Dangerously unprepared

Despite important steps taken by countries to respond to the COVID-19 pandemic, all countries—across all income levels—remain dangerously unprepared to meet future epidemic and pandemic threats, according to the new 2021 Global Health Security Index.

The report, released today by the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, with research by Economist Impact, measured the capacities of 195 countries to prepare for epidemics and pandemics. The data demonstrate that all countries have insufficient sustained health capacities, leaving the world acutely vulnerable to future health emergencies, including those potentially more devastating than COVID-19. The average overall 2021 GHS Index score is 38.9 out of a possible score of 100. No country scored in the top tier of rankings and no country scored above 75.9.

"COVID-19 offers a devastating illustration of how poor pandemic preparedness and response can impact health and security at every level—local, national, and global," said Ernest J. Moniz, co-chair and CEO of the Nuclear Threat Initiative. "The stakes are high, and world leaders need to act. Biological risks are growing in frequency, and all countries need more investment in durable capabilities to address these risks."

The GHS Index is designed to inform leaders of the foundational elements necessary to prepare their countries for future outbreaks and where they should prioritize planning and durable funding. It is not a direct predictor of performance in the face of a health emergency; as COVID-19 has demonstrated—contextual social, political, and cultural phenomena also impact how well a country responds to a biological event.

"Leaders now have a choice," said Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security. "They can make dedicated, sustainable investments in the new capacities created during the COVID-19 response to prepare their countries for the long term, or they can fall back into the decades-long cycle of panic-and-neglect that will leave the world at grave risk for inevitable future public health threats."

"One of the core principles of the GHS Index is that global health security is a collective responsibility," said Margaret A. Hamburg, NTI interim vice president for biological policy and programs. "The index can help leaders, health officials, and practitioners identify gaps and build sustained preparedness in their home countries and those in their regions."

The conclusions of the 2021 GHS Index are the result of a revised framework and updated data collection conducted between August 2020 and June 2021 that allowed researchers to glean hard truths about preparedness for future threats while assessing health security capacities during the ongoing pandemic. The index assessed countries across six categories, 37 indicators, and 171 questions using publicly available information. The index benchmarks health security in the context of other factors critical to fighting outbreaks, such as political and security risks, the broader strength of the health system, and country adherence to global norms.

"It can be difficult for countries to know how best to use their very limited resources to meaningfully protect themselves against future pandemics," said Anita Cicero, director of the Johns Hopkins Center for Health Security Deputy. "The Global Health Security Index can be used as a guidepost to identify and address yawning preparedness gaps with the ultimate goal of reducing health and economic impacts when the next public health crisis comes along."

Top findings

In addition to its overall finding that all countries remain dangerously unprepared for meeting future epidemic and pandemic threats, the GHS Index finds:

• Most countries, including high-income nations, have not made dedicated financial investments in strengthening epidemic or pandemic preparedness. One hundred fifty five out of 195 countries have not allocated national funds within the last three years to improve capacity, outside of public health emergencies, to address epidemic threats; and, among those who have, only two low-income countries have. Improving capacity requires a multi-year financial commitment, not just an increase in funding during a crisis.

• Most countries saw little or no improvements in maintaining a robust, capable, and accessible health system for outbreak detection and response. Seventy percent of countries show insufficient health capacity in clinics, hospitals, and community health centers.

• Political and security risks have increased in nearly all countries, and those countries with the fewest resources have the highest risk and greatest preparedness gaps. One hundred sixty one countries have low to moderate levels of public confidence in their government.

• Countries are continuing to neglect the preparedness needs of vulnerable populations, exacerbating the impact of health security emergencies. Only 33 countries have an overarching emergency preparedness and response plan in place that includes considerations for vulnerable populations.

• Countries are not prepared to prevent globally catastrophic biological events that could cause damage on a larger scale than COVID-19. One hundred seventy six countries have not published and implemented an overarching national public health emergency response plan for diseases with epidemic or pandemic potential.

Top recommendations

Based on these findings, and building on the 2019 GHS Index, the 2021 GHS Index includes an action plan for countries, international organizations, the private sector, and philanthropies to improve capacities and ensure the world is prepared for the next pandemic. Top recommendations include: countries should allocate health security funds in national budgets and conduct assessments, using the 2021 GHS Index as a reference to developing a national plan to identify their risks and fill gaps; international organizations should use the index to identify countries most in need of additional support; the private sector should use the index to look for opportunities to partner with governments; and philanthropies and funders should develop new financing mechanisms and use the Index to prioritize resources.

This report is the second edition of the GHS Index. It was developed in consultation with an international panel of 18 experts from 13 countries. The project included a year-long data collection and validation process by 80 Economist Impact researchers located around the world and opportunities for governments to validate data.

Visit www.ghsindex.org to explore the GHS Index data, download the full report and data model, view profiles for each country, use the score simulator, review the full methodology, watch the GHS Index video, and more.