The report, released Thursday, is the first comprehensive assessment of global health capabilities, giving countries an overall score based on several measures. Unlike other ratings, the Global Health Security Index benchmarks health security in the context of tools critical to fighting outbreaks, such as robust health systems, adherence to global norms, and political and security risks, including public confidence in government.

The United States does well in five of six preparedness categories but ranks 19^th — after Australia, Canada, Singapore and more than a half-dozen European countries — in an assessment of overall risk and vulnerability to biological threats. The factors driving down the U.S. score include the risks of social unrest and terrorism, and low public confidence in government. Liechtenstein ranked No. 1 on this measure.

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