The Global Health Security Index, published in October 2019 by public health experts (1), rated nations by their readiness to respond to infectious disease outbreaks. The United States ranked first, whereas New Zealand trailed in 35th place. Yet when the coronavirus disease 2019 (COVID-19) pandemic struck months later, these rankings turned out to be unreliable (2): The United States has to date reported the most deaths, whereas New Zealand fares considerably better. These results point to a fundamental challenge more than to the failings of a particular assessment approach. They may demonstrate that, for all our careful testing of Pharmaceuticals, researchers lack a solid evidence base regarding the effectiveness of health policies-against pandemics, and more widely.
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