Inaugural Global Health Security Index Finds No Country Is Prepared for Epidemics or Pandemics
  • News
  • October 24, 2019

United Nations should call heads-of-state summit on catastrophic biological risks by 2021

WASHINGTON, DC — National health security is fundamentally weak around the world, and no country is fully prepared to handle an epidemic or pandemic, according to the first comprehensive assessment and benchmarking of health security and related capabilities across 195 countries.

A joint project by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security, with research by The Economist Intelligence Unit (EIU), the inaugural Global Health Security Index released today finds severe weaknesses in countries’ abilities to prevent, detect, and respond to significant disease outbreaks. The average overall 2019 GHS Index score is 40.2 out of a possible score of 100. Even among the 60 high-income countries assessed, the average score is 51.9.

“The results are alarming: All countries—at all income levels—have major gaps in their capabilities, and they aren’t sufficiently investing in biological preparedness,” said NTI Co-Chair and CEO Ernest J. Moniz. “The bottom line is that global biological risks are growing—in many cases faster than health systems, security, science, and governments can keep up.  We need to ensure that all countries are prepared to respond to these risks.”

Center for Health Security Director Tom Inglesby said the GHS Index, developed with guidance from an International Panel of Experts from 13 countries, can be used by health and finance ministers, international organizations, philanthropists, funders, and academics. “Whether naturally occurring, intentional, or accidental, outbreaks in any country pose risks to global health, international security, and the worldwide economy,” Inglesby said. “We hope this index will help countries identify gaps, build preparedness and best practices, and track progress over time.”

“This index is a powerful tool for citizens and civil society to hold their government officials accountable for health preparedness,” said NTI Co-Chair Sam Nunn.

The GHS Index assesses countries across six categories, 34 indicators, and 140 questions deliberately using only public information. The index benchmarks health security in the context of other factors critical to fighting outbreaks, such as political and security risks, the broader health system, and country adherence to global norms.

Top findings

In addition to its overall finding that national health security is fundamentally weak around the world and no country is fully prepared for epidemics and pandemics, the GHS Index finds:

  • Countries are not prepared for a globally catastrophic biological event, including those that could be caused by the international spread of a new or emerging pathogen or by the deliberate or accidental release of a dangerous or engineered agent or organism.
    • 92% do not show evidence of requiring security checks for personnel with access to dangerous biological materials or toxins.
  • The available evidence suggests that most countries have not tested important health security capacities or shown that they would be functional in a crisis.
    • Fewer than 5% show a requirement to test their emergency operations centers at least annually.
  • Most countries have not allocated funding from national budgets to fill preparedness gaps.
    • Only 10% show evidence of senior leaders’ commitment to improve local or global health capacity.
  • More than half of countries face major political and security risks that could undermine national capability to counter biological threats.
    • Only 23% score in the top tier for political system and government effectiveness, representing approximately 14% of the global population.
  • Most countries lack foundational health systems capacities vital for epidemic and pandemic response.
    • Only 3% show a public commitment to prioritizing healthcare services for healthcare workers who become sick as a result of participating in a public health response.
  • Coordination and training are inadequate among veterinary, wildlife, and public health professionals and policymakers.
    • Only 30% demonstrate existence of mechanisms for sharing data among relevant ministries for human, animal, and wildlife surveillance.
  • Improving country compliance with international health and security norms is essential.
    • Less than 50% have submitted Confidence-Building Measures for the Biological Weapons Convention in the past three years.


The GHS Index findings and recommendations for how to address significant gaps in global health security come amid an ongoing Ebola outbreak in the Democratic Republic of Congo and five years after the United Nations (UN) Security Council met in crisis over the Ebola epidemic in West Africa.

The report describes that despite entry into force of revised International Health Regulations more than 10 years ago, decision makers only sporadically focus on health security and remain caught in a cycle of perpetual surprise when outbreaks occur in unanticipated locations. At a time when risks are magnified by a rapidly changing and interconnected world—and when technology advances make it easier to create and engineer pathogens—knowing the risks is clearly not enough. Political will is needed to protect people from the consequence of epidemics, to take action to save lives, and to build a safer and more secure world.

Top recommendations

A core principal of the GHS Index is that health security is a collective responsibility. The GHS Index offers 33 recommendations for individual countries and for the international community. Recommendations include:

  • The UN Secretary-General should call a heads-of-state-level summit by 2021 on biological threats including a focus on financing and emergency response.
  • National governments should commit to take action to address health security risks.
  • Health security capacity in every country should be transparent and regularly measured, and results should be published at least once every two years.
  • Leaders should improve coordination in insecure environments, especially linkages between security and public health authorities.
  • New financing mechanisms should be established to fill preparedness gaps, such as a new multilateral global health security matching fund and expansion of World Bank International Development Association allocations to include preparedness.
  • The UN Secretary-General should designate a permanent facilitator or unit for high-consequence biological events.
  • Countries should test their health security capacities and publish after-action reviews, at least annually.
  • Governments and donors should take into account countries’ political and security risk factors when supporting health security capacity development.

The GHS Index was developed over a two-and-a-half-year period. Key steps included an initial pilot project to test the framework; reviews by an International Panel of Experts that includes 21 experts from 13 countries; a year-long data collection and validation process by 110 EIU researchers; and opportunities for governments to validate data.

Visit to explore the GHS Index data, download the full report and data model, view profiles for each country, use the score simulator, review the full methodology, watch the GHS Index video, and more.

About the Nuclear Threat Initiative

The Nuclear Threat Initiative (NTI) works to protect our lives, environment, and quality of life now and for future generations. NTI works to prevent catastrophic attacks with weapons of mass destruction and disruption—nuclear, biological, radiological, chemical, and cyber. Learn more at

About the Johns Hopkins Center for Health Security

The Johns Hopkins Center for Health Security works to protect people’s health from epidemics and disasters and ensure that communities are resilient to major challenges. The Center examines how scientific and technological innovations can strengthen health security. It studies the policies, organizations, systems, and tools to prevent and respond to outbreaks and public health crises.  Learn more at

About The Economist Intelligence Unit

The Economist Intelligence Unit is the research arm of The Economist Group, publisher of The Economist. As the world’s leading provider of country intelligence, we help governments, institutions and businesses by providing timely, reliable and impartial analysis of economic and development strategies. Through a global network of more than 900 analysts and contributors, The EIU continuously assesses and forecasts political, economic and business conditions in more than 200 countries.  Learn more at



Cathy Gwin (NTI), 202-454-7706,

Jackie Fox (Center for Health Security), 443-510-0022,