While the 2021 Global Health Security Index reported that all countries remain dangerously vulnerable to future biological threats, it also showed marked improvements in preparedness in recent years for four nations. Released in December 2021, most recent version of the Index shows New Zealand, Lithuania, Chile, and Georgia improving their global rankings by as many as 12 points from the 2019 Index. Each country made significant strides in prevention, detection, and response categories included in the Index both before COVID-19 set in and to respond to the evolving pandemic and can serve as models for other governments.
The GHS Index’s scoring system creates an aggregate country score by averaging capacity strength in six indicator categories (Prevention, Detection and Reporting, Rapid Response, Health System, Compliance with International Norms, Risk Environment). It then ranks countries by comparing these scores to that of each of the 195 countries examined. In the 2021 GHS Index, New Zealand and Lithuania each moved up 12 spots, increasing their scores by seven and five points, respectively. Chile and Georgia also improved their scores, with Chile’s jumping three and Georgia’s increasing by four points. Details of each country’s successes are outlined below.
New Zealand leapt 12 places in the 2021 GHS Index with an index score of 62.5 out of 100. The island nation of 5 million scored above the global average in each indicator category with particular improvements in detection and reporting, and compliance with international norms.
Following plans it outlined in its 2019 Joint External Evaluation, New Zealand facilitated the transport of pathogen samples to testing laboratories and provided outbreak surge capability for its national public health lab systems, thus achieving full GHS Index credit for laboratory supply chain capacity. Also key were New Zealand’s robust epidemiology workforce training programs, which provided the country with at least one trained field epidemiologist per 200,000 people. These capacities allow for earlier detection and reporting of epidemics that may be of international concern, enabling swifter response.
Development of a 2019 National Disaster Resilience Strategy boosted New Zealand’s GHS Index score for compliance with international norms. The strategy calls for strengthening the emergency management workforce, developing plans for specific health risks, and ensuring regulations are adaptable for a variety of emergencies. As an example, prior to the COVID-19 pandemic, New Zealand allocated additional funding to District Health Boards (DHBs) to support measles outbreak responses and immunization campaigns. These existing funding mechanisms helped the DHBs coordinate pop-up and mobile centers for COVID-19 testing around the country.
These new policies and the public release of its 2019 JEE drove New Zealand’s improvement in the 2021 GHS Index rankings. New Zealand’s country profile and summary scoresheet are available on the GHS Index website.
With an Index score of 59.5 out of 100, Lithuania is ranked 21st out of 195 countries in the 2021 GHS Index. Thanks to improvements in rapid response and its overall health system, the Baltic nation of 2.3 million increased its score by nearly five points from the 2019 GHS Index.
Following a positive review of Lithuania’s risk communication strategy in its November 2018 JEE, the national COVID-19 Management Strategy successfully implemented the State Emergency Management Plan’s detailed risk community plan for the COVID-19 pandemic. Increases in the number of citizens with access to the internet, whether via mobile phones or computers, also boosted the country’s score in this indicator category.
Healthcare capacity in Lithuania also increased between the 2019 and 2021 GHS Indices. The country’s patient isolation strategy was amended in 2020 in response to the COVID-19 pandemic, as was the national procedure for health workforce training and planning for the demand of medical professionals. These two initiatives resulted in a doubling of Lithuania’s Index score for health capacity in clinics, hospitals, and community care centers.
Its updated policies and execution of plans during the COVID-19 pandemic moved Lithuania from 33rd to 21st in the 2021 GHS Index rankings. Lithuania’s country profile and summary scoresheet are available on the GHS Index website to explore and download.
With a 2021 GHS Index score of 56.2 out of 100, Chile was ranked 28 out of 195 countries. The country moved up 8 places in the global ranking between 2019 and 2021 on the strength of detection and reporting gains and health system improvements.
