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# BackgroundThis study aimed to evaluate the association between countries’ self-reported International Health Regulations (IHR) capacity and their COVID-19 control outcomes.# MethodsScores from the countries’ 2019 self-assessment report (State Party Self-Assessment Annual Reporting, SPAR) were used to represent countries’ core capacities. Two scales were used to represent countries’ COVID-19 control outcomes: “governmental response to COVID-19,” which included case public health (PH) measure intervals, case-PH measure speeds, government response stringency; and scale “COVID-19 outbreak progress within the country,” which included days between the first global and domestic cases, number of case growing weeks, and percentage of case growing weeks between 01 January 31 May, 2020. One hundred and seventy-four countries with COVID-19 data were included in the analysis. The human development index (HDI), health workforce density (HWD), health expenditure (HE), and international travel volume (ITV) were collected as controls. Chi-square and logistic regression analyses were carried out.# ResultsCountries with high SPAR scores responded significantly earlier, but 49.46% of countries with high and very high HDI implemented public health measures within a month of the first global case, whereas 20% of countries implemented PH measures after there was already a domestic case. Compared with low ITV countries, countries with high ITV had a 15 times greater risk of early importation of COVID-19 cases and a greater risk of having more weeks over which case numbers increased. However, countries with low HE and SPAR scores as health service provision were at significantly higher risk of community outbreak escalation.# ConclusionsTo some extent, countries’ COVID-19 control outcomes were reflected by their SPAR scores. However, SPAR do not measure the effectiveness of communication mechanisms between health professionals and political leaders in the activation of response systems. The country-based health expertise and health system is crucial to limiting further viral spread in the community.

Exploring association between countries’ self-reported International Health Regulations core capacity and COVID-19 control outcomes