The World Remains Dangerously Unprepared to Meet Future Health Emergencies

Countries worldwide still lack critical needs for COVID-19 assistance despite signs of hope in the unprecedented levels of investments in COVID-19 response, according to a recent report released by the Global Health Security (GHS) Index and conducted by the Nuclear Threat Initiative (NTI), the Johns Hopkins Center for Health Security and Economist Impact. The study finds this will hinder their ability to respond effectively to future health emergencies.

Findings highlight while some countries have built new capacities during the COVID-19 pandemic, many are temporary. Countries must commit durable funding for long-term preparedness. The report reveals despite the emergence of the COVID-19 pandemic within weeks of the release of the first Global Health Security Index, only two more countries, for a total of 69 of nearly 200, have overarching response plans in place to deal with diseases with epidemic and pandemic potential.

Built around a revised framework, the 2021 GHS Index assesses each country’s capacity to prevent, detect and respond to health emergencies, as well as the effectiveness of their health systems, their commitment to global norms, and the political, socioeconomic and environmental risk factors that can hinder effective response.

COVID-19 has prompted countries to develop some capacities identified as lacking by the 2019 GHS Index. However, no country is placed in the top tier of the 2021 GHS Index—preparedness remains fundamentally weak in all countries.

Whether countries will strengthen their preparedness for future epidemic and pandemic threats by making durable investments is currently unclear.

“Gaps in preparedness leave the world incredibly vulnerable to future health emergencies which could have an even more devastating impact than COVID-19,” said Claire Casey, Global Head of Policy & Insights at Economist Impact. “The second iteration of the Index should be a wake up call: leaders need to act now and put permanent capacities in place to prepare for future health crises.”

New findings from the 2021 Global Health Security Index reveal that:

Most countries, including many high-income countries, have not made dedicated investments in strengthening epidemic or pandemic preparedness

155 out of 195 countries have not allocated funds within the past three years to improve their capacity to address epidemic threats; among those who have, only two low-income countries have evidence of allocating funds. Ninety countries have not fulfilled their full financial contribution to the WHO; 14 of those countries are high-income.

Most countries saw little or no improvement in maintaining a robust, capable, and accessible health system for outbreak detection and response

70% of countries have insufficient health capacity in clinics, hospitals, and community health centers, including human resources and facilities capacity. Only 49 countries (25%) have published an updated health workforce strategy over the past five years to address staffing shortages.

Political and security risks have increased in nearly all countries, and those with the fewest resources have the highest risk and greatest preparedness gaps

Trust in government, which has been a key factor associated with success in countries’ responses to COVID-19, is low and decreasing. 161 countries have low to moderate levels of public confidence in their government. Only 16 countries score in the top tier for government effectiveness.

Countries are continuing to neglect the preparedness needs of vulnerable populations, exacerbating the impact of health security emergencies

Only 33 countries have an overarching emergency preparedness and response plan in place that includes considerations for vulnerable populations. 149 of 195 countries do not identify how risk communication messages will reach populations and sectors with different communication needs related to language, location, and media reach.

Countries are not prepared to prevent globally catastrophic biological events that could cause damage on a larger scale than COVID-19

Nearly two-thirds of countries have not published and implemented an overarching national public health emergency response plan for diseases with epidemic or pandemic potential. Seventy-three percent of countries do not have the ability to provide expedited approval for medical countermeasures, such as vaccines and antiviral drugs, during a public health emergency. One-hundred-seventy-eight countries score less than 50 out of 100 points for whole-of-government biosecurity systems, training, personnel vetting, transport of infectious substances, and cross-border transfer and screening.

“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.”

Dr. Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security said leaders now have a choice.

"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," Nuzzo said.