Unveiling Health Security Patterns in the European Union through a Hybrid Entropy-CoCoSo and K-Means Clustering Framework

Objectives: This study aimed to examine health security (HeS) patterns across European Union (EU) member states to address intra-regional disparities in health security, align with EU-wide policy objectives, and propose evidence-based recommendations for harmonizing preparedness measures while respecting national sovereignty. Methods: This research employed a hybrid multi-criteria decision-making framework, combining the Entropy Weight Method and Combined Compromise Solution (CoCoSo), to assess and rank EU countries, drawing on six Global Health Security Index indicators. K-means clustering classified countries into three performance tiers: High, Intermediate, and Dangerous. Data from the GHSI (2019, 2021) and the aggregated 2017-2021 period were analyzed to track temporal trends and cross-regional performance disparities. A comparative analysis of HeS priorities with the African and Eastern Mediterranean (EMR) Regions further contextualized the EU's HeS landscape. Results: Detection and Reporting, and Rapid Response emerged as the most critical dimensions influencing performance, while Risk Environment and Compliance with Norms showed minimal differentiation. High-performing countries, such as Finland and Germany, demonstrated resilience in surveillance and rapid response, while lower-tier nations, Cyprus, Luxembourg, Malta, and Romania, exhibited systemic vulnerabilities in biosecurity and emergency planning. Post-2019, health system resilience gained prominence, while compliance and risk environment remained neglected. The temporal analysis highlighted post-pandemic shifts in health system disparities. Cross-regional comparisons underscoring context-specific challenges. Conclusion: This study highlights the need for targeted investments in surveillance systems, laboratory infrastructure, and crisis preparedness to address specific gaps in different clusters. A metrics-driven framework can reduce regional disparities, promoting equity in preparedness. Policymakers should adopt a collaborative approach to mitigate crises, using high-performing clusters as benchmarks.