The Global Health Security Index (GHSI) is a good starting point on the road to minimising biological threats

A new paper explains how the GHSI can be used to guide preparations in New Zealand and the Pacific

New Zealand has done well to date in managing and eliminating (for now) COVID-19 disease. However, there have been sensible calls for an inquiry into New Zealand’s response. An inquiry could help determine what worked and what didn’t, what went well, and how we could do better next time. An inquiry should focus on ways to get the same result while suffering less harm (economically, socially, and in terms of health).

The Global Health Security Index

Fortunately, there is a lot of guidance for planning, such as The Global Health Security Index, which in 2019 independently scored countries on 140 items relevant to health security (NZ scored 54/100). This index highlights the diverse factors that go into protecting health by preventing, detecting, and responding to a threat, as well as the robust health system, commitments to international norms, and a well-managed risk environment that reduce the chance of harm.

Work should begin now to determine how the GHSI can help to prevent and manage the next threat. A paper published today (12 June 2020) in the New Zealand Medical Journal does exactly this, by explaining how the new GSHI can help guide New Zealand’s planning for biological threats, and also help enhance Pacific regional health security.

Improving preparations for biological threats

The paper on GHSI published today describes NZ’s score, as well as those of our Pacific neighbours. It outlines how New Zealand might better prepare and improve its resilience against the next threat. It also explains why aiding Pacific nations to enhance regional health security is critical. Given the potential for rapid spread of disease, if some are not prepared then no one is fully prepared.

The risks of anthropogenic threats (lab accidents, malicious use of biological weapons) is high, and the damage from these could be vast. Fortunately, there are many other tools in the GHSI toolkit that ought to be implemented now, to prevent accidental, unforeseen, unprecedented, or malicious risks before they occur.

These include screening of all DNA synthesised to order, consolidation of dangerous materials in a minimum number of laboratories, and standardised biosafety and biosecurity training. We also need a plan to protect vulnerable populations, such as residents in aged care facilities.

We need a generic pandemic plan, fit for all purposes, that is not merely based on pandemic influenza and a ‘let it in and manage it’ approach. Beyond pandemic planning however, there is much that can be done to reduce future biological risk. COVID-19 was nothing like influenza and the next threat could be nothing like COVID-19. Imagination is needed.

Border closures

Perhaps most critically, we need to better understand the criteria for border closure and border management mechanisms. Repeatedly over the last 3 years, prior to COVID-19, the Ministry of Health had been adamant that border closure would never be used. And yet, the first thing that New Zealand (and many other nations) did in the face of the COVID-19 pandemic was to start to close, and then completely close, the border.

It is entirely possible that the economically crippling level 4 lock-down might have been avoided with well-planned, well-rehearsed, early border closure according to pre-determined criteria. More thinking about when to implement border closures is needed.

Beyond GHSI

But we must also think beyond the GHSI because no single tool anticipates everything, and recent events (in NZ and around the world) demonstrate the importance of managing misinformation and disinformation campaigns, of avoiding the politicisation of public health emergencies, of quick decisive action, and of equitable and universal access to healthcare. There is much more that we can do to preserve human health in New Zealand and regionally in the face of inevitable future biological threats.

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