A study published in BMJ Global Health in July 2023 by researchers from the Brown University School of Public Health, the Bill & Melinda Gates Foundation, and the Nuclear Threat Initiative (NTI) found that vast majority of countries that entered the COVID-19 pandemic with strong capacity to prevent, detect, and respond to disease threats achieved lower pandemic mortality rates than less prepared nations.  

The researchers sought to understand how different countries performed during the COVID-19 pandemic and how that relates to their pandemic preparedness capacity as measured by the GHS Index. 

To answer this question, they assessed countries’ pandemic performance by examining “comparative mortality ratios,” which involved adjusting countries’ “excess deaths” to account for differences in the age of each country’s population. When the researchers took this approach, they found a significant correlation between higher levels of pandemic preparedness capacity and lower excess COVID-19 mortality.  

When accounting for two key differences between countries—the age of their populations and their capacity to diagnose COVID-19 cases and deaths—the pandemic clearly was less deadly in countries that rank high on the GHS Index. Although most highly prepared countries appear to have used their capacities well, the United States emerged as a key outlier. Despite ranking highest in the Index, 62 countries had lower comparative mortality ratios than the United States, illustrating that the way a country uses the tools and resources at its disposal also impact its overall performance. 

The study highlights one factor that could help explain the United States’ performance. It entered the pandemic with relatively poor scores in the GHS Index “risk environment” category, which includes measures of a country’s capacity to develop and implement policies that can affect its ability to marshal a timely, effective response 

Separately, the study found that top performers in the GHS Index risk environment category—including Iceland, Australia and New Zealand—also posted some of the lowest mortality rates during the pandemic. 

“This evidence, borne from the GHS Index, highlights the importance of getting every country—especially low-income ones—to have complete, properly analyzed information to drive efficient and effective pandemic response,” said Dr. Oyewale Tomori, a virologist and former president of the Nigerian Academy of Science “This underscores the value of ongoing GHS Index assessments.” 

Read “New Study Shows Robust Pandemic Preparedness Strongly Linked to Lower COVID-19 Mortality Rates” on the BMJ Global Health website here.