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Research Questions

  1. Where are potential future disease hot spots — which countries might be especially vulnerable to infectious disease outbreaks?
  2. How can the U.S. Department of Defense (DoD), the U.S. Department of Health and Human Services (HHS), other U.S. government agencies, and international partners set priorities for technical and funding support to countries that may be most vulnerable to disease outbreaks with transnational potential?

Recent high-profile outbreaks, such as Ebola and Zika, have illustrated the transnational nature of infectious diseases. Countries that are most vulnerable to such outbreaks might be higher priorities for technical support. RAND created the Infectious Disease Vulnerability Index to help U.S. government and international agencies identify these countries and thereby inform programming to preemptively help mitigate the spread and effects of potential transnational outbreaks.

The authors employed a rigorous methodology to identify the countries most vulnerable to disease outbreaks. They conducted a comprehensive review of relevant literature to identify factors influencing infectious disease vulnerability. Using widely available data, the authors created an index for identifying potentially vulnerable countries and then ranked countries by overall vulnerability score. Policymakers should focus on the 25 most-vulnerable countries with an eye toward a potential "disease belt" in the Sahel region of Africa.

The infectious disease vulnerability scores for several countries were better than what would have been predicted on the basis of economic status alone. This suggests that low-income countries can overcome economic challenges and become more resilient to public health challenges, such as infectious disease outbreaks.

Key Findings

Of the 25 Most-Vulnerable Countries, 22 Are in Africa, and the Other Three Are Afghanistan, Yemen, and Haiti

  • Conflict or recent conflict is present among more-vulnerable countries. Seven of the ten most-vulnerable countries are current conflict zones.
  • Of the 30 most-vulnerable countries, 24 form a solid, near-contiguous belt from the edge of West Africa to the Horn of Africa in Somalia — a disease hot spot belt. Were a communicable disease to emerge within this chain of countries, it could easily spread across borders in all directions.

The 25 Least-Vulnerable Countries Are in Europe, North America, and Asia-Pacific, with Robust Democracies, Economies, and Health Systems

  • The six least-vulnerable countries include all four Scandinavian countries, Germany, and Canada.
  • The 25 least-vulnerable countries tend to have larger medical workforces and medical expenditures; better health indicators; less corrupt and more-stable (usually democratic) governments; better human rights; and stronger economic development, transportation infrastructure, and technological sophistication.

A Broad Range of Factors Collectively Shapes a Country's Resilience to Infectious Diseases, Rather Than a Single Factor or Domain

  • A high vulnerability score alone does not necessarily condemn a country to poor outcomes with regard to disease outbreaks.
  • Targeted, timely, and culturally sensitive interventions in public health, health care, incident management, and governance, as well as prompt global aid response, can help in mitigating an infectious disease outbreak, as seen in the examples of Nigeria, Senegal, and Mali during the 2014 Ebola outbreak.

Recommendations

  • DoD, HHS, other U.S. government agencies, and other international partners should use this tool to inform their programming — to help identify vulnerable countries and set priorities for helping those countries build the capabilities they need to combat potential transnational disease outbreaks.
  • The U.S. government and its associated departments and agencies should work with governments of states that are particularly vulnerable in order to improve their public health systems (e.g., disease surveillance, laboratory testing, outbreak detection, rapid response teams for investigation and disease control measures) and medical care systems (e.g., professional training and certification, clinic and hospital care).
  • Exercises, including tabletop exercises, should be used to help countries better understand actions and actors, and the coordination needed among them, to best prepare systems to respond effectively to a disease threat that arises.
  • The international community should take more-extensive, preemptive measures to address the vulnerability at the country level in advance of future disease crises.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Developing a Framework to Assess Vulnerability

  • Chapter Four

    Results

  • Chapter Five

    Conclusions and Next Steps

  • Appendix A

    Overall Country Rankings

  • Appendix Country Bins for Missing Data Imputation

    Country Bins for Missing Data Imputation

This research was conducted within the International Security and Defense Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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