Capacity versus capability

An analysis published in BMJ Global Health looked at the relationship between the effectiveness of a country’s response to COVID-19 and the country’s performance on the Global Health Security Index, which assesses and benchmarks capacities in 195 countries using 171 indicators. The analysis was conducted by our partners at the Nuclear Threat Initiative and the Pandemic Center at the Brown University School of Public Health, with Bill & Melinda Gates Foundation and Oxford University.

The study used age-standardised excess deaths—or the number of deaths above and beyond those that would be expected in a given time period—as a measure of effective response. In doing so, it addresses the debate in emergency preparedness over the relationship between capacity (the resources to prevent, detect and respond to an emergency) and capability (the knowledge and skills that enable capacities to be used effectively in an emergency).

What did they find?

The authors found that countries that scored higher on the Global Health Security Index experienced fewer excess deaths during the COVID-19 pandemic. While previous studies showed the opposite finding using reported deaths due to COVID-19, this new analysis accounted for age and the potential underreporting of COVID-19 deaths in country-level data, producing a robust analysis.

Why is this important?

The Global Health Security Index assesses the resources and capacities available for preparedness in 195 individual countries, and highlights areas of risk that countries can address to improve their preparedness. It cannot predict whether a country can or will effectively mobilise these in a crisis. For example, COVID-19 showed us the role that political leaders play in the response.

This analysis highlights the importance of having capacities in place to respond to outbreaks effectively and suggests that countries can use the Global Health Security Index assessment to help inform preparedness planning, resource allocation, and other activities which are critical to ongoing preparedness. This finding is important given two major pressures today that could impact future pandemic preparedness - the end of the global health emergency and the economic woes being felt in many parts of the world.

Since the global health emergency ended, many countries have begun dismantling the infrastructure, systems, and other resources set up during the COVID-19 response. We need to think carefully about how we ensure that these capacities can be maintained and swiftly mobilised to respond to the next outbreak. As the Secretary-General of the WHO Tedros Adhanom Ghebreyesus puts it, we must preserve the "muscle memory" of this outbreak.

The effects of COVID-19 will be felt by individuals and societies for decades to come. Many countries are facing economic pressures, with opportunity costs leading to difficult decisions about where governments should invest. There is a need for co-ordinated action across government departments—not just health—to prevent, detect and respond to outbreaks, because the impacts are felt across government - such outbreaks are not just a “health” problem.

There is also a need for a change in attitude. As Dr Ghebreyesus points out, "governments must not see health as a cost, but as an investment in social, economic and political stability and security". So now is the time for countries to take stock of their response to the COVID-19 pandemic and use those lessons to inform preparedness planning, resource allocation, and other activities for future preparedness.

Individual countries need to improve their capacity to prevent, detect and respond to outbreaks. This does not just mean throwing money at the problem. Now is the time for well-thought out, targeted investments in health security that reflect the learnings from COVID-19 both within and between countries, as well as recognising the specific priorities and risks that countries face.

In addition, adhering to international norms should be a priority. Our globalised world means that we have a collective responsibility to be prepared. We are so interconnected and interdependent that individual countries’ level of preparedness can undermine that of others. As the saying goes: “no one is safe until everyone is safe”.

We don’t know when the next outbreak will happen, or what it might be. So our only choice is to prepare.

The Global Health Security Index is a project of the Nuclear Threat Initiative, the Pandemic Center at the Brown University School of Public Health and Economist Impact. You can find out more by visiting GHSIndex.com.