Spatial distribution of COVID-19 importation risk in South Asia against health emergency preparedness capacity and vulnerability

Abstract

The 2019 novel coronavirus outbreak has become a global security threat that requires both national and regional level preparedness and response mechanism. This study aims to assess the relative risk of importation of COVID-19 against the capacity and vulnerability of South Asian countries, specifically the member countries (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) of the South Asian Association for Regional Cooperation (SAARC).Capacity of the South Asian countries to detect and respond to COVID-19 outbreak was determined using the WHO International Health Regulations (IHR) Monitoring and Evaluation Framework. Assessment includes the average scores of the indicators from all capacities, excluding those of the capacities on food safety, chemical events, and radiation emergency. Vulnerability of these countries to such type of disease has been determined by the Infectious Disease Vulnerability Index. Prediction of the risk of case importation is based on the data on volume of air travel departing from airports in top ten COVID-19 infected countries and directed to the countries of South Asia. Number of infected individuals in each of the country included all confirmed cases recorded until March 04, 2020 in order to calculate the relative risk of case importation.The study presents a comparative analysis among the countries based on their risk, capacity and vulnerability. Among the South Asian countries, India, the country with highest importation risk has highest capacity to respond to outbreaks. Afghanistan is the most vulnerable country which has lowest risk of case importation, whereas it has the second lowest capacity. On the other hand, Nepal has the lowest capacity with moderate risk. Bhutan shows no risk of case importation. IHR indicator analysis indicates highest vulnerable countries need to focus more on the improvement of their capacity on health service provision, legislation and financing, risk communication, and points of entry.