Abstract
Objectives: Past studies show a mixed relationship between the Global Health Security (GHS) Index and COVID-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. We aimed to determine the relationship between GHS Index scores and COVID-19 pandemic excess mortality 2020-2021 and macroeconomic pandemic outcomes.
Design: Cross-sectional, multivariable regression design (controlling for per capita gross domestic product (GDP) and political corruption), comparing island and non-island jurisdictions.
Setting: 194 jurisdictions with 2019 GHS Index scores.
Outcome measures: Age-standardised cumulative excess mortality 2020-2021, GDP per capita growth 2019-2020 and 2020-2021.
Results: The GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020-2021 in non-island jurisdictions (β=-0.046, p=0.00068, adj R2=0.48), but not in island jurisdictions (β=0.012, p=0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP per capita growth through 2019-2020 or 2020-2021.
Conclusions: The GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the COVID-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the need to enhance how the Index measures border biosecurity capacities and capabilities, including the ability to support the exclusion/elimination strategies that successfully protected islands during the COVID-19 pandemic.