{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T04:31:18Z","timestamp":1775622678328,"version":"3.50.1"},"reference-count":40,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,15]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Past studies show a mixed relationship between the Global Health Security (GHS) Index and COVID-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. We aimed to determine the relationship between GHS Index scores and COVID-19 pandemic excess mortality 2020\u20132021 and macroeconomic pandemic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional, multivariable regression design (controlling for per capita gross domestic product (GDP) and political corruption), comparing island and non-island jurisdictions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>194 jurisdictions with 2019 GHS Index scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Age-standardised cumulative excess mortality 2020\u20132021, GDP per capita growth 2019\u20132020 and 2020\u20132021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020\u20132021 in non-island jurisdictions (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      =\u22120.046, p=0.00068, adj R\n                      <jats:sup>2<\/jats:sup>\n                      =0.48), but not in island jurisdictions (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      =0.012, p=0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP per capita growth through 2019\u20132020 or 2020\u20132021.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the COVID-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the need to enhance how the Index measures border biosecurity capacities and capabilities, including the ability to support the exclusion\/elimination strategies that successfully protected islands during the COVID-19 pandemic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-107918","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T05:40:24Z","timestamp":1764740424000},"page":"e107918","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Global Health Security Index and COVID-19 pandemic mortality 2020\u20132021: a comparative study of islands and non-islands across 194 jurisdictions"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1387-5047","authenticated-orcid":false,"given":"Matt","family":"Boyd","sequence":"first","affiliation":[{"name":"Adapt Research Ltd, Reefton, West Coast, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael George","family":"Baker","sequence":"additional","affiliation":[{"name":"Public Health, University of Otago Wellington, Wellington, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick","family":"Wilson","sequence":"additional","affiliation":[{"name":"Public Health, University of Otago Wellington, Wellington, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"2026010703453141000_15.12.e107918.1","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1016\/S0140-6736(24)00476-8","article-title":"Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950\u20132021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"Schumacher","year":"2024","journal-title":"Lancet"},{"key":"2026010703453141000_15.12.e107918.2","unstructured":"Mathieu E , Ritchie H , Rod\u00e9s-Guirao L , et al . 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