• Martin Cs Wong, Junjie Huang, Sunny H Wong, and Yuen-Chun TeohJeremyJOffice of Global Engagement Chinese University of Hong Kong, Hong Kong SAR 999077, China.Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China..
• The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR 999077, China.
• J R Soc Med. 2021 Mar 1; 114 (3): 121131121-131.

ObjectivesWe examined if the WHO International Health Regulations (IHR) capacities were associated with better COVID-19 pandemic control.DesignObservational study.SettingPopulation-based study of 114 countries.ParticipantsGeneral population.Main Outcome MeasuresFor each country, we extracted: (1) the maximum rate of COVID-19 incidence increase per 100,000 population over any 5-day moving average period since the first 100 confirmed cases; (2) the maximum 14-day cumulative incidence rate since the first case; (3) the incidence and mortality within 30 days since the first case and first COVID-19-related death, respectively. We retrieved the 13 country-specific International Health Regulations capacities and constructed linear regression models to examine whether these capacities were associated with COVID-19 incidence and mortality, controlling for the Human Development Index, Gross Domestic Product, the population density, the Global Health Security index, prior exposure to SARS/MERS and Stringency Index.ResultsCountries with higher International Health Regulations score were significantly more likely to have lower incidence (β coefficient -24, 95% CI -35 to -13) and mortality (β coefficient -1.7, 95% CI -2.5 to -1.0) per 100,000 population within 30 days since the first COVID-19 diagnosis. A similar association was found for the other incidence outcomes. Analysis using different regression models controlling for various confounders showed a similarly significant association.ConclusionsThe International Health Regulations score was significantly associated with reduction in rate of incidence and mortality of COVID-19. These findings inform design of pandemic control strategies, and validated the International Health Regulations capacities as important metrics for countries that warrant evaluation and improvement of their health security capabilities.

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