The U.S. and COVID-19: Leading the World by GHS Index Score, not by Response

Amid the threat posed by COVID-19 the Global Health Security (GHS) Index has been used repeatedly as a reference for global preparedness during the pandemic. This is a key goal of the GHS Index, and the COVID-19 pandemic has become a proof point for its main finding:  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.

Given that overall finding, it is important to dispel misconceptions regarding the score of 83.5 (out of a possible 100) received by the United States. Although the United States received the top score of 195 countries assessed and was ranked number one, its score and rank do not indicate that the country is adequately prepared to respond to potentially catastrophic infectious disease outbreaks. Significant preparedness gaps remain, and some of those are playing out in the current crisis. The United States’ response to the COVID-19 outbreak to date shows that capacity alone is insufficient if that capacity isn’t fully leveraged. Strong health systems must be in place to serve all populations, and effective political leadership that instills confidence in the government’s response is crucial.

Here’s where the United States had the weakest scores in the GHS Index:

• Across the six major categories explored in the GHS Index—prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment—the United States’ lowest score fell in the health system category, which measures whether a country has a sufficient and robust system in place to treat the sick and protect health workers.
• On healthcare access, the U.S. is ranked as 175 out of 195 countries. A lack of guaranteed access to healthcare for all citizens leaves many vulnerable in times of emergency, including health workers, as there is no federal commitment to prioritizing healthcare services for workers who become sick.
• The United States’ score for clinic, hospital, and community care capacity (which measures human resource capacity and facilities capacity) also is low at 60.4 out of 100. According to World Health Organization data last updated in 2013, the U.S. was tied for 75th worldwide for number of hospital beds, with an estimated 290 beds per 100,000 people.
• On political and security risks and socio-economic resilience, each of which can impact preparedness, the United States ranked just 59th of 195.
• On public confidence in government, the United States received a zero, indicating a low level of confidence among the public (less than 25%).
• In a recent analysis of the GHS Index focusing exclusively on indicators related to COVID-19 vulnerability, the U.S. scored 76.8 out of 100—more than 6 points lower than its overall score.

Here’s where the United States did particularly well:

• The detection category shows that the United States has strong capacities in lab systems, surveillance and reporting, in its epidemiology workforce, and in integrating data across sectors. However, since the GHS Index is based on publicly available information about national health security capacities, it does not take into consideration data pertaining to state-based testing, implementation, and reporting to the national level.
• The overall score of 83.5 put the United States in the top spot on the 195-country ranking; as such, it should be well-positioned to model best practices in preparedness and deploy its capabilities to assist other countries during global public health emergencies; however, the United States’ lack of support to the overall global response to COVID-19 suggests there is work to be done in this area.

The significant gaps in the United States’ GHS Index country profile are deeply concerning to health-care experts and professionals – and should be of concern to the general public and policymakers alike.

The way forward: In the past four months, the world has seen how an isolated outbreak in one country has rapidly grown to a global pandemic. The COVID-19 outbreak has proven that a threat anywhere is a threat everywhere, and no country can rely on the strength of its own preparedness alone. The global average GHS Index score is just 40.2, and the response to the COVID-19 outbreak makes it clear that the world is collectively unprepared for a pandemic. Plans to combat COVID-19 require local, national, regional, and global action, and the United States has an obligation to address the gaps in its own system and to invest in countries that are far less prepared.