Research Director, Adapt Research Ltd, Reefton, New Zealand
Public Health, University of Otago, Wellington, New Zealand.
BMJ Glob Health. 2020 Oct;5(10). doi: 10.1136/bmjgh-2020-003276.
The COVID-19 pandemic powerfully demonstrates the consequences of biothreats. Countries will want to know how to better prepare for future events. The Global Health Security Index (GHSI) is a broad, independent assessment of 195 countries' preparedness for biothreats that may aid this endeavour. However, to be useful, the GHSI's external validity must be demonstrated. We aimed to validate the GHSI against a range of external metrics to assess how it could be utilised by countries.
Global aggregate communicable disease outcomes were correlated with GHSI scores and linear regression models were examined to determine associations while controlling for a number of global macroindices. GHSI scores for countries previously exposed to severe acute respiratory syndrome (SARS), Middle East respiratory syndrome and Ebola and recipients of US Global Health Security Agenda (GHSA) investment were compared with matched control countries. Possible content omissions in light of the progressing COVID-19 pandemic were assessed.
GHSI scores for countries had strong criterion validity against the Joint External Evaluation ReadyScore (rho=0.82, p<0.0001), and moderate external validity against deaths from communicable diseases (-0.56, p<0.0001). GHSI scores were associated with reduced deaths from communicable diseases ((3, 172)=22.75, p<0.0001). The proportion of deaths from communicable diseases decreased 4.8% per 10-point rise in GHSI. Recipient countries of the GHSA (n=31) and SARS-affected countries (n=26), had GHSI scores 6.0 (p=0.0011) and 8.2 (p=0.0010) points higher than matched controls, respectively. Biosecurity and biosafety appear weak globally including in high-income countries, and health systems, particularly in Africa, are not prepared. Notably, the GHSI does not account for all factors important for health security.
The GHSI shows promise as a valid tool to guide action on biosafety, biosecurity and systems preparedness. However, countries need to look beyond existing metrics to other factors moderating the impact of future pandemics and other biothreats. Consideration of anthropogenic and large catastrophic scenarios is also needed.
COVID-19 大流行有力地展示了生物威胁的后果。各国将希望了解如何更好地为未来的事件做准备。全球卫生安全指数（GHSI）是对 195 个国家应对可能威胁生物安全的事件的准备情况的广泛、独立评估，可能有助于这一努力。然而，为了有用，GHSI 的外部有效性必须得到证明。我们旨在通过与一系列外部指标相关联来验证 GHSI，以评估其如何被各国利用。
将全球传染病的综合结果与 GHSI 得分相关联，并通过线性回归模型进行检验，以确定关联，同时控制许多全球宏观指标。将以前曾受到严重急性呼吸系统综合征（SARS）、中东呼吸系统综合征和埃博拉影响以及接受美国全球卫生安全议程（GHSA）投资的国家的 GHSI 得分与匹配的对照国家进行比较。根据不断发展的 COVID-19 大流行，评估了可能存在的内容遗漏。
各国的 GHSI 得分与联合外部评估准备得分（rho=0.82，p<0.0001）具有很强的效标效度，与传染病死亡率（-0.56，p<0.0001）具有中等的外部效度。GHSI 得分与传染病死亡率的降低有关（（3，172）=22.75，p<0.0001）。GHSI 每增加 10 分，传染病死亡率就降低 4.8%。接受 GHSA（n=31）的国家和 SARS 受影响的国家（n=26）的 GHSI 得分分别比匹配对照组高 6.0（p=0.0011）和 8.2（p=0.0010）分。全球范围内的生物安保和生物安全似乎薄弱，包括高收入国家，卫生系统，特别是非洲的卫生系统，没有做好准备。值得注意的是，GHSI 并没有考虑到对卫生安全很重要的所有因素。
GHSI 作为指导生物安保、生物安全和系统准备工作的有效工具具有很大的潜力。然而，各国需要超越现有指标，考虑到其他因素，这些因素会缓和未来大流行和其他生物威胁的影响。还需要考虑人为和大灾难的情景。
