High Global Health Security Index is a determinant of early detection and response to monkeypox: A cross-sectional study

Max Carlos Ramírez-Soto; Hugo Arroyo-Hernández

doi:10.1371/journal.pone.0307503

Peer Review History

Original SubmissionMay 14, 2024
24 Jun 2024 Decision Letter - Moises Leon Juarez, Editor PONE-D-24-19347High Global Health Security Index is a determinant of early detection and response to monkeypox: A cross-sectional studyPLOS ONE Dear Dr. Ramírez-Soto, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 08 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: We inform you that your work has been reviewed by the reviewers. Based on their comments and observations, we consider that you need to make rigorous changes for its possible publication in a journal. Below, I send you some suggestions that should be considered according to the reviewers' comments. Reviewer 1 It is a very well-documented and stated paper. However, a relevant previous paper proposes a relationship between monkeypox confirmed cases and deaths in a very similar period as the chosen by the one authors of this work (May 1, 2022, to May 15, 20,23). The authors of this paper found that the Pearson correlation test showed a significant positive linear relationship between total cases and total deaths with the GHSI. It is advisable to cite the direct aforegoing paper, which is considered to establish these relationships. Hasan MN, ArunSundar MS, Bhattacharya P, Islam A. Exploring the relationship between the Global Health Security Index and monkeypox: an analysis of preparedness and response capacities. International Journal of Surgery: Global Health. 2023 Jul 1;6(4). https://doi.org/10.1097/GH9.0000000000000229 Reviewer 2 The manuscript by Ramirez-Soto and Arroyo Hernandez presents an interesting analysis of the correlations between the GHS index and Mpox cases in different countries. Although the study is intriguing, I have major concerns. 1. What were the criteria for normalization to a scale of 0 to 100? 2. In Table 1, does “RIQ” stand for “IQR” in Spanish? 3. Does the international abbreviation stand for “until”? 4. Provide a more detailed description of each variable considered for correlation, especially AMR. 5. Describe variables that might differ regarding health safety capacities in the GHS index, specifically those implemented for COVID-19 versus MPXV. 6. Improve the quality of the figures. 7. Another study has evaluated the GHS index and Mpox preparedness. The authors should justify the differences and the novelty of this study compared to the previous one. Compare the results with other analyses published in articles like DOI: 10.1097/GH9.0000000000000229 and earlier reports by the authors in Peru. 8. The authors should clearly state the limitations in the conclusions. The claim that countries with a high GHS index can successfully respond to Mpox outbreaks is not sufficiently supported by the correlation data presented. More evidence is needed to confirm this claim. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: It is a very well documented and stated paper. However, there is a relevant previous paper which propose to establish a relation between total monkeypox confirmed cases and deaths in a very similar period of time as the chosen by the authors of this work (May 1, 2022 to May 15, 2023). Authors of this paper found that Pearson correlation test showed a significant positive linear relationship between total cases and total deaths with the GHSI. It should be highly advisable to cite maybe the direct aforegoing paper which considered to establish these relationships. Hasan MN, ArunSundar MS, Bhattacharya P, Islam A. Exploring the relationship between the Global Health Security Index and monkeypox: an analysis of preparedness and response capacities. International Journal of Surgery: Global Health. 2023 Jul 1;6(4). https://doi.org/10.1097/GH9.0000000000000229 Reviewer #2: The manuscript by Ramirez-Soto and Arroyo Hernandez presents an interesting analysis of the correlations between the GHS index and Mpox cases in different countries. Although the study is intriguing, I have major concerns. 1. What were the criteria for normalization to a scale of 0 to 100? 2. In Table 1, does “RIQ” stand for “IQR” in Spanish? 3. Does the international abbreviation stand for “until”? 4. Provide a more detailed description of each variable considered for correlation, especially AMR. 5. Describe variables that might differ regarding health safety capacities in the GHS index, specifically those implemented for COVID-19 versus MPXV. 6. Improve the quality of the figures. 7. Another study has evaluated the GHS index and Mpox preparedness. The authors should justify the differences and the novelty of this study compared to the previous one. Compare the results with other analyses published in articles like DOI: 10.1097/GH9.0000000000000229 and previous reports by the authors in Peru. 8. The authors should clearly state the limitations in the conclusions. The claim that countries with a high GHS index can successfully respond to Mpox outbreaks is not sufficiently supported by the correlation data presented. More evidence is needed to confirm this claim. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Jorge Alberto Álvarez Díaz Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". 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Revision 1