Chile’s score for real-time surveillance and reporting jumped 25 points from the 2019 GHS Index to the 2021 edition. The increase was driven by Chile’s report of a potential public health emergency of international concern in 2020 in response to the detection of autochthonous dengue on Easter Island. In addition, the 2019 rollout of EPIVIGILA, an electronic reporting surveillance system at the national and sub-national level, provided a solid platform for processing COVID-19 samples. These improvements in transparency, reporting, and surveillance were important improvements towards address preparedness needs of Chile.
To respond to COVID-19, the Chilean government established isolation rooms in Sanitary Residences across the country to house COVID positive patients. The Ministry of Health also set up geriatric-specific isolation areas. These two interventions demonstrated the country’s ability to increase the number of isolation units in response to an infectious disease outbreak.
The implementation of an electronic surveillance system and initiatives in response to the COVID-19 pandemic moved Chile up to be ranked 21st in the 2021 GHS Index. Chile’s country profile and summary scoresheet are available to view and explore on the GHS Index website.
Georgia’s 2021 GHS Index score was 52.6 out of 100, giving it a ranking of 40th out of 195. Its overall Index score increased nearly five points based on improvements in case-based investigation and health system supply chain.
In 2019, the Georgian government issued a decree allowing for public health screening of individuals arriving in the country through international airports. In addition, during the COVID-19 pandemic, the government began operating “COVID hotels” staffed with medical teams for infected individuals at low-risk for severe disease who were unable to isolate at home. Financial support for those isolating was also provided to citizens.
Georgia’s publicly available 2019 JEE reported that the country has domestic reserves of personal protective equipment, vaccines, and laboratory consumables, many of which were needed during the COVID-19 pandemic. It was also able to leverage government-funded domestic manufacturing during the pandemic to produce medical supplies.
The release of its 2019 JEE and implementation of COVID-specific policies helped Georgia move up eight spots in the 2021 GHS Index ranking. Georgia’s country profile and summary scoresheet are available to view and explore on the GHS Index website.
Application of these Results
While the Index is not intended to predict a country’s ability to respond to biological threats, it provides a snapshot of available capacities. The COVID-19 pandemic exemplified this, as some countries with the highest Index scores experienced the greatest burden of disease partly as a result of not leveraging all the capacities available to them. New Zealand, Lithuania, Chile, and Georgia all were able to respond effectively using competencies created in response to their JEEs and by quickly developing new capacities as the pandemic evolved. These efforts increased health emergency preparedness and thus their Index scores. Sustaining these capacities to address future threats should be national and global priorities.
The 2021 GHS Index also highlighted the importance of active participation in the WHO JEE process. Nearly every country that completed a JEE between the release of the 2019 GHS Index and the research period for the 2021 GHS Index boosted its scores. Since the Index is based entirely on publicly available data, published JEE reports greatly increase the amount of information included in the Index analyses while also serving as a valuable tool for countries to identify and address preparedness gaps. Enhancing transparency in country preparedness and ensuring capacities can be adequately scaled up when required are critical to a country’s biological threat response.
The Index and the JEE
While enhanced competencies recorded in the four most improved countries ranged from building adequate epidemiology workforces to strengthening medical surge capacity, the countries showing sustained preparedness improvements had one element in common: they all completed a Joint External Evaluation (JEE) between the 2019 and 2021, proving the importance and effectiveness of tools to monitor capacity building. The JEE provides a voluntary expert evaluation of health emergency capacities required of all countries under the International Health Regulations, providing a baseline assessment that governments can use to pinpoint weaknesses. Countries that take steps to fill identified preparedness gaps both improved their countries readiness and their Index scores.
While a critical tool for helping governments develop plans to improve preparedness, the JEE also provides valuable information for the GHS Index. Countries that complete a JEE receive points in the Index specifically for undertaking and publishing a JEE report since this evaluation shows a commitment to both international norms and to transparency about country capabilities. The JEE also provides foundational data about a country’s state of preparedness that is useful in Index analyses. Learn more about how the GHS Index builds on the JEE process here.