Global preparedness: How it’s evolved and what's next
2021
What were the key findings?
Although many countries were able to quickly develop capacities to address COVID-19, all countries remain dangerously unprepared for meeting future epidemic and pandemic threats. A great opportunity exists, however, to make new capacities more durable to further long-term gains in preparedness.
Key Takeaways
Most countries, including high-income nations, have not made dedicated financial investments in strengthening epidemic or pandemic preparedness.
Most countries saw little or no improvement in maintaining a robust, capable, and accessible health system for outbreak detection and response.
Political and security risks have increased in nearly all countries, and those with the fewest resources have the highest risk and greatest preparedness gaps.
Countries are continuing to neglect the preparedness needs of vulnerable populations, which exacerbates the impact of health security emergencies.
Countries are not prepared to prevent globally catastrophic biological events that could cause damage on a larger scale than COVID-19.
38.9 out of 100
+0.1 From 2019
The average country score in 2021 GHS Index is 38.9; essentially unchanged from 2019, showing continued weaknesses in global health security.
Averages by category
Prevention
Prevention of the emergence or release of pathogens, particularly those that may constitute a Public Health Emergency of International Concern.
28.4 -0.6 From 2019
Subcategories
45.3
Antimicrobial resistance (AMR)
Composite measure | Weighted average of the following indicators: 1.1.1-1.1.2
19.8
Zoonotic disease
Composite measure | Weighted average of the following indicators: 1.2.1-1.2.5
18.7
Biosecurity
Composite measure | Weighted average of the following indicators: 1.3.1-1.3.5
20.9
Biosafety
Composite measure | Weighted average of the following indicators: 1.4.1-1.4.2
2.6
Dual-use research and culture of responsible science
Composite measure | Weighted average of the following indicators: 1.5.1-1.5.2
63.3
Immunization
Composite measure | Weighted average of the following indicators: 1.6.1
N/A
Climate change adaptation and vector transmission
Composite measure | Weighted average of the following indicators: 1.7.1
Scores are out of 100
Detection and Reporting
Early detection and reporting of epidemics of potential international concern, which may spread beyond national or regional borders.
32.3 +2.9 From 2019
Subcategories
44.9
Laboratory systems strength and quality
Composite measure | Weighted average of the following indicators: 2.1.1-2.1.2
15.9
Laboratory supply chains
Composite measure | Weighted average of the following indicators: 2.2.1-2.2.2
34.6
Real-time surveillance and reporting
Composite measure | Weighted average of the following indicators: 2.3.1-2.3.3
34.7
Surveillance data accessibility and transparency
Composite measure | Weighted average of the following indicators: 2.4.1-2.4.5
16.9
Case-based investigation
Composite measure | Weighted average of the following indicators: 2.5.1-2.5.2
46.5
Epidemiology workforce
Composite measure | Weighted average of the following indicators: 2.6.1-2.6.2
Scores are out of 100
Rapid Response
Rapid response to and mitigation of the spread of an epidemic.
37.6 -4.0 From 2019
Subcategories
30.4
Emergency preparedness and response planning
Composite measure | Weighted average of the following indicators: 3.1.1-3.1.3
21.1
Exercising response plans
Composite measure | Weighted average of the following indicators: 3.2.1-3.2.2
27.0
Emergency response operation
Composite measure | Weighted average of the following indicators: 3.3.1
22.1
Linking public health and security authorities
Composite measure | Weighted average of the following indicators: 3.4.1
57.9
Risk communication
Composite measure | Weighted average of the following indicators: 3.5.1-3.5.2
65.7
Access to communications infrastructure
Composite measure | Weighted average of the following indicators: 3.6.1-3.6.4
39.0
Trade and travel restrictions
Composite measure | Weighted average of the following indicators: 3.7.1-3.7.2
Scores are out of 100
Health System
Sufficient and robust health system to treat the sick and protect healthcare workers.
31.5 +2.0 From 2019
Subcategories
30.0
Health capacity in clinics, hospitals and community care centers
Composite measure | Weighted average of the following indicators: 4.1.1-4.1.2
28.5
Supply chain for health system and healthcare workers
Composite measure | Weighted average of the following indicators: 4.2.1-4.2.3
10.3
Medical countermeasures and personnel deployment
Composite measure | Weighted average of the following indicators: 4.3.1-4.3.2
55.2
Healthcare access
Composite measure | Weighted average of the following indicators: 4.4.1-4.4.3
10.8
Communications with healthcare workers during a public health emergency
Composite measure | Weighted average of the following indicators: 4.5.1
40.5
Infection control practices
Composite measure | Weighted average of the following indicators: 4.6.1
45.1
Capacity to test and approve new medical countermeasures
Composite measure | Weighted average of the following indicators: 4.7.1
Scores are out of 100
Norms
Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms.
