The Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations (IHR ). The GHS Index is a project of the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security (JHU) and was developed with The Economist Intelligence Unit (EIU). These organizations believe that, over time, the GHS Index will spur measurable changes in national health security and improve international capability to address one of the world’s most omnipresent risks: infectious disease outbreaks that can lead to international epidemics and pandemics.
Why Is the GHS Index Needed?
It is likely that the world will continue to face outbreaks that most countries are ill positioned to combat. In addition to climate change and urbanization, international mass displacement and migration—now happening in nearly every corner of the world—create ideal conditions for the emergence and spread of pathogens. Countries also face an increased potential threat of accidental or deliberate release of a deadly engineered pathogen, which could cause even greater harm than a naturally occurring pandemic. The same scientific advances that help fight epidemic disease also have allowed pathogens to be engineered or recreated in laboratories. Meanwhile, disparities in capacity and inattention to biological threats among some leaders have exacerbated preparedness gaps.
The 2014 West Africa Ebola epidemic was a wake-up call. It prompted global leaders and the World Health Organization to realize that it’s not clear where the gaps are – or how to fill them. It also highlighted that leaders need better ways to understand and measure improvement in global capability to prevent, detect, and respond to infectious disease threats.
The GHS Index seeks to illuminate preparedness and capacity gaps to increase both political will and financing to fill them at the national and international levels.
Developing the GHS Index
To create the GHS Index, NTI, JHU, and the EIU project team—with generous grants from the Open Philanthropy Project, the Bill & Melinda Gates Foundation, and the Robertson Foundation—worked with an international advisory panel of 21 experts from 13 countries to create a detailed and comprehensive framework of 140 questions, organized across 6 categories, 34 indicators, and 85 subindicators to assess a country’s capability to prevent and mitigate epidemics and pandemics.
The GHS Index relies entirely on open-source information: data that a country has published on its own or has reported to or been reported by an international entity. The GHS Index was created in this way with a firm belief that all countries are safer and more secure when their populations are able to access information about their country’s existing capacities and plans and when countries understand each other’s gaps in epidemic and pandemic preparedness so they can take concrete steps to finance and fill them. The indicators and questions that compose the GHS Index framework also prioritize analysis of health security capacity in the context of a country’s broader national health system and other national risk factors.
The 140 GHS Index questions are organized across six categories:
Prevention: Prevention of the emergence or release of pathogens
Detection and Reporting: Early detection and reporting for epidemics of potential international concern
Rapid Response: Rapid response to and mitigation of the spread of an epidemic
Health System: Sufficient and robust health system to treat the sick and protect health workers
Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms
Risk Environment: Overall risk environment and country vulnerability to biological threats
Among its 140 questions, the GHS Index prioritizes not only countries’ capacities, but also the existence of functional, tested, proven capabilities for stopping outbreaks at the source. Several questions in the GHS Index are designed to determine not only whether a capacity exists, but also whether that capacity is regularly—for example, annually—tested and shown to be functional in exercises or real-world events.
The GHS Index also includes indicators of nations’ capacities and capabilities to reduce Global Catastrophic Biological Risks (GCBRs), which are biological risks of unprecedented scale that could cause severe damage to human civilization at a global level, potentially undermining civilization’s long-term potential. These are events that could wipe out gains in sustainable development and global health because of their potential to cause national and regional instability, global economic consequences, and widespread morbidity and mortality.
