According to the Global Health Security (GHS) Index, 2019, national health security is “fundamentally weak” around the world. The report gains significance in the context of the recent Coronavirus (COVID19) outbreak.
About the Index
- The Global Health Security (GHS) Index, a report from the Nuclear Threat Initiative, the Johns Hopkins Center for Health Security and the Economist Intelligence Unit, was released in October 2019.
- The GHS Index is the first comprehensive assessment and benchmarking of health security and related capabilities across the 195 countries that make up the States Parties to the International Health Regulations (IHR, 2005).
- The IHR, 2005 represents an agreement between 196 countries including all the World Health Organization (WHO) the Member States to work together for global health security.
- The GHS Index assesses countries’ health security and capabilities across six categories, 34 indicators, and 85 sub-indicators. The six categories are as follow:
- Prevention: Prevention of the emergence or release of pathogens.
- Detection and Reporting: Early detection and reporting for epidemics of potential international concern.
- Rapid Response: Rapid response to and mitigation of the spread of an epidemic.
- Health System: Sufficient and robust health system to treat the sick and protect health workers.
- Compliance with International Norms: Commitments to improving national capacity, financing plans to address gaps, and adhering to global norms.
- Risk Environment: Overall risk environment and country vulnerability to biological threats.
- The index measures countries’ capabilities from 0-100, with 100 representing the highest level of preparedness. The GHS Index scoring system includes three tiers.
- Low Scores: Countries that score between 0 and 33.3 are in the bottom tier.
- Moderate Scores: Countries that score between 33.4 and 66.6 are in the middle tier and
- High Scores: Countries that score between 66.7 and 100 are in the upper or “top” tier.
- International Preparedness
- The GHS Index analysis finds that no country is fully prepared for epidemics or pandemics. Collectively, international preparedness is weak.
- The average overall GHS Index score among all 195 countries assessed is 40.2 of a possible score of 100.
- Overall, the GHS Index finds severe weaknesses in-country abilities to prevent, detect, and respond to health emergencies; severe gaps in health systems; vulnerabilities to political, socioeconomic, and environmental risks that can hamper outbreak preparedness and response; and a lack of adherence to international norms.
- Ranking of Different Countries
- The US is the “most prepared” nation (scoring 83.5), with the UK (77.9), the Netherlands (75.6), Australia (75.5) and Canada (75.3) behind it. Thailand is ranked sixth in the Index — the highest ranking for an Asian country.
- Much of Europe, Russia, the Middle East, Asia, and Central and South America are described as “more prepared,” with scores between 66 and 34.3, while the majority of countries ranked “least prepared” are in Africa.
- India is ranked 57th with a score of 46.5, falling in the middle tier.
- North Korea (17.5), Somalia (16.6) and Equatorial Guinea (16.2) are listed in the index's bottom three.
- China – which is at the center of the recent coronavirus outbreak – is at the 51st place, scoring 48.2.
- Global Response: The UN Secretary-General should convene a global summit by 2021 on biological threats including a focus on financing and emergency response.
- National Commitment
- National governments should commit to taking action to address health security risks.
- Countries should test their health security capacities and publish after-action reviews, at least annually.
- Financing Mechanism: New financing mechanisms should be established to fill preparedness gaps, such as a new multilateral global health security matching fund and expansion of the World Bank International Development Association allocations to include preparedness.
- Institutional Approach: A separate and permanent facilitator or unit for high-consequence biological events, should be designated at the earliest.
- Capacity Development: Governments and donors should take into account countries’ political and security risk factors when supporting health security capacity development.
India’s Response to Health Emergencies
- Underprepared: The influenza A (H1N1) outbreaks since 2009 in Rajasthan, Maharashtra, Tamil Nadu, and other States have acutely underscored the need for better detection, awareness of symptoms and quarantining.
- Low Expenditure: Health expenditure by the government in India is less than 1.5% of Gross Domestic Product, which is low for a middle-income country.
- Availability of Health Professionals: India has a low availability of health professionals. According to the WHO, India has only 80 doctors per 1,00,000 people.
- Impact of Climate Change: India’s health status is being worsened by climate shocks. An HSBC study of 67 countries ranks India as the most climate-vulnerable one because of the impact of severe temperature increases and declines in rainfalls.
- Each State in India needs to expose crucial gaps in areas such as adequacy and supply of diagnostic equipment, health facilities, hygienic practices, and prevention and treatment protocols.
- Separate funding for dealing with a health catastrophe.
- Investing in health and education
- Kerala’s experience in 2018 with the deadly Nipah virus shows the value of investing in education and health over the long term. Kerala’s government efforts kept the mortality rate from the Nipah virus relatively low.
- Protecting Biodiversity
- Nearly two-thirds of known pathogens and three-quarters of newly emerging pathogens are spread from animals to humans (recent example - SARS-CoV-2).
- Reasons for the same can be traced to increased human encroachment on wildlife territory; land-use changes that increase the rate of human-wildlife and wildlife-livestock interactions; and climate change.
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