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Assessing global preparedness for the next pandemic: development and application of an Epidemic Preparedness Index
  1. Ben Oppenheim,
  2. Mark Gallivan,
  3. Nita K Madhav,
  4. Naor Brown,
  5. Volodymyr Serhiyenko,
  6. Nathan D Wolfe,
  7. Patrick Ayscue
  1. Metabiota, San Francisco, California, USA
  1. Correspondence to Dr Ben Oppenheim; boppenheim{at}


Introduction Robust metrics for national-level preparedness are critical for assessing global resilience to epidemic and pandemic outbreaks. However, existing preparedness assessments focus primarily on public health systems or specific legislative frameworks, and do not measure other essential capacities that enable and support public health preparedness and response.

Methods We developed an Epidemic Preparedness Index (EPI) to assess national-level preparedness. The EPI is global, covering 188 countries. It consists of five subindices measuring each country’s economic resources, public health communications, infrastructure, public health systems and institutional capacity. To evaluate the construct validity of the EPI, we tested its correlation with proxy measures for preparedness and response capacity, including the timeliness of outbreak detection and reporting, as well as vaccination rates during the 2009 H1N1 influenza pandemic.

Results The most prepared countries were concentrated in Europe and North America, while the least prepared countries clustered in Central and West Africa and Southeast Asia. Better prepared countries were found to report infectious disease outbreaks more quickly and to have vaccinated a larger proportion of their population during the 2009 pandemic.

Conclusion The EPI measures a country’s capacity to detect and respond to infectious disease events. Existing tools, such as the Joint External Evaluation (JEE), have been designed to measure preparedness within a country over time. The EPI complements the JEE by providing a holistic view of preparedness and is constructed to support comparative risk assessment between countries. The index can be updated rapidly to generate global estimates of pandemic preparedness that can inform strategy and resource allocation.

  • health systems
  • public health
  • epidemics

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  • Handling editor Stephanie M Topp

  • Contributors BO, NB and PA conceived and designed the study. BO, MG, VS and NB acquired the data. BO, MG, NM, VS and PA drafted the article and BO, MG, NM, VS, NW and PA analysed the data and revised the article. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data necessary to replicate results—including data and code required to reproduce empirical analyses presented in this article—will be made available to researchers upon request.

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