Analyzing Self-Evaluation Capacity Scores Related to Infectious Disease Control in International Health Regulations during the First Year of the COVID-19 Pandemic

Background: COVID-19 is hitting the world hard despite the requirement to establish minimum core capacity by the International Health Regulations (IHR) 2005. In addition, COVID-19 was most severe in countries reporting good IHR capacities, such as the US, UK, Germany, and France. This study aimed to identify changes in the average score of member countries' IHR self-evaluation capacity (e-SPAR) in 2020 compared to 2019, then analyze the factors that influenced it. For that purpose, first, we calculated the absolute difference between e-SPAR scores in 2019 and 2020 of 154 countries. Then Wilcoxon Sign-rank test was performed to identify its significance. After Chi-Square Test, Multiple Regression Analysis was applied to analyze the relationship between countries’ changes in e-SPAR scores and their COVID-19’s case fatality rate (CFR), Human Development Index, Civil Liberties, and Government Effectiveness. Results: Our findings showed that the average e-SPAR score in 2020 was significantly higher than in 2019. Of the 154 countries, the e-SPAR score of 98 countries (63.63%) was increased in 2020. Among this group, 63 countries (64.28%) were middle-income countries. Capacities about Risk Communication, National Health Emergency Framework, and Ports of entry were the three capacities that experienced the most significant increase. Meanwhile, among 56 of 154 countries (36.36%) whose scores did ​​​​not increase, 26 countries (46.42%) were high-income countries. The IHR coordination and National Focal Points, Food Safety, and Risk Communication were the only capacities that significantly decreased during the pandemic. Our model showed that COVID-19 CFR influenced the changes in e-SPAR scores of 154 countries (p<0.01), as well as the countries whose score increased (p<0.05), but not the countries whose e-SPAR score did not increase.Conclusion: We concluded that the COVID-19 pandemic is an alarm for countries to re-evaluate their capacities more carefully. Continues external evaluation approach like Joint External Evaluation (JEE) should be a necessary approach for future preparation.