Researchers at Johns Hopkins University released the Global Health Security (GHS) Index in 2019, a study that looked at the projected readiness of 195 countries in the world for a pandemic like coronavirus. While not meant to be used as a predictive tool, the index was designed to pinpoint strengths and weaknesses in the health systems of countries on a global level.
Scores were given to countries in categories such as the ability to prevent and detect infectious diseases, the potential for rapid response, and the environment for risk. Out of a possible score of 100, the overall average score of all countries assessed in the study was 40.2.
President Donald Trump referred to the GHS Index during a February news briefing, showing its 300-plus pages to reporters.
“The Johns Hopkins, I guess—is a highly respected, great place—they did a study, comprehensive: ‘The Countries Best and Worst Prepared for an Epidemic.’ And the United States is now—we’re rated No. 1,” Trump said. “We’re rated number one for being prepared.”
Roughly a month after that briefing, the U.S. was ranked No. 3 in the world for having the most confirmed cases of coronavirus with over 55,000 individuals confirmed to be infected by the virus.
While the U.S. was ranked No. 1 on the GHS Index with a total score of 83.5, the study found that preparation could be improved on a global level.
“The overarching finding of the index is that no country is fully prepared,” said senior scholar at the Johns Hopkins Center for Health Security and co-leader of the development of the GHS Index Dr. Jennifer Nuzzo in a Wednesday interview with Newsweek.
“We made the case when we published it that yes, the U.S. and all the rest of the countries that score at the top should not sit back and just relax because first of all, they didn’t have everything that they needed and deficiencies in any one area can potentially break the response,” Nuzzo continued. “I think we’re seeing some of that now.”
“It’s hard to say this country lacked ‘X,’ and therefore they had this number of cases, and this country lacked ‘Y,’ and then they had this,” Nuzzo added. “So you can’t really directly extrapolate. It’s potentially a lens with which when you see case numbers, you could try to interpret where it could go based on what they’re able to do and what we think they have. It’s not perfect, but where you might see weakness in their response.”
According to the GHS Index, China ranked 31 out of 195 countries with a 48.2 index score. Among China’s greatest strengths was rapid response to the threat of an epidemic, including its ability to restrict trade and travel. Yet China became the global epicenter of the novel coronavirus, with over 81,000 cases confirmed in the country.
“In December and January when we started hearing about cases in China, the rest of the world was trying to interpret those case numbers,” Nuzzo explained. “In part, an interpretation of those case numbers requires an understanding of how capable are they at testing. Do we think they can collect specimens and transport them? Do we have a sense of what their epidemiological capacity is to be able to interview cases and identify contacts that may be infected?”
“In a global situation, we’re all dependent on each other and we’re all dependent on knowing what each other’s strengths and weaknesses are, so that we can better interpret those data and we can better understand what our individual countries’ risks are and how we should respond based on what we’re seeing happening in other countries,” Nuzzo added.
Coming in 31st on the GHS Index was Italy which received high scores for detection and reporting infectious diseases. Italy currently has the second-highest number of coronavirus cases in the world with over 69,000 confirmed cases reported, a fact Nuzzo said may have to do with the older-skewing demographic in the country.
“Countries that have younger age structures might not be as hard hit as, say, Italy which is a fairly old country, demographically speaking,” Nuzzo said.
Roughly in the middle of the index with a ranking of 97 was the Middle Eastern country of Iran, which currently has over 27,000 confirmed cases. Iran has rejected outside aid in dealing with the pandemic. Tuesday, the country revoked its previous approval for the humanitarian organization Doctors Without Borders to assist with coronavirus treatment.
“Since the national mobilization for confronting corona is ongoing, and the medical capabilities of Iranian Armed Forces are entirely at its service, Iran does not need hospitals established by foreigners and such presence is irrelevant,” said Iranian Health Minister Alireza Vahabzadeh on Monday.
Nuzzo said that social and political factors, including the efficacy of governments, were also taken into account when creating the index.
“We didn’t just look at the health capacities but also just the general risk environment in countries. That includes just how strong their governments are, whether there’s corruption or other things,” Nuzzo said. “I think if we look at the U.S., maybe there will be areas that the U.S. will lose points in the next time we do the index, but I think a lot of the challenges that we are having are probably due to some of these governance issues—which maybe weren’t apparent the first time we measured, but which may become apparent upon remeasure.”
Some countries that ranked poorly on the GHS index, such as Mauritania which came in on the list at No. 157, have a low occurrence of coronavirus. Currently, the country only has two reported cases of COVID-19.
“Just epidemiologically speaking,” Nuzzo said, “I would expect all countries to be hit hard. Some countries may do better, the ones that are able to respond really quickly.”
Nuzzo said she hopes global governments will give more attention to strengthening their health systems in the future.
“One of the reasons we started the index was to bring to national leaders, elevate this conversation, pitch it at national leaders and say, ‘Preparedness pays,'” Nuzzo said. “You may have lots of competing priorities but investments in preparedness pay off. It may seem like a cost that you’re not willing to incur but when a situation happens and, trust us, a situation will happen, you’re going to be much better off if you have put in the work in advance.”
Recent data indicates 440,359 confirmed cases of coronavirus worldwide. While 19,753 individuals have died as a result of the virus, 112,032 people are listed as fully recovered. The graphic below, provided by Statista, illustrates the distribution of COVID-19 cases around the world as of March 25 at 6 a.m.
World Health Organization advice for avoiding spread of coronavirus disease (COVID-19)
- Clean hands frequently with soap and water, or alcohol-based hand rub.
- Wash hands after coughing or sneezing; when caring for the sick; before; during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
- Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
- Avoid touching your hands, nose and mouth. Do not spit in public.
- Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.
- If you feel unwell (fever, cough, difficulty breathing) seek medical care early and call local health authorities in advance.
- Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.
- Healthy individuals only need to wear a mask if taking care of a sick person.
- Wear a mask if you are coughing or sneezing.
- Masks are effective when used in combination with frequent hand cleaning.
- Do not touch the mask while wearing it. Clean hands if you touch the mask.
- Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of mask.
- Do not reuse single-use masks.