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.”