Welcome to the2019 Global Health Security Index

The GHS Index is the first comprehensive assessment of global health security capabilities in 195 countries. Read more about the Index and the international panel that helped develop it, download the report and data model, and watch our introductory video.

GHS Index Map

40.2

Data in Action
The average overall GHS Index score is 40.2 out of a possible 100. While high-income countries report an average score of 51.9, the Index shows that collectively, international preparedness for epidemics and pandemics remains very weak.

Findings and Recommendations

The GHS Index assesses countries’ health security and capabilities across six categories, 34 indicators, and 85 sub-indicators. The findings are drawn from open source information that answered 140 questions across the categories.

The full report offers 33 recommendations to address the gaps identified by the index.

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  1. National health security is fundamentally weak around the world. No country is fully prepared for epidemics or pandemics, and every country has important gaps to address.

    Data Highlights:

    • 40.2: average overall Global Health Security Index score of a possible score of 100
    • 116: high- and middle-income countries not scoring above 50


    Recommendations:

    • National governments should commit to take action to address health security risks.
    • Health security capacity in every country should be transparent and regularly measured, and results should be published at least once every two years.
    • Leaders should improve coordination, especially linkages between security and public health authorities, in insecure environments.
    • New financing mechanisms should be established to fill preparedness gaps, such as a new multilateral global health security matching fund; and expansion of World Bank International Development Association (IDA) allocations to include preparedness.
    • The Office of the United Nations (UN) Secretary-General should designate a permanent facilitator or unit for high-consequence biological events.
    • Countries should test their health security capacities and publish after-action reviews, at least annually.
    • Governments and donors should take into account countries’ political and security risk factors when supporting health security capacity development.
    • The UN Secretary-General should call a heads-of-state-level summit by 2021 on biological threats including a focus on financing and emergency response.

     

    Read more on the Report & Model page.

  2. Countries are not prepared for a globally catastrophic biological event.

    Data highlights:

    • 81% of countries score in the bottom tier for indicators related to deliberate risks (biosecurity)
    • 66% score in the bottom tier for indicators related to accidental risks (biosafety).
    • Fewer than 5% of countries provide oversight for dual-use research
      Zero: Number of countries that have legislation or regulations in place that require companies to screen DNA synthesis
    • 92% of countries do not show evidence of requiring security checks for personnel with access to dangerous biological materials or toxins


    Recommendations:

    • Governments and international organizations should develop the capabilities to address fast-moving pandemic threats.
    • Governments should include measurable biosecurity and biosafety benchmarks in national health security strategies and track progress on an annual basis.
    • A dedicated international normative body should be developed to promote the early identification and reduction of biological risks associated with advances in technology.
    • Public and private organizations should invest a percentage of their sustainable development and health security portfolios in the area of biosecurity.
    • Funders and researchers should provide incentives to identify and reduce biological risks associated with advances in technology and should invest in technical innovations that can improve biosecurity.
    • Leaders should prioritize the development of operational linkages between security and public health authorities for biological crises.
    • Countries and international organizations should prioritize the development of national biosurveillance capabilities and a global biosurveillance architecture.

     

    Read more on the Report & Model page.

  3. There is little evidence that most countries have tested important health security capacities or shown that they would be functional in a crisis.

    Data highlights:

    • 85% show no evidence of having completed a biological threat–focused International Health Regulations (IHR) simulation exercise with the World Health Organization (WHO) in the past year
    • Fewer than 5% show a requirement to test their emergency operations center at least annually
    • 77% do not demonstrate a capability to collect ongoing or real-time laboratory data
    • 24% show evidence of a nationwide specimen transport system
    • 89% do not demonstrate a system for dispensing medical countermeasures during a public health emergency
    • 19% demonstrate at least one trained field epidemiologist per 200,000 people


    Recommendations:

    • Countries should test their health security capacities and publish after-action reviews, at least annually. By holding annual simulation exercises, countries will show commitment to a functioning system. By publishing after-action reviews, countries can transparently demonstrate that their response capabilities will function in a crisis and can identify areas for improvement.
    • Health security financing, evaluations, and planning should prioritize functional capability and regular exercises.

     

    Read more on the Report & Model page.

