The 2021 Global Health Security (GHS) Index: Aotearoa New Zealand's improving capacity to manage biological threats must now be consolidated.

The 2021 Global Health Security (GHS) Index Report was published on 8 December 2021. With an average country score of 38.9 out of a possible 100 points, global scores are essentially unchanged from 2019. Despite experience with the COVID-19 pandemic, no country is adequately prepared for future biological threats. No country scored above 75.9 and the scores of the bottom 11 States have all fallen since 2019. Aotearoa New Zealand, however, has substantially improved its country score, rising to 13th in the world at 62.5/100. This gain is partly driven by consolidation of capabilities developed and deployed in response to COVID-19. This is promising progress, but a lot more can be done to ensure legacy benefits from the pandemic response, notably through the proposed restructuring of the health system (Pae Ora (Healthy Futures) Bill). In this viewpoint article, we discuss this recent further development of the GHS Index, highlight the global results for 2021, delve into New Zealand's progress, and discuss what more is needed.

Optimizing Island Refuges against global Catastrophic and Existential Biological Threats: Priorities and Preparations.

Human civilization is vulnerable to global catastrophic biological threats and existential threats. Policy to mitigate the impact of major biological threats should consider worst-case scenarios. We aimed to strengthen existing research on island refuges as a mitigating mechanism against such threats by considering five additional factors as well as recent literature on catastrophic risks and resilience. We also analyzed the performance of potential refuge islands during early phases the COVID-19 pandemic. Using a composite indicator (scored from 0-1) based on 14 global macroindices, we present analysis supporting Australia (0.71), New Zealand (0.64), and Iceland (0.58) as the leading candidate island nation refuges to safeguard the survival of humanity and a flourishing technological civilization from the threat of a catastrophic pandemic. Data from the COVID-19 pandemic supports this finding where islands have performed relatively well. We discuss the persisting weaknesses of even the best candidate refuges and the growing literature describing what preparations such a refuge should ensure to enhance resilience. Refuge preparations by Australia and New Zealand, in particular, may additionally provide some immunity against winter-inducing catastrophes such as global nuclear war. Existing disaster resilience frameworks such as the Sendai framework could be worded to mandate preventive measures against global catastrophic and existential threats. The issue of island refuges against certain global catastrophic risks should be raised at relevant international political summits.

Proof-of-concept calculations to determine the health-adjusted life-year trade-off between intravitreal anti-VEGF injections and transmission of COVID-19.

BACKGROUND: Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID-19 pandemic, in order to minimize the risk of disease transmission. METHOD: We performed probability calculations to estimate COVID-19 infection status and likelihood of disease transmission among neovascular age-related macular degeneration patients and health-care workers during anti-VEGF procedures, at various community prevalence levels of COVID-19. We then applied the expected burden of COVID-19 illness and death expressed through health-adjusted life-years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti-VEGF injections were not performed. RESULTS: Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID-19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID-19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5-43%). CONCLUSION: Unless COVID-19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID-19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.