Table 1. Summary of measures across 96 countries.
Measures
|
Minimum
|
Maximum
|
Mean
|
SD
|
Joint External Evaluation (JEE)a
|
|
|
|
|
|
Overall score
|
1.36
|
4.60
|
2.70
|
0.92
|
|
Prevention
|
1.00
|
5.00
|
2.75
|
1.10
|
|
Detection
|
1.00
|
5.00
|
3.23
|
0.89
|
|
Response
|
1.07
|
4.93
|
2.59
|
1.06
|
|
Other areas
|
1.00
|
5.00
|
2.30
|
1.20
|
Covid-19 performanceb
|
|
|
|
|
|
Covid-19 fatality rate
|
6.00
|
94115.00
|
16036.88
|
23844.31
|
|
Number of Covid-19 infections per million
|
0.20
|
1915.00
|
256.84
|
434.54
|
|
Number of Covid-19 deaths per million
|
3324.00
|
3233165.00
|
276323.48
|
466535.29
|
Infectious diseases performancec
|
|
|
|
|
|
Influenza and pneumonia deaths (per 100,000 people)
|
2.05
|
246.59
|
69.29
|
56.64
|
|
New HIV infection (per 1,000 uninfected population)
|
0.01
|
8.62
|
0.85
|
1.62
|
|
Tuberculosis incidence (per 100,000 population)
|
0.00
|
486.50
|
145.38
|
144.69
|
|
Malaria incidence (per 1,000 population at risk)
|
0.04
|
21.13
|
2.09
|
2.85
|
|
Hepatitis B surface antigen (HBsAG) prevalence among children under 5 years old (%)
|
41.00
|
99.00
|
86.66
|
13.75
|
|
Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds (%)
|
4.00
|
99.00
|
78.58
|
22.58
|
|
Pneumococcal conjugate 3rd dose (PCV3) immunization coverage among 1-year-olds (%)
|
3.00
|
99.00
|
81.25
|
18.05
|
|
Human papillomavirus (HPV) immunization coverage among 15-year-old girls (%)
|
0.00
|
99.00
|
51.80
|
28.20
|
Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) indicatorsd
|
|
|
|
|
|
Overall SDGs (Global Index Score)
|
37.70
|
83.00
|
60.60
|
10.10
|
|
Mean of overall SDGs except SDGs 3
|
38.65
|
82.15
|
60.45
|
9.60
|
|
Goal 1. No poverty
|
0.00
|
100.00
|
78.36
|
28.69
|
|
Goal 2. Zero hunger
|
14.70
|
83.20
|
50.00
|
13.06
|
|
Goal 3. Good health and well-being
|
21.80
|
96.70
|
62.96
|
20.06
|
|
Goal 4. Quality education
|
4.80
|
99.30
|
62.23
|
26.60
|
|
Goal 5. Gender equality
|
24.60
|
89.40
|
59.43
|
16.15
|
|
Goal 6. Clean water and sanitation
|
28.90
|
98.30
|
68.43
|
17.32
|
|
Goal 7. Affordable and clean energy
|
0.00
|
94.20
|
53.26
|
30.72
|
|
Goal 8. Decent work and economic growth
|
21.90
|
92.70
|
60.94
|
16.32
|
|
Goal 9. Industry, innovation and infrastructure
|
0.80
|
92.80
|
29.36
|
23.78
|
|
Goal 10. Reduce inequalities
|
0.00
|
100.00
|
56.31
|
23.05
|
|
Goal 11. Sustainable cities and communities
|
26.40
|
97.30
|
65.00
|
16.20
|
|
Goal 12. Responsible consumption and production
|
28.90
|
93.70
|
71.94
|
12.48
|
|
Goal 13. Climate action
|
23.30
|
95.80
|
80.14
|
13.90
|
|
Goal 14. Life below water
|
10.70
|
65.20
|
48.04
|
9.28
|
|
Goal 15. Life on land
|
25.70
|
90.40
|
60.35
|
12.35
|
|
Goal 16. Peace, justice and strong institutions
|
36.70
|
92.90
|
63.04
|
13.17
|
|
Goal 17. Partnerships for the goals
|
0.00
|
100.00
|
60.38
|
14.24
|
|
3.8. UHC service coverage index
|
25.00
|
89.00
|
58.01
|
16.53
|
|
3.8. Catastrophic health expenditure (exceeding 10% of total consumption expenditure)
|
0.20
|
544.20
|
9.05
|
9.04
|
|
3.8. Catastrophic health expenditure (exceeding 25% of total consumption expenditure)
|
0.10
|
22.20
|
2.40
|
3.47
|
Potential Joint External Evaluation (JEE) indicators
|
|
|
|
|
|
Trade
|
321.00
|
10.00
|
81.35
|
51.80
|
|
Median per-capita Income
|
15725.00
|
47.00
|
3069.33
|
4627.51
|
|
Economic Freedom (score out of 10)
|
8.71
|
4.45
|
6.68
|
0.92
|
|
Civil society participation
|
9.00
|
1.00
|
4.59
|
1.88
|
|
Ratification of 18 International Human Rights Treaties
|
13.00
|
1.00
|
3.76
|
2.53
