The Manohar Parrikar Institute for Defence Studies and Analyses (MP-IDSA), New Delhi organised a virtual discussion on the Global Health Security (GHS) Index, on 12 January 2022. The discussion was held with members from NITI Ayog headed by Dr. Rakesh Sarwal, Additional Secretary. The discussion was chaired by Ambassador Sujan R. Chinoy, Director General, MP-IDSA, and was attended by Dr. Uttam Sinha, Col. (Dr.) DPK Pillay, Capt. Anurag Bisen (Indian Navy), Dr. Nihar R Nayak, Mr. Bipandeep Sharma along with the team from NITI Ayog and other faculty members of MP-IDSA.

Executive Summary

In October 2019, the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health, in collaboration with Economist Impact, released the GHS Index. It evaluates and compares health security and associated measures and skills required to deal with it in 195 nations. Pandemics and healthcare are two of the most serious risks to security and well-being. It revealed the fragility of the global healthcare infrastructure. The COVID-19 pandemic has driven the world’s overburdened healthcare system to cope and perform better. To fulfil the pressures of future health demands, India needs to invest more in its healthcare system. The GHS Index is a useful tool for detecting weaknesses in our healthcare system.

Detailed Report

Amb. Chinoy made the opening remarks and introduced to the audience the GHS Index report. While emphasizing the criticality of the healthcare system, he underlined that ‘no one is safe till everyone is safe.’ He emphatically observed that India has done remarkably well in not only vaccinating 70 per cent of the adult population but equally assisting a number of countries with medicines, vaccines and technical support, particularly in the neighbourhood. This follows India’s ‘first responder’ approach with its neighbouring countries. Amb. Chinoy further added that India must spend more on the healthcare system to meet future challenges of health. “We need to deepen our cooperation with countries like Japan, Australia and the US”, he remarked. Very candidly he stated that while the GHS Index is an interesting tool and possibly a guidepost in identifying gaps in the healthcare system but one needs to, at the same time, approach the methodology with a critical bent of mind especially when it comes to GHS Index performance evaluation of India’s capacity and response.

Col. (Dr.) DPK Pillay shared his views on the significance of health security. With historical evidences and timelines, Col. Pillay highlighted that more people were killed by the Spanish flu than those in World Wars I and II. He further stated that infectious diseases like HIV/AIDS, tuberculosis (TB) and malaria have always tested the health system. Like the chair he also emphasized that India had responded to the recent pandemic fairly well given the inherent challenges. In the past too, India has performed exceptionally to prevented Smallpox and Polio. Quoting Mahatma Gandhi, “Health is the real wealth, not the pieces of gold and silver”. Col. Pillay highlighted constitutional provisions related to health particularly Article 39, Article 42, and Article 47. Explaining the significance of Sustainable Development Goals (SDGs), he stressed on the objective of Goal 3 (Good Health and Well-Being) and that India should put all its resources to achieve it by 2030.

He also mentioned three dimensions of an effective healthcare system, i.e., robust health services and infrastructure, preventive measures and timely monitoring; and financial allocations. Col. Pillay further commented on the role of the government in the healthcare system and described various measures including Mission Indradhanush that guaranteed access to healthcare and health services. The government’s focus on community-based disease prevention, health promotion, nutrition promotion and preparedness for pandemic, surveillance, water and sanitation, etc are commendable, he observed. India has taught the world a lot in terms of disease surveillance and control. One of the striking policy interventions has been the capping of prices of essential drugs and medical devices.

Mr. Bipandeep Sharma summarized the methodology of the GHS Index. He explained that the Index is meant to measure health security capacities of individual states depending on various parameters. The 2021 GHS Index includes a number of indicators that have been revised or added into the framework since the last report in 2019. The current GHS Index consists of 171 questions (compared with 140 in 2019) grouped into 37 indicators across six overarching categories. The Index includes research for 195 countries.

