Where Did We Go Wrong?

Ashwini Arumugam

April 3, 2020

Do grades correlate to performance? This was precisely the goal of the 2019 Global Health Security Index, which assessed the health security of 195 countries in managing a theoretical future outbreak. Now, countries are facing the true test with combating COVID19 and their previous grades are not predicting their current performance.

Prior influenza pandemics of 1918, 1957, and 1968 have highlighted the dramatic social and economic impact of pandemics. However, we have not learned our lessons from history and most countries were deemed ill-prepared to handle a pandemic by the 2019 Global Health Security Index, which evaluated countries based on the following 6 categories:

From the anthrax threat in 2001 to the Ebola scare in 2014, the attention to public health has waxed and waned. Take the US for example, the budget for biodefense has ranged from 294 million (2001) → 5.2 billion (2004) → 3.8 billion (2006), less than 1% of the US GDP, in hopes to prepare the country for the next global threat. Improving surveillance systems, communication, and laboratory diagnostics may have contributed to the US ranking No.1 based on the Global Health Security Index for preparedness, with an overall score of 83.5 (equivalent to a “B”). However, our high ranking has not translated to our management of COVID19. We still struggle to have adequate testing, PPE, and medical supplies to manage the growing number of cases.

In comparison, South Korea ranked No. 9 and Italy ranked No. 31 on the Global Health Security Index, spending ~7.3% and 8.9% of their GDP respectively on healthcare according to the W.H.O.

South Korea and Italy management techniques for COVI19 have been vastly different. Both locations had COVID19 outbreaks at similar times, in rural settings. South Korea learned from the 2009 H1N1 influenza pandemic and focused on identifying & isolating cases. In addition to high volume testing, South Korea enforced a law that grants the government-wide authority to access CCTV footage, GPS tracking, credit card transactions, immigration entry information, and other personal details of people confirmed to have an infectious disease. This level of response comes from swift government intervention and unified coordination, but at the cost of privacy-- which is less appealing for Americans and Europeans.

Italy, on the other hand, tried to focus testing on symptomatic patients and depended on medical staff to track close contacts. The extensive burden placed on human resources has taken a toll on the country’s ability to manage, and while the Italian government has enforced social distancing, having streets patrolled, their actions may have come a little too late. Countries like Iceland, which ranked No. 58 in preparedness, have quickly learned from their colleagues and conducted broad testing and social distancing policies, bringing them close to 1,400 cases and only 4 deaths as of April 4, since their first identified patient on February 28th.

As trade and travel expand on a global level, so does the transmission of infectious diseases. While the Global Health Security Index made strong recommendations that ALL countries improve their public health systems infrastructure, COVID19 has left many “top scores” scrambling to get a hold of this pandemic, and a lot of professionals questioning the criteria of the Global Health Security Index. Does the US still deserve that “B”?