International Panel of Experts
David M. Barash, Executive Director, GE Foundation
David Blazes, Senior Program Officer, Surveillance and Epidemiology, Global Health Program, Bill & Melinda Gates Foundation
Mukesh Chawla, Adviser, Health, Nutrition and Population, World Bank; Chair, UNAIDS and World Bank Global Economics Reference Group on HIV-AIDS
Chaeshin Chu, Deputy Scientific Director, Division of Risk Assessment and International Cooperation, Korea Centers for Disease Control and Prevention (KCDC)
Scott F. Dowell, Deputy Director, Vaccine Development and Surveillance, Global Health Program, Bill & Melinda Gates Foundation
Wu Fan, Deputy Director General, Shanghai Municipal Health Commission, China
Dylan George, Vice President, Technical Staff and BNext, In-Q-Tel
Lawrence O. Gostin, Faculty Director and Founding Chair, O’Neill Institute for National and Global Health Law, Georgetown University Law Center
Ernesto Gozzer, Associate Professor, Universidad Peruana
Cayetano Heredia; International Consultant
Wilmot James, Visiting Professor, Political Science and Pediatrics, Columbia University
Julius J. Lutwama, Senior Principal Research Officer, Ministry of Health, Uganda; Head of the Department of Arbovirology, Emerging and Re-Emerging Viral Infectious Diseases, Uganda Virus Research Institute (UVRI)
Issa Makumbi, Director, Public Health Emergency Operations Centre, Ministry of Health, Uganda
Pretty Multihartina, Director, Center for Health Determinant Analyst, Ministry of Health, Indonesia
Lee Myers, Manager, a.i., Emergency Management Centre for Animal Health (EMC-AH), Food and Agriculture Organization (FAO) of the United Nations (on behalf of the United States Department of Agriculture)
Indira Nath, Former Senior Professor and Head, Department of Biotechnology, All India Institute of Medical Sciences
Simo Nikkari, Director and Professor, Centres for Military Medicine and Biothreat Preparedness, FDF Logistics Command, Finland
The Honorable Cllr. Tolbert G. Nyenswah, Director General, National Public Health Institute, Liberia
Robert Powell, Editorial Director Americas, Thought Leadership, The Economist Intelligence Unit
Malik Muhammad Safi, Director of Health Programs and Head of Health Planning, System Strengthening and Information Analysis Unit, Ministry of National Health Services, Regulation and Coordination, Pakistan
Tomoya Saito, Chief Senior Researcher, Department of Health Crisis Management, National Institute of Public Health, Japan
Oyewale Tomori, Professor of Virology; Former President, Nigerian Academy of Science
About the Index Project Team
The GHS Index is a project of the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security (JHU) and was developed with The Economist Intelligence Unit (EIU).
Nuclear Threat Initiative
The Nuclear Threat Initiative works to protect our lives, environment, and quality of life now and for future generations. We work to prevent catastrophic attacks with weapons of mass destruction and disruption (WMDD)—nuclear, biological, radiological, chemical, and cyber.
Johns Hopkins Center for Health Security
The Johns Hopkins Center for Health Security works to protect people’s health from epidemics and disasters and ensure that communities are resilient to major challenges. The Center examines how scientific and technological innovations can strengthen health security. We study the policies, organizations, systems, and tools to prevent and respond to outbreaks and public health crises. We advance policies and practice to address a range of challenges, including the global rise in emerging infectious diseases, a continued risk of pandemic flu, major natural disasters, our dependence on vulnerable infrastructure, outbreaks of foodborne illness, and the potential for biological, chemical, or nuclear accidents or intentional threats.
The Economist Intelligence Unit
The Economist Intelligence Unit is the research arm of The Economist Group, publisher of The Economist. As the world’s leading provider of country intelligence, The Economist Intelligence Unit helps governments, institutions and businesses by providing timely, reliable and impartial analysis of economic and development strategies. Through our public policy practice, we provide evidence-based research for policymakers and stakeholders seeking measurable outcomes in fields ranging from technology and finance to energy and health. We conduct research through interviews, regulatory analysis, quantitative modelling and forecasting, and display the results via interactive data visualization tools. Through a global network of more than 900 analysts and contributors, The Economist Intelligence Unit continuously assesses and forecasts political, economic and business conditions in more than 200 countries.
GHS Index Co-Leaders
Elizabeth E. Cameron, PhD, Vice President, Global Biological Policy and Programs, Nuclear Threat Initiative
Jennifer B. Nuzzo, DrPH, SM, Associate Professor, Johns Hopkins Bloomberg School of Public Health; Senior Scholar, Johns Hopkins Center for Health Security
Jessica A. Bell, MS, Senior Program Officer, Global Biological Policy and Programs, Nuclear Threat Initiative
Michelle Nalabandian, MFS, Program Officer, Global Biological Policy and Programs, NTI
John O’Brien, Intern, Global Biological Policy and Programs, NTI
Avery League, Intern, Global Biological Policy and Programs, NTI
Sanjana Ravi, MPH, Senior Analyst, Senior Research Associate, JHU Center for Health Security
Diane Meyer, RN, MPH, Managing Senior Analyst, Research Associate, JHU Center for Health Security
Michael Snyder, MALD, Analyst, Research Associate, JHU Center for Health Security
Lucia Mullen, MPH, Analyst, Research Associate, JHU Center for Health Security
Lane Warmbrod, MS, MPH, Analyst, Research Associate, JHU Center for Health Security