Ranked: Global Pandemic Preparedness by Country
The world has experienced many pandemics throughout its history, but not every era has had the benefit of modern medicine and hindsight.
However, even with the readily available medical expertise and equipment that exists today, it is still unevenly distributed throughout the globe. Combine this with a highly interconnected global economy, and large populations are still at risk from infection.
Today’s chart pulls data from the 2019 Global Health Security Index, which ranks 195 countries on health security. It reveals that while there were top performers, healthcare systems around the world on average are fundamentally weak—and not prepared for new disease outbreaks.
Pathways for Commerce and Disease
Modern transportation and trade have linked the farthest stretches of the world to fuel a global economy. Physical distance plays less a limiting role and more an enabling one to form a flat world as Thomas Friedman put it, creating opportunities for commerce anywhere in the world.
A person can sell dishware from his home in Cusco, Peru, online to a customer in Muncie, Indiana, with products manufactured in China, from materials sourced in Africa.
While these connections sound sterile, there are people interacting with one another to procure, manufacture, package, and distribute the goods. The connections are not just through products, but also people and animals across many borders.
Now, add up the interactions within the global food supply chain with plants and livestock and tourism industries and place them under the pressures of climate change, urbanization, international mass displacement, and migration—and the volume and variety of opportunities for disease transmission and mutation becomes infinite.
The same pathways of global commerce become the transmission vectors for disease. A cough in Dubai can become a fever in London with one flight and one day.
You Cannot Manage What You Do Not Measure
Despite this, we still live with national healthcare systems that look inward towards national populations, with less of a focus on integrating what is happening with the outside world.
The Global Health Security (GHS) Index is the first comprehensive effort to assess and benchmark health security and related capabilities by nation, and it tracks six key factors to come up with an overall score for each of the 195 countries in the ranking:
Prevention of the emergence or release of pathogens
- Detection and Reporting
Early detection and reporting for epidemics of potential international concern
- Rapid Response
Capability of rapidly responding to and mitigating the spread of an epidemic
- Health System
Sufficient and robust and health system to treat the sick and protect health workers
- Compliance with Global Norms
Compliance with international norms by improving national capacity, financing plans to address gaps
- Risk Environment
Risk environment and country vulnerability to biological threats
Country Overall Rankings
Overall, the rankings uncover a distressing insight. Global preparedness for both epidemics and pandemics is weak, with the average score in the index sitting at 40.2 out of 100.
The countries with the highest scores have effective governance and politics systems in place, while those with the lowest scores fall down for their inadequate healthcare systems—even among high-income countries.
Here are the 50 highest-ranking countries in the index:
|Rank||Country||GHS Index Score|
|#1||🇺🇸 United States||83.5|
|#2||🇬🇧 United Kingdom||77.9|
|#9||🇰🇷 South Korea||70.2|
You can view the complete rankings of all 195 countries on the GHS Index website.
Interestingly, 81% of countries score in the bottom tier for indicators related to biosecurity—and worse, 85% of countries show no evidence of having completed a biological threat-focused simulation exercise in conjunction with the World Health Organization (WHO) in the past year.
Confirmed COVID-19 Cases vs. Global Health Security Score
Many healthcare systems have had their security tested with the outbreak of COVID-19.
Although it is still extremely early, there appears to be a relationship between a nation’s health security and its ability to cope with pandemics.
Takeaways: A World Unprepared
While there may be top performers relative to other countries, the overall picture paints a grim picture that foreshadowed the current crisis we are living through.
“It is likely that the world will continue to face outbreaks that most countries are ill positioned to combat. In addition to climate change and urbanization, international mass displacement and migration—now happening in nearly every corner of the world—create ideal conditions for the emergence and spread of pathogens.” – The Global Health Security Index, 2019
The report outlined eight critical insights about global health security in 2019 that reveal some of the problems countries are now facing.
- National health security is fundamentally weak globally. No country is fully prepared for epidemics or pandemics, and every country has important gaps to address.
- Countries are not prepared for a globally catastrophic biological event.
- There is little evidence that most countries have tested important health security capacities or shown that they would be functional in a crisis.
- Most countries have not allocated funding from national budgets to fill identified preparedness gaps.
- More than half of countries face major political and security risks that could undermine national capability to combat biological threats.
- Most countries lack basic health systems capacities critical for epidemic and pandemic response.
