Global Health Security Index: Advancing Collective Action and Accountability Amid Global Crisis


The 2021 Global Health Security (GHS) Index was published by the Centre for Health Security at John Hopkins University, Maryland, along with Nuclear Threat Initiative, a non-profit organisation based in Washington, D.C. The Index assesses the ‘health security capacities’ of 195 countries that are party to the International Health Regulations, 2005 (IHR). This is the second GHS Index; the first was launched in the year 2019.

The 2021 report aims to improve national and international health security to diminish the risk of "infectious disease outbreaks that can lead to international epidemics and pandemics.” It was written by Jessica A. Bell from the Nuclear Threat Initiative and Jennifer B. Nuzzo from the Centre for Health Security at John Hopkins University.

The London-based policy research organisation Economist Impact was tasked with forming a multidimensional framework to assess countries for the GHS Index. The organisation examined publicly available data from each country – legal texts, government websites, government and private publications and more. The Index ranked the countries in six aspects – “prevention, detection and reporting, rapid response, health systems, compliance with international norms, and risk environment.”

The GHS Index is based on three fundamental principles of rewarding transparency, recognising that several factors contribute to emergency preparedness, and expanding accountability and responsibility among countries, inter-governmental organisations, donors and the private sector. The report’s scoring system includes five tiers with groupings – in ascending order – of 0-20, 20.1-40, 40.1-60, 60.1-80, and 80.1-100. Countries with the most extensive capacities for containing disease outbreaks score the highest.

The report states that the GHS Index only measures the resource capacity of a country, and that it cannot predict how well the government will be able to use such infrastructure in a crisis. The 2021 Index credits countries that showed a commitment towards sharing data during the Covid-19 pandemic, establishing emergency preparedness plans, creating ‘non-pharmaceutical intervention’ plans, and conducting tests and contact tracing for people exposed to the virus. Despite the significant measures undertaken during the Covid-19 pandemic, the report states that almost all parties to the IHR remain unprepared to deal with similar outbreaks in the future. 

This 269-page report is divided into eight chapters: GHS Index Co-Leaders and Project Staff (chapter 1); Acknowledgements (chapter 2); Executive Summary (chapter 3); About the Index (chapter 4); Key Findings (chapter 5); Recommendations (chapter 6); Methodology (chapter 7); Country Profiles (chapter 8).


  1. The average country score in the GHS Index was 38.9 out of 100, unchanged from 2019. None of the member countries were placed in the top tier of the Index (80.1-100), indicating a fundamental unpreparedness which exists among all nations.

  2. The United States of America secured the first rank in the Index with a score of 75.9 out of 100. It was followed by Australia (71.1), Finland (70.9), Canada (69.8) and Thailand (68.2).

  3. With a score of 16, Somalia ranks the lowest in the Index, immediately preceded by Yemen (16.1), North Korea (16.1), Syria (16.7) and Equatorial Guinea (17.4).

  4. India secured the 66th rank in the overall GHS Index, with a score of 42.8.

  5. India ranked 85 in the ‘prevention of the emergence or release of pathogens’ category. The following are the country’s rankings in the remaining five categories: detection and reporting of diseases (51); rapid response (139); health systems (56); compliance with international norms (92); and risk environment and country vulnerability (73).

  6. As many as 169 countries scored below 50 out of 100 in the index measuring countries’ capacities for preventing the emergence or release of potential epidemic- or pandemic-causing pathogens. This category has the lowest average score (28.4) out of the six measured in the GHS Index.

  7. Only three countries – Australia, Thailand and the United States – scored in the top tier (80.1-100) in the category ‘early detection and reporting epidemics of potential international concern’.

  8. No country scored in the top tier in the category relating to rapid responses for the mitigation of the spread epidemic diseases. The report reveals that about 58 per cent of countries scored below average. Only 69 countries have an “overarching national public health emergency response plan” in place that covers communicable diseases that could develop into an epidemic or a pandemic.

  9. The GHS Index notes the capacity at hospitals, clinics and community centres in the 195 countries to be insufficient, with an average score of 31.5 out of 100. As high as 91 per cent of countries do not have plans or guidelines for dispensing measures – for vaccines, antiviral drugs and more – during a public health emergency.

  10. Out of the 195 countries, 155 have not allocated national funds for improving their capacities to address the threat of a pandemic in the last three years. The report states that 90 countries have not fulfilled their funding obligations to the World Health Organization and that 14 of these are high-income countries.

  11. Most countries have shown insufficient staff availability in healthcare facilities. Only 49 countries (25 per cent) had released an updated ‘health workforce strategy’ to address staffing shortages over the past five years.

  12. The report states that 149 out of the 195 countries have not identified how ‘risk communication messages’ relating to health security emergencies could reach vulnerable communities, who are disadvantaged in terms of language, location and media reach.

  13. The report states that governments should use the GHS Index to locate ‘risk factors’ and ‘security gaps’ in their healthcare systems and encourages them to be more transparent about sharing capacities and risk factors.

  14. The report encourages international institutions like the United Nations, World Health Organization and the World Bank to use the findings of the GHS Index to better aid countries, especially those with greater socio-economic and political risk factors, to expand their health capacities to respond better to disease emergencies in the future.

    Focus and factoids by Tathagat Singh.


Jessica A. Bell and Jennifer B. Nuzzo


Nuclear Threat Initiative, Washington, D.C.; Centre for Health Security, John Hopkins University, Maryland


Dec, 2021