Research Versus Reality in Pandemic Preparedness
High scores don’t equal success
In 2019, experts from the Nuclear Threat Initiative(NTI), Johns Hopkins Bloomberg School of Public Health, and The Economist Intelligence Unit teamed up to create the first Global Health Security Index(GHS). Analyzing 195 countries, they used a six-step measurement system to determine which countries were the best and worst prepared to handle biological risks, including infectious diseases such as Covid-19. This report came out in October of 2019, just a few months before the first cases of the virus were found in the United States, and painted a different picture of how the world would handle a pandemic.
Their methodology was a “comprehensive framework of 140 questions, organized across 6 categories, 34 indicators, and 85 sub-indicators to assess a country’s capacity to prevent and mitigate epidemics and pandemics.” The six major categories they used were:
- Prevention: Prevention of the emergence or release of pathogens
- Detection and Reporting: Early detection and reporting for epidemics of potential international concern
- Rapid Response: Rapid response to and mitigation of the spread of an epidemic
- Health System: Sufficient and robust health system to treat the sick and protect healthcare workers
- Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms
- Risk Environment: Overall risk environment and country vulnerability threats
One of the overall findings of the GHS Index stated, “National health security is fundamentally weak around the world. No country is fully prepared for epidemics or pandemics, and every country has important gaps to address.” They found that the average score of countries across the world in terms of preparedness was 40.2 out of 100 and 166 high to middle-income countries did not receive a score above 50.
As the above graphic shows, the United States received the highest overall score (83.5), scoring highest in the categories of (1) Prevention, (2) Early Detection & Reporting, (4) Sufficient & Robust Health System, and (5) Commitments to Improving National Capacity. The United Kingdom came in second followed by the Netherlands. But while the methodology was sound and the assessment well-intentioned, it is obvious that this measurement system did not accurately determine the real ability of a country to handle a pandemic.
The United Kingdom and the United States, the two countries with the highest scores, currently have the 5th and 11th highest Covid-19 deaths per 100,000 population. Many of the African nations colored in red and orange on the map, signaling their shortcomings in handling biological risks, currently have some of the lowest rates of Covid-19 deaths per 100k. For instance, in the Index, Tanzania had a score of 36.4 coming in at 101 in the world, but has the third-fewest deaths per 100k. The Côte d’Ivoire had a score of 17.1, 199th in the world, but has a Covid-19 death rate of 0.85 per 100k. The UK’s deaths per 100k sits at 189.75 and the US at 164.96. And for comparison, New Zealand, which is considered to have handled the pandemic the best, was ranked 35th in the Index with a score of 55.0.
So how do we explain this assessment versus how countries have actually handled the pandemic?
If we looked at a color-coded map of the world now, it would look drastically different in some regions, but the GHS Index is not necessarily wrong. The Index used a very specific set of metrics and research to determine a country’s preparedness to handle biological risks, and much of that had to do with infrastructure, modern technology of the healthcare system, and more simply put, money. The Index favored infrastructure in “developed” nations, which in terms of the research, is logical.
There are probably some other explanations for why countries in South American and Africa handled the pandemic much better than the US or UK, like demographics or the virus not spreading as fast in warmer climates with people outdoors. But the Index did not assign the proper “weight” of governance and sociological factors when it comes to responding to a pandemic. The assigned weight for category (6) which accounted for those factors was 12.8%, the lowest of the six categories. It was an unpredictable oversight that made social media consider the map severely flawed and point out the usual Western bias when it comes to research (though that didn’t happen in this case).
While having the best and most expensive healthcare systems in the world is wonderful, it has no benefits if it isn’t used correctly or the biological risk is not taken seriously by the decision-makers. Governance and sociological factors were both put under category (6) Overall Environment and Country Vulnerability to Biological Threats where the United States ranked 19th and the United Kingdom 26th. The US and UK are largely considered to be two of the countries that handled the pandemic the worst and it wasn’t for lack of infrastructure but lack of government response. The Index did not (and could not) account for the caveat that large portions of populations and elected officials would deem the pandemic a conspiracy.
Going off of the conspiracy standpoint, other sociological factors played a role in how a population handled the pandemic. The Index did include indicators of public confidence in government and local media and reporting, but levels of political polarization and a severe sense of cultural individualism played an important role especially in the United States. Something as simple as wearing a mask was an “impingement on individual freedom” instead of concern for someone else, and acknowledging that the pandemic was real meant countering viewpoints of beloved politicians. Add in the ideology that capitalism and the free market take precedent over human health, and it is clear that the cultural and governance factors played a much bigger role in the real-world handling of the Coronavirus than the Index could expect.
The GHS Index did have accurate assessments, such as a general overview of the way Europe handled the pandemic, but moving forward, biological risk reports become just as much political and cultural risk assessments as they do scientific. Yet, there is no way for researchers to predict which leaders will be in power when biological disasters hit and nearly impossible to understand how a population would react.
