Health preparedness and how to measure it in advance
/I was reading this email from CSIS about the impact of COVID-19 on SE Asia and the news that HCMC and Hanoi are asking for social distancing rules NOT to be extended. I started to think about both preparedness for pandemics and what we can learn from this one. Specifically, are we measuring the right stuff?
The Gates Foundation, which has really been ahead of the curve here, put together a document in October of last year entitled “Global Health Security Index.” It is basically a measure of a country’s preparedness to global health emergencies. It was done with the help of Johns Hopkins, which has also been very strong in mapping the disease.
Source: Gates Foundation, Johns Hopkins
The Global Health Security (GHS) Index is the first comprehensive assessment and benchmarking of health security and related capabilities across…195 countries ...These organizations believe that, over time, the GHS Index will spur measurable changes in national health security and improve international capability to address one of the world’s most omnipresent risks: infectious disease outbreaks that can lead to international epidemics and pandemics.
So, if this really is an index of how well-prepared countries are, we should expect that the better prepared will do well.
First, looking at the list itself, the rankings aren’t that surprising. Big rich countries are clustered at the top, while failed states are at the bottom. There are some surprises in the mix, though:
Thailand is ranked 6th (!). It has a high capacity to deal with infectious diseases with a great system in place. This New Yorker article talks about it in detail. The US was a helpful partner there.
South Korea is well up there at 9th, helped by a strong medical system.
Japan is surprisingly low, ranked 21 in the world, despite its wealth and high-tech economy.
Vietnam and China are ranked 50 and 51, respectively. Good for Vietnam, somewhat low for China. I think we tend to forget that while China is the second largest economy, it is still fairly poor with a per capita GDP of less than $10k per person. Vietnam is way lower at less than $3k, so its ranking is quite high.
But in SE Asia, even Laos and Cambodia are punching a bit above their weight - Laos is just above the average and Cambodia is just below. Both of which is respectable given how poor both countries are.
Source: Johns Hopkins University
So how did the ranking do? Turns out, it was not a good ranking of the effectiveness of a country’s response to COVID-19.
Looking at deaths per 100k, there is absolutely no correlation between ranking and response. The higher the ranking, the higher the deaths per 100k. But I don’t actually believe that - it’s just that there is no correlation between rankings and deaths.
[Big caveat here, this New York Times story makes a strong argument that deaths are wildly underreported, and that has been a criticism of China from beginning. I expect many PHD dissertations will be written about the full death tally of COVID-19 - who was uncounted, who was counted when they were probably killed by something else.]
Source: GHS, Johns Hopkins University
Vietnam hasn’t had any deaths, while the US (ranked #1) is in the middle of the pack in terms of deaths per 100k. The chart on the right looks at the countries with the worst figures of deaths per 100k (and China), and there doesn’t seem to be any link. If we did a scatterplot, there would be no clear line up to the right.
It may have to do with the underlying health of the population, so tomorrow I am going to look at some of those things. But at first glance, using smoking as a proxy, there doesn’t seem to be any clear line. Smoking in Vietnam is about the same as the Philippines, but the latter has done a poor job in controlling the disease.
It seems pretty clear that you can have a great system in place (and the US and other developed countries generally do), but it takes political will to implement measures that will be effective. It may help if you are authoritarian, but New Zealand is a counterexample to that.
Let me be clear: I don’t think that the GHS Index is done poorly or that it’s not measuring the right things. There might be things that can be improved in the index, but it seems like it is looking at the right areas. The problem is that the health care system means nothing if there is no political leadership to make sure it is used effectively.