Global Health Security Index is associated with Covid-19 Pandemic Mortality 2020-2021 but not for Island Jurisdictions

BackgroundPast studies show a mixed relationship between the Global Health Security (GHS) Index and Covid-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. MethodsMultiple linear regression analyses (controlling for per capita GDP and political corruption) across GHS Index scores, age-standardised excess mortality for 2020-2021, and GDP per capita growth, for island and non-island jurisdictions separately. ResultsThe GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020-2021 in non-island jurisdictions ({beta} = -0.046, p = 0.00068, adj R2 = 0.45), but not in island jurisdictions ({beta} = 0.027, p = 0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP growth through 2019-2020 or 2020-2021. ConclusionThe GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the Covid-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the 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 argued to predict excess mortality through the Covid-19 pandemic when accounting for under-reporting and population age-structure. However, the methodology of some key analyses has been criticised. Furthermore, even if associated with outcomes, it is debated whether the Index is equally applicable across different jurisdictions as a guide to pandemic preparedness. What this study adds?We analysed 47 island and 142 non-island jurisdictions separately using methodology that addressed published criticism of previous studies. We found that the GHS Index was associated with good health outcomes in non-islands but not in islands. We infer that non-islands and islands exhibited fundamentally different responses and experiences during the Covid-19 pandemic and may require different pandemic policies. 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 outcomes. The findings also suggest that border biosecurity, which island states have by virtue of their geography, but other states need to generate by design, may need much greater focus in metrics like the GHS Index.