|
|
Current health expenditure (% of GDP)
|
16.89
|
2.14
|
6.15
|
2.87
|
|
Domestic general government health expenditure as percentage of general government expenditure
|
23.60
|
1.80
|
8.83
|
4.84
|
|
Trust in government
|
84.63
|
17.15
|
51.43
|
19.83
|
|
Trust in government (confidence in police total)
|
7.62
|
4.52
|
6.28
|
0.84
|
|
Trust in government (trust worthiness and confidence)
|
6.46
|
2.27
|
4.17
|
0.83
|
|
Trust in government (public trust in politicians)
|
6.42
|
1.59
|
3.37
|
1.19
|
|
Political stability index (by the Global Economy)
|
1.53
|
-0.27
|
0.42
|
0.52
|
|
Financial Globalization indices
|
0.70
|
0.00
|
0.20
|
0.22
|
|
Growth rates of household expenditure or income per capita
|
8.00
|
-4.00
|
2.08
|
2.52
|
|
Proportion of people living below 50 percent of median income
|
25.00
|
4.00
|
13.33
|
5.34
|
|
Proportion of population reporting having felt discriminated against, by grounds of discrimination, sex and disability
|
28.30
|
5.40
|
19.68
|
6.66
|
|
Social security rate
|
38.20
|
0.00
|
19.24
|
9.52
|
|
2019 Civil society organization sustainability index
|
5.70
|
2.50
|
4.41
|
0.70
|
Covariatee
|
|
|
|
|
|
Population ages 65 and above (% of total population)
|
1.00
|
28.00
|
7.30
|
6.43
|
|
Urbanization rate
|
-1.23
|
5.43
|
2.41
|
1.50
|
Note: aJEE scores were collected from the WHO Strategic Partnership Portal from 2016 to 2019. bCovid-19 performance data were collected from Worldometer as of 9 July 2021. cInfectious diseases performance data were collected from World Health Rankings 2018 and World Health Statistics 202.dSDG and UHC data were collected from Sustainable Development Solution Network and United Nations. eCovariate data were collected from World Bank 2019 and World Factbook 2020.
Table 2. Adjusted association between Joint External Evaluation (JEE) scores and Covid-19 performance across 96 countries.
JEE scores
|
COVID-19 fatality ratea
|
Number of COVID-19 infections per millionb
|
Number of COVID-19
deaths per milliona
|
β
|
P-value
|
β
|
P-value
|
β
|
P-value
|
JEE scorec
|
-0.151
|
0.418
|
0.338*
|
0.016
|
0.275
|
0.137
|
Prevention
|
-0.086
|
0.663
|
0.338
|
0.021
|
0.213
|
0.282
|
Detection
|
-0.109
|
0.503
|
0.176
|
0.169
|
0.101
|
0.538
|
Response
|
-0.158
|
0.370
|
0.303*
|
0.027
|
0.197
|
0.267
|
Other areas
|
-0.297
|
0.120
|
0.348*
|
0.016
|
0.383*
|
0.042
|
Note: *p<0.05. a Adjusted by the proportion of population age 65 and above (% of total population) and urbanization rate. bAdjusted by urbanization rate. The JEE scores were collected from the WHO Strategic Partnership Portal from 2016 to 2019. The JEE score is ranged from 1 (no capacity) to 5 (substantial capacity) across 48 indicators. These indicators are divided into four sections: prevention, detection, response, and other areas. We used the average score for each four section and the overall average score of four sections as the final JEE scorec. For Covid-19 performance, the number of cases (cumulative count of detected and laboratory confirmed positive cases), the number of deaths (cumulative number of deaths among detected cases), and the number of deaths per one million population were extracted from Worldometer as of 9 July 2021. Covid-19 fatality rate was calculated as proportion of the number of deaths out of the number of cases. The Covid-19 infections per million was calculated as the number of cases per population in million. The number of Covid-19 deaths per million was calculated as the number of deaths per population in million.
