This paper reports finding a significant positive correlation globally between countries’ SPAR scores that indicate their capacities to deal effectively with public health risks and events and their COVID-related morbidity and mortality. Significance disappears in most cases when examined regionally. The authors offer minimal speculation as to the reasons for the unexpected finding, but sensibly suggest both additional factors, not currently assessed by SPAR, and further research.

Abstract
The International Health Regulations (IHR) is a critical legal tool that ensures and improves the capacity of all signatories, or States Parties, to prevent detect, assess, notify, and respond to public health risks and acute events of domestic and international concern. States Parties of the IHR assess their capacities and report annually to the World Health Assembly on the implementation status of these regulations using the Self-Assessment Annual Reporting Tool (SPAR). This paper examines the relationship between total average SPAR scores and COVID-19 morbidity and mortality. A positive significant correlation was observed between total average SPAR score and log values of COVID-19 cases and deaths per 100,000 population. Nevertheless, when examined by World Health Organization regions, this positive significant correlation remained only for a few, signalling that regional dynamics and factors may not be adequately captured by SPAR scores. In addition to the State Parties assessment, a community and civil society inclusive IHR monitoring mechanism is recommended for a more comprehensive assessment.

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