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Abstract
The COVID-19 pandemic has highlighted the importance of countries’ preparedness and response capacities in mitigating the spread of infectious diseases. This study investigated the relationship between the Global Health Security (GHS) Index— as a measure of country’s preparedness and response capacity — and epidemic growth rate, defined as the number of days it took to reach specific COVID-19 case-thresholds (100, 1,000, and 10,000 cases). It was hypothesized that countries with a higher GHS Index score had a slower epidemic growth rate than countries with a lower GHS Index score. The socio-ecological model was applied to guide variable selection, and Cox proportional hazards models were used to evaluate the influence of preparedness and response capacity on epidemic growth rates. The models accounted for various covariates, and several analyses were conducted to validate the assumptions and model to ensure the robustness of the findings. Contrary to the initial hypothesis, the results revealed a positive association between higher GHS Index scores and a faster epidemic growth rate. This finding may be attributed to factors such as enhanced detection and reporting capacities in high-GHS Index countries and their earlier exposure to COVID-19 due to global interconnectedness. Non-pharmaceutical interventions, particularly facial covering policies and early contact tracing, were found to have significant protective effects across thresholds. Sensitivity analyses confirmed the robustness of the primary results. These findings have important public health implications. They suggest that current capacity measures may inadequately capture operational response capacity and highlight the need for frameworks that better differentiate between detection and response capacity and between a country’s ‘capacity’ and ‘capability’. Additionally, the study emphasized the importance of early adoption of policy measures to maximize public health gains and to address global health inequities. Study limitations included variability in country-level reporting, reliance on a composite index, and limitations to the specific milestones included in the study. Future research recommendations included exploration of disaggregated components of the GHS index, incorporation of other measures to differentiate between detection and response capabilities, and longitudinal studies to examine the impact of different interventions, amongst other recommendations to enhance pandemic response globally.