Table 3. Association between Joint External Evaluation (JEE) scores and other infectious diseases performance across 96 countries.
Other infectious diseases performance
|
JEE scores
|
β
|
P-value
|
Influenza and pneumonia deaths (per 100,000 people)a
|
JEE scorec
|
-0.315*
|
0.016
|
Prevention
|
-0.397**
|
0.004
|
Detection
|
-0.241*
|
0.037
|
Response
|
-0.276*
|
0.026
|
Other areas
|
-0.278*
|
0.039
|
New HIV infection (per 1,000 uninfected population)b
|
JEE scorec
|
-0.118
|
0.307
|
Prevention
|
-0.075
|
0.517
|
Detection
|
-0.151
|
0.190
|
Response
|
-0.114
|
0.323
|
Other areas
|
-0.123
|
0.285
|
Tuberculosis incidence (per 100,000 population) b
|
JEE scorec
|
-0.186
|
0.071
|
Prevention
|
-0.167
|
0.105
|
Detection
|
-0.197
|
0.056
|
Response
|
-0.221*
|
0.031
|
Other areas
|
-0.148
|
0.153
|
Malaria incidence (per 1,000 population at risk) b
|
JEE scorec
|
-0.281*
|
0.038
|
Prevention
|
-0.239
|
0.079
|
Detection
|
-0.347*
|
0.010
|
Response
|
-0.221
|
0.105
|
Other areas
|
-0.326*
|
0.015
|
Hepatitis B surface antigen (HBsAG) prevalence among children under 5 years old (%)b
|
JEE scorec
|
-0.078
|
0.450
|
Prevention
|
-0.091
|
0.382
|
Detection
|
-0.073
|
0.480
|
Response
|
-0.075
|
0.469
|
Other areas
|
-0.085
|
0.414
|
|
|
|
|
Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds (%)b
|
JEE scorec
|
-0.037
|
0.723
|
Prevention
|
-0.044
|
0.675
|
Detection
|
-0.052
|
0.617
|
Response
|
-0.007
|
0.943
|
Other areas
|
-0.073
|
0.481
|
Measles-containing-vaccine second-dose (MCV2) immunization coverage by the nationally recommended age (%)b
|
JEE scorec
|
0.506***
|
<0.001
|
Prevention
|
0.542***
|
<0.001
|
Detection
|
0.461***
|
<0.001
|
Response
|
0.494***
|
<0.001
|
Other areas
|
0.510***
|
<0.001
|
Pneumococcal conjugate 3rd dose (PCV3) immunization coverage among 1-year-olds (%)b
|
JEE scorec
|
0.252*
|
0.025
|
Prevention
|
0.234*
|
0.038
|
Detection
|
0.205
|
0.070
|
Response
|
0.284*
|
0.011
|
Other areas
|
0.205
|
0.070
|
Human papillomavirus (HPV) immunization coverage among 15-year-old girls (%)b
|
JEE scorec
|
-0.117
|
0.502
|
Prevention
|
-0.023
|
0.894
|
Detection
|
-0.028
|
0.872
|
Response
|
-0.026
|
0.883
|
Other areas
|
-0.115
|
0.512
|
Note: ***p<0.001, **p<0.01, *p<0.05. aData were collected from the World Health Rankings in 2018. bData were collected from the World Health Statistics in 2020. The JEE scores were collected from the WHO Strategic Partnership Portal from 2016 to 2019. The JEE score is ranged from 1 (no capacity) to 5 (substantial capacity) across 48 indicators. These indicators are divided into four sections: prevention, detection, response, and other areas. We used the average score for each four section and the overall average score of four sections as the final JEE scorec.
Table 4. Association between Covid-19 and influenza and pneumonia performance and potential Joint External Evaluation (JEE) indicators across 96 countries.
