Global Health Security Index not a proven surrogate for health systems capacity to respond to pandemics: The case of COVID-19

Robert Kaba Alhassan (Lead / Corresponding author), Edward Nketiah-Amponsah, Agani Afaya, Solomon Mohammed Salia, Aaron Asibi Abuosi, Jerry John Nutor

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
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Introduction Global Health Security borders on prevention, detection and response to public health threats like the novel coronavirus disease 2019 (COVID-19). Global Health Security Index (GHSI) of 2019 and 2021 revealed the world remains ill-prepared to deal with future pandemics, evident in the historic impact of COVID-19 on countries. As at 7th December 2022, COVID-19 has infected over 600 million people and claimed over six million lives, mostly in countries with higher GHSI scores.
Objective Determine whether the GHSI scores of countries have a correlation with COVID-19 cases, deaths and vaccination coverage, while adjusting for country level dynamics.
Methods This paper utilizes GHSI database of 195 countries. Data consists of 171 questions grouped into 37 indicators across six overarching categories on health security and COVID-19. Multivariate multiple regression analysis with robust standard errors was conducted to test the hypothesis that high GHSI ratings do not guarantee better COVID-19 outcomes like cases, deaths and vaccination coverage. Also, avplots STATA command was used to check outliers with potential negative effect on outcome and predictor variables.
Results Global average GHSI score for all 195 countries was 38.9. United States of America recorded the highest GHSI score of 75.9 but also recorded one of the highest COVID-19 cases and deaths; Somalia recorded the worst GHSI score of 16.0 and one of the lowest COVID-19 cases and deaths. High GHSI scores did not associate positively with reduction in COVID-19 cases (Coef=157133.4, p-value=0.009, [95%CI 39728.64 274538.15]) and deaths (Coef=1405.804, p-value=0.047, [95%CI 18.1 2793.508]). However, high GHSI ratings associated with increases in persons fully vaccinated per 100 population (Coef=0.572, p-value=0.000, [95%CI.272.873]).
Conclusion It appears the world might still not be adequately prepared for the next major pandemic, if the narrative remains unchanged. Countries that recorded higher GHSI scores, counter-intuitively, recorded higher COVID-19 cases and deaths. Countries need to invest more in interventions towards attaining Universal Health Coverage (UHC) including integrated health systems and formidable primary health care to enhance preparedness and response to pandemics.
Original languageEnglish
Pages (from-to)196-205
Number of pages10
JournalJournal of Infection and Public Health
Issue number2
Publication statusPublished - 21 Dec 2022


  • COVID-19
  • Global Health Security Index
  • Universal Health Coverage
  • Primary Health Care
  • Pandemics
  • Preparednes
  • Health systems


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