Next steps
Efforts are currently underway to further refine the GHS Index based on constructive feedback from experts and lessons learnt since the original model was developed. However, the GHS Index’s overarching finding still holds true: that no country is sufficiently prepared for epidemics or pandemics.1 The project team and International Panel of Experts fully anticipate that the GHS Index will undergo iterative refinement as stakeholders continue using the tool, identify shortcomings and learn more about COVID-19 and other diseases that may emerge in the future.
In light of the faults laid bare by COVID-19, we have already begun reexamining indicators of leadership, trust in government and political risk. The next iteration of the GHS Index, slated to release in 2021, will also emphasise other indicators that COVID-19 has shown to be vital for pandemic response, particularly those capturing state capacity to sustain societal functioning during a major outbreak. At present, we tentatively anticipate adding metrics of government effectiveness, as well as measures examining contact tracing and data sharing. We also anticipate revising several existing questions and adding over 20 new questions addressing zoonotic disease spillover events, scaling of testing capacities, abilities to test for novel pathogens, non-pharmaceutical interventions, private sector participation in exercises, risk communication, mis-information and disinformation, trade and travel, health security financing, social cohesion, illicit activities carried out by non-state actors, supply chains for medical supplies, laboratory supplies and medical countermeasures. Drawing further from the COVID-19 experience, we may also revisit weighting schemes for select categories and indicators.
In the longer term, we hope that the global health security community examines bigger-picture methodological issues around health security metrics. Many commonly used indicators of health security capacity—including those featured in the GHS Index, JEE and IHR Monitoring and Evaluation Framework—reflect a highly technocratic conceptualisation of outbreak prevention, detection and response. This framing likely fails to account for many social, institutional and cultural determinants of health system functioning and population health.
Furthermore, many of the indicators featured across all of these tools are investment-focused and capacity-focused. Future monitoring and evaluation efforts might benefit from deeper engagement with outcomes of health systems-strengthening and health security-strengthening efforts, such as health service coverage, health equity and health system failures. Subsequent iterations of the GHS Index specifically will have to contend with gaps in public data availability that disproportionately affect scores in LMICs. Inclusion of metrics capturing the quality and effectiveness of decision-making during a crisis might strengthen the tool even further.