47.8 +0.4 From 2019
Subcategories
58.5
IHR reporting compliance and disaster risk reduction
Composite measure | Weighted average of the following indicators: 5.1.1-5.1.2
50.0
Cross-border agreements on public health and animal health emergency response
Composite measure | Weighted average of the following indicators: 5.2.1
56.1
International commitments
Composite measure | Weighted average of the following indicators: 5.3.1-5.3.2
18.7
JEE and PVS
Composite measure | Weighted average of the following indicators: 5.4.1-5.4.2
35.2
Financing
Composite measure | Weighted average of the following indicators: 5.5.1-5.5.4
68.4
Commitment to sharing of genetic & biological data & specimens
Composite measure | Weighted average of the following indicators: 5.6.1
Scores are out of 100
Risk Environment
Overall risk environment and country vulnerability to biological threats.
55.8 0.0 From 2019
Subcategories
58.1
Political and security risk
Composite measure | Weighted average of the following indicators: 6.1.1-6.1.7
60.9
Socio-economic resilience
Composite measure | Weighted average of the following indicators: 6.2.1-6.2.6
50.2
Infrastructure adequacy
Composite measure | Weighted average of the following indicators: 6.3.1-6.3.3
54.7
Environmental risks
Composite measure | Weighted average of the following indicators: 6.4.1-6.4.3
55.3
Public health vulnerabilities
Composite measure | Weighted average of the following indicators: 6.5.1-6.5.4
Scores are out of 100
Countries must act
No single country can face the next pandemic alone. But when governments invest in preparedness, funders direct resources strategically, and partners collaborate on solutions, we all become safer.
Top Recommendations
Countries should dedicate funds in national budgets to conduct health security assessments using the GHS Index and develop a national plan to identify their risks and fill gaps.
International organizations should use the GHS Index to identify countries most in need of additional support.
The private sector should use the GHS Index to look for opportunities to partner with governments to develop solutions.
Philanthropies and funders should develop new financing mechanisms and use the GHS Index to prioritize resources.
Recommendations for
- Prioritize the building and maintaining of health security capacities in national budgets. Those capacities are not just beneficial for health security emergencies; they are important for responding to routine health threats and can provide important benefits to countries’ overall health and development.
- Conduct assessments, using findings from the 2021 GHS Index, to identify their risk factors and capacity gaps, and develop a plan to address them.
- Develop, cost, and make financial arrangements to support a National Action Plan for Health Security if they have completed Joint External Evaluations.
- Undertake a JEE to better understand their gaps if they have not done so already. Data from the 2021 GHS Index may be used to update JEE data and supplement it with additional data regarding health systems and risk factors.
- Be more transparent with their capacities and risk factors. National decision makers need readily available information about their country’s plans and other capacities, and increased transparency is essential for global prevention, detection, and response to epidemics and pandemics.
- Conduct comprehensive after-action COVID-19 pandemic reports so that they can learn from this crisis and ensure that capacities developed during the pandemic are expanded and sustained for future public health emergencies.
- Use the findings of the 2021 GHS Index to identify countries that may benefit most from additional support to improve their readiness for future disease emergencies, prioritizing assistance to countries with higher political and socioeconomic risk factors.
- Support countries in addressing the urgent global need to strengthen health systems as part of countries’ public health capacity-building efforts.
- Work with countries to make available more data, especially standardized data, that can be used to assess the strength of health systems, particularly with respect to their preparedness for infectious disease emergencies.
- Use data from the 2021 GHS Index to supplement their efforts to monitor ongoing and future disease emergencies to identify where rapid deployment of international assistance may help to mitigate the impact of events and prevent cross-border spillover.
- Support the formation of a dedicated international normative body to promote the early identification and reduction of globally catastrophic biological risks.
- Work to improve coordination among national and global actors to address high consequence biological events, including deliberate attacks. Specifically, the Office of the UN Secretary-General should work in concert with the WHO, the UN Office for the Coordination of Humanitarian Affairs, and the UN Office for Disarmament Affairs to designate a permanent facilitator or unit for high-consequence biological events and call a heads-of-state-level summit on biological threats that is focused on creating sustainable health security financing and new international emergency response capabilities.
- Use the 2021 GHS Index to partner with governments to help address gaps in country preparedness and to assess likely vulnerabilities in countries where they operate. Companies and other private organizations should use these findings to encourage governments to make improvements.
- Identify and support private-sector resources, plans, and programs that can augment government capacities, especially in countries with few developed capacities.
- Increase their sustainable development and health security portfolios in research, development, and capacity building, using the 2021 GHS Index to identify priority areas aimed at preventing epidemics and pandemics from causing catastrophic damage on a global scale.
- Create new financing mechanisms, such as a global health security matching fund, and expand availability of World Bank International Development Association allocations to allow for investments to fill epidemic and pandemic preparedness gaps for countries in need.
- Use the 2021 GHS Index to prioritize resources. Countries with low scores related to risk environment—including political and security, socioeconomic, infrastructure, environmental, and public health risks— should be identified as priorities for capacity development and should receive prompt international assistance when infectious disease emergencies occur within their borders.
- Advocate to country governments to make available national resources to support preparedness and capacity development.
2021 Global Health Security Index
Explore the Data
The GHS Index supports decision makers. National policymakers can use the data to get better prepared, and global organizations can use the country-level data to monitor health emergencies and advocate for action.