4 Jul 2024 Author Response Response to reviewers Title of the article: High Global Health Security Index is a determinant of early detection and response to monkeypox: A cross-sectional study Reference number: PONE-D-24-19347 Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: Thank you for your comments. 2. Thank you for uploading your study's underlying data set. Unfortunately, the repository you have noted in your Data Availability statement does not qualify as an acceptable data repository according to PLOS's standards. At this time, please upload the minimal data set necessary to replicate your study's findings to a stable, public repository (such as figshare or Dryad) and provide us with the relevant URLs, DOIs, or accession numbers that may be used to access these data. For a list of recommended repositories and additional information on PLOS standards for data deposition, please see https://journals.plos.org/plosone/s/recommended-repositories. Response: Thank you for your comments. 3. We note that Figure S1 in your submission contain map images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright. We require you to either present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or remove the figures from your submission: Response: Thank you for your comments. Figure S1 has been removed. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Response: Thank you for your comments. The references have been corrected. Reviewer #1: It is a very well-documented and stated paper. However, a relevant previous paper proposes a relationship between monkeypox confirmed cases and deaths in a very similar period as the chosen by the one authors of this work (May 1, 2022, to May 15, 20,23). The authors of this paper found that the Pearson correlation test showed a significant positive linear relationship between total cases and total deaths with the GHSI. It is advisable to cite the direct aforegoing paper, which is considered to establish these relationships. Hasan MN, ArunSundar MS, Bhattacharya P, Islam A. Exploring the relationship between the Global Health Security Index and monkeypox: an analysis of preparedness and response capacities. International Journal of Surgery: Global Health. 2023 Jul 1;6(4). https://doi.org/10.1097/GH9.0000000000000229. Response: Thank you for your comments. According Avi et al. The value proposition of the Global Health Security Index. BMJ Glob Health. 2020;5(10):e003648. Drawing simple correlations with countries’ overall scores does not account for the fact that these scores are meant to capture capacities spanning the breadth of the health security life cycle, from outbreak prevention at the source, to early detection, to rapid response. In other words, overall scores summarise country capacities across all categories. However, countries with high overall scores may still have low category-level, indicator-level and sub-indicator-level scores that more strongly influence outbreak-associated outcomes. Therefore, we encourage users wishing to analyse correlations between country scores and health outcomes to examine scores at more granular levels, adjust model weights to reflect country contexts and priorities and consider more nuanced outcomes when analysing countries’ performances during outbreaks. In these context, studies of Hasan et al. International Journal of Surgery: Global Health. 2023 Jul 1;6(4), and Ramírez-Soto MC. Monkeypox Outbreak in Peru. Medicina (Kaunas). 2023 Jun 6;59(6):1096, They only perform a correlation between the overall GHS index score and the Mpox case, and cannot represent the category, indicator and sub-indicator of the GHS index. Therefore, we hypothesized that the GHS indicators of detection, prevention, reporting, health system, rapid response, compliance with international standards and risk environment could explain global and regional Mpox case rates (category and sub-indicators). Thus, we aimed to analyze the correlation between the GHS index and Mpox case rates in different countries and regions. The evaluation of the GHS on Mpox is critical for transmission control and will provide important insights into the relationships between the GHS index and Mpox cases rates. In addition, in Discussion section, Limitations and strengths, We explain as a strength of the study the analysis of indicators and sub-indicators “According to the GHS Index Report, the overall scores summarize a country's capacity across all categories, but countries with high overall scores may have low scores at the category, indicator and sub-indicator levels. Therefore, scores at the category, indicator and sub-indicator levels have a greater influence on outbreak-related outcomes than overall scores. Because of this, an analysis of the GHS Index suggests that adjusted analyses of the correlation between country scores and health outcomes at the category, indicator and sub-indicator levels should be performed, as we did in the present study”. We have also included a paragraph in the Introduction section on the limitations of the GHS index overall scores. Reviewer #2: The manuscript by Ramirez-Soto and Arroyo Hernandez presents an interesting analysis of the correlations between the GHS index and Mpox cases in different countries. Although the study is intriguing, I have major concerns. Comment 1. What were the criteria for normalization to a scale of 0 to 100? Response: Thank you for your comments. We have explained these details in paragraph 2 of the Methods section “The overall score (0 to 100) for each country is a weighted sum of the scores in the six categories. The score for each category is given on a scale from 0 to 100. A score of 100 represents the most favourable health security conditions, but does not mean that a country has a perfect national health security situation. A score of 0 is the least favourable condition, but does not imply a lack of capacity. Each category is standardized on the basis of the sum of its underlying indicators and sub-indicators, and a weight is assigned to each. The weights in the model are dynamic and can be changed by the users. To facilitate reproducible comparisons across countries, categories and indicators, measurements have been normalized to a scale of 0 to 100”. Comment 2. In Table 1, does “RIQ” stand for “IQR” in Spanish? Response: Thank you for your comments. The sentences in Results section has been corrected. Comment 3. Does the international abbreviation stand for “until”? Response: Thank you for your comments. In the manuscript we have not used the abbreviation “until”. Comment 4. Provide a more detailed description of each variable considered for correlation, especially AMR. Response: Thank you for your comments. In Table S2 is shown GHS Index indicator