Association Between Preparedness and Response Measures and COVID-19 Incidence and Mortality

The COVID-19 pandemic is the most disruptive global health threat in a century. We analyzed publicly available data on preparedness capacity, COVID-19 incidence and mortality, governance, and testing. Although other analyses have suggested that preparedness assessments do not correlate with effective pandemic response, we found that testing rates correlate with both COVID-19 incidence and mortality and strongly correlated with country preparedness capacity as measured by the Joint External Evaluation (JEE). There is a statistically significant association between preparedness capacities and COVID-19 case incidence and an independent association between governance and COVID-19 case and mortality rates. Legislation, surveillance, and risk communication capacities were associated with lower COVID-19 case incidence and mortality. Preparedness and governance are independently associated with COVID-19 pandemic severity. Preparedness capacities are not sufficient -- capacity and governance are both critical to pandemic control. Countries must improve public health systems and implement strong government leadership. Article SummaryCountry preparedness capacities and country leadership policy response (governance) are both critically important to control pandemics. Without appropriate policy action, public health preparedness is insufficient for effective pandemic response.