Is the Global Health Security (GHS) Index a Significant Factor Associated with COVID-19 Control? A Country Level Analysis

Abstract

Background: Few studies have examined the health capability of different countries in face of the COVID-19 pandemic. We tested the hypothesis that countries with higher capabilities of global health security were associated with significantly better control of COVID-19.

Methods: We retrieved global data and recently published literature on COVID-19 incidence and mortality. Also, we extracted data from the Global Health Security (GHS) index, which is a comprehensive evaluation of the capabilities of global health security in 195 countries. A linear regression analysis was performed with different COVID-19 incidence/mortality rates as outcomes, whilst controlling for Human Development Index (HDI), Gross Domestic Product (GDP), and the population density of each country.

Findings: Countries with higher GHS index were significantly more likely to have lower maximum 14-day cumulative incidence rate per 100,000 population (β coefficient -76, 95% C.I. -116, -37). The same incidence outcome was significantly lower in countries that were “more prepared” (β coefficient -127, 95% C.I. -181, -73) and “most prepared” (β coefficient -152, 95% C.I. -228, -75) (all p<0·001). A similar association was found for the rate of incidence increase per 100,000 population starting from a date when 100 confirmed cases have been reported at 5-days; as well as the incidence and mortality per 100,000 population within 30 days from the date when the first COVID-19 patient was diagnosed. Among the six GHS categories, “prevention of the emergence or release of pathogens” and “overall risk environment and country vulnerability to biological threats” were significantly associated with most incidence and mortality outcomes.

Interpretation: The GHS index was found to be a significant predictor of COVID-19 pandemic control. These findings inform policy-makers in formulating mitigation strategies to combat emerging infectious pandemics, and support the use of the index as a framework for countries where their health security capabilities might warrant further improvements.

Funding Statement: There is no funding for this study.

Declaration of Interests: The authors declare no conflict of interest

Ethics Approval Statement: This study was approved by the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong (SBRE19-583).