Takemi Program in International Health
The Takemi Program in International Health seeks to improve health and health systems around the world by welcoming mid-career health professionals and scholars to the Harvard T. H. Chan School of Public Health to conduct path breaking research and develop their leadership skills.
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Health Security Preparedness
Addressing Inequality in Health Preparedness Measures
Adam Abdullahi 1 and Jesse Bump 1
¹ Takemi Program in International Health, Harvard T.H Chan School of Public Health, Boston, MA
Contact: E: adamabdullahi@hsph.harvard.edu X: @DrAdamAbdullahi
Introduction
Global health disparities remain a significant challenge in addressing preparedness for pandemics, particularly in low-resource settings with fragile health systems. Traditional preparedness instruments, such as the International Health Regulations and frameworks such as Global Health Security Index (GHSI), focus on static measures (e.g., laboratory and work force capacity) which fails to predict real-world responses.
There is a significant disconnect between GHSI scores and pandemic response outcomes, particularly in lower-ranked countries. We hypothesize that dynamic measures such as response speed play a significant factor and could be integrated into existing preparedness tools to better reflect and predict pandemic responses.
Objectives
- Evaluate the existing literature on preparedness measures and after-action reports to understand the role of static versus dynamic factors.
- Identify key dynamic measures that significantly influence pandemic preparedness and outcomes and propose actionable modifications to integrate these measures into current global health preparedness frameworks.
Methods
- Content analysis of indicators of GHSI to assess their focus on static preparedness measures.
- Thematic literature analysis using PubMed searches of health security terminology (2000–2024) to validate the emphasis on static versus dynamic measures in existing research.
- Content analysis of COVID-19 after-action reports to identify and propose surrogate dynamic preparedness indicators based on the experiences of countries with varying pandemic response performances.
Data Sources
- Global Health Security Index (GHSI) framework: 6 categories, 37 indicators, and 171 questions covering health security across 195 countries.
- PubMed literature database search for health security terminologies (2000–2024).
- COVID-19 After Action Reports and COVID-19 performance data (Johns Hopkins COVID-19 Resource Centre; Lowy Institute Performance Index).
Results
Correlation between COVID-19 cases/deaths and GHSI scores showing poor prediction
Analysis indicates a weak correlation between high GHSI scores and effective COVID-19 response outcomes (cases and deaths per million), highlighting the limited predictive value of static preparedness metrics. Countries with lower GHSI scores sometimes outperformed higher-ranked nations, suggesting significant influence from unmeasured dynamic factors.
Literature search of Health Security terms reflected the elements of GHSI
Thematic analysis of 2100 articles reveals a predominant focus on static preparedness elements (e.g., health infrastructure, policy frameworks, laboratory capacity) within existing health security research literature. Dynamic preparedness elements such as governance agility, public trust, and speed of decision-making remain significantly underrepresented, highlighting critical gaps for future research.
Key dynamic measures from COVID-19 response
After-action reports from best- and worst-performing countries revealed consistent patterns across key dynamic preparedness domains. Best performers (e.g., Vietnam, South Korea, New Zealand, Senegal) demonstrated fast decision-making, streamlined governance, high public trust, and the ability to apply lessons from prior outbreaks. In contrast, worst-performing countries (e.g., US, UK, Brazil, India) experienced delayed responses, fragmented leadership, low public compliance, and poor integration of past lessons. These findings reinforce the importance of governance agility, public trust, and adaptability as critical, yet underrepresented, components of preparedness.
Conclusion and Recommendations
- Traditional preparedness tools, such as the Global Health Security Index (GHSI), predominantly focus on static structural indicators like laboratory capacity and legislation. However, our analysis shows that these measures fail to predict real-world response outcomes, as demonstrated during the COVID-19 pandemic.
- Dynamic preparedness factors—such as governance agility, public trust, and the ability to adapt based on prior epidemic experience—were consistently observed in high-performing countries and underlie their successful responses. These factors remain underrepresented in current preparedness frameworks.
- We recommend the integration of dynamic indicators into existing tools to strengthen their predictive validity and practical relevance. Doing so will ensure preparedness assessments reflect not just capacity on paper, but readiness in practice—particularly in low-resource settings where adaptability, trust, and leadership agility become paramount.
Acknowledgements
Takemi Program in International Health