The assessment of each country’s ability to prevent, detect and respond to health emergencies in 2021 was based on public information. Researchers also weighed other factors, such as public confidence in government. The average country score for 2021 was 38.9 out of a possible 100 points, essentially unchanged from 2019. No country scored above 75.9.
The United States, with its vast wealth and scientific capability, maintained its top overall ranking — it was also No. 1 when the first index was released in 2019. But the United States also scored lowest on public confidence in government, a key factor associated with high numbers of coronavirus cases and deaths. That factor may explain why other countries that received top marks in 2019 also responded poorly during the pandemic.
Over nearly two years, the report said, U.S. politicians have questioned the motives and messages of health officials and debated the seriousness of the virus and the effectiveness and safety of vaccines. “The result: in many areas of the country, people have been unwilling to comply with public health recommendations that would slow the spread of the virus.”
The other countries in the top 10: Australia, Finland, Canada, Thailand, Slovenia, the United Kingdom, Germany, South Korea and Sweden.
Although the report identifies preparedness resources and capacities available in a country, it cannot predict how well they will be used in a crisis. “If you were trying to measure places that are at risk for fires, you want to know if the place has fire alarms,” said Jennifer Nuzzo, a senior scholar at Hopkins. “But if you live in a country where the alarms go off and your political leaders tell you, ‘Pay no attention to that alarm, don’t leave the building,’” that doesn’t mean that the fire alarms don’t work, she said.
For instance, it found that the United States had more capacity to prevent and respond to epidemics than any other country, but it also had more reported cases and deaths than any other nation.
Some countries had a foundation for preparedness that “did not necessarily translate into successfully protecting against the consequences of the disease because they failed to also adequately address high levels of public distrust in government,” the authors wrote.
Nuzzo put it more bluntly. “We started this pandemic with a leg up, and we should have done better,” she said. “If you don’t have public trust in government, you can have the greatest vaccines in the world but people won’t take them.”
Researchers gave credit to countries that demonstrated sustainable efforts that could be applied to a range of disease threats, and that were transparent about their capacities. That’s where countries such as Israel and Singapore lost points, Nuzzo said.
“We don’t want to give passes to certain countries that we know inherently have the capacity, because we have colleagues there,” she said. “When an outbreak happens, every other country is going to be looking to them and asking if they can contain it, and some countries make it more clear what the answer is.”
The 268-page report found some encouraging signs. It noted big gains in New Zealand’s laboratory strength and disease detective workforce. Although Angola and Rwanda are not among the top-scoring countries, both received generally high praise for their covid-19 responses and saw improvements in their scores from 2019, Nuzzo said.
But although many countries were able to quickly ramp up new labs and create armies of contact tracers to track the spread of the coronavirus, they didn’t develop strategies for creating and scaling responses to future emergencies, the report found.
Among its recommendations: Countries should allocate funds for health security in their national budgets; international organizations should identify countries most in need of additional support; the private sector should look for ways to partner with governments; and philanthropies should develop new financing mechanisms, such as a global health security matching fund, to prioritize resources.
Tom Frieden, a former director of the Centers for Disease Control and Prevention, agreed with the report’s bottom line. “No country is adequately prepared and there’s a need for urgent action to address that,” he said.
But, he added, “we need assessments that monitor the actual performance of health systems.”
Frieden, who is chief executive of Resolve to Save Lives, part of the global public health organization Vital Strategies, said his group has developed a global goal for early detection and response to health threats called 7-1-7: Countries should be able to identify a suspected threat within seven days, inform the next levels of public health authority within one day, and mount an effective response within another seven days.
Nuzzo said researchers who produced the 2021 report added measures that reflected some of the lessons learned so far from the coronavirus pandemic, including laboratory strength and quality, medical stockpiles and contact tracing capability. Experts also discussed whether some variables, such as public trust in government, should be given additional weight. But ultimately, they decided against it because it wasn’t clear how much weight to give those factors for future health emergencies.
The report was developed in consultation with an international panel of 18 experts. It included year-long data collection and validation by a research group of The Economist.
Two individuals who played key roles in the first report have since joined the Biden administration. Beth Cameron, a vice president at NTI, was tapped in January to lead the Directorate of Global Health Security and Biodefense at the National Security Council (NSC). She had also been the senior director for global health security and biodefense at the NSC under President Barack Obama. Tom Inglesby, director of the Johns Hopkins Center for Health Security, is also a senior adviser for the administration’s covid-19 response at the Department of Health and Human Services.