| Background:Human society has been continuously affected by major infectious disease outbreaks and other public health emergencies.Since the 21st century,the international community has put lots of efforts in the development of health emergency management systems and public health emergency core capacities in order to better cope with the impacts of future health crisis.In order to guide countries to carry out targeted monitoring and evaluation of public health emergency response capacity,WHO has established a capacity monitoring and evaluation tool including Joint External Evaluation(JEE)under the framework of International Health Regulations(IHR).IHR JEE adopts a peer-reviewed approach,its indicator tool covers 49 indicators in 19 technical areas,and it has been widely used in more than 100 countries,and the assessment results basically reflect the overall national emergency response capacity.However,some studies have shown that the IHR JEE capacity evaluation results are not good predictors of actual pandemic preparedness and response capacity.In addition,there are some crossover between assessment tools such as the IHR JEE and the Global Health Security Index(GHSI).The purpose of this study is to conduct a comprehensive analysis of the global IHR JEE assessment results,to compare the inherent differences in public health emergency response capacity among countries,and to analyze the correlation between the IHR JEE results and other assessment tools,to identify the problems and shortcomings in the practical application of the IHR JEE tool,and to provide a useful reference for the construction of a domestic health emergency response capacity index system in China in the future by using the IHR JEE tool.Objectives:(1)To describe the overall trend of IHR JEE global evaluation results and the differences in evaluation results among WHO regions and countries,and to understand the overall level of public health emergency response capacity and major problems in each country.(2)To analyze the correlation between the IHR JEE evaluation results and International Health Regulations State Party Self-Assessment Annual Report(IHR SPAR),GHSI and other global health security-related evaluation tools,and to provide references for improving the evaluation tools.(3)To compare the capacity gaps in key areas between countries with higher and lower scores,and to identify priority areas for IHR core capacity building.Methods:Each evaluation tool was obtained from its official website data,and after downloading the assessment report,Microsoft Excel 2021 software was used to enter and organize the data,SPSS 25.0 and Stata SE 15.0 software were used to analyze the data,and the charts were made by Microsoft Excel 2021 software,Withdraw software and Origin The IHR JEE individual indicator tools were described by 5-point raw scores,which were not standardized for the time being;when comparing IHR JEE with other indicator tools,the data were standardized by percentages,and the standardization formula was S=(X-Xmin)÷(Xmax-Xmin)×100.The mean was used to describe the concentrated trend for the measurement data,and the standard deviation,variance and quartiles to describe discrete trends,which were mainly presented using bar charts,histograms,scatter plots,box plots or tables.Statistical inference of differences between indicators was made by Student’s t-test,and correlation analysis between indicators was done by Spearman’s linear correlation analysis,and differences were considered statistically significant at P<0.05.Results:(1)Analysis of IHR JEE results:There are 113 countries have conducted IHR JEE in global,and 105 countries have published mission reports.The more concentrated time period of the assessment is from September 2016 to November 2018,and the number of countries conducting monthly assessments from 2019 onwards has slightly decreased.The average global score is 2.72,with the majority of countries scoring between 1.00 and 3.00,and 47 countries(less than the half of 105)exceeding the global average;the highest average score is 4.60 point for Singapore;the lowest average score is 1.36 point for Central Africa;the top scoring countries are mainly in the Western Pacific region,and the bottom scoring countries are in the Western Pacific region.The top-ranked countries are mainly from the Western Pacific region,while the bottom-ranked countries are mainly from the African region.Comparing the scores in each area,the higher scoring technical areas include immunization(3.9 points),surveillance(3.3 points),and national laboratory systems(3.1 points),while the lower scoring technical areas include antimicrobial resistance(2.1 points),biosafety and security(2.2 