This article has been written by Ms. Pooja Padmanabhan, a 3rd year student of VIT, University Chennai. 

ABSTRACT

The global health security index uses its pillars of health security including prevention, detection, response, health, norms, and risk to assess and understand the gaps that nations are facing in exploiting their capacities and resources. Later, the same is informed to the governments, and policies are developed, which help in targeting the investments accordingly. These data can be used by nations to guide their preparedness initiatives and by international governmental bodies and other global organizations, who can monitor and promote improved readiness for health emergencies using data at the national level.

Keywords: GHS Index, risk, health, data, risk, country

INTRODUCTION

Global Health Security Index ( hereinafter referred to as GHS Index ), runs across about 195 countries and is considered to be the first comprehensive benchmark of health security and its related countries. These 195 nations comprise states that are party to the International Health Regulation ( hereinafter referred to as IHR ), The Nuclear Threat Initiative ( hereinafter referred to as NTI ), and the members of the Johns Hopkins Center for Health Security ( JHU )working with the Economist Intelligence Unit ( EIU ) developed this GHS Index. This Index aims to set a high threshold for preparedness against diseases ( epidemics) that could later become of serious global concern ( pandemics ). 

GHS INDEX

A form of assessment and benchmarking of health security and associated capacities of about 195 countries. NTI is a non-profit global security organization that focuses on diminishing the nuclear and biological threats impacting humanity. Johns Hopkins Center has been established to recognize the significant role of communication in public health. The method adopted for preparing such a ranking includes 6 aspects .  The WHO and EIU researchers provided the 34 indicators and 85 sub-indicators that make up the GHS Index. In order to facilitate repeatable comparisons, the data is divided into binary and categorical scales using a 0–100 scale. The process of validating and reviewing data for the model guarantees uniformity among nations. Expert weights are provided by the GHS Index International Panel of Experts; however, users can modify the weights according to context-specific factors.

2019 was the year in which this Index was published, at a time very closely connected to the beginning of the COVID-19 pandemic. During the onset of the pandemic, there were speculations made by various authors on the relation between the GHSI score of nations and the COVID-19 per capita death rate. Moreover, some studies compared and concluded how there were certain nations that despite having a mediocre GHSI score had been battling the pandemic well. 

Some have asserted that the indicators selected for inclusion in the GHS Index may reflect a systematic bias towards higher-income countries. 

The underlying principle behind the GHS index includes the following:

• Capacities must be exercised to be effective in a crisis
• Countries have a much harder time containing epidemics at their source if they lack a stable, peaceful society and access to healthcare.
•  Countries should handle the threats of today while also planning for the biological hazards of the future.
• Reduce the Global Catastrophic Biological Risks (GCBRs) immediately.
• Trust and transparency are essential components of pandemic readiness. Security of the global health system is a shared duty of nations, industries, and as a matter of general international security. In order to attain health security, nations must first recognize their own advantages and disadvantages as well as those of their neighbours.

This index mainly aims to guide decision-makers to improve their country’s preparedness for infectious disease outbreaks and high consequences as well as globally catastrophic biological events. GHS index relied on the open source data published by a country on its own platforms. Last but not least, the Index helps national governments, development banks, and charitable donors more methodically allocate funds to close the gaps that are most critical to stopping, identifying, and acting quickly on biological events before they spread or have cascading and destabilizing effects. Compiling and presenting readiness data from all around the world can help identify financial needs, sharpen awareness of strengths and weaknesses, and boost political will to make the necessary changes. 

SCORING AND RANKING

An intuitive way to monitor longitudinal and cross-sectional trends, summarise complicated health system capacity across a range of situations, and push for necessary policy change is through scoring. In addition, scoring is widely utilised in many fields of research, including economic, policy, development, and global health. It is also a feature of well-known health security assessment instruments like the JEE. The index goes beyond the JEE by focusing on health system capacities required to mitigate epidemic threats, with 131 countries ranking in the lowest tier of scores, highlighting critical vulnerabilities in global capacities to care for sick patients and protect health workers during emergencies. 

CATEGORIES

These six categories include prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment.  Prevention of the spread or discharge of infections, including those that, according to the widely accepted definition of a Public Health Emergency of International Concern, poses an extreme risk to public health. Early identification and reporting of epidemics that have the potential to spread beyond national or regional borders and pose a global health risk. This category’s indicators evaluate the epidemiology workforce, real-time monitoring and reporting, laboratory systems, and data integration between the environmental, animal, and human health domains to prompt action to stop an epidemic from spreading and mitigate its effects. This category’s indicators evaluate risk communication, emergency response operation, reaction plan exercise, emergency response coordination, and public health and security authorities’ limits on trade, travel, and access to the communications infrastructure. Robust and adequate healthcare system to care for the ill and safeguard medical personnel. Pledges to respect international standards, fund initiatives to close gaps, and increase national capabilities. Overall risk environment and country vulnerability to biological threats.

BIOSAFETY AND BIOSECURITY

Biosafety and biosecurity are regarded by the GHS Index as essential elements of global health security. As a result, the tool has a wide range of indications that gauge the ability of the nation in several fields. It is true that many low- and middle-income nations (LMICs) have different health objectives than their wealthier counterparts, and that many LMICs may not have the resources to give biosafety and biosecurity top priority.17 However, there is an uneven distribution of health and security hazards among nations related to dual-use research, unintentional pathogen outbreaks, and intentional misuse of biological resources. If these risks materialise, LMICs will remain disproportionately exposed and are more likely to suffer considerable illness and mortality. Until action is made to monitor and develop their specific biosecurity and biosafety capacities, this vulnerability will persist.

