Global Health Security Index Scores are associated with Covid-19 Pandemic Health and Macroeconomic Outcomes

Background Past studies show a mixed relationship between the Global Health Security (GHS) Index and Covid-19 pandemic health outcomes. While some recent work suggests higher GHS Index scores are associated with better mortality outcomes there remains scope for additional analyses considering island nations and macroeconomic outcomes of the pandemic. Methods Correlation and multiple linear regression analyses (controlling for per capita GDP) across GHS Index scores, age-standardised excess mortality for 2020–2021, and GDP per capita growth, for island and non-island jurisdictions separately. Results The GHS Index moderately to strongly predicted better health outcomes in terms of age-standardised excess mortality through 2020–2021 in non-island jurisdictions (Pearson’s r = -0.53, p < 0.00001; Spearman’s rho = -0.61, p < 0.00001; β = -5.54 [95% CI = -3.68 to -7.40], p <0.00001), but not in island jurisdictions (r = -0.17, p = 0.25; rho = 0.00, p = 0.98; β = 0.65, p = 0.675). A 5-point rise in GHS Index was associated with a 26.75/100 000 population reduction in excess mortality. A higher GHS Index predicted higher year-on-year GDP growth through the pandemic for non-islands (2019–2020: β = 0.11, [95% CI = 0.04– 0.17, p = 0.00156]; 2020–2021: β = 0.09, [95% CI = 0.04–0.15, p = 0.00173]), but not for islands. For non-islands, a 5-point increase in GHS Index predicted increase in GDP per capita growth of 0.55% in 2019–2020, and 0.45% in 2020–2021. Conclusion The GHS Index demonstrated clear associations with favourable health and macroeconomic outcomes of non-island jurisdictions through the Covid-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest 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. What is already known? The Global Health Security (GHS) Index has been shown to predict excess mortality through the Covid-19 pandemic when accounting for under-reporting and population age-structure. However, it is debated whether the Index is equally applicable across different jurisdictions as a guide to pandemic preparedness. What this study adds? When we analysed 49 island and 145 non-island jurisdictions separately, the GHS Index was much more strongly associated with good health outcomes in non-islands than islands. We also found higher Index scores were associated with better macroeconomic outcomes in non-islands. How might this study affect research, practice, or policy? This study confirms the potential of the GHS Index as a starting point for pandemic readiness. Jurisdictions should look to enhance capacities and capabilities most associated with Covid-19 health and macroeconomic outcomes. The findings also suggests that border biosecurity, which island states have by virtue of their geography but other states need to generate by design, need much greater focus in the GHS.