USA Most Prepared Country for Pandemics

Despite our poor showing against COVID-19, we have the best infrastructure in place.

When I saw this story on Glenn Reynolds’ Facebook page, sourced from Fox News, I was more than a little skeptical:

Fox News (“US was more prepared for pandemic than any other country, Johns Hopkins study found“):

The United States was ranked the best-prepared country in the world to handle a pandemic in late 2019 by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security (JHCHS) — an assessment seemingly at odds with claims by Democrats that the Trump administration left the country vulnerable to the ongoing coronavirus outbreak.

The Global Health Security Index was was “developed with guidance from an international panel of experts from 13 countries, with research by the Economist Intelligence Unit” from 2018 to 2019, The Washington Post reported last year. “More than 100 researchers spent a year collecting and validating publicly available data.”

At the same time, the paper noted that the U.S. score was still not perfect, and that “factors driving down the U.S. score include the risks of social unrest and terrorism, and low public confidence in government.”

A commenter who got to the post before me pointed to a different spin coming from a more trusted source.

WaPo (“None of these 195 countries — the U.S. included — is fully prepared for a pandemic, report says“):

After an Ebola epidemic devastated West Africa in 2014, many countries took steps to boost their preparedness. But even as the risk of such outbreaks increases, no country — the United States included — is fully prepared to respond to a deliberate or accidental threat with the potential to wipe out humanity, according to a report assessing the efforts of 195 countries.

The report, released Thursday, is the first comprehensive assessment of global health capabilities, giving countries an overall score based on several measures. Unlike other ratings, the Global Health Security Index benchmarks health security in the context of tools critical to fighting outbreaks, such as robust health systems, adherence to global norms, and political and security risks, including public confidence in government.

The United States does well in five of six preparedness categories but ranks 19th — after Australia, Canada, Singapore and more than a half-dozen European countries — in an assessment of overall risk and vulnerability to biological threats. The factors driving down the U.S. score include the risks of social unrest and terrorism, and low public confidence in government. Liechtenstein ranked No. 1 on this measure.

Looking at the report itself, from whence I captured the graphic atop the post, I’d say Fox actually outperforms WaPo here. While I think the takeaway reached by WaPo—that nobody is fully prepared—is more useful than Fox’s–we’re #1, so suck it Dems—the fact that WaPo went out of its way to hide that the US was indeed ranked first overall is problematic.

More important than the US being number 1, though, is how few countries are in the same category:

The Anglosphere United States, United Kingdom, Canada, and Australia join only a handful of countries on the planet in the “most prepared” category. Indeed,

The GHS Index analysis finds no country is fully prepared for epidemics or pandemics. Collectively, international preparedness is weak. Many countries do not show evidence of the health security capacities and capabilities that are needed to prevent, detect, and respond to significant infectious disease outbreaks. The average overall GHS Index score among all 195 countries assessed is 40.2 of a possible score of 100. Among the 60 high-income countries, the average GHS Index score is 51.9. In addition, 116 high- and middle-income countries do not score above 50.

Our 83.5 is not only the highest score it’s more than double the overall average and half again the average of the high-income countries. Indeed, we’re the only country in the 80s; the number two country, the UK, is at 77.9.

Then again, South Korea, ranked ninth with a 70.2, is kicking our ass in handling this particular crisis.

Which, returning to the Fox News report, would seem to be damning to President Trump. Despite having the best infrastructure in place anywhere, we’re nowhere close to doing the best job addressing it. That’s a failure of leadership.

UPDATE: In response to some early questions, here are the categories included in the index:

GHS Index Category Scores:

Prevention: Fewer than 7% of countries score in the highest tier for the ability to prevent the emergence or release of pathogens.

Detection and Reporting: Only 19% of countries receive top marks for detection and reporting.

Rapid Response: Fewer than 5% of countries scored in the highest tier for their ability to rapidly respond to and mitigate the spread of an epidemic.

Health System: The average score for health system indicators is 26.4 of 100.

Compliance with International Norms: Less than half of countries have submitted Confidence-Building Measures under the Biological Weapons Convention (BWC) in the past three years, an indication of their ability to adhere to important international norms and commitments related to biological threats.

Risk Environment: Only 23% of countries score in the top tier for indicators related to their political system and government effectiveness.

