Review of Health Security Capacities in Light of 2019-nCoV Outbreak – Opportunities for Strengthening IHR (2005) Implementation

Abstract

Background: In December 2019, China reported cases of pneumonia caused by unknown etiology to the World Health Organisation. As of 4 February 2020, there have been approximately 20,000 confirmed cases of novel coronavirus (2019-nCoV) infection reported across more than 20 countries. On January 30, WHO declared the outbreak of the novel coronavirus to be a public health emergency of international concern (PHEIC). Public health measures to prevent, detect, and respond to events are essential to control public health risks including infectious disease outbreaks as highlighted in the International Health Regulations (2005) (IHR). In this study, we sought to review the current levels of health security capacities to prevent, detect, respond, and establish enabling functions for an effective response and operational readiness against public health risks and events including infectious disease outbreaks.

Methods: To evaluate health security capacities, we used 18 indicators from the IHR State Party Annual Reporting (SPAR) Tool and associated data from national SPAR reports to develop five indices a) prevent, b) detect, c) respond, d) enabling function and e) operational readiness. We used SPAR 2018 data exclusively for all of the indicators and categorised countries into five levels across the indices, where level 1 indicates the lowest level of national capacity and level 5 indicates the highest level of national capacity. We present cumulative scoring data for the 182 State Parties (countries) included in this study and present analysis at the regional level (using the six geographical WHO regions).

Findings: Approximately 33% of the countries analysed have limited prevent and response capacities, and many such countries are those that are classified by the World Bank as low and lower-middle-income nations. In addition, our study shows that approximately 40% of countries have level 4 or level 5 prevent and response capacities. Findings also show that 75% of countries analysed scored more highly in the detect index as compared to the other indices applied. The analysis revealed that half of all countries included in this study do not currently have an effective enabling function for public health risks and events including infectious disease outbreaks (level 1 and level 2). 56% of countries have level 4 or level 5 enabling function capacities in place. In terms of operational readiness, approximately 17% of all countries have limited operational readiness capacities (level 1 and level 2), while more than half of all countries (57%) are currently operationally ready to prevent, detect and control an outbreak of a novel infectious disease (36% at level 4 and 21% at level 5).

Interpretation: Countries vary widely in terms of their capacity to prevent, detect and control outbreaks, which is underpinned by global variances in the strength of health systems to manage health emergencies. Half of all countries analysed in this study currently have in place operational readiness capacities which should enable an effective response to any potential health emergencies including 2019-nCoV. However, it is crucial to integrate/triangulate findings from local risk assessments to fully understand national readiness capacities in relation to 2019-nCoV. Some countries may require external support if cases are identified and the infection spreads rapidly within their borders. As part of the commitment to the IHR (2005) countries should be implementing capacity building action to strengthen their ability to effectively prevent and manage health emergencies and the application of data analysis can support focused targeting of critical gaps that currently exist. Commitment to IHR (2005) also involves collaboration between States Parties to improve capacities for preventing and managing health emergencies which should also be carried out to improve preparedness. This will strengthen global readiness to contain existing outbreaks including the ongoing international spread of 2019-nCoV.

Funding: None.

Declaration of Interest: None.

Ethical Approval: The data used in the study are publicly available on the WHO website. Ethical approval was not required.

Keywords: Health Security, IHR capacity and Operational Readiness