Health security at the national level is fundamentally weak around the globe, and not a single country is fully prepared to handle a future epidemic or pandemic, a report from the Global Health Security Index warns.
A joint project of the Nuclear Threat Initiative, the Johns Hopkins Center for Health Security, and the Economist Intelligence Unit, with funding from the Bill & Melinda Gates Foundation, the Robertson Foundation, and the Open Philanthropy Project, the index assesses health security and related capabilities at the national level based on thirty-four indicators and a hundred and forty questions in six categories of preparedness — prevention, detection and reporting, rapid response, health system capacity, compliance with international norms, and risk environment. The project's inaugural report, Global Health Security Index: Building Collective Action and Accountability (324 pages, PDF), found severe vulnerabilities in countries' capacity to prevent, detect, and respond to health emergencies; large gaps in the capacity of their national health systems; worrisome exposure to political, socioeconomic, and environmental risks that could affect outbreak preparedness and response; and a lack of adherence to international norms. Indeed, the average score for the hundred and ninety-five countries included in the report was just 40.2 out of a possible 100, with the sixty high-income countries included in the report averaging a score of only 51.9.
According to the report, 92 percent of the countries in the index do not require security checks for personnel with access to dangerous biological materials or toxins; fewer than 5 percent mandate the testing of emergency operations centers at least annually; only 10 percent have allocated funding to fill preparedness gaps; most lack foundational health systems capacities that are vital for epidemic and pandemic response, with only 3 percent demonstrating a public commitment to prioritizing healthcare services for healthcare workers who become sick while responding to a public health emergency; and fewer than half have submitted confidence-building measures to the Biological Weapons Convention in the past three years.
Recommendations for strengthening national and global health security include holding a United Nations summit by 2021 on a range of biological threats; improving the transparency and regular assessment of health security capacities in every country; improving public health coordination in insecure environments; and establishing new financing mechanisms designed to fill preparedness gaps, including a new multilateral global health security matching fund and the expansion of World Bank International Development Association allocations to include pandemic preparedness. The report's authors also call on governments and donors to take into account political and security risk factors when supporting health security capacity development.
"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 NTI co-chair and CEO Ernest J. Moniz. "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."