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The Joint External Evaluation tool is a World Health Organization-recommended method for evaluating countries' capacities under the International Health Regulations (2005) (IHR). It encompasses a national preparedness assessment process for public health threats and offers a structured framework for planning and implementing effective response measures. A tailored approach is necessary for Nigeria's federated system of government, in which most constitutional requirements for public health and associated issues are decentralized to the state level. The Nigeria Centre for Disease Control and Prevention (NCDC) developed an assessment tool to identify state-level health security gaps and support the development of improvement plans. With input from state and national public health leaders and legal experts, a legislative evaluation was conducted to determine specific IHR activities that could be implemented within the state's legal framework to accelerate the implementation of the Integrated Disease Surveillance and Response strategy and IHR. The resulting assessment instrument was piloted in Kano, Enugu, and Kebbi states, followed by a consensus meeting to identify additional areas for improvement. The revised tool contains 14 technical areas and 35 indicators tailored to implementing improvement plans. By recognizing the unique characteristics of subnational entities and their implications for pandemic preparedness, the tool provides an innovative approach to health security for countries with multilayered governance structures or geographic diversity. Conducting a subnational health security assessment is a crucial step in ensuring preparedness for public health threats and enhancing health security in Nigeria's federated system of government.

Objectives: The objective of this study was to examine the association between several country-level systemic indices and the deaths from COVID-19 across African countries. Method: Regression analyses were conducted to test the association between selected indices and deaths from COVID-19 across African countries. All tests were run at the α = 0.05 level of significance. Result: We found a statistically significant correlation between total COVID-19 deaths per million and Stringency Index ( p -value <0.001) and Human Development Index ( p -value <0.001). Multiple regression analysis showed that Stringency Index was the only variable that remained significant when other factors are controlled for in the model. Conclusion: Countries in Africa with poorer governance, inadequate pandemic preparedness and lower levels of development have unexpectedly fared better with respect to COVID-19 deaths mainly because of having a younger population than the countries with better indices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Owoyemi, Balogun, Okoro, Ndoro, Fasominu, Atanda and Abioye.)

Across the world, the level of pandemic preparedness varies and no country is fully prepared to respond to all public health events. The International Health Regulations 2005 require state parties to develop core capacities to prevent, detect, and respond to public health events of international concern. In addition to annual self-assessment, these capacities are peer reviewed once every 5 years through the voluntary Joint External Evaluation (JEE). In this article, we share Nigeria's experience of conducting a country-led midterm self-assessment using a slightly modified application of the second edition of the World Health Organization (WHO) JEE and the new WHO benchmarks tool. Despite more stringent scoring criteria in the revised JEE tool, average scoring showed modest capacity improvements in 2019 compared with 2017. Of the 19 technical areas assessed, 11 improved, 5 did not change, and 3 had lower scores. No technical area attained the highest-level scoring of 5. Understanding the level of, and gaps in, pandemic preparedness enables state parties to develop plans to improve health security; the outcome of the assessment included the development of a 12-month operational plan. Countries need to intentionally invest in preparedness by using existing frameworks (eg, JEE) to better understand the status of their preparedness. This will ensure ownership of developed plans with shared responsibilities by all key stakeholders across all levels of government.