UK falls off second spot in global ranking of pandemic preparedness

The UK has been knocked off its coveted second spot in a prestigious global ranking of pandemic preparedness.

The latest edition of the Global Health Security Index – a two-yearly assessment of 195 countries’ ability to respond to pandemics – ranks the UK seventh overall after its poor response to Covid exposed serious gaps in the country’s preparedness.

The fall in the rankings will come as a blow to ministers, who, particularly in the early days of the pandemic, boasted of the UK’s position as the second best prepared country in the world.

The 2019 index, published just months before the emergence of Covid, gained notoriety for putting the United States and the UK, which went on to become the worst pandemic performers among the richest nations, in first and second place.

The index, published by organisations including the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health and the Economist, ranks countries in six categories: their ability to prevent, detect and respond to a pandemic; their health system; commitment to international norms and practices; and their risk environment, which covers areas such as trust in government and social cohesion.

According to Jessica Bell, one of the authors of the report, a range of factors let the UK down.

“The UK had a low score in the epidemiological workforce… whether that’s people that can do contact tracing or laboratory support. The UK scored zero out of 100 for epidemiological workforce capacity,” she said.

It also scored poorly in access to healthcare, a reflection of the UK’s overwhelmed hospitals and GPs, and funding for pandemic preparedness.

Despite the fact the UK has had more than 10 million cases and 146,000 deaths it is ranked higher than countries much less hard hit by Covid.

These include South Korea – a country with a slightly smaller population than the UK’s but which has seen just under 4,000 deaths and 482,000 cases, which was ranked ninth. Singapore, whose response was highly lauded at the beginning of the pandemic, came 23rd on the index.

The US retains its top spot, despite both a high death and case rate and an early response led by then President Donald Trump characterised by denial, inconsistent messaging and touting of unproven treatments.

The US was followed by Australia, Finland, Canada, Thailand, Slovenia and then the UK.

The report acknowledges that the US’s pandemic response has “generally been viewed as extremely poor”.

“The result highlights that although the GHS Index can identify preparedness resources and capacities available in a country, it cannot predict whether or how well a country will use them in a crisis,” it says.

The index cannot anticipate how a country’s political leaders will respond to recommendations from health or science experts, for example.

Ms Bell, senior director for global biological policy and programmes at the Nuclear Threat Initiative, said: “While the US was ranked number one that was not necessarily indicative of a country’s performance in the face of an emergency.

“The contextual issues like social, political and cultural phenomena also impact how the US responded to Covid-19… the US actually scored the lowest possible score of public confidence in government and this is something that has been key in countries that have had the highest number of cases – a lack of confidence in the government has had a direct impact on the response,” she said.

Clare Wenham, associate professor in global health policy at the London School of Economics, agreed it was strange that the US came top when it had high rates of both death and infection.

“You need to know the nuance of the political landscape to understand how a country will respond.

“As we know too well, you can have the best health system and health indicators in the world, but if the government isn’t ready to use it – or prioritise other areas of political life first – then this doesn’t matter. I still don’t know how this index can capture that,” said Dr Wenham.

All the indicators had equal weight in the index – so, if levels of trust in government had a big impact on how well a country responded to the pandemic this would not show up in the ranking.

The US scored 75.9 out of a possible 100 points, showing that it was wanting in key areas, said Ms Bell.

The index found that all countries remain “dangerously unprepared” to fight future pandemics.

Most countries, including high-income nations, have not made dedicated financial investments in strengthening epidemic or pandemic preparedness. And political and security risks have increased in nearly all countries, with 161 countries having low to moderate levels of public confidence in their government.

When asked if countries that ranked near the top of the index might become complacent, Ms Bell said: “I’d say for decades there has been complacency around public health and national security as it relates to biological threats. That’s in large part why we’re here in this Covid situation.”

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