Potential JEE indicators
|
COVID-19 fatality ratea
|
Number of COVID-19 infections per millionb
|
Number of COVID-19 deaths per milliona
|
Influenza and pneumonia mortality rate per 100,000 a
|
β
|
P-value
|
β
|
P-value
|
β
|
P-value
|
β
|
P-value
|
1. Globalization
|
Trade
|
-0.033
|
0.802
|
-0.005
|
0.968
|
-0.013
|
0.919
|
0.004
|
0.969
|
2. Variables on High Income Countries
|
Median per-capita Income
|
-0.336
|
0.118
|
0.063
|
0.656
|
0.034
|
0.874
|
-0.049
|
0.742
|
Economic Freedom
(score out of 10)
|
-0.085
|
0.645
|
0.057
|
0.682
|
-0.030
|
0.875
|
-0.020
|
0.875
|
Civil society participation
|
-0.001
|
0.995
|
0.046
|
0.714
|
0.072
|
0.675
|
0.274*
|
0.022
|
Ratification of 18 International Human Rights Treaties
|
-0.096
|
0.529
|
0.297*
|
0.015
|
0.447*
|
0.002
|
-0.155
|
0.151
|
3. Health System Capacity
|
Current health expenditure (% of GDP)
|
0.047
|
0.718
|
-0.098
|
0.373
|
-0.144
|
0.275
|
-0.014
|
0.879
|
Domestic general government health expenditure as percentage of general government expenditure
|
-0.211
|
0.177
|
0.105
|
0.412
|
0.239
|
0.161
|
-0.189
|
0.089
|
4. Political Leadership
|
Trust in government
|
-0.272
|
0.348
|
-0.468
|
0.104
|
-0.410
|
0.210
|
-0.368*
|
0.023
|
Trust in government (confidence in police total)
|
-0.344
|
0.494
|
-0.022
|
0.951
|
0.109
|
0.865
|
-0.501
|
0.082
|
Trust in government (trust worthiness and confidence)
|
-0.169
|
0.289
|
0.098
|
0.444
|
0.034
|
0.837
|
-0.045
|
0.697
|
Trust in government (public trust in politicians)
|
-0.195
|
0.184
|
0.030
|
0.810
|
-0.013
|
0.932
|
-0.193
|
0.059
|
5. Context overlooked
|
Political stability index (by the Global Economy)
|
-0.065
|
0.761
|
-0.119
|
0.495
|
-0.182
|
0.427
|
-0.065
|
0.678
|
6. Degree of National Wealth
|
Financial Globalization indices
|
-0.225
|
0.284
|
0.020
|
0.909
|
0.223
|
0.317
|
0.002
|
0.989
|
7. Equalities
|
Growth rates of household expenditure or income per capita
|
-0.155
|
0.475
|
0.036
|
0.834
|
-0.147
|
0.523
|
0.002
|
0.986
|
Proportion of people living below 50 percent of median income
|
-0.008
|
0.952
|
-0.038
|
0.747
|
0.061
|
0.662
|
0.087
|
0.337
|
Proportion of population reporting having felt discriminated against, by grounds of discrimination, sex and disability
|
-0.357
|
0.294
|
-0.322
|
0.365
|
-0.250
|
0.563
|
0.106
|
0.447
|
8. Social security
|
Social security rate
|
-0.054
|
0.769
|
0.125
|
0.420
|
0.035
|
0.849
|
0.155
|
0.201
|
9. Civil Society Capacity
|
2019 Civil society organization sustainability index
|
0.273
|
0.233
|
0.003
|
0.984
|
0.218
|
0.347
|
-0.171
|
0.296
|
Note: *p<0.05. aAdjusted population ages 65 and above (% of total population) and urbanization rate. bAdjusted urbanization rate. For Covid-19 performance, the number of cases (cumulative count of detected and laboratory confirmed positive cases), the number of deaths (cumulative number of deaths among detected cases), and the number of deaths per one million population were extracted from Worldometer as of 9 July 2021. Covid-19 fatality rate was calculated as proportion of the number of deaths out of the number of cases. The Covid-19 infections per million was calculated as the number of cases per population in million. The number of Covid-19 deaths per million was calculated as the number of deaths per population in million. For potential JEE indicators, we collected the data in 2021 from the official websites of international organizations such as United Nations, World Bank, United Nations Human Rights Office of the High Commissioner, Organization for Economic Cooperation and Development, Sustainable Development Solution Network, the Global Economy, Trading Economics, Family Health International, United States Agency for International Development, International Center for Not-for-profit Law, and World Factbook Urbanization.
Table 5. Association between Covid-19 and influenza and pneumonia performances and Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) indicators across 96 countries.
