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Global health security: where is the data to inform health system strengthening?

The Ebola outbreak in West Africa (2013–2016) triggered a renewed interest and sense of urgency about global health security. A surge of reports and publications ensued, examining various aspects of emerging infectious disease outbreaks. In 2016, Olivero and colleagues published a biogeographical approach mapping favourable conditions that facilitated the Ebola outbreak, in terms of environmental factors and the presence of potential host animals.1 Constructing biological vulnerability maps has value to guide preparations for future emerging infectious disease outbreaks, especially in low-income and middle-income countries. But perhaps more important is the need to develop similar ‘vulnerability maps’ to capture the ability of health systems to prevent or respond to major infectious disease challenges. Without a health system vulnerability map, or the public availability of the data to generate it, efforts to achieve global health security in relation to emerging infectious disease outbreaks will likely be limited and post hoc, rather than pre-emptive and strategic. Unfortunately, the revived interest in global health security has not been matched with commensurate action. In 2014, the G7 (Group of Seven) endorsed the Global Health Security Agenda (GHSA), a partnership of governments and international organisations with the goal of accelerating the achievement of the core disease outbreak preparedness and response capacities as required by the International Health Regulations, but progress has been limited.

Formal assessment of countries’ compliance with International Health Regulations is done through a Joint External Evaluation process. As part of this process, governments essentially assess themselves, followed by an independent international validation of the self-reported assessment. So far, 53 countries have initiated this Joint External Evaluation process. However, despite WHO reports that 43 Joint External Evaluation missions have been completed to date, including six GHSA-supported assessments completed in 2015,2 just 23 completed evaluation reports are publicly available online. This exercise is limited …