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JMIR Public Health Surveill
. 2024 Feb 15;10:e40491. doi: 10.2196/40491
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LEARNING FROM COVID-19: WHAT WOULD IT TAKE TO BE BETTER PREPARED IN THE EASTERN
MEDITERRANEAN REGION?

Lara Kufoof


LARA KUFOOF, MSC

1Project Management Office, Global Health Development, Eastern Mediterranean
Public Health Network, Amman, Jordan
Find articles by Lara Kufoof
1, Rana Hajjeh


RANA HAJJEH, MD

2Department of Program Management, Regional Office for the Eastern
Mediterranean, World Health Organization, Cairo, Egypt
Find articles by Rana Hajjeh
2, Mohannad Al Nsour


MOHANNAD AL NSOUR, PHD

3Global Health Development, Eastern Mediterranean Public Health Network, Amman,
Jordan
Find articles by Mohannad Al Nsour
3, Randa Saad


RANDA SAAD, MD

4Department of Research and Policy, Global Health Development, Eastern
Mediterranean Public Health Network, Amman, Jordan
Find articles by Randa Saad
4, Victoria Bélorgeot


VICTORIA BÉLORGEOT, MSC

5Regional Office for the Eastern Mediterranean, World Health Organization,
Cairo, Egypt
Find articles by Victoria Bélorgeot
5, Abdinasir Abubakar


ABDINASIR ABUBAKAR, MSC, MD

5Regional Office for the Eastern Mediterranean, World Health Organization,
Cairo, Egypt
Find articles by Abdinasir Abubakar
5, Yousef Khader


YOUSEF KHADER, SCD

6Department of Public Health, Faculty of Medicine, Jordan University of Science
and Technology, Irbid, Jordan
Find articles by Yousef Khader
6,✉, Salman Rawaf


SALMAN RAWAF, PHD

7Department of Primary Care and Public Health, School of Public Health at
Imperial College London, London, United Kingdom
Find articles by Salman Rawaf
7
Editors: Amaryllis Mavragani, Travis Sanchez
Reviewed by: Dong Keon Yon, Sokaina El Khamlichi
 * Author information
 * Article notes
 * Copyright and License information

1Project Management Office, Global Health Development, Eastern Mediterranean
Public Health Network, Amman, Jordan
2Department of Program Management, Regional Office for the Eastern
Mediterranean, World Health Organization, Cairo, Egypt
3Global Health Development, Eastern Mediterranean Public Health Network, Amman,
Jordan
4Department of Research and Policy, Global Health Development, Eastern
Mediterranean Public Health Network, Amman, Jordan
5Regional Office for the Eastern Mediterranean, World Health Organization,
Cairo, Egypt
6Department of Public Health, Faculty of Medicine, Jordan University of Science
and Technology, Irbid, Jordan
7Department of Primary Care and Public Health, School of Public Health at
Imperial College London, London, United Kingdom
✉

Corresponding Author: Yousef Khader yskhader@just.edu.jo

✉

Corresponding author.

Received 2022 Jun 23; Revision requested 2023 Sep 13; Revised 2023 Sep 24;
Accepted 2023 Nov 21; Collection date 2024.

©Lara Kufoof, Rana Hajjeh, Mohannad Al Nsour, Randa Saad, Victoria Bélorgeot,
Abdinasir Abubakar, Yousef Khader, Salman Rawaf. Originally published in JMIR
Public Health and Surveillance (https://publichealth.jmir.org), 15.02.2024.

This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work, first published in JMIR Public Health and
Surveillance, is properly cited. The complete bibliographic information, a link
to the original publication on https://publichealth.jmir.org, as well as this
copyright and license information must be included.

