Global Health Security (GHS) Index 2021 | Advancing Collective Action and Accountability Amid Global Crisis

Global Health Security (GHS) Index 2021 | Advancing Collective Action and Accountability Amid Global Crisis
Authors: Jessica A. Bell; Jennifer B. Nuzzo; Nellie Bristol; Gabrielle Essix; Christopher Isaac; Amanda Kobokovich; Diane Meyer; Lucia Mullen; Sophie Rose
Date posted: December 08, 2021
Publication type: Report 268 pages
Publisher: Nuclear Threat Initiative

Nearly two years after the World Health Organization (WHO) recognized COVID-19 as a Public Health Emergency of International Concern, some lessons from the pandemic are clear:
Countries’ ability to measure the number of COVID-19 cases and deaths depend on their having public health capacities such as diagnostic and screening tests, which were not adequately established in many countries before the pandemic. For example, the WHO has estimated that six of every seven COVID-19 infections in Africa go undetected due to limited testing capacity.a As a result, official country reports of cases and deaths may not accurately reflect the full impact of COVID-19.

The availability of health security capacities in countries does not automatically translate into protection from illness, death, and economic consequence. Successful outcomes during a pandemic depend on political will and government readiness and flexibility to use available capacities in a way that aligns with evolving evidence-based public health recommendations for disease containment and mitigation. The public must trust advice from health officials and not face hurdles, such as lost income, if protective recommendations are to be followed.

National risk environments—measured by disorderly transfers of power, social unrest, international tensions, and distrust in medical and health advice from the government— can have an outsized impact on a country’s ability to successfully use its health security capacities to respond to an emerging outbreak. The success of disease-mitigation efforts is contingent upon public trust in government, healthcare institutions, and public health professionals. In the absence of trust, public cooperation and compliance with recommendations—including physical distancing, mask mandates, and shutdowns— are likely to fail and be more vulnerable to corrosive misinformation. Countries with those risk factors must develop strategies to minimize their influence—such as working to foster trust and prevent the politicization of a crisis—to enable a successful response.

Public health and health system capacities must be coupled with policies and programs that enable all people to comply with public health recommendations. Universal health coverage, paid sick leave, subsidized childcare, income assistance, and food and housing assistance are examples of policies that helped populations comply with protective public health measures of the COVID-19 pandemic. For example, Ghana and Ukraine both provide wraparound services, such as economic or medical support, to infected patients and their contacts to self-isolate or quarantine. New Zealand raised its minimum wage and began providing weekly benefits to support participation of public health measures in society. Portugal extended temporary citizenship to asylum seekers and migrants during the pandemic, thereby dismantling barriers to accessing healthcare among those populations.

See World Health Organization, “Six in Seven COVID-19 Infections Go Undetected in Africa,” October 14, 2021.

Media Release
2021 Global Health Security Index Finds All Countries Remain Dangerously Unprepared for Future Epidemic and Pandemic Threats
Report calls on national and global leaders to sustain and expand upon preparedness capacities developed to fight COVID-19
WASHINGTON, DC (December 8, 2021) — Despite important steps taken by countries to respond to the COVID-19 pandemic, all countries—across all income levels—remain dangerously unprepared to meet future epidemic and pandemic threats, according to the new 2021 Global Health Security (GHS) Index.

The report, released today by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, with research by Economist Impact, measured the capacities of 195 countries to prepare for epidemics and pandemics. The data demonstrate that all countries have insufficient sustained health capacities, leaving the world acutely vulnerable to future health emergencies, including those potentially more devastating than COVID-19. The average overall 2021 GHS Index score is 38.9 out of a possible score of 100. No country scored in the top tier of rankings and no country scored above 75.9.

“COVID-19 offers a devastating illustration of how poor pandemic preparedness and response can impact health and security at every level—local, national and global,” said NTI Co-Chair and CEO Ernest J. Moniz. “The stakes are high, and world leaders need to act. Biological risks are growing in frequency, and all countries need more investment in durable capabilities to address these risks.”

The GHS Index is designed to inform leaders of the foundational elements that are necessary to prepare their countries for future outbreaks and where they should prioritize planning and durable funding. It is not a direct predictor of performance in the face of a health emergency; as COVID-19 has demonstrated—contextual social, political, and cultural phenomena also impact how well a country responds to a biological event.

“Leaders now have a choice,” said Dr. Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security. “They can make dedicated, sustainable investments in the new capacities created during the COVID-19 response to prepare their countries for the long term, or they can fall back into the decades-long cycle of panic-and-neglect that will leave the world at grave risk for inevitable future public health threats.”…