March 20, 2020

By Nicholas LePan Visual Capitalist

The world has experienced many pandemics throughout its history, but not every era has had the benefit of modern medicine and hindsight.

However, even with the readily available medical expertise and equipment that exists today, it is still unevenly distributed throughout the globe. Combine this with a highly interconnected global economy, and large populations are still at risk from infection.

Today’s chart pulls data from the 2019 Global Health Security Index, which ranks 195 countries on health security. It reveals that while there were top performers, healthcare systems around the world on average are fundamentally weak—and not prepared for new disease outbreaks.

Pathways for Commerce and Disease

Modern transportation and trade have linked the farthest stretches of the world to fuel a global economy. Physical distance plays less a limiting role and more an enabling one to form a flat world as Thomas Friedman put it, creating opportunities for commerce anywhere in the world.

A person can sell dishware from his home in Cusco, Peru, online to a customer in Muncie, Indiana, with products manufactured in China, from materials sourced in Africa.

While these connections sound sterile, there are people interacting with one another to procure, manufacture, package, and distribute the goods. The connections are not just through products, but also people and animals across many borders.

Now, add up the interactions within the global food supply chain with plants and livestock and tourism industries and place them under the pressures of climate change, urbanization, international mass displacement, and migration—and the volume and variety of opportunities for disease transmission and mutation becomes infinite.

The same pathways of global commerce become the transmission vectors for disease. A cough in Dubai can become a fever in London with one flight and one day.

You Cannot Manage What You Do Not Measure

Despite this, we still live with national healthcare systems that look inward towards national populations, with less of a focus on integrating what is happening with the outside world.

The Global Health Security (GHS) Index is the first comprehensive effort to assess and benchmark health security and related capabilities by nation, and it tracks six key factors to come up with an overall score for each of the 195 countries in the ranking:

1. Prevention
   Prevention of the emergence or release of pathogens
2. Detection and Reporting
   Early detection and reporting for epidemics of potential international concern
3. Rapid Response
   Capability of rapidly responding to and mitigating the spread of an epidemic
4. Health System
   Sufficient and robust and health system to treat the sick and protect health workers
5. Compliance with Global Norms
   Compliance with international norms by improving national capacity, financing plans to address gaps
6. Risk Environment
   Risk environment and country vulnerability to biological threats

Note: 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).

Country Overall Rankings

Overall, the rankings uncover a distressing insight. Global preparedness for both epidemics and pandemics is weak, with the average score in the index sitting at 40.2 out of 100.

The countries with the highest scores have effective governance and politics systems in place, while those with the lowest scores fall down for their inadequate healthcare systems—even among high-income countries.

Here are the 50 highest-ranking countries in the index:

Showing 1 to 10 of 50 entries Previous Next

Rank	Country	GHS Index Score
#1	United States	83.5
#2	United Kingdom	77.9
#3	Netherlands	75.6
#4	Australia	75.5
#5	Canada	75.3
#6	Thailand	73.2
#7	Sweden	72.1
#8	Denmark	70.4
#9	South Korea	70.2
#10	Finland	68.7

You can view the complete rankings of all 195 countries on the GHS Index website.

Interestingly, 81% of countries score in the bottom tier for indicators related to biosecurity—and worse, 85% of countries show no evidence of having completed a biological threat-focused simulation exercise in conjunction with the World Health Organization (WHO) in the past year.

Confirmed COVID-19 Cases vs. Global Health Security Score

Many healthcare systems have had their security tested with the outbreak of COVID-19.

Although it is still extremely early, there appears to be a relationship between a nation’s health security and its ability to cope with pandemics.

Takeaways: A World Unprepared

While there may be top performers relative to other countries, the overall picture paints a grim picture that foreshadowed the current crisis we are living through.

“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.” – The Global Health Security Index, 2019

The report outlined eight critical insights about global health security in 2019 that reveal some of the problems countries are now facing.

1. National health security is fundamentally weak globally. No country is fully prepared for epidemics or pandemics, and every country has important gaps to address.
2. Countries are not prepared for a globally catastrophic biological event.
3. There is little evidence that most countries have tested important health security capacities or shown that they would be functional in a crisis.
4. Most countries have not allocated funding from national budgets to fill identified preparedness gaps.
5. More than half of countries face major political and security risks that could undermine national capability to combat biological threats.
6. Most countries lack basic health systems capacities critical for epidemic and pandemic response.
7. Coordination and training are inadequate among veterinary, wildlife, and public health professionals and policymakers.
8. Improving country compliance with international health and security norms is essential.

A Stark Reality

The intention of the Global Health Security Index is to encourage improvements in the planning and response to one of the world’s most omnipresent risks–infectious disease outbreaks. When this report was released in 2019, it revealed that even the highest ranking nations still had gaps to fill in preparing for a pandemic.

Of course, hindsight is 20/20. The COVID-19 outbreak has served as a wake-up call to health organizations and governments around the world. Once all of the curves have been flattened, the next version of this report will undoubtedly be viewed with renewed interest.