Countries’ progress towards Global Health Security (GHS) increased health systems resilience during the Coronavirus Disease-19 (Covid-19) pandemic

A difference-in-difference study of 191 countries

Bibliographic Data

ID19592744
AuthorsTyler Y Headley (0000-0002-8934-0102, New York University Abu Dhabi, corresponding author), Sooyoung Kim (0000-0001-8804-1162, New York University, corresponding author), Yesim Tozan (0000-0001-8997-8897, New York University, corresponding author)
EditorsSanjana Mukherjee (0000-0002-6039-9506)
Year2025
Volume5
Issue1
Pagese0004051
Publication date2025-01-07
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0004051
PMID39775240
OpenAlexW4406139392
LanguageEN
Citations received2
References cited26

Research on health systems resilience during the Coronavirus Disease-2019 pandemic frequently used the Global Health Security Index (GHSI), a composite index scoring countries’ health security and related capabilities. Conflicting results raised questions regarding the validity of the GHSI as a reliable index. This study attempted to better characterize when and to what extent countries’ progress towards Global Health Security (GHS) augments health systems resilience. We used longitudinal data from 191 countries and a difference-in-difference (DiD) causal inference strategy to quantify the effect of countries’ GHS capacity as measured by the GHSI on their coverage rates for essential childhood immunizations, a previously established proxy for health systems resilience. Using a sliding scale of cutoff values with step increments of one, we divided countries into treatment and control groups and determined the lowest GHSI score at which a safeguarding effect was observed. All analyses were adjusted for potential confounders. World Bank governance indicators were employed for robustness tests. While countries with overall GHSI scores of 57 and above prevented declines in childhood immunization coverage rates from 2020–2022 (coef: 0.91; 95% CI: 0.41–1.41), this safeguarding effect was strongest in 2021 (coef: 1.23; 95% CI: 0.05–2.41). Coefficient sizes for overall GHSI scores were smaller compared to several GHSI sub-components, including countries’ environmental risks (coef: 4.28; 95% CI: 2.56–5.99) and emergency preparedness and response planning (coef: 1.82; 95% CI: 0.54–3.11). Our findings indicate that GHS was positively associated with health systems resilience during the pandemic (2020) and the following two years (2021–2022), that GHS may have had the most significant protective effects in 2021 as compared with 2020 and 2022, and that countries’ underlying characteristics, including governance quality, bolstered health systems resilience during the pandemic

Disease · Environmental health · Global health · Pandemic · Public health · Statistics · COVID-19 epidemiological studies · Demography · Medicine · Vaccine Coverage and Hesitancy · Viral Infections and Outbreaks Research