India ranks 66th amongst 195 countries on the Global Health Security Index

The Global Health Security (GHS) Index released its latest edition of the report last week. The 2021 edition of the Index highlights the dangerous levels of unpreparedness of nations around the world in handling future epidemic and pandemic threats.

India is no exception to the global state of affairs and its capability levels in dealing with such outbreaks have in fact reduced since 2019 when the first edition of the Index was published. Research for the 2021 GHS Index was conducted between August 2020 and June 2021. It can be surmised then that though India built additional capacities during the Covid pandemic, many of them were temporary, Covid-19-specific measures.

The Global Health Security (GHS) Index is an assessment and benchmarking of health security and related capabilities across 195 countries that make up the States Parties to the International Health Regulations (IHR [2005]). The index is designed to inform leaders of the foundational elements that are necessary to prepare their countries for future outbreaks and where they should prioritize planning and invest durable funding. By assessing these capacities every 2-3 years, the GHS Index stimulates political will and action to prioritize addressing these gaps. It is developed in partnership with the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, working with Economist Impact.

India's overall score on the GHS Index 2021 is 42.8 out of 100, slightly lower than the overall score of 43.6 on the 2019 edition of the GHS Index. India ranks 66th amongst 195 countries on the GHS Index 2021, moving 5 positions lower than the 61st position held in 2019. According to the GHS Index 2021, India’s detection and reporting procedures have improved over the last two years. However, its capabilities in emergency preparedness and response planning have fallen during the same period and have negatively contributed to the lower overall score in 2021.

In comparison to the benchmarked G20 peers, India's overall score of 42.8 on the GHS Index 2021 is the lowest. It is, however, higher than the world average of 38.9. USA topped the GHS Index in 2021 with a score of 75.9. It was ranked first in the GHS Index 2019 as well.

Critics of the GHS Index claim that despite its ranking, the USA reported the highest number of Covid-19 cases. The results thus highlight that the GHS Index can only identify preparedness resources and capacities available in any country, but it cannot predict whether or how well a country will use these resources in times of a crisis.

Categories

The GHS Index assesses countries across 6 categories containing a total of 37 indicators. Results at this level provide insights into the overall finding.

Prevention

This category factors the prevention of the emergence or release of pathogens, including those constituting an extraordinary public health risk in keeping with the internationally recognized definition of a Public Health Emergency of International Concern. Indicators in this category assess antimicrobial resistance (AMR), zoonotic disease, biosecurity, biosafety, dual-use research and culture of responsible science, and immunization.

• India's capabilities in the prevention of the emergence or release of pathogens, including those constituting an extraordinary public health risk, covered by the Prevention category, remain poor and is scored at the 29.7 percentile level.
• Biosafety (structures, systems, and standards that must be implemented to maintain safe laboratory and research environments, particularly in the context of handling biological agents with a high risk of causing disease in the laboratory workers) has not shown any improvement over the last 2 years and scores 0 out of 100 on GHS Index 2019 and 2021.
• Dual use (oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, and/or other dual use research) has not shown any improvement over the last 2 years and scores 0 out of 100 on GHS Index 2019 and 2021.

Detection & Reporting

This category factors early detection and reporting for epidemics that can spread beyond national or regional borders. Indicators in this category assess laboratory systems strength and quality, laboratory supply chains, real-time surveillance and reporting, surveillance data accessibility and transparency, case-based investigation, and epidemiology workforce.

• India's capabilities in detection and reporting have improved by 6.3 percentage points between 2019 and 2021.
• India's strength and quality of Laboratory systems to identify the pathogenic cause of an outbreak rapidly and accurately has improved significantly which is reflected in the indicator score rising from 75 in 2019 to 87.5 in 2021.
• The ability to identify, locate and treat or isolate individuals with infectious diseases, denoted through the "Case-based investigations" indicator, has also improved as reflected in its score moving up from 0 in 2019 to 25 in 2021.
• A robust sample transport system and the ability to scale up transport and testing systems during emergencies, reflected through the "Laboratory supply chains" indicator, remains a weak spot that weighs down negatively on the overall score for the Detection and Reporting category.

Rapid Response

This category factors rapid response to and mitigation of the spread of an epidemic. Indicators in this category assess emergency preparedness and response planning, exercising response plans, emergency response operation, linking public health and security authorities, risk communication, access to communications infrastructure, and trade and travel restrictions.