SDGs and UHC indicators
|
COVID-19 fatality ratea
|
Number of COVID-19 infections per million b
|
Number of COVID-19 deaths per milliona
|
Influenza and pneumonia mortality rate per 100,000 b
|
β
|
P-value
|
β
|
P-value
|
β
|
P-value
|
β
|
P-value
|
Overall SDGs (Global Index Score)
|
-0.504
|
0.060
|
0.088
|
0.584
|
0.093
|
0.692
|
-0.451*
|
0.021
|
Mean of overall SDGs except SDGs 3
|
-0.490
|
0.064
|
0.070
|
0.656
|
0.120
|
0.601
|
-0.378
|
0.051
|
Goal 1. No poverty
|
-0.172
|
0.335
|
-0.057
|
0.652
|
-0.132
|
0.392
|
-0.148
|
0.258
|
Goal 2. Zero hunger
|
-0.386*
|
0.030
|
0.144
|
0.233
|
-0.312
|
0.075
|
0.034
|
0.797
|
Goal 3. Good health and well-being
|
-0.335
|
0.157
|
0.181
|
0.253
|
-0.136
|
0.502
|
-0.656***
|
<0.001
|
Goal 4. Quality education
|
-0.510*
|
0.015
|
0.113
|
0.415
|
0.013
|
0.944
|
-0.319*
|
0.037
|
Goal 5. Gender equality
|
-0.087
|
0.609
|
0.069
|
0.496
|
0.172
|
0.233
|
-0.187
|
0.125
|
Goal 6. Clean water and sanitation
|
-0.076
|
0.681
|
-0.127
|
0.193
|
0.004
|
0.978
|
0.190
|
0.154
|
Goal 7. Affordable and clean energy
|
-0.134
|
0.576
|
0.148
|
0.349
|
-0.022
|
0.914
|
-0.579***
|
<0.001
|
Goal 8. Decent work and economic growth
|
-0.430*
|
0.007
|
-0.079
|
0.464
|
-0.430*
|
0.007
|
0.050
|
0.677
|
Goal 9. Industry, innovation and infrastructure
|
-0.110
|
0.560
|
0.006
|
0.962
|
-0.183
|
0.252
|
-0.111
|
0.417
|
Goal 10. Reduce inequalities
|
0.006
|
0.964
|
0.061
|
0.511
|
0.041
|
0.721
|
-0.098
|
0.305
|
Goal 11. Sustainable cities and communities
|
-0.121
|
0.507
|
-0.023
|
0.838
|
0.024
|
0.877
|
-0.301*
|
0.022
|
Goal 12. Responsible consumption and production
|
0.027
|
0.859
|
-0.010
|
0.926
|
0.128
|
0.325
|
0.032
|
0.774
|
Goal 13. Climate action
|
-0.066
|
0.613
|
0.029
|
0.752
|
0.206
|
0.060
|
0.151
|
0.104
|
Goal 14. Life below water
|
0.197
|
0.117
|
-0.053
|
0.557
|
0.019
|
0.864
|
-0.128
|
0.161
|
Goal 15. Life on land
|
-0.168
|
0.181
|
0.148
|
0.102
|
0.233*
|
0.028
|
0.188*
|
0.036
|
Goal 16. Peace, justice and strong institutions
|
-0.307
|
0.059
|
0.044
|
0.701
|
-0.125
|
0.375
|
-0.187
|
0.117
|
Goal 17. Partnerships for the goals
|
0.305*
|
0.013
|
-0.043
|
0.630
|
0.098
|
0.359
|
-0.023
|
0.802
|
3.8. UHC service coverage index
|
-0.092
|
0.659
|
0.067
|
0.654
|
-0.101
|
0.600
|
-0.441*
|
0.003
|
3.8. Catastrophic health expenditure (exceeding 10% of total consumption expenditure)
|
0.060
|
0.721
|
0.009
|
0.948
|
0.020
|
0.904
|
0.285*
|
0.025
|
3.8. Catastrophic health expenditure (exceeding 25% of total consumption expenditure)
|
-0.019
|
0.911
|
0.027
|
0.840
|
0.022
|
0.892
|
0.317*
|
0.012
|
Note: ***p<0.001, *p<0.05. aAdjusted population ages 65 and above (% of total population) and urbanization rate. bAdjusted urbanization rate. For Covid-19 performance, the number of cases (cumulative count of detected and laboratory confirmed positive cases), the number of deaths (cumulative number of deaths among detected cases), and the number of deaths per one million population were extracted from Worldometer as of 9 July 2021. Covid-19 fatality rate was calculated as proportion of the number of deaths out of the number of cases. The Covid-19 infections per million was calculated as the number of cases per population in million. The number of Covid-19 deaths per million was calculated as the number of deaths per population in million. The SDGs and UHCs indicators were collected from Sustainable Development Solution Network and United Nations.