Johns Hopkins Center for Health Security Teams with NTI and the Economist Intelligence Unit to Develop a Global Health Security Index

We are very excited to announce that thanks to generous support from the Open Philanthropy Project and the Robertson Foundation, our Center is working with the Nuclear Threat Initiative (NTI) and the Economist Intelligence Unit (EIU) to develop a Global Health Security Index.

The mission of the index is to encourage progress towards a world that is capable of preventing epidemics of international impact (either natural, accidental or deliberate) from arising, or, should, prevention fail, respond quickly to contain them.

In the first phase of this project, our team is focusing on developing a framework (i.e., the value, principles, attributes, and major components) to assess and compare countries’ levels of health security. To help inform the development our framework, we are convening next month an international expert advisory group. Once we’ve developed our framework, we will begin the process of assessing, collecting, and analyzing data on a country-by-country-basis. 

Below we explain in more detail why we’ve embarked on this important project.

Why try to measure global health security?

Recent infectious disease outbreaks, such as the ongoing Zika virus outbreak, the Ebola outbreak in West Africa, and the spread of MERS-CoV in the Middle East, continue to show us that when individual countries experience difficulties detecting and effectively containing the spread of infectious disease outbreaks, they can quickly threaten the health, security, and economies of countries across the globe. The increasing frequency of events that threaten global health security illustrates how now, more than ever, there is a strong global need for collective action to bolster all countries’ health security capabilities.

Some measures have been taken by the World Health Organization (WHO) and more recently through the Global Health Security Agenda (GHSA). Although these are worthwhile, important initiatives, they have some limitations that an index could address.  

In 2005, updates were made to the International Health Regulations (IHRs) to improve countries’ abilities to detect, assess, notify, and report public health emergencies of international concern (PHEICs). Among the modifications, the revised IHRs created a set of 8 core public health capacities that countries must develop. To help countries assess their progress, the World Health Organization created a list of indicators for development of the IHR core capacities. But lack of funding, lack of political will, and a myriad of other factors have slowed implementation of the revised IHRs.  By its implementation deadline in mid-2012, approximately 80% of the 194 WHO member states had not reported implementation of the core competencies required under the IHRs. The results of those countries that do report are publicly available.

Recognizing the lack of progress toward implementation of the IHRs, the Obama Administration in early 2014 announced the launch of the Global Health Security Agenda. The initiative, which has since attracted the participation of more than 50 countries, attempts to establish common goals and methods to reduce the spread and impact of infectious disease by strengthening countries’ abilities to prevent, rapidly detect, and effectively respond to disease outbreaks. Participating countries have developed commitment packages and related targets under the GHSA.

The WHO recently launched an effort that is complementary to the goals of the GHSA. In developing the WHO IHR Joint External Evaluation (JEE) tool, the WHO has created a framework and process by which countries can measure their capacities to implement the IHRs. The JEE tool provides a standard metric by which countries can, on a voluntary-basis, assess their current baseline capacities and measure future progress toward full development of IHR capabilities to prevent, detect, and respond to public health threats, whether they are naturally occurring, deliberate, or accidental. Though the passage of the IHRs required countries to conduct self-assessments of their IHR capacities, the JEE enables countries to sign up for external evaluations by their peers. It is this peer-to-peer aspect that seems to be attractive for countries. Those involved in the JEE process have reported that countries that have volunteered to undergo a JEE have found the exercise to be helpful to their own planning effort. The positive reviews of the JEE process have spread, and countries continue to volunteer to undergo a JEE.

The GHSA and the JEE are important steps toward increasing accountability and transparency for countries’ efforts to improve their current global health security capacities. As we have written before, the international community—including the current US Administration--should continue to do all it can to support these efforts.

But the GHSA and JEE process alone will likely not fully address the need to motivate improvements in global health security. More work is needed to encourage those countries who have not yet signed up for the GHSA to participate. And work will be needed to ensure that all countries agree to undergo a JEE and—most importantly—take meaningful action to improve their scores in the areas that the JEE identifies as needing improvement.

Finally, the determinants of a country’s global health security are not entirely in the hands of the health sector. Larger political factors—such as land use policies and the presence of terrorist groups--can influence a country’s risk of experiencing an outbreak or bioattack. Societal factors, such as government corruption, social stability, and basic infrastructure, can be important determinants of how ably that country can contain the event before it spills across its borders.  These factors, while important determinants of global health security, are not incorporated into existing frameworks like the GHSA or JEE.

Why an index?

For the reasons articulated above, we think more work is needed to identify trends promoting global health security and to examine underlying conditions that contribute to or detract from favorable health security conditions. Metrics also are needed to identify areas in greatest need of improvement and to create political incentives for health security investments. A global health security index that is informed by international expert judgment, measured by a nongovernmental entity, and made publicly available could highlight current needs and add momentum to existing global health security efforts.

In preparation for this work, we have spent almost two years researching this topic and have learned that indices can be important tools in measuring and motivating progress. There is much evidence in the literature that national and international indices are influential in affecting government decision making. Policymakers tend to rely on these tools because decision-making processes that rely on indices can be presented as efficient, consistent, legitimate, transparent, scientific, and impartial. They also are relatively easy for the public to interpret.

Social science researchers have determined that indices tend to motivate policymakers to respond via three complementary mechanisms. First, indices can influence governments through the creation of international pressures (e.g., credit-rating agencies may respond to a country’s ranking in an international corruption index). Second, they can influence domestic political pressures (e.g., via mobilization of advocacy groups). Even the anticipation of negative publicity can prompt governments to review and modify domestic policies. Third, indices can have reputational effects on individuals or groups of policymakers and can motivate change through peer pressure.

We also have direct, favorable experiences in creating an index related to this topic. For several years our center director, Tom Inglesby, has been involved in the creation of the National Health Security Preparedness Index, which measures US states’ progress in preparing for, preventing, and responding to potential health incidents. Tom will bring to our team his experiences in developing and refining the NHSPI, which is now in its fourth iteration.

Why this team?

This effort will be jointly led by our Center and NTI, and developed with help from EIU.

NTI works to protect our lives, environment, and quality of life now and for future generations. They work to prevent catastrophic attacks with weapons of mass destruction and disruption (WMDD)—nuclear, biological, radiological, chemical, and cyber. Founded in 2001 by former U.S. Senator Sam Nunn and philanthropist Ted Turner, NTI is guided by a prestigious, international board of directors. Sam Nunn serves as chief executive officer; Des Browne is vice chairman; and Joan Rohlfing serves as president.

Economist Intelligence Unit (EIU) is the research arm of The Economist Group, publisher of The Economist. As the world’s leading provider of country intelligence, it helps governments, institutions, and businesses by providing timely, reliable, and impartial analysis of economic and development strategies. Through its public policy practice, the EIU provides evidence-based research for policymakers and stakeholders who are seeking measureable outcomes, in fields ranging from gender and finance to energy and technology. It conducts research through interviews, regulatory analysis, quantitative modeling, and forecasting, and it displays the results using interactive data visualization tools. Through a global network of more than 350 analysts and contributors, the EIU continuously assesses and forecasts political, economic, and business conditions in more than 200 countries.

NTI and EIU make for expert partners on this project, as we intend to build on their experience and success in developing the NTI Nuclear Security Index.  Created in 2012, this first-of-its-kind resource is designed to encourage governments to take actions and build confidence in the security of their nuclear materials. Now in its third edition, the NTI Index is recognized as the premiere resource and tool for tracking progress on nuclear security and identifying priorities.