Joint External Evaluations as Predictors of Excess Mortality During the COVID-19 Pandemic Público

Grube, Steven (Fall 2023)

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As the world enters the interpandemic period, it is essential that global health leaders accelerate preparedness and resilience against the next pandemic, building upon hard-fought COVID-19 experiences.  To adequately prepare for the next pandemic, global health leaders must discriminate between effective and ineffective measures using universally applicable metrics and compensate for disparities in disease detection and reporting systems.  World Health Organization (WHO)-led Joined External Evaluations (JEE) are conducted collaboratively between recognized experts and nations requesting the evaluation.  This study intends to understand whether JEEs can serve as predictors for the ultimate outcome from pandemics, excess morality, or whether non-technical factors must be incorporated into a more comprehensive prediction of pandemic preparedness that allows counties opportunities to address specific weaknesses. 

The authors used 103 publicly available JEE reports conducted during 2016 through 2019 and WHO estimates of excess mortality for 2020 and 2021 to regression modeling of technical indicators, their sums in a given technical area, and the sums of the Prevent, Detect, and Respond domains.  

Estimated excess deaths among high- and low-income countries were both significantly lower than those of middle-income countries but did not differ significantly from one another.  No preparedness domain, technical area, or individual indicator correlated with decreased mortality across all countries or across all income strata, although the technical area of “National legislation, policy,  and financing” and the indicator “Mechanisms for responding to zoonoses and potential zoonoses are established and functional” both correlated with higher excess mortality during the pandemic.  

Currently, Joint External Evaluations are likely competent vehicles to gauge countries’ assessment of their progress towards meeting metrics that WHO states are important in improving preparedness against emerging health threats and pandemics as lain out in the IHR (2005).  Variability in death registry completeness likely played a large role in the incongruous findings.  Expanding the aperture of technical assessments to include bedrock aspects of pandemic preparedness systems such as supply chains and public trust, approaching pandemic preparedness as a global community, and improving vital statistics capture can lay the foundation for measurable indicators that ideally correlate with earlier detection and successful pandemic response.

Table of Contents

Table of Contents

Introduction                                                                                                                            1

Literature Review                                                                                                                   5

Methods                                                                                                                                  7

Results                                                                                                                                    10

Discussion                                                                                                                              18

References                                                                                                                              25

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