By Elly Vaughan, Shreya Mukarji and Amanda Stucke

March 2024 saw the fourth anniversary of restrictions on people's movements on a scale never before seen owing to the pandemic. This offers us another opportunity to reflect on what covid-19 taught us about global health security and our ability to respond.

Covid-19 highlighted the difference between the capacities that help prepare us (plans, stockpiles) and the capabilities that help mobilise those capacities to respond to an emergency effectively (political leadership, public trust in institutions and leaders). Professor Michael Stoto of Georgetown University highlights the value of indexes, and particularly the Global Health Security Index, that assess and benchmark capacity in showing where countries are performing well and highlighting gaps in capacity that can spur action.

A criticism levelled at the Global Health Security Index and other measures of preparedness capacity is that their assessments were not predictive of actual outcomes in the covid-19 pandemic—although results vary depending on the outcome measures used. In his paper, Professor Stoto rightly points out that such indexes are not designed to and cannot predict outcomes because of the complex and interconnected nature of the different elements of pandemic response. The UK government’s covid inquiry is expected to hear four years’ worth of evidence, highlighting how difficult it is to unpick what happens during a pandemic response.

“Predictive validity is a perfectly reasonable approach in systems where cause-effect relationships are relatively stable and knowable.” Here Professor Stoto highlights that in an increasingly complex and uncertain world, predictive models are less likely to be able to capture the complete set of variables that determine specific outcomes. Professor Stoto goes on to highlight the methodological inadequacy of using a single outcome measure (deaths) to quantify the predictive value of such a complex array of interventions. Doing so ignores many other outcomes that are of value to society and individuals—a challenge shared by many quantitative health models.

The Global Health Security Index aims to measure how well prepared countries are, to enable them to improve their preparedness. It is a tool. Just as a hammer can’t tighten a screw, the Global Health Security Index can’t and doesn’t try to predict how a myriad of factors will interact during the response to a health security threat to produce a specific outcome.

So what can an index like the Global Health Security Index do, if it cannot predict? How is it valuable for a leader or decision-maker?

No one indicator can truly capture the breadth and depth of health security threats, mitigations and responses. This is where the index adds value by measuring multidimensional concepts that cannot be captured by a single indicator. It is not as simple as “do this one thing and you’ll prevent this number of deaths from a pandemic”. By creating a robust, large set of data inputs to inform policy priority-setting and decision-making, the index provides the blueprint for creating an enabling environment that gives countries the best chance of achieving their desired outcomes. It also acknowledges risks and uncertainties which may impact the outcomes in question.

Decision-making and planning for an outbreak can only be effective if the underlying data is relevant and reliable. Covid-19 highlighted the importance of collecting uniform and comparable data, and while many countries collect their own data on inputs, methodologies and approaches vary significantly. For a truly global threat like health security, this makes it difficult to identify the weak links and understand where the risks lie. The index fills in this gap by allowing leaders to track and measure not only their progress but also their comparative progress against other countries.

Last but not least, an index can support stakeholders with a seat at the table—governments, policymakers, industries and advocacy groups—to take stock of an issue and identify areas where additional effort, like regulation and investment, is needed. A preliminary assessment tool can yield strengths, weaknesses, opportunities and threats for each country leader to take into account when making strategic decisions relevant to their own context.

The fact that the Global Health Security Index cannot predict is not a disadvantage. It is not built to. It is instead designed to evolve. As we learn more over time, the index can adapt to incorporate these new learnings, knowledge and measures. One could argue that this allows it to be more powerful than a tool designed to predict using only what we know now.

Contributors:

Elly Vaughan
Senior Manager, Global Health Policy and Insights at Economist Impact

Elly is Senior Manager, Global Health Policy and Insights, at Economist Impact. Alongside working on a variety of projects on non-communicable diseases, Elly has specific expertise in emergency preparedness and response, as Lead of the Global Health Security Index and having worked on a number of reviews for the European Centre for Disease Prevention and Control (ECDC) and Robert Koch Institute, including several peer-reviewed publications.

Shreya Mukarji
Manager, Policy and insights

Shreya Mukarji is a Manager with the Policy & Insights practice at Economist Impact. Shreya leads research programs involving macroeconomic analysis, benchmarking and policy analysis for governments and non-profit organisations. Her areas of focus include sustainability (circular economy and ocean health), education, and the intersection between health and security. Key projects that she has managed include the Global Health Security Index, Plastics Management Index, Inclusive Internet Index and the Worldwide Educating for the Future Index. Shreya has also played a key role in the development and management of Back to Blue, an initiative of Economist Impact and The Nippon Foundation, that aims to build evidence-based approaches and solutions to the pressing issues faced by the ocean. She holds a Master's degree in International Studies from Durham University and a Bachelor's degree in Economics from St Stephen’s College.

Amanda Stucke
Principal, Health Policy & Insights, Economist Impact

Amanda is a principal in the Health Policy & Insights Practice at Economist Impact, based in London. She collaborates within a global, multidisciplinary team to lead and deliver robust, high-visibility research and analysis programs across the public and private global health ecosystem. Her main area of focus is unlocking the potential of health to drive growth and development at the population level, including across topics such as ageing, healthspan and longevity; health security; AMR; health investment and finance; workforce wellbeing; and social and commercial determinants of health.
Amanda brings approaches such as systems thinking and design, strategic foresight, policy and comparative analysis, economic modelling, decision science, and translational research and writing to bridge the gap between evidence and practice. Prior to joining Economist Impact, she led a major health innovation initiative for the Surgeon General of the US Navy, and executed an economic study of cancer screening with the Ministry of Health in Greenland. Amanda has led and contributed to other global health initiatives in countries such as Brazil, Bangladesh and Haiti.
Amanda holds a masters degree in Health Policy & Clinical Practice from the Geisel School of Medicine at Dartmouth. She has also received training as a foresight practitioner from the School of International Futures.