PMC Copyright notice
PMCID: PMC10871069  PMID: 38359418


ABSTRACT

The COVID-19 transmission in the Eastern Mediterranean Region (EMR) was
influenced by various factors such as conflict, demographics, travel and social
restrictions, migrant workers, weak health systems, and mass gatherings. The
countries that responded well to COVID-19 had high-level political commitment,
multisectoral coordination, and existing infrastructures that could quickly
mobilize. However, some EMR countries faced challenges due to political
instability and fragile health systems, which hindered their response
strategies. The pandemic highlighted the region’s weak health systems and
preparedness, fragmented surveillance systems, and lack of trust in information
sharing. COVID-19 exposed the disruption of access and delivery of essential
health services as a major health system fragility. In 2020, the World Health
Organization (WHO) conducted a global pulse survey, which demonstrated that the
EMR experienced the highest disruption in health services compared to other WHO
regions. However, thanks to prioritization by the WHO and its member states,
significant improvement was observed in 2021 during the second round of the
WHO’s National Pulse Survey. The pandemic underscored the importance of
political leadership, community engagement, and trust and emphasized that
investing in health security benefits everyone. Increasing vaccine coverage,
building regional capacities, strengthening health systems, and working toward
universal health coverage and health security are all priorities in the EMR.
Emergency public health plays a key role in preparing for and responding to
pandemics and biological threats. Integrating public health into primary care
and investing in public health workforce capacity building is essential to
reshaping public health and health emergency preparedness.

Keywords: COVID-19, integration, pandemic preparedness, primary health care,
public health


INTRODUCTION

The World Health Organization (WHO) was first alerted to cases of pneumonia of
unknown origin on December 31, 2019. By January 30, 2020, the WHO had declared
the novel coronavirus outbreak a public health emergency of international
concern [1]. The WHO’s Director General described this outbreak of COVID-19 as a
pandemic on March 11, 2020 [2]. Since then, many countries have announced
several restrictive public health measures to contain the virus, such as travel
bans, border restrictions, lockdowns, and mandatory quarantines [3]. As a
result, global economic growth was severely impacted, with the global gross
domestic product dropping by 6.7% in 2020 [4,5]. These measures, along with the
strain on resources due to the care of those infected with COVID-19, have
disrupted the access to and delivery of essential health services [6]. Even the
strongest health systems were heavily impacted and overwhelmed by the pandemic.

In 2020, the WHO conducted a global pulse survey to understand the impact of
COVID-19 on health systems. Almost 90% of the 105 engaged countries reported
interruptions in different services, ranging from routine and elective service
delivery to critical care, especially in low- and middle-income countries [6].
Financial constraints, supply chain disruptions, redirection of services to the
care of patients with COVID-19, and workforce unavailability affected access to
essential health services [5]. The pandemic revealed that no country was
sufficiently prepared against biological threats. Many risks and gaps were
identified in the current public health system that hindered countries’
capacities for response. These challenges and gaps called for increased
investments and stronger political will to enhance health emergency preparedness
[7].

In January 2020, the WHO activated its incident management system at all 3
levels of the organization (global, regional, and country levels), in line with
the WHO’s emergency response framework [3]. This system safeguards the
coordination of response actions during public health emergencies [3]. The WHO’s
Eastern Mediterranean Region (EMR) Incident Management Support Team (IMST) for
COVID-19 was activated on January 22, 2020, as a coordination mechanism
providing technical, strategic, and operational support to EMR countries. It has
been operational for over 2 years as the WHO’s longest-running IMST. On January
29, 2020, the first cases of COVID-19 were reported in the EMR, and by April 10,
2020, all 22 EMR countries and territories had reported COVID-19 cases [8].

The EMR is composed of 22 countries, categorized into 3 groups based on
socioeconomic development. Group 1 includes Bahrain, Kuwait, Oman, Qatar, Saudi
Arabia, and the United Arab Emirates (UAE), which have the most resources and
are all high-income countries. Group 2 includes Egypt, Iran, Iraq, Jordan,
Lebanon, Libya, Morocco, Palestine, Syria, and Tunisia, which have the next most
level of resources and are upper-middle– or lower-middle–income countries. Group
3 includes Afghanistan, Djibouti, Pakistan, Somalia, Sudan, and Yemen, which
have the least resources and are all either lower-middle– or low-income
countries [9]. The diversity of country incomes, emergencies, cultures, and
health system capacities in the EMR led to varying response capacities, COVID-19
knowledge and risk perceptions, and socioeconomic impacts, which have usually
been substantial [10].

This viewpoint highlights the challenges that faced EMR countries and their
achievements and lessons learned during the COVID-19 pandemic. It provides an
overview of the unequal COVID-19 vaccination coverage in the region and
discusses the methods and approaches of how to reshape public health in the
region and strengthen health emergency preparedness, providing recommendations
for the way forward.