ANALYSIS ON THE RESULTS OF THE GHS Index  

The United States has the greatest readiness score (83.5) on the GHS index, five points ahead of the United Kingdom. In particular, the US leads in four of the six categories (international norm compliance, detection, capability of the health system, and prevention). Luxembourg’s overall score of 43.8 places it at the 67th spot in the world ranking. The majority of the top 20 nations are OECD members, with the exception of Thailand (sixth) and Malaysia (18th).

Two of the three nations with the greatest number of vaccine doses given per hundred people were the US and the UK, which are ranked #1 and second on the GHS ranking, respectively. The US also had the highest proportion of fully vaccinated individuals amongst these two nations (i.e., receiving both doses of a two-dose vaccination or a single dose of a one-dose vaccine). On the other hand, in the early stages of the worldwide COVID-19 vaccine deployment, the UK was rated 23rd out of all OECD countries for the percentage of the population that had received all recommended vaccinations. 

In terms of the total number of cases and deaths since the pandemic’s start, the US is ranked lowest in the world. When it comes to the number of cases per million, deaths per million, recovery rate, and tests per thousand, the United States is superior than only four other nations. The US is ranked 32nd out of 36 OECD nations, with Spain, Sweden, the UK, and the Netherlands following in order of rank, respectively, at 33rd, 34th, and 36th. Top of the performance list based on the four variables of interest is New Zealand, which ranks 35th globally based on the GHS index. It outperforms other countries ranked in the top 10 based on the GHS index, with Australia, South Korea, and Lithuania (tie) coming in at 4th, 9th, and 33rd places, respectively.

FINDINGS

• The majority of nations, including those with substantial incomes, have not allocated specific funds to bolstering their readiness for epidemics or pandemics.
• The majority of nations witnessed little to no progress in keeping a strong, competent, and easily accessible health system for the purpose of detecting and responding to outbreaks.
• Almost every country has seen a rise in political and security concerns; those with the fewest resources are most at risk and have the biggest gaps in their readiness.
• Nation-states persist in disregarding the readiness requirements of susceptible communities, intensifying the consequences of health security crises.
• Nations are ill-prepared to avert worldwide catastrophic biological calamities that might inflict more devastation than COVID-19.

RECOMMENDATIONS

The GHS Index helps assess health security capacities in national budgets, identifying risk factors and capacity gaps. Data from the 2021 Index can be used to update JEE data and supplement it with additional health systems and risk factors. Transparency with capacities and risk factors is crucial for global prevention, detection, and response to epidemics and pandemics. The 2021 GHS Index can help identify countries that need additional support for future disease emergencies, prioritizing those with higher risk factors. Strengthen health systems as part of public health capacity building efforts. Increase data availability for assessing health system preparedness. Monitor disease emergencies and support the formation of a dedicated international normative body. Improve coordination among national and global actors to address high-consequence biological events, including deliberate attacks. The 2021 GHS Index can be used to partner with governments to address gaps in country preparedness and assess vulnerabilities. Private organizations can use the findings to encourage improvements, support private-sector resources, and increase sustainable development and health security portfolios. Philanthrophists  and funds should create new financing mechanisms, prioritize resources, and advocate for country governments to make available national resources for preparedness and capacity development. 

CONCLUSION

Three basic elements form the foundation of the GHS Index:

• Encouraging transparency: Only publicly available and transparent data may be evaluated by the GHS Index.
• Understanding that being ready is influenced by a variety of factors: The GHS Index assesses cross-cutting variables linked to socioeconomic resilience, social vulnerabilities, and effective biological threat mitigation in addition to fundamental public health and healthcare preparedness capabilities.
• Increasing accountability and responsibility: The GHS Index was created with the knowledge that assessing a nation’s capabilities and risks will lead to a greater level of accountability and encourage collaboration between nations, intergovernmental bodies, the private sector, and donors to make sure nations are ready for health security threats.

REFERENCES

This article is a report that was originally authored by Jessica A. Bell, Chris Isaac, and Gabrielle Essix and published on the NTI website. The link for the same is herein. https://www.nti.org/about/programs-projects/project/global-health-security-index/ 

This article was originally authored by Nuclear Threat Initiative and published by Nuclear Threat Initiative. The link for the same is herein. https://www.jstor.org/stable/resrep44061.6

This article was originally authored by Peter G Goldschmidt  and published by Frontiers. The link for the same is herein. https://www.frontiersin.org/articles/10.3389/fepid.2022.846260/full 

This article was originally authored by Ravi SJ, Warmbrod KL, Mullen L,and others on  The value proposition of the Global Health Security Index. and published on BMJ Global Health . The link for the same is herein. https://www.ecohealthalliance.org/wp-content/uploads/2020/10/The-value-proposition-of-the-Global-Health-Security-Index.pdf 

The GHS Index of 2021, titled ADVANCING COLLECTIVE ACTION AND ACCOUNTABILITY AMID GLOBAL CRISIS developed with the Economist impact. The link for the same is herein. https://ghsindex.org/wp-content/uploads/2021/12/2021_GHSindexFullReport_Final.pdf