- Coordination and training are inadequate among veterinary, wildlife, and public health professionals and policymakers.
- Improving country compliance with international health and security norms is essential.
A Stark Reality
The intention of the Global Health Security Index is to encourage improvements in the planning and response to one of the world’s most omnipresent risks–infectious disease outbreaks. When this report was released in 2019, it revealed that even the highest ranking nations still had gaps to fill in preparing for a pandemic.
Of course, hindsight is 20/20. The COVID-19 outbreak has served as a wake-up call to health organizations and governments around the world. Once all of the curves have been flattened, the next version of this report will undoubtedly be viewed with renewed interest.
Mapped: The European CBD Landscape in 2020
This graphic explains the innately complex legal status of CBD products in Europe and highlights the countries leading the CBD charge.
Mapped: The European CBD Landscape in 2020
To say CBD has risen in popularity over the last decade is an understatement.
Not only have CBD consumer products rapidly infiltrated a long list of industries, new research discoveries continue to prove their therapeutic benefits. By 2023, the European CBD market is estimated to reach €1.4 billion.
However, a big problem remains—there is an incredible amount of uncertainty surrounding what is legal, and what isn’t. The above infographic from Elements of Green sheds some light on the innately complex legal status of CBD products in Europe.
The Great CBD Debate
CBD—short for cannabidiol—is a non-psychotropic compound produced by cannabis plants.
While most European countries have legalised it in some way, the caveat for many is that it must be extracted from industrial hemp, thus containing less than 0.2% THC—the intoxicating compound also found in cannabis. On the other hand, countries such as France and Norway only permit CBD isolate (the pure form of CBD) with no THC.
In 2019, the European Food Safety Authority (EFSA) designated CBD products as a novel food. This means that companies should seek authorisation to bring products to market, although it is not required by law.
However, the industry has now hit a fork in the road, as the European Commission (EC) recently announced it will be suspending applications for novel foods status while it determines whether or not certain CBD products should be labelled as narcotics instead.
The Legal Landscape in 2020
As the industry flip flops between regulations, consumers and investors need to understand that each country has its own laws surrounding the use of CBD.
|Country||CBD Legal Staus|
|🇦🇹 Austria||Legal grey area (legal lean)|
|🇧🇦 Bosnia and Herzegovina||Illegal|
|🇧🇪 Belgium||Legal grey area (restricted lean)|
|🇨🇿 Czech Republic||Legal grey area (legal lean)|
|🇭🇷 Croatia||Legal grey area (legal lean)|
|🇪🇪 Estonia||Legal grey area (legal lean)|
|🇫🇮 Finland||Legal grey area (restricted lean)|
|🇭🇺 Hungary||Legal grey area (legal lean)|
|🇮🇸 Iceland||Legal grey area (legal lean)|
|🇮🇪 Ireland||Legal grey area (restricted lean)|
|🇮🇹 Italy||Legal grey area (restricted lean/legal for medical use)|
|🇱🇻 Latvia||Legal grey area|
|🇱🇮Liechtenstein||Legal grey area|
|🇲🇹 Malta||Legal grey area/legal for medical use|
|🇲🇰 North Macedonia||Legal for medical use|
|🇳🇴 Norway||Legal for medical use|
|🇵🇹 Portugal||Legal for medical use|
|🇷🇸 Serbia||Legal grey area (restricted lean)|
|🇬🇧 United Kingdom||Unrestricted|
While a handful of European countries have made it illegal to import, buy, or possess CBD, the vast majority have legalised CBD products that either comply with the Novel Foods Act, or can be obtained from a licensed medical practitioner.
Of these countries, Germany and the UK lead the European CBD market, followed by Switzerland, Austria, Spain, and Greece.
A Call For Change
A progessive stance on cannabis legalisation combined with increasing consumer demand has led to several countries showing remarkable growth, such as Poland, Bulgaria, Netherlands, and Luxembourg.
Luxembourg in particular presents a compelling growth story, as it plans to fully legalise adult-use recreational cannabis in 2021, which would make it the first European country to do so.
Despite its small size, Luxembourg could in fact be instrumental in encouraging neighbouring countries to implement similar reforms, also known as the neighbour effect.
Growing Pains of a Nascent Industry
Considering each country has its own unique restrictions in place, CBD consumers should educate themselves on the regulations and laws relevant to them.
