Cultural context and pandemic preparedness: Reassessing the Global Health Security Index's predictive power during COVID-19.

The Global Health Security Index (GHSI) is designed to measure countries' preparedness for infectious disease outbreaks, yet its ability to reflect COVID-19 outcomes remains contentious. This study reexamines the GHSI's relevance by investigating the association between GHSI scores and COVID-19 mortality while accounting for differences in cultural traits and other socioeconomic factors across countries. Initial analyses confirm a positive association between raw COVID-19 deaths and GHSI scores, consistent with prior studies. However, when controlling for cultural tightness-looseness-a measure reflecting the rigidity of social norms-higher GHSI values appear to correlate with fewer excess deaths. When accounting for differences in economic development, health infrastructure, inequality, and governance across countries, we arrive at the same finding, while auxiliary sensitivity tests suggest that unobserved confounding is unlikely to negate the observed relationship. Additionally, countries with higher GHSI values show superior pandemic management through increased COVID-19 testing and vaccine administration. These findings challenge prevailing criticisms of the GHSI, offering a more nuanced perspective that recognizes its utility. By showing the interplay between global health security and societal factors, this study provides insights for refining pandemic preparedness frameworks and highlights the need for a multidimensional approach to assessing public health resilience.