• India's capabilities in rapid response to and mitigation of the spread of an epidemic have decreased further between 2019 and 2021 and is scored at the 30.3 percentile level on the GHS Index 2021. Thailand tops the list in this category with a score of 91.5.
• Risk communication (having a strategy and platform to expediently provide the general public with appropriate messages and quell potential rumors or mis- and dis-information) score has increased from 58.3 in 2019 to 70.8 in 2021.
• Linking public health and security authorities (multi-sectoral response between public health and security authorities to health threats) appears non-existent as reflected in the score of 0 on both the GHS Index in 2019 and 2021.
• Trade and travel restrictions that can hamper the response to a public health emergency by limiting the availability of supplies or human resources, as well as affecting economies, have been scored 0 on both the GHS Index in 2019 and 2021.

Health Systems

This category assesses the sufficiency and robustness of the health systems to treat the sick and protect health workers. Indicators in this category assess health capacity in clinics, hospitals, and community care centers; supply chain for the health system and healthcare workers; medical countermeasures and personnel deployment; healthcare access; communications with healthcare workers during a public health emergency; infection control practices, and capacity to test and approve new countermeasures.

• India's sufficiency and robustness of the health systems have remained unchanged between 2019 and 2021 and are scored at the 46.1 percentile level on the GHS Index 2021. The average score in this category is 31.5 out of 100, with 73 countries scoring in the bottom tier (0-20). The USA tops the list in this category with a score of 75.2.
• The two indicators of Communications and Infection control practices are scored at 100 out of 100 in 2021.
• Medical countermeasures and personnel deployment (systems in place to support the deployment of medical countermeasures such as vaccines and to receive foreign health personnel during emergencies) appear non-existent as reflected in the score of 0 on both the GHS Index in 2019 and 2021.

Norms

This category factors commitments to improving national capacity, financing plans to address gaps, and adhering to global norms. Indicators in this category assess IHR reporting compliance and disaster risk reduction; cross-border agreements on public animal health and emergency response; international commitments; completion and publication of WHO Joint External Evaluation (JEE) and the World Organisation for Animal Health (OIE) Performance of Veterinary Services (PVS) Pathway assessments; financing; and commitment to sharing of genetic and biological data and specimens.

• India's commitment to improving national capacity, financing plans to address gaps, and adhering to global norms remained unchanged between 2019 and 2021 and is scored at the 47.2 percentile level on the GHS Index 2021. The USA tops the list in this category with a score of 75.9.
• Cross-border agreements for preventing the spread of infectious diseases across borders through routine travel and commercial activities appear non-existent as reflected in the score of 0 on both the GHS Index in 2019 and 2021.

Risk Environment

This category factors the overall risk environment and the country's vulnerability to biological threats. Indicators in this category assess political and security risks; socio-economic resilience; infrastructure adequacy; environmental risks; and public health vulnerabilities that may affect the ability of a country to prevent, detect, or respond to an epidemic or pandemic and increase the likelihood that disease outbreaks will spill across national borders.

• The overall risk environment and India's vulnerability to biological threats have improved marginally between 2019 and 2021 and is scored at the 60.2 percentile level on the GHS Index 2021. Norway tops the list in this category with a score of 89.
• Infrastructure adequacy (the adequacy of roads, airports, and power networks necessary to meet community needs) has scored 50 out of 100 on the GHS Index 2021 in comparison to 33.3 on the GHS Index 2019.
• The political and security risks that may increase vulnerability to biological threats appear to have increased as reflected in the reduced score of 58.3 in 2021 in comparison to 65.5 in 2019.

The way forward

On the basis of the findings, the GHS Index 2021 report has made a few recommendations for countries to improve their capacities and be better prepared for the next pandemic. The suggestions include prioritizing the building and maintaining of health security capacities in national budgets; conducting assessments to identify risk factors and capacity gaps; making financial arrangements to support national action plans for public health security; undertaking a Joint External Evaluation to better understand capacity and performance gaps.

One of the key recommendations of the report is for countries to be more transparent with their capacities and risk factors so that the public is fully aware of the situation. Increased transparency can only help further in global prevention, detection, and response to epidemics and pandemics, the report added.