Despite these often confusing laws and restrictions, it is clear that demand for CBD products is growing exponentially. As a result, the continent may have the potential to overtake North America as the largest CBD market in the world.
Global COVID-19 Containment: Confirmed Cases, Updated Daily
This continuously updated chart provides a more complete look at the efficacy of COVID-19 containment strategies.
Global COVID Containment: Confirmed Cases, Updated Daily
Sometimes, it helps to gain a fresh perspective.
Since the pandemic began, there have been innumerable tracking resources made available online, but rarely do they paint a complete picture of a country’s containment progress.
How Much Progress Is Really Being Made
Featured above, this continuously updated chart from Our World in Data provides a more complete look at the efficacy of COVID-19 containment strategies, sorted by country.
It is a variation of the Epidemic Curve (or “epi curve”), showing confirmed COVID-19 cases per country in relation to their testing rates—what’s revealed is the strength of each country’s containment strategy.
Only a fraction of total cases–those confirmed by a test–is known. This is why we spent recent months building the database and the visualization tool to make this variation of the epidemic curve possible.
— Our World in Data
Why Look at it This Way? Adequate Benchmarking
Countries vary widely in how they monitor and report on COVID-19. Cases in this particular chart were confirmed via laboratory testing, and the data covers 66% of the globe’s population.
Depending on a country’s containment efforts, confirmed cases can differ dramatically from total cases. To get a better idea of that difference, Our World in Data looked closer at the extent of testing. As they report, the World Health Organization considers an adequate benchmark to be 10-30 tests per confirmed case. And for those countries that experience larger outbreaks, there must be more tests conducted per confirmed case.
What the COVID Test-to-Case Ratio Tells Us
- Line Trajectory: In this chart, rising lines show that the average number of laboratory-confirmed cases has increased over time, and vice versa for falling lines. Beyond flattening the curve, the end game is to have all of those lines reach zero.
- Blue Lines: The darker the blue line, the more likely that the line is an accurate indicator, as thousands of tests have been administered per confirmed case. The more blue lines this chart shows over time, the better for us all.
- Red Lines: By contrast, the warmer the color of the line, the fewer tests are being administered per confirmed case, and it is less likely to be an accurate measure of COVID-19 cases. Red lines, for example, indicate that only five tests are conducted for every confirmed case, suggesting that the count is not accurate and that many cases are going unreported.
Consider these three scenarios in the diagram above, and hover over countries in the main visualization to compare:
- Country A: Winning the fight against COVID-19.
These countries, like New Zealand, have steadily increased the number of tests per confirmed case. Country A administers hundreds or thousands of tests per confirmed case. The likelihood of missed cases is far lower, most cases are accounted for, and they can confidently state they are winning the fight against COVID-19.
- Country B: A severe, prolonged outbreak.
In comparison, countries like the U.S. have experienced a steady rise in confirmed cases. They also have lower rates of testing—only five tests per confirmed case. Country B cases are likely to be higher than the number reported, a fact that is especially concerning given that the U.S. has already surpassed the rest of the world’s countries in confirmed cases.
- Country C: A volatile scenario.
While confirmed cases decrease, there is much room for doubt. In Country C (South Africa for instance), confirmed cases are decreasing, but very few tests are administered. Unfortunately, this indicates there are many unrepresented cases. Country C probably has a larger problem than its downward trajectory would indicate.
Cases Per Million People
From a different angle, we can see daily new COVID-19 cases per capita. This gives us a better sense of how countries compare in terms of confirmed cases.
Countries like Thailand, New Zealand, and South Korea all show relatively low rates of COVID-19 per capita, as well as high levels of testing. Conversely, countries like Spain and Kuwait reveal high levels of confirmed cases per capita and extremely low testing rates.
Another Perspective for Good Measure
For a holistic view of testing, the map below shows us the daily number of tests for each newly confirmed COVID-19 case, based on a rolling 7-day average.
Countries like Norway, Australia, and Canada reveal strong testing-to-confirmed-case ratios. In contrast, countries like Bolivia and the Philippines reveal the probability of out-of-control outbreaks.
Due to lower levels of testing in relation to confirmed cases, countries in red are more likely to leave cases unreported.
Making Sense of the Unknown
Although charts like these allow us to look at relationships between critical variables, there are no guarantees of what will come of this outbreak or any second waves.
The only certainty right now, is uncertainty. But with visualizations like this one—updated daily—we can at least stay up-to-speed with the knowledge curve.
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