COVID-19 International Task Force Emergency Response Capacity Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
Emergency Response Capacity Team, Emergency Response and Recovery Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
BMJ Open. 2021 Dec 2;11(12):e050052. doi: 10.1136/bmjopen-2021-050052.
The COVID-19 pandemic has highlighted the importance and complexity of a country's ability to effectively respond. The Joint External Evaluation (JEE) assessment was launched in 2016 to assess a country's ability to prevent, detect and respond to public health emergencies. We examined whether JEE indicators could be used to predict a country's COVID-19 response performance to tailor a country's support more effectively.
From April to August 2020, we conducted interviews with Centers for Disease Control and Prevention country offices that requested COVID-19 support and previously completed the JEE (version 1.0). We used an assessment tool, the 'Emergency Response Capacity Tool' (ERCT), to assess COVID-19 response performance. We analysed 28 ERCT indicators aligned with eight JEE indicators to assess concordance and discordance using strict agreement and weighted kappa statistics. Generalised estimating equation (GEE) models were used to generate predicted probabilities for ERCT scores using JEE scores as the independent model variable.
Twenty-three countries met inclusion criteria. Of the 163 indicators analysed, 42.3% of JEE and ERCT scores were in agreement (p value=0.02). The JEE indicator with the highest agreement (62%) was 'Emergency Operations Center (EOC) operating procedures and plans', while the lowest (16%) was 'capacity to activate emergency operations'. Findings were consistent with weighted kappa statistics. In the GEE model, EOC operating procedures and plans had the highest predicted probability (0.86), while indicators concerning response strategy and coordination had the lowest (≤0.5).
Overall, there was low agreement between JEE scores and COVID-19 response performance, with JEE scores often trending higher. JEE indicators concerning coordination and operations were least predictive of COVID-19 response performance, underscoring the importance of not inferring country response readiness from JEE scores alone. More in-depth country-specific investigations are likely needed to accurately estimate response capacity and tailor countries' global health security activities.
新冠疫情突出了一个国家有效应对疫情的能力的重要性和复杂性。联合外部评估（JEE）评估于 2016 年启动，旨在评估一个国家预防、发现和应对公共卫生突发事件的能力。我们研究了 JEE 指标是否可用于预测一个国家应对新冠疫情的表现，以便更有效地调整对各国的支持。
2020 年 4 月至 8 月，我们对请求新冠疫情支持并已完成 JEE（第 1.0 版）评估的疾病预防控制中心国家办事处进行了访谈。我们使用评估工具“应急响应能力工具”（ERCT）评估新冠疫情应对表现。我们分析了 28 个与 8 个 JEE 指标一致的 ERCT 指标，使用严格一致性和加权 Kappa 统计数据评估一致性和差异。使用广义估计方程（GEE）模型，使用 JEE 得分作为独立模型变量，生成 ERCT 得分的预测概率。
有 23 个国家符合纳入标准。在分析的 163 个指标中，JEE 和 ERCT 评分有 42.3%是一致的（p 值=0.02）。一致性最高的 JEE 指标（62%）是“应急行动中心（EOC）操作程序和计划”，而最低的（16%）是“激活应急行动的能力”。加权 Kappa 统计数据也得到了一致的结果。在 GEE 模型中，EOC 操作程序和计划的预测概率最高（0.86），而涉及应对策略和协调的指标的预测概率最低（≤0.5）。
总体而言，JEE 评分与新冠疫情应对表现之间的一致性较低，且 JEE 评分往往呈上升趋势。涉及协调和运营的 JEE 指标对新冠疫情应对表现的预测性最低，这突出了不能仅根据 JEE 评分推断国家应对准备情况的重要性。可能需要更深入的国家特定调查，以准确估计应对能力，并调整各国的全球卫生安全活动。
