Leadership, political and security risks, and trust in government
Some experts have rightly observed an inverse relationship between overall GHS Index scores and suboptimal COVID-19 outcomes in some high-income countries—most notably, the USA, which despite having the highest overall GHS Index score, currently reports the highest number of confirmed COVID-19 cases of any country.3 30 33 34 In fact, JEE Scores for both the USA and the UK share the same inverse relationship with reported COVID-19 outcomes.
There are several possible explanations for these observed disparities. For example, while the USA does maintain strong overall capacities for preventing, detecting and responding to epidemic and pandemic threats, ineffective federal leadership and an inability to deploy available capacities may have precluded a concerted whole-of-government response to the pandemic. Still, despite a high overall score, some of the USA’s category-specific scores—specifically, those in category 4 (health system) and category 6 (risk environment)—do, in fact, reflect these vulnerabilities. The USA ranks 175th out of 195 countries on healthcare access, 75th in the world for number of hospital beds and earned a score of only 60.4/100 for clinic, hospital and community care capacity.35 Similarly, the USA ranks 59th out of 195 countries on measures of socioeconomic and political resilience and received a zero on measures of public confidence in government.35 Thus, even in high-scoring countries, weak governance, poor leadership and inconsistent risk messaging could impede effective implementation and coordination of core health security functions during outbreak response. And, as we explain further in the next section, country scores solely reflect the presence or absence of critical health security capacities. They alone do not—and cannot—provide causal explanations for reported health outcomes.