CHALLENGES IN THE EMR

Over 50% of the countries in the region are affected by complex emergencies,
either directly or indirectly. The EMR holds 9 major humanitarian emergencies,
102 million people needing humanitarian assistance (37% of the global total),
and over 32 million refugees and internally displaced persons [8]. Political
instability, fragile health systems in some EMR countries, multiple disease
outbreaks, and poor accessibility and availability of basic health care services
have hampered the effectiveness and efficiency of the strategies adopted to
combat COVID-19 [11]. The COVID-19 response in the EMR was influenced by
multiple factors affecting viral transmission, such as state fragility and
conflict; demographics, as this region has a younger population than most; early
applications of travel and social restrictions, which limited spread at the
beginning of the pandemic; large numbers of migrant workers; mass gatherings;
and pilgrimage. Saudi Arabia made an unprecedented decision to downsize Hajj and
suspend Umrah, and other EMR countries implemented public health and social
measures. However, as “COVID-19 fatigue” set in, many countries loosened their
restrictive measures, which often affected the disease trend [10]. Although some
countries used and built on past health emergency experiences and systems, such
as Saudi Arabia applying lessons learned from the Middle East respiratory
syndrome experience [12,13], other countries were poorly prepared. For example,
6 EMR countries still lack national infection prevention and control guidelines,
and 5 (Afghanistan, Iraq, Libya, Palestine, and Tunisia) developed their
infection prevention and control guidelines in the past year only, with the
support of the WHO [14]. The COVID-19 pandemic has exposed gaps in the health
systems at multiple levels globally, even in high-income countries with strong
health systems. The Islamic Republic of Iran, for example, which had a strong
existing health care system, witnessed the largest rate of infections and deaths
[15].

The pandemic also highlighted the weak epidemiological capacity of the region
[13]. Data were generated but were not always analyzed, interpreted, and used as
evidence for action. Additionally, surveillance systems are fragmented, with
many being old and paper based [16]. There is also an issue of trusting the
shared information in the region because of the underreporting of some countries
or their hesitancy to share data [17,18].

Several countries within the EMR encountered obstacles in addressing the
COVID-19 pandemic. For instance, Pakistan struggled due to its fragile health
care infrastructure, characterized by shortages of health care professionals,
hospital beds, and essential medical equipment necessary for treating patients
with COVID-19 [19]. Similarly, Iran encountered difficulties in delivering
crucial medical and humanitarian supplies due to economic sanctions [20].
Additionally, Yemen and Syria faced difficulties managing the pandemic within
the context of ongoing conflict, displacement, and the challenges of maintaining
health care infrastructure and resources [21].


ACHIEVEMENTS AND LESSONS LEARNED

Despite the abovementioned challenges, there are many successes and lessons
learned. First, the EMR countries that succeeded in facing COVID-19 had
high-level political commitment and high-level multisectoral coordination.
Often, the heads of state or prime ministers led the multisectoral committees or
crisis committees, and this is an example of leadership. Also, regional
laboratories were quick to mobilize and build on previous infrastructure and
systems, such as those dedicated to influenza, polio, and other communicable
diseases [10,22]. Polio response teams were used in the field and played major
roles in COVID-19 vaccination and community mobilization [22]. Before the
COVID-19 pandemic, the region had expanded its influenza network due to the
influenza pandemic potential. The WHO supported the strengthening of influenza
surveillance and testing for respiratory infections. As a result, most countries
had the capacity to test for respiratory viruses in a timely manner, allowing
the successful use of reverse transcription polymerase chain reaction (RT-PCR)
tests for SARS-CoV-2 testing in influenza labs and national influenza centers
[23]. RT-PCR capacity for SARS-CoV-2 was expanded quickly to subnational levels
across all 22 EMR countries. The WHO ensured the quality of SARS-CoV-2 testing
by encouraging all countries to participate in the external quality assessment
program for national and subnational laboratories. The WHO’s logistics hub in
Dubai, UAE, which is the WHO’s largest repository of medical equipment and
supplies globally, was also an asset to the region as it moved thousands of tons
of supplies to the world and the region, including millions of RT-PCR tests
[24].

Due to a lack of high-quality data, epidemiologists had to consider a variety of
indicators [25], including testing rates and measuring the burden on health
systems-related indicators, such as hospital occupancy, intensive care unit
occupancy, bed occupancy rates, and case fatality ratios. These indicators
allowed the WHO to estimate the extent of the pandemic and the COVID-19
response. A very high case fatality ratio could mean that the country is not
reporting all cases, has a weak testing capacity or strategy, is poorly managing
cases, or may have different case fatality definitions. Therefore, it is
important to not only report data but to also interpret it for evidence-based
policy making [25].

