Estimating global public health security preparedness capacity: The contribution of SPAR and JEE.

Background: To promote transparency and mutual accountability in global public health security among WHO States Parties, Article 54 of the International Health Regulations (2005) (IHR) obliges State Parties to regularly report capacities to prevent, protect against, control, and provide a public health response to the international spread of disease. Two prominent tools for assessing capacities, a mandatory State Parties Annual Self-Assessment (SPAR) and a voluntary Joint External Evaluation (JEE), cover similar concepts and structure, but agreement between the tools has not been assessed in a long term global analysis. Methods: This ecological study compared quantitative capacity scores from 1445 indicator-matched paired observations from 108 SPAR and JEE assessments completed in the same year, by 93 States Parties, between 2016 and 2023. Mixed effects methods were used to estimate mean agreement for each indicator, comparing tool editions/years, regions, and income groups. Findings: Overall, SPAR scores were higher than JEE scores, with the least agreement observed with indicators scoring near Level 3-4 capacity. However, consistency between SPAR and JEE evaluations improved recently, particularly in the latest 2022-2023 editions where 25 of the 28 matched indicator capacity scores were not significantly different on average. Three indicators with significant score disagreement pertained to infection prevention and control, health-care association infection surveillance, and national IHR focal point functions. Interpretation: Improved alignment between SPAR and JEE, particularly in recent editions, combined with the identification of remaining indicator disagreement, strengthens the evidence base for continued improvement in these essential assessment tools.