Few countries prepared for global disease outbreaks

Countries are not prepared for the possible international spread of new or emerging pathogens or for the deliberate or accidental release of dangerous agents, according to a new index that assesses the capabilities of 195 nations.

The Global Health Security Index is a joint project by the Nuclear Threat Initiative and the Johns Hopkins Center for Health Security, with research by The Economist Intelligence Unit. Released Thursday, the Index finds major deficiencies in countries’ abilities to prevent, detect, and respond to substantial disease outbreaks.

“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.”

Among the striking statistics cited in the Index report, 92 percent of governments do not show evidence of requiring security checks for personnel with access to dangerous biological materials or toxins. And at least 75 percent of countries received low scores on globally catastrophic biological risk-related indicators, the greatest vulnerability being oversight of dual-use research.

The average overall 2019 GHS Index score is 40.2 out of a possible score of 100. Even among the high-income countries assessed, the average score is 51.9. The United States has the overall highest score on the Index, partly predicated on the transparent information that’s publicly available to measure the country’s preparedness. However, the United States lags in areas such as access to health care and public confidence in government.

“We made a number of recommendations in the report and one of the key recommendations is that the United Nations Secretary-General should call a heads-of-state summit by 2021,” Beth Cameron, vice president, Global Biological Policy and Programs at NTI, told Homeland Preparedness News. “We believe one of the greatest deficits in health security is there’s still insufficient political will to fill the gaps. And we looked at factors in this Index we think decision-makers will care about. It ranks countries and it compares how different countries do with different aspects to health security. We are hopeful it will really motivate countries to improve.”

Although 86 percent of countries invest local or donor funds in health security, few countries pay for health security gap assessments and action plans out of national budgets, according to the report.

The report’s authors also examined whether countries had emergency operation centers in place. An EOC is one of the hallmarks of a prepared public health system, says Cameron. The researchers asked countries if there was a requirement for them to exercise these centers on an annual basis so that the “world would know, their neighbors would know, that it is functional in a crisis,” Cameron said.

The 316-page report also outlined the concept of ‘one health,’ or the intersection between human, animal, and agricultural health. According to the report, nearly two-thirds of known pathogens and three-quarters of newly emerging pathogens are zoonotic—meaning they spread from animals to humans.

“What we found in the data I think isn’t surprising,” said Jessica Bell, senior program officer, Global Biological Policy and Programs at NTI. “We see legislation focused on particular ministries but that don’t highlight the need for coordination across ministries that takes into account that one health aspect.”

Other findings include:

• Only 51 percent of countries offer field epidemiological training programs that explicitly include animal health professionals, although a much larger number (80 percent) offer an applied epidemiological training program.

• 62 percent of countries have not submitted a report to the World Organisation for Animal Health on the incidence of human cases of zoonotic diseases for the past calendar year.

• The majority of countries are facing land-use changes, measured by the percentage change in forest area, which could affect the risk of emerging zoonotic disease.

As for the Index as a whole, Cameron says it complements the World Health Organization’s voluntary external assessment of countries’ preparedness for epidemics and pandemics and that methodology for the report was applied to all countries that are state parties to the International Health Regulations.

“The first thing that countries can do, we hope, is to understand the gaps,” Cameron said. “Second, the Index motivates conversations between sectors of government in how to fill the gaps. And, third, to get the political will to take action to finance and to fill those gaps so we get to a much better place.”