PMC:7545501 / 25054-30247 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7545501","sourcedb":"PMC","sourceid":"7545501","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7545501","text":"Considerations for GHS Index users\nSome researchers have turned to the GHS Index to elucidate observed between-country disparities in COVID-19-associated morbidity, mortality and case fatality estimates.4 30 33 36 However, drawing simple correlations with countries’ overall scores does not account for the fact that these scores are meant to capture capacities spanning the breadth of the health security life cycle, from outbreak prevention at the source, to early detection, to rapid response. In other words, overall scores summarise country capacities across all categories. However, countries with high overall scores may still have low category-level, indicator-level and sub-indicator-level scores that more strongly influence outbreak-associated outcomes. Therefore, we encourage users wishing to analyse correlations between country scores and health outcomes to examine scores at more granular levels, adjust model weights to reflect country contexts and priorities and consider more nuanced outcomes when analysing countries’ performances during outbreaks. For example, users might examine relationships between category 2 (detection) scores and the number of misidentified or under-reported cases in a given country, rather than examining correlations between countries’ overall scores and absolute case counts.\nFurthermore, we stress that implementation of health security capacities is rarely—if ever—a linear process. In other words, the mere presence of a given capacity does not always translate predictably into a desired health outcome or impact. Conceptualising health systems as complex adaptive systems may offer more insight into the varied pathways by which countries achieve public health goals. Rickles et al37 note, for example, that single events can have long-lasting effects on complex systems (‘history matters’), a phenomenon known as path dependence. Paina and Peters further explicate this point, describing how path dependence can complicate health system evolution, particularly in the context of rapidly changing technology and when diverse stakeholders are involved—as is the case in the global health security space.38 They also highlight the futility of transposing health system innovations from countries where they have succeeded into countries with different political processes, or that have not established the institutions or systems required for said innovations to succeed. This might further explain why countries with similar levels of capacity (as indicated by GHS Index scores) might nevertheless report divergent COVID-19 outcomes.\nComposite scores and quantitative correlations are thus useful, but alone are insufficient tools for determining causal relationships between health system capacities and observed health outcomes. The GHS Index’s transparent accounting of country capacities across various domains of health security is intended to function as a gateway to more nuanced case study analyses, in-country evaluations or after-action assessments that could help elucidate the causal mechanisms underpinning observed health outcomes during or after an outbreak. These latter approaches are better-suited to answering why, with respect to COVID-19, high-scoring countries like the USA, the UK, Sweden and Brazil have fared significantly worse than similarly high-ranked states like Thailand, and even compared with lower-ranked states like New Zealand, Vietnam and the Republic of Korea.\nSuch analyses of health system dynamics across specific country contexts are beyond the scope of the GHS Index itself, which solely monitors and documents the presence or absence of critical health security capacities. Therefore, to maximise the utility of the GHS Index, users should couple reviews of country scores with additional modes of data collection and analysis to answer questions regarding relationships between health capacities and health outcomes. Such approaches might include key informant interviews, surveys, in-country observations, case study analyses, focus groups or participatory action research methods.\nImportantly, users should also note that the GHS Index is not a forecasting tool. Rather, it offers a cross-sectional snapshot of countries’ health security capacities as measured at one point in time. It cannot and does not predict whether or how a country will leverage available capacities to mitigate an unfolding crisis, nor does it make assumptions about the political decision-making processes underpinning these efforts. Furthermore, the inaugural GHS Index—which features data collected between 2018 and 2019 and was released in September 2019—does not account for many countries’ efforts to scale up testing and healthcare capacities in response to COVID-19, nor whether these efforts could be readily leveraged for future emergencies.\nFinally, we reiterate that scores in all categories are intended to provide a comprehensive snapshot, based on publicly available data, of country capacities in these areas. Scores and their accompanying justifications are meant to inform—not supplant—country efforts to undertake JEEs and prioritise health security-strengthening measures in their respective 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