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The COVID-19 pandemic revealed that many countries are not equipped or able to effectively respond to emerging diseases. Doing better when the next dangerous pathogen emerges depends on understanding which capacities most effectively enable countries to prevent, detect and respond to epidemics and pandemics, and investing adequately in those capacities in advance. With that in mind, more than a dozen studies and reports have assessed the association between COVID-19 health outcomes and the leading country-level metrics of pandemic preparedness: States Parties Annual Report, the Joint External Evaluation (JEE) and the Global Health Security (GHS) Index. Most of the assessments have failed to find a clear association between COVID-19 mortality and infection rates and those pandemic preparedness metrics, 1–8 including those studies that account for under-reporting and factors that …