Suboptimal US Response to COVID-19 Despite Robust Capabilities and Resources

“As measured by the GHS [Global Health Security] Index, the US was better positioned than most other countries to respond to COVID-19. The Index includes 140 questions that assess national capacities or abilities among 6 categories: (1) prevention of the emergence, release, or spread of pathogens; (2) early detection and reporting for epidemics of potential international concern; (3) rapid response to and mitigation of the spread of an epidemic; (4) sufficient and robust health system to treat affected patients and protect health workers; (5) commitments to improving national capacity, financing plans to address gaps, and adhering to global norms; and (6) overall risk environment and country vulnerability to biological threats. The Index is scored on a 0- to 100-point scale, with 100 representing the highest possible score a country can receive. However, although the Index is useful in identifying gaps in pandemic preparedness, the GHS Index rankings and scores are not correlated with COVID-19 death rates.

The US outranked the other 194 countries assessed by the GHS Index because it has more capacities and fewer identified risks than other countries. The US has high-quality laboratories, trained epidemiologists, and a stockpile along with plans to distribute personal protective equipment in public health emergencies. The US also has an emergency operations center and risk communication plans. In addition, there is the world-renowned US Centers for Disease Control and Prevention (CDC) that works across the globe to improve the ability of other countries to detect and respond to infectious disease threats.

[..] Despite its top overall ranking on the index, the US received a low score on a key factor that can determine how well a country is able to react to a pandemic: public confidence in the government. The US is one of only a small number of high-income countries in the Index that received the lowest possible score on public confidence in the government. Poor confidence in the government can undermine the public’s adherence with disease-control measures, such as wearing masks or stay-at-home recommendations, and has been reported among the existing challenges to the US COVID-19 response.

In addition, the US received low scores on important indicators pertaining to the strength of its health system and the ability of its people to access health care without barriers. For example, among the 60 high-income countries in the GHS Index, the US ranked 38th for its number of physicians per capita and 40th for its number of hospital beds per capita. On access to health care, the US was ranked 175th globally due to its absence of laws mandating universal health care coverage and large numbers of underinsured and uninsured individuals. A lack of guaranteed access to health care for all citizens leaves many individuals vulnerable during times of emergency. In 2020, the US Congress passed legislation to remove cost barriers for SARS-CoV-2 testing, but testing costs remain and have been cited as a barrier to expanding the number of tests performed in the US.

[..] going forward, the Index should include new or stronger metrics about additional capacities, such as medical supply chains and a better understanding of national leadership. The strength of a country’s leadership and the confidence of its people in their government and their leaders is just as important (if not more important) than technical capacities. Future versions of the Index will give greater weight to these factors.”

Full editorial, Nuzzo JB, Bell JA and Cameron EE. JAMA 2020.9.16