And here are the high priority recommendations offered:

  • National governments should commit to take action to address health security risks. Leaders should closely coordinate and track in-country health security investments with an emphasis on coordinating them with improvements to routine public health and healthcare systems.
  • Health security capacity in every country should be transparent and regularly measured. The results of those external evaluations and self-assessments should be published at least once every two years.
  • National and international health, security, and humanitarian leaders should improve coordination among sectors, including operational links between security and public health authorities, in response to high-consequence biological events, deliberate attacks, and events occurring in insecure environments. They also should work to reduce political and socioeconomic risk factors that can impede outbreak response, including in conflict zones.
  • New financing mechanisms to fill epidemic and pandemic preparedness gaps are urgently needed and should be established. These could include a new multilateral global health security financing mechanism, such as a global health security matching fund; expansion of availability of the World Bank International Development Association (IDA) allocations to allow for preparedness financing; and/or development of other new ways—including through existing donor and multilateral financing programs for global health and disaster preparedness and response—to expand resources to incentivize countries to prioritize preparedness funding.
  • The Office of the UN Secretary-General, working in concert with the WHO, the UN Office for the Coordination of Humanitarian Affairs, and the UN Office for Disarmament Affairs, should designate a permanent facilitator or unit for high-consequence biological events that could overwhelm the capacities of the current international epidemic response architecture and result in mass casualties. This function would not be operational in nature, but rather the facilitator or unit would convene the public health, security, and humanitarian sectors before and during crises to identify and fill gaps in global preparedness specific to rapidly spreading events with the potential for great loss of life. The person or unit with this responsibility also would spur simulation exercises in concert with the UN Operations and Crisis Centre to promote unity of effort across public health, humanitarian, and security-led responses.
  • Countries should test their health security capacities and publish after-action reviews, at least annually. By holding annual simulation exercises, countries will show commitment to a functioning system. By publishing after-action reviews, countries can transparently demonstrate that their response capabilities will function in a crisis and can identify areas for improvement.
  • National governments and donors should take into account countries’ risk factors for significant disease outbreaks when making resources available to support health security capacity development. Countries with low scores related to risk environment should be identified as priority areas for capacity development and should receive prompt international assistance when infectious disease emergencies occur within their borders.
  • Given the enormous national need, the UN Secretary-General should call a heads-of-state-level summit on biological threats by 2021 focused on creating sustainable health security financing and new international emergency response capabilities.

The top-ranked countries:

  • 1 United States 83.5
  • 2 United Kingdom 77.9
  • 3 Netherlands 75.6
  • 4 Australia 75.5
  • 5 Canada 75.3
  • 6 Thailand 73.2
  • 7 Sweden 72.1
  • 8 Denmark 70.4
  • 9 South Korea 70.2
  • 10 Finland 68.7
  • 11 France 68.2
  • 12 Slovenia 67.2
  • 13 Switzerland 67.0
  • 14 Germany 66.0

For reasons I don’t have time to dig into, Switzerland is the last of the “Most Prepared” countries and Germany the first of the “More Prepared.”

James Joyner
About James Joyner
James Joyner is a Security Studies professor at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.


  1. OzarkHillbilly says:

    I do not have time to read the report but I have to wonder how the score changes in relation to income levels in the US, because we all know there is a vast difference in access to healthcare for the poor vs the wealthy.

  2. Hal_10000 says:

    Which makes our current situation all the more damning of the President. Obama (and Bush, to some extent) created a machine ready to respond to this sort of thing. And he botched it. He now has a good team in place. But the only thing that has kept this from becoming a complete disaster is our immense industrial power and the basic goodness of the American people.

  3. Mu Yixiao says:

    I don’t have time to read it right now (I’m at work*), but I’m curious what part of “prepared” they’re talking about.

    S. Korea is kicking our ass in the “start fast and test”, but are they able to handle severe effects of mass infection? This goes back to the map from yesterday showing where in the US is prepared best–and it was talking about handling the severe effects of infection, not in preventing or getting ahead of the curve.

  4. Teve says:

    That massive car wreck I was in in late 2018, that you could buy a medium-size house for the bills i get? I’m going to put off declaring bankruptcy for that, for a few more months, because I have a retail job and here in Florida it’s entirely likely I’ll get this virus. I’m 43 and fairly healthy, but anything can happen. I could end up in the ICU again. Wouldn’t make any sense to declare bankruptcy, only to get $50,000 more debt two months later.