  4. Most countries have not allocated funding from national budgets to fill identified preparedness gaps.

    Data Highlights:

    • 5% score in the top tier for financing
    • One country, Liberia, has published a description of specific funding from its national budget for gaps identified in existing assessments and/or national action plans
    • 10% show evidence of senior leaders’ commitment to improve local or global health security capacity


    Recommendations:

    • Health security preparedness financing should be tracked by a specific, globally recognized entity and briefed annually to heads of state.
    • Domestic financing for health security should be urgently increased, made transparent, and tied to benchmarks within national action plans.
    • Decision makers should create new health security preparedness financing mechanisms that incentivize measurable improvements, such as a such as a new multilateral global health security matching fund, and expansion of IDA allocations to include preparedness.
    • International leaders should examine the availability of financing to support rapid and complete outbreak response. The UN should track and publish outbreak-related costs and contributions.

     

    Read more on the Report & Model page.

  5. More than half of countries face major political and security risks that could undermine national capability to counter biological threats.

    Data Highlights:

    • Higher overall score: Countries with effective governance and political systems
    • 55% score in the bottom and middle tiers for political and security risks indicators
    • 15% score in the highest tier for public confidence in government
    • 23% score in the top tier for political system and government effectiveness, representing approximately 14% of the global population


    Recommendations: 

    • Plans should be developed to assist countries with challenging risk environments and to bolster preparedness in countries bordering those at increased risk.
    • National governments and donors should assess political and security risk factors when making resources available to support capacity development.
    • The UN Security Council should urgently convene a series of meetings aimed at the development of rapid response capabilities, strategies, workforce, and protections necessary for outbreaks that originate in or spread to countries with high political or security risks.

     

    Read more on the Report & Model page.

  6. Most countries lack foundational health systems capacities vital for epidemic and pandemic response.

    Data Highlights:

    • Lowest scoring category: for health systems, average score of 26.4; 131 countries in the bottom tier; weaknesses among even high-income countries
    • 27% demonstrate the existence of an updated health workforce strategy
    • 3% show a public commitment to prioritizing healthcare services for healthcare workers who become sick as a result of participating in a public health response
    • Low scores: physician and nurse/midwife density per 100,000 population
    • 11% show plans to dispense medical countermeasures during health emergencies


    Recommendations:

    • Decision makers should measure and take into account health system capabilities as an integral part of all health security planning, investments, and financing strategies.
    • Leaders should take steps to build and maintain robust healthcare and public health workforces that play a major role in biological crises.
    • National Action Plan for Health Security (NAPHS) should take into account specific benchmarks to improve and finance the overall health system and its workforce.

     

    Read more on the Report & Model page.

  7. Coordination and training are inadequate among veterinary, wildlife, and public health professionals and policymakers.

    Data Highlights:

    • 30% demonstrate existence of mechanisms for sharing data among relevant ministries for human, animal, and wildlife surveillance
    • 8% demonstrate a cross-ministerial unit dedicated to zoonotic disease
    • 51% offer field epidemiological training programs that explicitly include animal health professionals
    • 62% 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


    Recommendations:

    • National public and animal health authorities should coordinate during the development of NAPHS and should incorporate a One Health approach as part of pandemic planning and national disaster preparedness and response efforts.
    • Countries should identify an agency and grant it authority to coordinate training and information sharing among human, animal, and environmental health professionals for outbreak preparedness and response.
    • Decision makers should consider infectious disease risks when developing policies and plans related to climate change, land use, and urban planning.

     

    Read more on the Report & Model page.

  8. Improving country compliance with international health and security norms is essential.

    Data Highlights:

    • <50% have submitted Confidence-Building Measures for the Biological Weapons Convention (BWC) in the past 3 years
    • 30% score well for UN Security Council Resolution (UNSCR) 1540 implementation measures related to legal frameworks and enforcement for countering biological weapons
    • 5% have in place a publicly available plan or policy for sharing genetic data, clinical specimens, and/or isolated biological materials that extends beyond influenza
    • 31% do not show evidence of a cross-border agreement on public health emergency response
    • 45% have conducted and published a WHO Joint External Evaluation (JEE) or precursor evaluation

     

    Recommendations:

    • Countries should regularly undergo and publish a WHO JEE to increase transparency around global health security capacities and capabilities.
    • Countries should establish national and regional protocols for rapidly sharing genetic materials and specimens during public health emergencies.
    • National health authorities should develop epidemic- and pandemic-specific preparedness and response strategies as part of routine disaster and broader national security planning efforts.

     

    Read more on the Report & Model page.

75%

Data in Action
At least 75% of countries receive low scores on globally catastrophic biological risk-related indicators, the greatest vulnerability being oversight of dual-use research.
Data in Action
Although 86% 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.
Country Ranking View of Index Results