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

Objectives: This study aimed to analyze and compare health security performance (HSP) between Gulf Cooperation Council and non-Gulf Cooperation Council countries within the Eastern Mediterranean Region (EMR) for 2019 and 2021, recognizing the critical role of health security in managing global health threats. Methods: The study utilized data from the Global Health Security Index (GHSI) for 2019 and 2021. Key health security priorities were identified using the entropy objective weighting method. The VIKOR (VIseKriterijumska Optimizacija I Kompromisno Resenje) method was employed to rank countries based on overall performance. K-means clustering was applied to group countries with similar health security profiles. Pearson's and Spearman's rank correlation coefficients were used to assess relationships between independent HSP indicators and overall performance scores. Results: A significant shift in health security priorities within the EMR was observed between 2019 and 2021, with prevention gaining prominence. Gulf Cooperation Council countries emphasized detection and reporting, while non-Gulf Cooperation Council countries prioritized health systems and prevention. Gulf Cooperation Council countries, particularly Qatar and Saudi Arabia, consistently demonstrated strong HSP. Conversely, non-Gulf Cooperation Council countries facing conflict and instability, such as Yemen, Somalia, and Syria, exhibited weaker performance. Health system capacity, prevention, detection and reporting, and risk environment showed robust correlations with overall HSP. Conclusion: This study underscores the necessity for tailored, adaptive policies to address HSP disparities across regions, highlighting investment in prevention, detection, and reporting. It stresses international collaboration, improved policy implementation, and ongoing research to enhance global health security systems across diverse contexts.