Department of Health Management and Policy, School of Health, Georgetown University, Washington DC, USA.
RAND Corporation and, RAND Pardee Graduate School, Santa Monica, CA, USA.
Global Health. 2023 Sep 23;19(1):72. doi: 10.1186/s12992-023-00973-2.
A number of scientific publications and commentaries have suggested that standard preparedness indices such as the Global Health Security Index (GHSI) and Joint External Evaluation (JEE) scores did not predict COVID-19 outcomes. To some, the failure of these metrics to be predictive demonstrates the need for a fundamental reassessment which better aligns preparedness measurement with operational capacities in real-world stress situations, including the points at which coordination structures and decision-making may fail. There are, however, several reasons why these instruments should not be so easily rejected as preparedness measures.From a methodological point of view, these studies use relatively simple outcome measures, mostly based on cumulative numbers of cases and deaths at a fixed point of time. A country's "success" in dealing with the pandemic is highly multidimensional - both in the health outcomes and type and timing of interventions and policies - is too complex to represent with a single number. In addition, the comparability of mortality data over time and among jurisdictions is questionable due to highly variable completeness and representativeness. Furthermore, the analyses use a cross-sectional design, which is poorly suited for evaluating the impact of interventions, especially for COVID-19.Conceptually, a major reason that current preparedness measures fail to predict pandemic outcomes is that they do not adequately capture variations in the presence of effective political leadership needed to activate and implement existing system, instill confidence in the government's response; or background levels of interpersonal trust and trust in government institutions and country ability needed to mount fast and adaptable responses. These factors are crucial; capacity alone is insufficient if that capacity is not effectively leveraged. However, preparedness metrics are intended to identify gaps that countries must fill. As important as effective political leadership and trust in institutions, countries cannot be held accountable to one another for having good political leadership or trust in institutions. Therefore, JEE scores, the GHSI, and similar metrics can be useful tools for identifying critical gaps in capacities and capabilities that are necessary but not sufficient for an effective pandemic response.
许多科学出版物和评论都表明，诸如全球卫生安全指数（GHSI）和联合外部评估（JEE）得分等标准准备指数并没有预测到 COVID-19 的结果。在某些人看来，这些指标没有预测能力，这表明需要进行根本性的重新评估，使准备措施更好地与现实压力情况下的运作能力保持一致，包括协调结构和决策可能失败的点。然而，有几个原因表明，这些工具不应该轻易被视为准备措施而被拒绝。从方法论的角度来看，这些研究使用相对简单的结果衡量标准，主要基于特定时间点的累计病例和死亡人数。一个国家在应对大流行方面的“成功”是多方面的——包括健康结果以及干预和政策的类型和时间——过于复杂，无法用一个数字来表示。此外，由于完整性和代表性差异很大，死亡率数据随时间和管辖权的可比性值得怀疑。此外，分析使用的是横截面设计，这种设计不适合评估干预措施的影响，尤其是对 COVID-19 而言。从概念上讲，当前准备措施未能预测大流行结果的一个主要原因是，它们不能充分捕捉到有效政治领导存在的变化，这种领导对于激活和实施现有系统、增强政府应对措施的信心是必要的；或者对于建立快速和适应性强的应对措施所需的人际信任和对政府机构和国家能力的信任的背景水平。这些因素至关重要；如果不能有效地利用能力，仅仅有能力是不够的。然而，准备措施旨在确定各国必须填补的差距。有效的政治领导和对机构的信任与政治领导或对机构的信任一样重要，但不能相互问责。因此，JEE 得分、GHSI 和类似的指标可以作为识别能力和能力方面关键差距的有用工具，这些差距对于有效应对大流行是必要的，但不是充分的。
