Enhanced Preparedness Assessments Require New Capacity Building Approaches

July 21, 2022
Nellie Bristol

COVID-19 created a real-world stress test for pandemic preparedness and response. While there were some successes, many systems showed dangerous faults. The authors of national health emergency capacity assessments have analyzed those failings and incorporated lessons learned into revised tools, creating more comprehensive readiness benchmarks for future pandemics. But while the revisions expand the scope and rigor of preparedness measurements, most countries already were failing to meet standards laid out in earlier versions. Protecting lives and economies from the next crisis will take an influx of financial and technical resources, new approaches that break down capacity building into manageable tasks, and sustained, proactive leadership to ensure effective implementation.


The 3rd edition of the World Health Organization’s Joint External Evaluation (JEE) Tool, released at the end of June, takes aim at several shortcomings revealed by COVID. First launched in 2016 and revised in 2018, the JEE provides a framework used by external reviewers to assess gaps in national core capacities required by the  International Health Regulations. The new version provides a range of more detailed contextual and technical questions for reviewers to consider and incorporates new and revised indicators into the 19 technical areas included in the tool. Among areas that will be more comprehensively examined are national health threat alert systems, analysis and information sharing, and management of health emergency response.


New indicators provide more detailed assessments of emergency readiness and logistics and supply chain management, both dangerous COVID weaknesses. Others measure policies related to sanitary animal practices, spurred by indications that that COVID infection was at least amplified in a Wuhan wet market, and workforce surge capacity, a response to a vast overtaxing of medical personnel and public health leadership over the last several years. To help address inequities exposed and exacerbated by the pandemic, the JEE places a particular emphasis on gendered approaches to preparedness and response.


COVID lessons were incorporated into other health security capacity assessments as well. The Global Health Security Index, produced jointly by the Nuclear Threat Initiative, the Johns Hopkins University Center for Health Security, and Economist Impact, added 31 new measures to its 2021 version. Based on publicly available data, including the JEE, the Index assesses health emergency capacities and enabling environments—political, regulatory, and social—of all 195 countries. Measures added based on analyses of COVID weaknesses include risk identification for zoonotic spillover, scaling capacity for pathogen testing and lab facilities, and ability to implement non-pharmaceutic interventions, such as masking requirements and stay-at-home orders. The 2021 Index showed that even as many countries proved they could ramp up new capacities during the pandemic, some responses were crippled by long-unaddressed weaknesses, such as lack of health care surge capacity and critical medical supplies.


Both the JEE and GHS Index also place new emphasis on border control operations and effective public health communications, areas that caused concern early in the pandemic. In a measure authors likely did not even consider before COVID hit, the assessments include evaluations of misinformation and disinformation management, with the Index focusing on accurate messages from national leaders.


While there has been criticism of both JEEs and the Index, they help countries understand their state of preparedness and provide quantitative measures to track improvements. They also highlight the multisectoral nature of successful pandemic response and provide specific investment targets for international financing. But even with COVID’s devastation top of mind and clear examples of what went wrong, many countries still have struggled to bolster preparedness meaningfully for the long term. The overall score for countries from the inaugural GHS Index in 2019 and in 2021 continue to show dangerous preparedness gaps in virtually every country. Further, while 116 countries had completed a JEE by end of May 2022, implementation of resulting National Action Plans for Health Security, aimed at mitigating identified weaknesses, has lagged.


While using the harsh reality of COVID-19 to augment existing capacity assessments should result in more effective preparedness, meeting the new standards will require reinvigorated leadership and new implementation approaches. WHO and others are exploring capacity development methods that focus on achievement of discrete improvements over a specified time frame to spur more effective action. As many countries already are overwhelmed by the scope of the task, providing technical and financial support for countries to move on a smaller number of self-identified priorities will be even more critical under the new indices.


COVID-19 offers a frightening vision of our global future as epidemics and pandemics become more common. While assessments and remediation strategies are critical to improving health security, safeguarding the world from even greater losses requires new implementation approaches and proactive leadership to ensure needed capacities move from plans to tangible protections.