When a Zika virus outbreak initially isolated in Uganda’s Zika Forest unexpectedly emerged across several Pacific island states in 2007, Yap Island was hit particularly hard. More than 70% of those living on the tiny Micronesia island—5,000 people—were infected. Several years later, a Zika outbreak in French Polynesia from 2013 to 2014 resulted in 30,000 infections before spreading to seven additional island states in the region.
The GHS Index underscores the tenet that no country is prepared unless all are prepared, but small island nations face unique challenges in preventing, detecting, and responding to infectious diseases. Public health spending as a percentage of overall government spending is typically low; healthcare infrastructure and technologies are frequently lacking; and health workforce capacities remain limited, despite a rapidly increasing need for resources due to growing populations, large burdens of both communicable and non-communicable diseases, and increasing vulnerability to severe weather and other consequences of climate change.
GHS Index findings highlight the vulnerability: apart from Iceland and Cyprus, every island country with a population below one million people scores well below the GHS Index global average. For the 40 Small Island Developing States (SIDS) included in the Index, the average overall score is 28.9. Of the SIDS, only Singapore scores above the global average of 40.2.
Developing workable solutions is challenging. Small island states tend to have smaller populations, with less specialized bureaucratic and health structures. Although many have formal or informal relationships with larger countries and agreements to share supplies, send samples for complex testing, and fulfill other critical needs, long distances between island countries and their neighbors make such arrangements difficult to effectively maintain.
Furthermore, in a pandemic, demand for resources likely would exceed available surge capacity, making it even more difficult for small nations to procure needed drugs, vaccines, therapeutics, or other resources. Larger countries might opt to first focus on meeting national rather than regional or global demands for health services and medical countermeasures—a phenomenon observed during the 2009 H1N1 influenza pandemic.
This is why the GHS Index takes a nation-by-nation look at the availability of resources. Although it may make sense for countries to form agreements and share resources, examining the potential limitations of this approach is also important. Countries should know that such agreements may not be operationally feasible during large public health emergencies.