{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T09:49:25Z","timestamp":1776332965806,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.159002.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000}}],"reference-count":59,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019725","name":"Deanship of Scienti\ufb01c Research, Prince Sattam bin Abdulaziz University","doi-asserted-by":"crossref","award":["project number: PSAU\/2024\/R\/1445"],"award-info":[{"award-number":["project number: PSAU\/2024\/R\/1445"]}],"id":[{"id":"10.13039\/100019725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Objectives Infectious diseases present significant challenges to global health security in contemporary, interconnected global environments. This study aimed to evaluate and compare health security performance in Western Asia (WA), with a focus on income group-based disparities and region-specific insights. Methods This study utilized the Global Health Security Index (GHSI) to assess health security across 17 WA countries categorized by income level. Health security indicators for 2019 and 2021 were analyzed using the D-CRITIC method to determine the relative importance of each indicator (Global Health Security Index, 2021): https:\/\/ghsindex.org\/report-model\/). A combined D-CRITIC-CoCoSo framework was employed to rank the countries, followed by K-means clustering for grading. The study also investigated correlations between financial allocation\u2019s indicators and health security outcomes using Spearman\u2019s rank correlation. A comparative analysis elucidated regional disparities across income categories. Results This study highlights WA\u2019s progress in health security by prioritizing foundational health systems, detection\/reporting, rapid response, and risk management. From 2019 to 2021, priorities varied by income group, with high-income countries focusing on detection, upper-middle-income countries focusing on risk environments, and low-income countries focusing on prevention. While some nations demonstrated improvement, others, such as Armenia, experienced decline, revealing persistent vulnerabilities. This study revealed significant variability in health security capacity, with both progress and setbacks among countries in different clusters. High- and upper-middle-income countries, such as Qatar and Georgia, leverage investments and international partnerships to improve their rankings, while conflict-affected, low-resource countries, including Iraq, Yemen, and Syria, face stagnation or decline. Strong correlations were observed between financial resource allocation indicators and health performance. Higher investments in countries like Armenia and Georgia led to significantly improved health outcomes, while minimal spending in Syria and Yemen weakened their resilience to health threats. Conclusion Disparities in health resilience persist, underscoring the need for equitable resource allocation and regional cooperation to enhance public health security.<\/ns3:p>","DOI":"10.12688\/f1000research.159002.2","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T16:23:58Z","timestamp":1743179038000},"page":"43","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Income-Based analysis of health security in Western Asia through an integrated GHSI, MCDM, and Clustering Model"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5456-1303","authenticated-orcid":false,"given":"Adel A.","family":"Nasser","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6586-2141","authenticated-orcid":false,"given":"Abed Saif Ahmed","family":"Alghawli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salem","family":"Saleh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amani A. 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Flaih, Cihan University-Erbil, Kurdistan Region, 17 Jan 2025, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/14-43\/v1#referee-response-358024","order":0,"name":"referee-response-358024","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Abed Saif Ahmed Alghauli<\/b>; \n<i>Posted: 17 Mar 2025<\/i>; \n<b>Responses to Peer Review Report of Laith R. Flaih, Cihan University-Erbil, Kurdistan Region, Iraq<\/b> \n<b>Dear Prof. Laith R. Flaih,<\/b> Thank you for your thoughtful review and for the insightful comments provided on our manuscript. Your feedback has been invaluable in guiding our revisions. \n<b>Comment 1:<\/b> Add novelty of this work at the end of the introduction section. \n<b>Response:<\/b> Thank you for your valuable feedback. In response, we have added a new paragraph at the end of the Introduction that highlights the significant contributions and novelty of our study. \n<b>Comment 2:<\/b> The justification for using K-means clustering could be elaborated. \n<b>Response:<\/b> Thank you for your valuable feedback regarding Section 2.4. We appreciate your suggestion to elaborate on the justification for using K-means clustering. In response, we have updated this section to provide a more in-depth discussion of the rationale behind selecting K-means as our clustering method \n<b>Comment 3:<\/b> Add the study limitations section. \n<b>Response:<\/b> Thank you for your insightful comment regarding the inclusion of a limitations and future work section. We recognize the importance of