Health security disparities in the Eastern Mediterranean Region: A comparative analysis using an integrated MCDM and clustering approach

A study published in the Journal of Biosafety and Biosecurity assessed health security across 21 countries in the Eastern Mediterranean Region (EMR), including six Gulf Cooperation Council (GCC) nations and 15 non-GCC countries, using Global Health Security Index (GHSI) data from 2019 and 2021. To address the limitations of the conventional GHSI, which fails to fully reflect regional characteristics and conduct targeted subgroup comparisons, the researchers from Yemen and Saudi Arabia adopted an integrated framework combining the entropy weight method, VIKOR multi-criteria decision-making model and k-means clustering. It explores changes in health security performance, indicator priorities and regional disparities before and during the COVID-19 pandemic.

The team evaluated six core health security dimensions: prevention, detection and reporting, rapid response, health systems, compliance with international norms, and risk environments. “Our results reveal obvious shifts in indicator weights across the EMR amid the pandemic,” shares corresponding author Abed Saif Ahmed Alghawli. “In 2019, health system capacity was the most weighted indicator, while prevention gained greater importance in 2021 as a response to the public health crisis. Across the whole region, rapid response and risk environment indicators consistently had low weights, representing universal weaknesses in health security construction.”

Notably, sub-regional differences are prominent between GCC and non-GCC states. GCC countries with solid economic foundations and sound medical infrastructures prioritized detection and reporting as well as regulatory compliance, maintaining outstanding overall health security performance. “Qatar and Saudi Arabia ranked top two in the region in both years; Qatar even achieved a perfect score in 2021 and took the leading position,” says Ahmed Alghawli. “Most GCC nations stayed in high and medium performance clusters, though a few experienced mild performance declines.”

In contrast, non-GCC countries mainly focused on improving health systems and preventive measures. “Plagued by long-term conflicts, economic disparities, inadequate medical facilities and poor sanitation, their overall health security lagged far behind GCC counterparts,” says Ahmed Alghawli. “Ranking and clustering analyses show that most non-GCC countries fell into medium-low and low-performance groups.”

In particular, war-torn nations including Yemen, Somalia and Syria suffered sharp drops in nearly all health security indicators and remained at the bottom of the rankings. Although a small number of non-GCC countries saw slight improvements, their health systems still faced severe challenges.

Correlation analysis further proved that health system capacity, prevention, detection and reporting have strong positive correlations with overall health security performance, meaning investment in these fields can effectively lift national health security levels. By comparison, compliance with international norms shows a weak correlation with comprehensive performance, largely due to political instability and conflicts that hinder policy implementation in many EMR countries.

“This study verifies that economic strength and political stability are critical guarantees for robust health security,” says Ahmed Alghawli. “The EMR faces severe regional imbalance in public health development.” 

The team put forward targeted recommendations accordingly. All countries in the region should dynamically optimize health security strategies and prioritize enhancing rapid response capabilities and risk management. Differentiated policies should be formulated for GCC and non-GCC countries, and regional cooperation and resource support need to be strengthened to narrow the development gap. “Additionally, all nations shall improve policy execution mechanisms, consolidate basic medical infrastructures, and build more resilient health systems to cope with emerging infectious disease threats and various public health emergencies,” says Ahmed Alghawli. “Follow-up research can extend the research period, combine qualitative analysis and explore more assessment models to enrich studies on regional health security.”

Contact the author:

Abed Saif Ahmed Alghawli, Department of Computer Science, College of Sciences and Humanities, Building No: 16 A 3, Prince Sattam Bin Abdulaziz University, Al-Kharj 16700, Saudi Arabia. a.alghauly@psau.edu.sa

Funder:

This study was supported via funding from Deanship of Scientific Research, Prince Sattam bin Abdulaziz University [project number: PSAU/2024/R/1445].

Conflict of interest:

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

See the article:

Adel A. Nasser, Abed Saif Ahmed Alghawli, S. Saleh, Amani A.K. Elsayed. Health security disparities in the Eastern Mediterranean Region: A comparative analysis using an integrated MCDM and clustering approach. Journal of Biosafety and Biosecurity.Volume 7, Issue 1. 2025, Pages 38-51. https://doi.org/10.1016/j.jobb.2025.01.001.(https://www.sciencedirect.com/science/article/pii/S2588933825000020)