and sub-indicators variables selected for the study. Comment 5. Describe variables that might differ regarding health safety capacities in the GHS index, specifically those implemented for COVID-19 versus MPXV. Response: Thank you for your comments. We included the GHS index categories associated with COVID-19 mortality. We did not find any other studies evaluating GHS index categories and indicators with COVID-19 cases. In the case of Mpox, the two previous studies only evaluated the overall GHS index score, which is not representative of the categories and indicators and has limitations. To date, there have been no further analyses of the GHS index categories and indicators for monkeypox case rates. This is explained in paragraph 2 of the introduction. Comment 6. Improve the quality of the figures. Response: Thank you for your comments. The figures attached in the PDF are shown with high resolution. Comment 7. Another study has evaluated the GHS index and Mpox preparedness. The authors should justify the differences and the novelty of this study compared to the previous one. Compare the results with other analyses published in articles like DOI: 10.1097/GH9.0000000000000229 and earlier reports by the authors in Peru. Response: Thank you for your comments. According Avi et al. The value proposition of the Global Health Security Index. BMJ Glob Health. 2020;5(10):e003648. Drawing simple correlations with countries’ overall scores does not account for the fact that these scores are meant to capture capacities spanning the breadth of the health security life cycle, from outbreak prevention at the source, to early detection, to rapid response. In other words, overall scores summarise country capacities across all categories. However, countries with high overall scores may still have low category-level, indicator-level and sub-indicator-level scores that more strongly influence outbreak-associated outcomes. Therefore, we encourage users wishing to analyse correlations between country scores and health outcomes to examine scores at more granular levels, adjust model weights to reflect country contexts and priorities and consider more nuanced outcomes when analysing countries’ performances during outbreaks. In these context, studies of Hasan et al. International Journal of Surgery: Global Health. 2023 Jul 1;6(4), and Ramírez-Soto MC. Monkeypox Outbreak in Peru. Medicina (Kaunas). 2023 Jun 6;59(6):1096, They only perform a correlation between the overall GHS index score and the Mpox case, and cannot represent the category, indicator and sub-indicator of the GHS index. Therefore, we hypothesized that the GHS indicators of detection, prevention, reporting, health system, rapid response, compliance with international standards and risk environment could explain global and regional Mpox case rates (category and sub-indicators). Thus, we aimed to analyze the correlation between the GHS index and Mpox case rates in different countries and regions. The evaluation of the GHS on Mpox is critical for transmission control and will provide important insights into the relationships between the GHS index and Mpox cases rates. In addition, in Discussion section, Limitations and strengths, We explain as a strength of the study the analysis of indicators and sub-indicators “According to the GHS Index Report, the overall scores summarize a country's capacity across all categories, but countries with high overall scores may have low scores at the category, indicator and sub-indicator levels. Therefore, scores at the category, indicator and sub-indicator levels have a greater influence on outbreak-related outcomes than overall scores. Because of this, an analysis of the GHS Index suggests that adjusted analyses of the correlation between country scores and health outcomes at the category, indicator and sub-indicator levels should be performed, as we did in the present study”. We have also included a paragraph in the Introduction section on the limitations of the GHS index overall scores. Comment 8. The authors should clearly state the limitations in the conclusions. The claim that countries with a high GHS index can successfully respond to Mpox outbreaks is not sufficiently supported by the correlation data presented. More evidence is needed to confirm this claim. Response: Thank you for your comments. Conclusion has been corrected “These finding suggest that countries with higher health security capacity on the GHS index are better equipped to detect more cases of Mpox in the current outbreak. Therefore, a robust health infrastructure and preventive measures to ensure an accessible health system are critical to detecting Mpox cases. To improve our understanding of the role of capacities in preparing for and responding to an outbreak, countries should continue to measure health security capacities using the GHS Index”. Attachments Attachment Submitted filename: Response to reviewers_R1_Correct.docx https://doi.org/10.1371/journal.pone.0307503.r002
8 Jul 2024 Decision Letter - Moises Leon Juarez, Editor High Global Health Security Index is a determinant of early detection and response to monkeypox: A cross-sectional study PONE-D-24-19347R1 Dear Dr. Ramírez-Soto, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Moises Leon Juarez Academic Editor PLOS ONE Additional Editor Comments (optional): Dear Dr. Ramírez Soto It is a pleasure to inform you about the decision made about his work: High Global Health Security Index is a determinant of aerial detection and response to monkeypox: A cross-sectional study". Based on the changes and recommendations that the reviewers made to your work, we have decided to accept your work for publication. Reviewers' comments: https://doi.org/10.1371/journal.pone.0307503.r003
Formally Accepted
17 Jul 2024 Acceptance Letter - Moises Leon Juarez, Editor PONE-D-24-19347R1 PLOS ONE Dear Dr. Ramírez-Soto, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Moises Leon Juarez Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0307503.r004

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