addressing the constraints of our study and outlining potential avenues for further research. In response to your feedback, we have added a dedicated section that discusses the limitations and proposes future research directions. \n<b>Comment 4:<\/b> While the manuscript is generally well written, minor issues should be revised, for example, in the conclusion section \u201cWestern African countries can address disparities in health resilience more effectively\u2026\u201d \n<b>Response:<\/b> Thank you for your thoughtful review and for pointing out the minor issues in the manuscript. We appreciate your attention to detail and have made the necessary corrections to the conclusion section. The reference to &quot;Western African countries&quot; has been updated to &quot;Western Asian&quot; to ensure accuracy and clarity in our findings We hope that these responses adequately address your concerns and further improve our manuscript. Thank you again for your valuable insights!","URL":"https:\/\/f1000research.com\/articles\/14-43\/v2#referee-comment-13577","order":1,"name":"referee-comment-13577","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.174669.r367984, Prof Ahmed Sultan Al-Hegami, Sana'a University, Sana'a, 17 Mar 2025, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/14-43\/v1#referee-response-367984","order":2,"name":"referee-response-367984","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Abed Saif Ahmed Alghauli<\/b>; \n<i>Posted: 17 Mar 2025<\/i>; \n<b>Responses to Peer Review Report of Prof. Ahmed Sultan Al-Hegami, Sana'a University, Sana'a, Yemen<\/b> \n<b>Dear Prof. Ahmed Sultan Al-Hegami,<\/b> Thank you for taking the time to review our manuscript and for your valuable feedback. Your insights have been instrumental in improving the quality of our work. \n<b>Comment 1:<\/b> I recommend summarizing the main contributions of the study more clearly. For instance, the introduction of an integrated MCDM and K-means framework is significant, as it combines multicriteria decision-making with dynamic clustering to address the limitations of global indices like the GHSI. This enables a nuanced analysis of health security in Western Asia (WA). Additionally, the study highlights the divergent priorities among WA regions, emphasizing the need for context-specific policy approaches. It effectively maps health security priorities and classifies countries, revealing intra-regional disparities and gaps in post-pandemic resilience. Lastly, the identification of gaps, along with data-driven recommendations, will be crucial for the ongoing development of health security in WA. \n<b>Response:<\/b> Thank you for your valuable feedback. In response, we have added a new paragraph at the end of the Introduction that succinctly summarizes the significant contributions of our study. This includes the introduction of the integrated MCDM and K-means framework, the analysis of intra-regional disparities, and the practical recommendations provided for enhancing health security in WA.  \n<b>Comment 2:<\/b> I recommend that the authors expand their discussion to better illustrate the implications of their findings using the methodology for enhancing health security in WA countries and shaping global health governance. For example, elaborate on how countries can prioritize investments and resource allocation. Provide more detail on tailored interventions for each cluster, emphasizing practical implementation and the rationale behind these strategies. \n<b>Response:<\/b> Thank you for your constructive feedback. In response, we have revised the first section, &quot;4.5 Implications and Recommendations.&quot; We have added a new paragraph at the end of this section to emphasize the practical implications of our study from two perspectives: improving health security in WA and advancing the Sustainable Development Goals (SDGs). This includes specific strategies for prioritizing resource allocation and tailored interventions for each cluster, with an emphasis on practical implementation and the rationale supporting these strategies.  \n<b>Comment 3:<\/b> Suggest areas for future research that could build on the findings. \n<b>Response:<\/b> Thank you for your insightful comment regarding the inclusion of a limitations and future work section. We recognize the importance of addressing the constraints of our study and outlining potential avenues for further research. In response to your feedback, we have added a dedicated section that discusses the limitations and proposes future research directions. This section outlines how future studies can build upon our findings, including exploring alternative methodologies, expanding the dataset, and examining additional regional contexts to enhance the robustness of health security analyses. We hope that these responses adequately address your concerns and further strengthen our manuscript. Thank you again for your valuable insights!","URL":"https:\/\/f1000research.com\/articles\/14-43\/v2#referee-comment-13578","order":3,"name":"referee-comment-13578","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was supported via funding from Deanship of Scienti\ufb01c Research, Prince Sattam bin Abdulaziz University [project number: PSAU\/2024\/R\/1445]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}