points),emergency preparedness(2.3 points),risk communication(2.3 points),chemical incidents(2.3 points),and radiation incidents(2.3 points).Specifically for each indicator,the higher scoring indicators include P7.2(4.1 points),D2.4(3.7 points),D1.1(3.6 points)and P7.1(3.6 points),mainly in the areas of immunization,surveillance and national laboratory systems under the broad category of prevention and detection;the lower scoring indicators are P3.4(1.8 points),P3.2(2.1 points),P5.2(2.1 points),P6.1(2.2 points),P6.2(2.2 points),R1.2(2.2 points),and CE.1(2.2 points),mainly in the areas of antimicrobial resistance,food safety,biosafety and security,and emergency preparedness and chemical incidents under the broad category of prevention.(2)Analysis of the application value of the IHR JEE indicator tool:For the tool,IHR JEE showed moderate correlation(0.3≤|r|≤0.8)with IHR SPAR,GHSI,Universal Health Coverage Index(UHCI),Regional Safety Assessment Index(RSAI)and Worldwide Governance Index(WGI),with a slightly stronger correlation(|r|=0.575)with UHCI.In addition,the correlation between IHR SPAR and GHSI,UHCI and RSAI is also at a medium level,but the correlation with WGI is weak(|r|<0.3),and the correlation between IHR SPAR and GHSI is slightly stronger(|r|=0.539).For the indicator domains,national legislation,policy and financing,food safety,national laboratory system,emergency response,ports of entry,chemical and radiological events are moderately correlated(0.3≤|r|≤0.8);radiological event capacity,environment and resources correlation 0.809(P<0.05)is the highest,health financing correlation coefficient is 0.800(P<0.05),IHR human resource workforce 0.322(P<0.05)had the lowest correlation;case management correlations for IHR-related hazards were not statistically significant(P>0.05).IHR JEE and GHSI laboratory specimen transport system indicators had the highest correlation coefficient of 0.798(P<0.05),antimicrobial resistance,biosafety and security-related multiple indicators had coefficients averaging above 0.5(P<0.05),the coefficients of multiple indicators related to emergency planning,emergency drills,and risk communication were on average lower than 0.3(P<0.05),and the differences in the correlations of their indicators such as zoonotic disease reporting,close tracking,animal health field epidemiology training programs,biosafety drills,disinformation,health manpower strategies of healthcare institutions,transnational agreements,and funding budgets were not statistically significant(P>0.05).(3)Typical country capacity gap analysis:Comparing the capacity advantages and gaps of four countries,namely,Central Africa,Chad,Singapore,and Canada,the main capacity gaps are reflected in various aspects such as risk analysis and assessment,information monitoring and early warning,emergency planning and exercises,and post-evaluation and improvement,etc.At the same time,attention should be paid to cultivating and playing the role of highly qualified public health personnel and on-site epidemiologists in capacity building.Conclusions:(1)The overall level of the current IHR JEE assessment scores of countries is not high,and there are large shortcomings in the areas of public health emergency preparedness,risk communication,chemical incidents and radiation incidents,and the status of capacity assessment and improvement of countries in the African region deserves attention.(2)The correlation between IHR JEE with IHR SPAR,GHSI,UHCI,RSAI and WGI has reference significance,and the adjustment of tools can be considered.Important indicators and principles of tools such as UHCI,RSAI and WGI can be considered for inclusion in IHR JEE,and it is necessary to consider the inclusion of One Health related indicators and macro risk indicators in GHSI and IHR JEE.The indicators of antimicrobial drug resistance,biosafety and security can be considered to be merged,and it is necessary to further sort out and unify the indicators of emergency planning,emergency drill and risk communication.(3)The priority areas of capacity gaps among countries and IHR core capacity building are mainly in the areas of legislative framework,institutional mechanism,monitoring and reporting procedures,training incentives and contingency/emergency plans.(4)The IHR JEE assessment is practical and has the application value and prospect of being used in conjunction with the IHR SPAR,GHSI and the domestic public health emergency response capacity assessment index system,and is of reference to China in terms of understanding the global health security situation and filling the shortcomings in monitoring and early warning,response and information dissemination. |
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