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. 2021 Dec;6(12):e007581.
doi: 10.1136/bmjgh-2021-007581.

Analysing COVID-19 outcomes in the context of the 2019 Global Health Security (GHS) Index

Sophie M Rose  1   2 , Michael Paterra  3 , Christopher Isaac  4 , Jessica Bell  4 , Amanda Stucke  3 , Arnold Hagens  5 , Sarah Tyrrell  3 , Michael Guterbock  3 , Jennifer B Nuzzo  2
Affiliations

Analysing COVID-19 outcomes in the context of the 2019 Global Health Security (GHS) Index

Sophie M Rose et al. BMJ Glob Health. 2021 Dec.

Abstract

Introduction: The Global Health Security Index benchmarks countries' capacities to carry out the functions necessary to prevent, detect and respond to biological threats. The COVID-19 pandemic served as an opportunity to evaluate whether the Index contained the correct array of variables that influence countries' abilities to respond to these threats; assess additional variables that may influence preparedness; and examine how the impact of preparedness components change during public health crises.

Methods: Linear regression models were examined to determine the relationship between excess mortality per capita for the first 500 days of countries' COVID-19 pandemic and internal Index variables, as well as external variables including social cohesion; island status; perceived corruption; elderly population size; previous epidemic experience; stringency of non-pharmaceutical interventions; and social and political polarisation.

Results: COVID-19 outcomes were significantly associated with sociodemographic, political and governance variables external to the 2019 Index: social cohesion, reduction in social polarisation and reduced perceptions of corruption were consistently correlated with reduced excess mortality throughout the pandemic. The association of other variables assessed by the Index, like epidemiological workforce robustness, changed over time. Fixed country features, including geographic connectedness, larger elderly population and lack of prior coronavirus outbreak experience were detrimental to COVID-19 outcomes. Finally, there was evidence that countries that lacked certain capacities were able to develop these over the course of the pandemic.

Conclusions: Additional sociodemographic, political and governance variables should be included in future indices to improve their ability to characterise preparedness. Fixed characteristics, while not directly addressable, are useful for establishing countries' inherent risk profile and can motivate those at greater risk to invest in preparedness. Particular components of preparedness vary in their impact on outcomes over the course of the pandemic, which may inform resource direction during ongoing crises. Future research should seek to further characterise time-dependent impacts as additional COVID-19 outcome data become available.

Keywords: COVID-19; health systems evaluation.

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Conflict of interest statement

Competing interests: Economist Impact is a consulting firm that has relationships with a range of clients in the healthcare sector that include non-governmental organisations, governments, arm’s length bodies, charities and industry. They maintained editorial independence at all times during this project. No other conflicts of interest were declared.

Figures

Figure 1
Figure 1
Correlation analysis of real time surveillance and reporting (2.2) and urbanisation (6.4.1.a) indicators. Indicators are normalised on a scale of 0–100, where 100=most favourable for preparedness.
Figure 2
Figure 2
(A) Correlation analyses of GHS index real time surveillance and reporting (2.2) and international commitment (5.3) indicators; (B) correlation analyses of GHS index real time surveillance and reporting (2.2) and political and security risk (6.1) indicators. GHS, Global Health Security.
See this image and copyright information in PMC

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