Limited testing capacity, supplies, and infrastructure were other reasons
countries did not provide accurate data [26]. For example, Somalia and Djibouti
did not have RT-PCR capacity at the beginning of the pandemic; however, they
managed to procure the needed equipment [27,28]. Enhanced data reporting was
significantly increased due to improved laboratory capacity in the region, both
for testing and sequencing. The pandemic was an opportunity to build capacity in
genome sequencing, enabling the monitoring of the circulation of SARS-CoV-2
variants. Almost 15 countries in the region have genome sequencing capacity and
are able to support other countries without such capacity [16,29].

The pandemic resulted in several innovations, including apps, telemedicine,
hotlines, and e-clinics. More countries in the region used innovative solutions
to improve data collection, analysis, and dissemination to build strong
surveillance capacities and bridge information gaps. For example, using phone
companies’ mobility data to measure whether social interventions are
successfully implemented allowed for a better understanding of people’s mobility
patterns [30]. Another innovation included oxygen production and supply, as some
countries, such as Somalia, had no oxygen plants and no capacity to produce
oxygen [31]. Since Somalia did not have electric power, especially at the
subnational level, they built small solar plants and used solar power to
generate oxygen [31]. Similarly, there was a lot of stigma around mental health
in the region [32]. However, during the pandemic, 17 countries (Afghanistan,
Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Pakistan,
Palestine, Qatar, Saudi Arabia, Tunisia, UAE, and Yemen) incorporated mental
health and psychosocial support within their emergency response plans by
establishing hotlines, e-clinic consultations, and platforms to serve the remote
areas [33-35].

A total of 17 EMR countries (Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait,
Lebanon, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Sudan, Syria Arab
Republic, Tunisia, UAE, and Yemen) banned waterpipe smoking outdoors; however,
this was temporary [36]. In terms of the next steps and moving forward, the
region needs to take advantage of these innovations and opportunities to enhance
preparedness because they are feasible if there is the right commitment and
policies.

There was a need for epidemiological modeling to predict the potential impact of
public health and social measures, so the WHO established a modeling support
team and used data from countries that requested this assistance to help model
the progression of the pandemic [37]. COVID-19 also increased interest in
epidemiological studies on the ground, including seroprevalence studies to
understand population immunity levels or risk factors. The WHO provides standard
protocols for seroprevalence studies [38]. The WHO also worked with countries on
vaccine effectiveness studies, and many countries took part in clinical trials
on vaccines and therapeutics. Through this, countries built their capacities,
which is helpful for preparedness [16].

The positive side of the COVID-19 pandemic was that it revealed many of the gaps
and weaknesses in the public health system and how to bridge these gaps [7]. The
gaps include the nonflexibility of the health systems, workforce shortages,
health service fragmentation (primary care, secondary care, and public health),
and designs of health facilities. Additionally, misinformation was a significant
challenge during the pandemic, and the outdated “disease model” adopted by most
health systems does not meet the current needs of the population [39]. Indeed,
access and use of essential health services such as maternal and neonatal care
and routine immunization were highly affected [40]. The WHO conducted 3 surveys
[41,42] to measure the global disruption of essential health services. The
first, conducted between May 2020 and July 2020, showed that the EMR was the WHO
region with the highest disruption in health services due to health center
closures, stigma, and fear of transmission [41]. The WHO worked closely with
countries and published guidelines to address the impact of the pandemic on
essential health services, including how primary health care workers should be
trained to screen for COVID-19 [40]. The same survey conducted a year later, in
April 2021, demonstrated a significant improvement in the continuity of
essential health services, although they were still disrupted [42].