  5. Slugger says:

    How about if we decide how prepared we were when this is all over? You don’t know how your plane will fly until you actually get it into the air. No matter how brilliant your planning and your modeling, you have to give reality its turn at bat before declaring victory.
    In a year from now we should take a dispassionate, clear-eyed look at what happened. I sure that there were things we did well and things that could have been done better. I do fear that we are too divided by partisanship and overcommitted to our ideologies for a meaningful analysis to occur. This is all our faults.

  6. rachel says:

    Then again, South Korea, ranked ninth with a 70.2, is kicking our ass in handling this particular crisis.

    Leadership matters.

  7. Kathy says:

    Democrats: You left the barn door open and the horse escaped.

    Trump’s brain (aka Fox News): We have the most secure doors in the world!

  8. OzarkHillbilly says:

    @Slugger: You mean the US healthcare “system” might be analogous to the 787 MAX?

  9. Teve says:

    @OzarkHillbilly: not fair. The 737 rarely kills people.

  10. OzarkHillbilly says:

    @Teve: True dat.

  11. Stormy Dragon says:

    I wonder what the data collection period for this study was, and how much this rating is more a reflection of pre-2016 America than it is of post-2016 America

  12. gVOR08 says:

    The U. S., by virtue of being the most prosperous large developed nation, in 2019 was best prepared for a hypothetical pandemic.

    In late 2019 and early 2020 the U. S. did not successfully take advantage of those strengths to implement actions to respond to COVID-19.

    I see no contradiction in those two statements. Biggest example – we had the capability to quickly develop and deploy testing specific to COVID-19, we failed to do so, for reasons that are still not clear.

    Or to put it differently, contra FOX, Obama left us well prepared, Trump squandered it.

  13. Sleeping Dog says:

    This shows the difference between being prepared and having the ability to execute. The US was better prepared, but SK successfully implemented its more limited resources, therefore has been more effective. Yes this is damning for Tiny.

  14. @James:

    Which, returning to the Fox News report, would seem to be damning to President Trump. Despite having the best infrastructure in place anywhere, we’re nowhere close to doing the best job addressing it. That’s a failure of leadership.


  15. Scott says:

    And then there is this bureaucratic dysfunction (which started with an Obama administration official apparently).

    DHS wound down pandemic models before coronavirus struck

    The Department of Homeland Security stopped updating its annual models of the havoc that pandemics would wreak on America’s critical infrastructure in 2017, according to current and former DHS officials with direct knowledge of the matter.

    From at least 2005 to 2017, an office inside DHS, in tandem with analysts and supercomputers at several national laboratories, produced detailed analyses of what would happen to everything from transportation systems to hospitals if a pandemic hit the United States.

    Two points

    1) It is a shame this capability was kicked around from place to place

    2) It is hopeful that we had a pretty good capability and the data is still probably there if slightly out of date.

  16. Kit says:

    I’ll make the bold prediction that the GHS Index will, at a minimum, start to weigh aspects of readiness differently by the time the next report is issued.

  17. Michael Reynolds says:

    We learned about Coronavirus on the same day as South Korea.

    We have just passed them in deaths per capita. Their cases are leveling off, ours are skyrocketing. We’ve blown past SK, Iran, France, Germany and Spain and now sit in third place for total number of cases, edging up on Italy and China. In a week or two we will likely be the most infected nation on earth in terms of total cases.

    The difference is political leadership. The amount by which our per capita death rate exceeds South Korea’s will be the Trump Deaths. MAGA!

  18. JDM says:

    Yes, there has been significant bureaucratic dysfunction on all levels; national, state and local. But this is one example of the US Government actually doing the right thing. The Alcohol and Tobacco Tax and Trade Bureau, has cut red tape and regulations to allow distillers to manufacture hand sanitizer.

    And from the Seattle Times a story about Washington State distillers making hand sanitizer.

  19. Mikey says:
  20. Scott F. says:

    @Steven L. Taylor:
    Wait, wait… I don’t think you and James understand.

    The State (USA! USA!) is the best prepared in the world
    Trump IS the state (as he’s contended repeatedly, “L’État, c’est moi!”)
    Ergo, Trump is the best prepared in the world (any shortcomings in US response are the fault of the Deep State and libtards)

    It’s as simple as that for the Trumpkins.


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