Dataset Information

Global Health Security Preparedness and Response: An Analysis of the Relationship between Joint External Evaluation Scores and COVID-19 Response Performance.

ABSTRACT:

Objectives

The COVID-19 pandemic has highlighted the importance and complexity of a country's ability to effectively respond. The Joint External Evaluation (JEE) assessment was launched in 2016 to assess a country's ability to prevent, detect and respond to public health emergencies. We examined whether JEE indicators could be used to predict a country's COVID-19 response performance to tailor a country's support more effectively.

Design

From April to August 2020, we conducted interviews with Centers for Disease Control and Prevention country offices that requested COVID-19 support and previously completed the JEE (version 1.0). We used an assessment tool, the 'Emergency Response Capacity Tool' (ERCT), to assess COVID-19 response performance. We analysed 28 ERCT indicators aligned with eight JEE indicators to assess concordance and discordance using strict agreement and weighted kappa statistics. Generalised estimating equation (GEE) models were used to generate predicted probabilities for ERCT scores using JEE scores as the independent model variable.

Results

Twenty-three countries met inclusion criteria. Of the 163 indicators analysed, 42.3% of JEE and ERCT scores were in agreement (p value=0.02). The JEE indicator with the highest agreement (62%) was 'Emergency Operations Center (EOC) operating procedures and plans', while the lowest (16%) was 'capacity to activate emergency operations'. Findings were consistent with weighted kappa statistics. In the GEE model, EOC operating procedures and plans had the highest predicted probability (0.86), while indicators concerning response strategy and coordination had the lowest (≤0.5).

Conclusions

Overall, there was low agreement between JEE scores and COVID-19 response performance, with JEE scores often trending higher. JEE indicators concerning coordination and operations were least predictive of COVID-19 response performance, underscoring the importance of not inferring country response readiness from JEE scores alone. More in-depth country-specific investigations are likely needed to accurately estimate response capacity and tailor countries' global health security activities.

SUBMITTER: Nguyen L

PROVIDER: S-EPMC8640194 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Global Health Security Preparedness and Response: An Analysis of the Relationship between Joint External Evaluation Scores and COVID-19 Response Performance.

Nguyen Laura L Brown Morgan Sydney MS Couture Alexia A Krishnan Sharanya S Shamout Mays M Hernandez Luis L Beaver Jennifer J Gomez Lopez Arianna A Whitson Cassidy C Dick Leah L Greiner Ashley Lauren AL

BMJ open 20211202 12

<h4>Objectives</h4>The COVID-19 pandemic has highlighted the importance and complexity of a country's ability to effectively respond. The Joint External Evaluation (JEE) assessment was launched in 2016 to assess a country's ability to prevent, detect and respond to public health emergencies. We examined whether JEE indicators could be used to predict a country's COVID-19 response performance to tailor a country's support more effectively.<h4>Design</h4>From April to August 2020, we conducted int ...[more]

PMID: 34857565

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Project description:The Joint External Evaluation (JEE) assesses national capacities to implement the International Health Regulations (IHR). Previous studies have found that higher JEE scores are associated with fewer communicable disease deaths. But given the impact of COVID-19 in many countries, including those believed to have developed IHR capacities, the validity of the JEE for pandemic preparedness has been questioned. We constructed univariable and multivariable linear regression models to investigate the relationship between JEE scores and i) deaths from communicable diseases before the pandemic and ii) deaths from COVID-19. We adjusted for country differences in age, health system access, national wealth, health expenditure, democratic governance, government restrictions, pre-pandemic tourist arrivals and testing capacity (estimated by test positivity rates). For COVID-19 deaths, we calculated cumulative deaths per 100,000 at 3, 6 and 12 months into the pandemic. A total of 91 countries were included, with a median JEE score of 50%. On multivariable linear regression the association between JEE scores and log COVID-19 deaths was significant and positive at 3 months (β 0.05, p = 0.02), becoming statistically non-significant, at 6 (β 0.02, p = 0.27) and 12 months (β -0.03, p = 0.19), while the association with log communicable disease deaths was significant and negative (β -0.03, p = 0.003). A higher Stringency Index was significantly associated with higher log COVID-19 deaths at 3 (β 0.04, p = 0.003) and 6 (β 0.04, p = 0.001) months, but not at 12 months (β 0.02, p = 0.08). Higher test positivity rates were associated with higher log COVID-19 deaths at all time points, at least partially attenuating the positive association between Stringency Index and log COVID-19 deaths. While universal health coverage indices (β -0.04 p<0.001) and international tourist arrivals were associated with log communicable disease deaths (β 0.02, p = 0.002), they were not associated with log COVID-19 deaths. Although the same tool is used to assess capacities for both epidemics and pandemics, the JEE may be better suited to small outbreaks of known diseases, compared to pandemics of unknown pathogens.

Project description:BackgroundFood systems instantiate the complex interdependencies across humans, physical environments, and other organisms. Applying One Health approaches for agri-food system transformation, which adopts integrated and unifying approaches to optimize the overall health of humans, animals, plants, and environments, is crucial to enhance the sustainability of food systems. This study develops a potential assessment tool, named the global One Health index-Food Security (GOHI-FS), aiming to evaluate food security performance across countries/territories from One Health perspective and identify relevant gaps that need to be improved for sustainable food systems.MethodsWe comprehensively reviewed existing frameworks and elements of food security. The indicator framework of GOHI-FS was conceptualized following the structure-process-outcome model and confirmed by expert advisory. Publicly available data in 2020 was collected for each indicator. The weighting strategy was determined by the Fuzzy Analytical Hierarchy Process. The data for each indicator was normalized and aggregated by weighted arithmetic mean. Linear regressions were performed to evaluate the associations of GOHI-FS with health and social-economic indicators.ResultsThe GOHI-FS includes 5 first-level indicators, 19 second-level indicators and 45 third-level indicators. There were 146 countries/territories enrolled for evaluation. The highest average score of first-level indicators was Nutrition (69.8) and the lowest was Government Support and Response (31.3). There was regional heterogeneity of GOHI-FS scores. Higher median scores with interquartile range (IQR) were shown in North America (median: 76.1, IQR: 75.5-76.7), followed by Europe and Central Asia (median: 66.9, IQR: 60.1-74.3), East Asia and the Pacific (median: 60.6, IQR: 55.5-68.7), Latin America and the Caribbean (median: 60.2, IQR: 57.8-65.0), Middle East and North Africa (median: 56.6, IQR: 52.0-62.8), South Asia (median: 51.1, IQR: 46.7-53.8), and sub-Saharan Africa (median: 41.4, IQR: 37.2-46.5). We also found significant associations between GOHI-FS and GDP per capita, socio-demographic index, health expenditure and life expectancy.ConclusionsGOHI-FS is a potential assessment tool to understand the gaps in food security across countries/territories under the One Health concept. The pilot findings suggest notable gaps for sub-Saharan Africa in numerous aspects. Broad actions are needed globally to promote government support and response for food security.

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Dataset Information

Global Health Security Preparedness and Response: An Analysis of the Relationship between Joint External Evaluation Scores and COVID-19 Response Performance.

Objectives

Design

Results

Conclusions

Publications

Global Health Security Preparedness and Response: An Analysis of the Relationship between Joint External Evaluation Scores and COVID-19 Response Performance.

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