Better pandemic preparedness does correlate with lower COVID-19 mortality

Paradoxically, many countries with strong pandemic preparedness have reported high coronavirus disease 2019 (COVID-19) mortality. After adjusting for country under-reporting by using total excess mortality estimates, and age distributions by using indirect standardization, we find the resulting comparative mortality ratios are predicted by pandemic preparedness. Countries with higher scores on the Global Health Security Index had significantly lower COVID-19 mortality (r(192) = -.32, p<.001). These findings can help inform and prioritize future pandemic preparedness work.