Goldschmidt Peter G
World Development Group, Inc., Bethesda, MD, United States.
Front Epidemiol. 2022 Jun 13;2:846260. doi: 10.3389/fepid.2022.846260. eCollection 2022.
The Global Health Security Index (GHSI) was published in October 2019 (after more than 2 years in preparation); at about the same time that the COVID-19 pandemic (COVID) started. The GHSI was intended to score countries' pandemic preparedness. Within months of the start of the pandemic, articles began to be published that claimed to assess the GHSI's validity. They correlated GHSI scores with countries' COVID per capita death rates. They showed that the better prepared a country, the higher the death rate: a result that was counter to what would have been expected. This article takes another look at the GHSI by exploring the relationship in major European Union countries plus the United Kingdom. The analysis reported here confirms that early on the higher the GHSI score, the higher the COVID per capita death rate ( = 0.52, < 0.05). But, by the end of 2020, there was no correlation. By July 2021, the correlation was in the expected direction: the higher the GHSI score, the lower the COVID per capita death rate ( = -0.55, < 0.05); ditto case fatality rate ( = -0.74, < 0.01). Further, the GHSI was better correlated with excess mortality, the best measure of pandemic impact ( = -0.69, < 0.01). However, per capita GDP was as good a predictor of excess mortality ( = -0.71, < 0.01) and the Health System Performance Index of case fatality rate ( = -0.71; < 0.01). By the end of 2021, the correlation between GHSI scores and COVID per capita death rates had strengthened ( = -0.71; < 0.01). This exploratory analysis is not intended to produce generalizable conclusions about the effectiveness of countries' COVID pandemic response management, which continues to evolve and hence can only be properly assessed after the pandemic has ended. Nevertheless, the following conclusions would seem to be warranted: 1) there seems to have been a rush to judge, or, at least, to publish, and 2) the validity of any forward looking pandemic preparedness score depends not only on being able to assess countries' capabilities but also being able to forecast what governments will (and will not) do in any given situation, a seemingly quixotic quest.
《全球卫生安全指数》（GHSI）于2019年10月发布（经过两年多的筹备）；大约与此同时，新冠疫情（COVID）开始爆发。GHSI旨在对各国的疫情防范能力进行评分。在疫情爆发后的几个月内，就开始有文章发表，声称要评估GHSI的有效性。这些文章将GHSI分数与各国的人均新冠死亡率进行关联。结果显示，一个国家准备越充分，死亡率越高：这一结果与预期相反。本文通过探究欧盟主要国家以及英国之间的关系，对GHSI进行了重新审视。此处报告的分析证实，早期GHSI分数越高，人均新冠死亡率越高（ = 0.52， < 0.05）。但是，到2020年底，两者并无关联。到2021年7月，这种关联呈现出预期的方向：GHSI分数越高，人均新冠死亡率越低（ = -0.55， < 0.05）；病死率情况相同（ = -0.74， < 0.01）。此外，GHSI与超额死亡率的相关性更强，超额死亡率是衡量疫情影响的最佳指标（ = -0.69， < 0.01）。然而，人均国内生产总值对超额死亡率的预测效果相当（ = -0.71， < 0.01），对病死率的卫生系统绩效指数的预测效果也相当（ = -0.71； < 0.01）。到2021年底，GHSI分数与人均新冠死亡率之间的相关性增强（ = -0.71； < 0.01）。这项探索性分析并非旨在就各国应对新冠疫情的管理有效性得出可推广的结论，因为情况仍在不断演变，因此只有在疫情结束后才能进行恰当评估。尽管如此，以下结论似乎是合理的：1）似乎存在急于下判断，或者至少急于发表观点的情况；2）任何前瞻性疫情防范分数的有效性不仅取决于能否评估各国的能力，还取决于能否预测政府在任何特定情况下会（或不会）采取的行动，这似乎是一项不切实际的任务。
