they truly mean for all stakeholders in health security. The report is extremely detailed and provides country-specific pages so that the reader can look at the specific findings for each of the 195 countries. While the Global Health Security Index found considerable gaps in global epidemic and pandemic preparedness and response, it also provided realistic and detailed recommendations to help guide efforts to address these opportunities for change.
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