Objective   To analyze differences in the indicator framework of the Global Health Security Index (GHSI) and the scores of GHSI indicators for 195 contracting countries of International Health Regulations 2005 (IHR2005) between 2019 and 2021.

  Methods   Yearly GHSI evaluation reports and the data on 195 contracting countries of IHR2005 on GHSI indicator scores for years of 2019 and 2021 were downloaded from official GHSI website (https://www.ghsindex.org) and changes in GHSI indicator framework and contracting country-specific scores of GHSI indicators were analyzed. Paired T-test was used to compare between-year differences in and correlations of country-specific scores of GHSI indicators. General linear regression was adopted to assess the collinearities and correlations between total score and scores of primary/secondary indicators of GHSI for 195 contracting countries of IHR2005 in 2021.

  Results  In 2021, the average GHSI score was 38.9 (in a scale with 5 categories and the maximum score of 100) for the 195 contracting countries of IHR2005 nearly the same as that (40.2) of 2019; none of the 195 contracting countries was assessed as having the GHSI score of the optimum grade (the scores of > 80) and 66.7% of the countries were scored below 40, with a median score of 34.9. Compared to that of 2019, the GSHI 2021 index framework was supplemented with 3 secondary indicators, 11 tertiary indicators, and 31 questions. The results of paired T-test showed that the average score of GHSI for the 195 contracting countries in 2021 was increased by 0.1 point against that of 2019, but the difference was not statistically significant (P > 0.05). In comparison with those in 2019, following average scores decreased significantly for primary indicators of preventing the emergence or spread of pathogens (reduced by 0.6, t = – 2.413; P < 0.05) and rapidly responding to/reducing disease transmission (by 4.0, t = – 9.402; P < 0.05), secondary indicators of zoonosis prevention (by 4.8, t = – 6.590; P < 0.001) and trade and travel restrictions (by 58.3, t = – 33.158; P < 0.001). There were strong correlations between country-specific scores of secondary indicators of 2019 and those of 2021, except for the score of trade and travel restrictions (r = 0.117) and the score of implementing response plan (r = 0.237) . General linear regression analysis showed that there was no collinearity among the country-specific scores of 6 primary indicators in 2021, but the total scores of all indicators were significantly correlated with the scores of 6 primary indicators (P < 0.05 for all).

  Conclusion   Based on the assessment using GHSI scores, none of the 195 IHR2005 contracting countries is well prepared for the next probable disease pandemic and the ability to prevent and respond to public health emergencies needs to be improved for the countries.