Abstract
Our newly published research shows that better pandemic preparation (indicated by higher Global Health Security (GHS) Index scores) predicted lower Covid-19 mortality, but only for non-island nations. We analysed 47 island and 142 non-island jurisdictions separately, addressing methodological weaknesses in previous studies.2 For non-islands, a 10-point increase in GHS Index score predicted 26.7 fewer deaths per 100,000 population. Island nations had much lower mortality (mean 59 vs 193 per 100,000 for non-islands) regardless of their GHS Index scores, suggesting geography and border control were more impactful than internal health security capacities.
The "Risk Environment" category of the GHS Index (including governance quality, social cohesion, and trust among other factors) had the strongest relationship with reduced pandemic mortality. The findings suggest border biosecurity deserves greater focus in pandemic preparedness metrics. It is valuable to develop health security capabilities and capacities, but a one-size-fits-all approach to pandemic preparedness and mitigation does not seem appropriate across all jurisdictions.