Mr. Bipandeep Sharma diligently explained the performances of each country, which is a weighted sum of the six categories such as Prevention, Detection and Reporting, Rapid Response, Health System, Compliance and International Norms and Risk. Each category is scored on a scale of 0 to 100, in which 100 represents the most favorable health security conditions and 0 represents the least favorable conditions. Based on the GHS Index criteria, a score of 100 does not indicate that a country has perfect national health security conditions, and a score of 0 does not mean that a country has no capacity. Instead, the scores of 100 and 0 represent the highest or lowest possible score respectively. He then elaborated how each category is normalized on the basis of the sums of its underlying indicators and sub-indicators. He concluded his presentation by giving insightful views on sub-classification of these broad six categories on which the score of each country is calculated. Interjecting, Amb. Chinoy raised doubts about the credibility of such reports and raised some important questions on the politicization of the pandemic and some of the underlying motives behind such studies.

The NITI Aayog team hereon joined the discussion. Dr. Rakesh Sarwal, Additional Secretary, NITI Aayog, complimented MP-IDSA for organising the virtual discussion on Global Health Security Index. Dr. Sarwal an MBBS and a doctorate in public health from Johns Hopkins University in response to the question raised by Amb. Chinoy stated that NITI Aayog does not subscribe to the GHS Index report but treats it as a case study evaluating the methodology that governs the report. He clearly emphasized that “we can adopt our own best practices in the healthcare arena.” He also mentioned that NITI Aayog recently produced a booklet on home care model and Covid-19 management at home. He further commented that health affects the economy and society of a nation and brought attention on two issues:

1. How do the armed forces in India maintain public health in their cantonment and enclaves? What are the best practices that civilians should learn from the defence forces in maintaining the healthcare system?
2. How is the security of a nation interlinked to global health? How are other countries managing in terms of isolating their armed forces from the larger pandemic and yet maintaining their vigilance on the border and preparedness for eventualities? And, the role of armed forces in helping civilian authorities in managing pandemics?

For a discussion on the methodology of the GHS Index, Ms. Prachi Goswami, an intern at NITI Aayog made her presentation. Ms. Goswami commented that the GHS Index is western oriented. Working in a privileged environment, western thinking is not exposed to the ground reality of emerging economies like India. She mentioned the historical aspect of the GHS Index and particularly emphasized the political and security risk part of the Index. It includes societal risk, risk of terrorism, armed conflicts, governmental territorial control and international tensions. One of the pitfalls, she observed, was that the methodology focused on tactical infrastructure without taking into consideration the political and social determinants of public health. Resultantly, those countries that are ranked ‘good’ on the GHS Index have performed ‘bad’ in the case of Covid-19, for instance the US. But those countries ranked relatively poor on the GHS Index performed well on Covid-19 performance, for instance India. She conclusively stated that the GHS Index in not a conclusive or a complete study.

Mr. Madan Gopal, senior consultant, NITI Aayog, commented on the accuracy of the GHS Index. There is a major concern, he stated, of not submitting data by various institutions. He also mentioned that there has been a UN Security Council Resolution 2532 which recognizes that Covid-19 “is likely to endanger the maintenance of peace and security.” He also gave insights on how we can build indicators which can be measured and validated. He mentioned a Red Book of the military on public health and healthcare measures in armed forces cantonment areas.

Discussion, Comment and Question

Following this extensive discussion, Amb. Chinoy called upon Dr. Uttam Kumar Sinha, Centre Head, Non-Traditional Security Centre, MP-IDSA, for his remarks.

Dr. Sinha stated that while such studies are instructive, the need is to develop our own framework, parameters and responses. He also observed that human well-being approach will be critical in future. In an interconnected world, the interface between human and infectious diseases are likely to increase in the future. MP-IDSA given its knowledge base and expertise can look at the non-medical attributes to the pandemic such as domestic political responses. He mentioned two important concerns that need to be studied. These are economic policies and aspirations; and social, political and cultural norms. He also added that the Army Medical Corps has a long history of preventive measures with the Station Health officers (SHOs) who engage with Preventive & Social Medicine (PSM). Responding to Dr. Sinha’s suggestion, Dr. Sarwal added that the Armed Forces Medical College (AFMC) Pune can be requested to give inputs.

Amb. Chinoy responding to the presentations suggested a need for training human resources to meet future healthcare requirements. He also raised an important question on Atma Nirbhar Bharat in manufacturing medical devices. Responding to it, Mr. Madan Gopal completely agreed and Dr. Sarwal added that the Atma Nirbhar Bharat in the health sector is a high priority area for the government.

Report prepared by Mr. Pintu Kumar Mahla, Research Intern, Non-Traditional Security Centre, MP-IDSA.