COVID-19 VACCINATION

With regard to vaccination, increasing vaccine coverage is a WHO priority for
some EMR countries. In less than a year, effective vaccines were developed,
tested, produced, and administered, which is an unprecedented success in the
history of infectious diseases [43]. The goal of the WHO for the EMR is to reach
40% coverage by the end of 2021 and 70% by mid-2022. A total of 9 countries
(Bahrain, Iran, Jordan, Kuwait, Morocco, Oman, Qatar, Saudi Arabia, Tunisia, and
the UAE) have so far achieved the end-year goal; however, 6 conflict-affected
countries (Afghanistan, Djibouti, Somalia, Sudan, Syria, and Yemen) are at less
than 10% coverage as of December 2021 [44,45]. As of October 21, 2023, a total
of 13,533,465,652 vaccine doses had been administered worldwide. Globally, the
persons vaccinated with a complete primary series per 100 population and the
persons vaccinated with at least 1 booster or additional dose per 100 population
were 66.18 and 31.9, respectively. In the EMR, the respective figures were 51.61
and 19.0, respectively. Within the EMR, the figures were lower, with 51.61
individuals per 100 population having completed a primary series and 19.0
individuals per 100 population having received at least one booster or an
additional dose [46].


RECOMMENDATIONS FROM THE WORLD HEALTH ASSEMBLY THAT BENEFIT THE EMR

Many committees presented their recommendations during the last World Health
Assembly, including the Independent Panel for Pandemic Preparedness (established
by the WHO and Global Preparedness Monitoring Board) and the Independent
Oversight Committee. The committees came up with over 200 recommendations [47],
but some of the key recommendations and lessons learned that will benefit the
EMR include the following:

 1. The importance of political leadership is what made a big difference in the
    countries that did better than others.

 2. Community engagement and community trust are important to prevent the
    pandemic’s spread and major economic collapse.

 3. “No one is safe until everyone is safe” is not just a slogan, because if any
    country does not implement prevention measures, the virus can travel to
    other areas of the world.

 4. The return on investment in health security is immense. How long does it
    take to receive a return on your investment? How much do we need to invest
    in pandemics? There were estimates done, and an early estimate of the cost
    of the pandemic was about US $11 trillion up to the middle of 2021; another
    US $10 trillion has been added since then. However, if you invest in
    preparedness, it will cost US $5 per person per year, so for a global
    population of 8 billion, it will only cost US $40 billion. To prompt action
    from policy makers, it is essential to present them with these monetary
    figures.


RESHAPING PUBLIC HEALTH

During the COVID-19 pandemic, different reasons have called on the EMR countries
to reshape their public health. Many countries in the EMR are experiencing new
dynamic population growth due to birth, migration, and aging populations.
Additionally, the region is facing what is termed a “brain drain.” For example,
Egypt has a shortage of doctors because 65% of Egyptian doctors leave the
country to seek opportunities abroad. Additionally, the world is witnessing
continuous technological advances in the biological, physical, and digital
spheres [48].

The burden of the disease in the region should also be considered. The Institute
of Health Metrics studied the number of deaths per 100,000 in 2019, per disease
per country, and showed that besides the known causes of death such as
communicable disease, noncommunicable disease, etc, the region has witnessed
other causes of mortality due to violence, mainly in Iraq, Syria, and Yemen.
Accordingly, in the region, the leading cause of death from 2000-2019 was
related to collective violence and interventions [49].

Furthermore, there is no specific data on public health personnel in the region.
Data are mainly available on medical health workers, and Saudi Arabia and Sudan
are the only 2 countries with registered public health professionals in the Arab
world. On the other hand, only a small proportion of the public health workforce
(public health consultants) are fully trained with 4-5 years of competency-based
training, and around one-quarter (public health practitioners) are qualified in
public health but without structured training. Therefore, the public workforce
in the region needs to be tackled in terms of skills, experience, and
foundational knowledge [50].

Investments in primary health care to mitigate the risks of future pandemics and
to maintain accessibility and delivery of essential health services during
emergencies [40]; investment in the health workforce, including training,
mobilization, and redistribution to sustain high-quality essential health
services delivery; and data management and surveillance are key elements of a
successful response [16]. These actions and initiatives can also expand and
reinforce health system capacities, providing an opportunity within the COVID-19
response for countries to reshape their health workforce and services and
improve health security for future health emergencies [7,40,51].

Integrating public health into primary health care is an essential approach to
reshaping public health and achieving preparedness. Primary care is the first
point of contact for the community with the health system; it must be available
24 hours a day and should provide services in a continuous, personalized, and
holistic way. Unfortunately, in many settings, primary health care focuses on
treating the illness rather than preventing it. Therefore, integrating public
health functions into the primary health care system is highly significant to
ensure disease prevention, health promotion and protection, and a proper
response to threats [39].

Accordingly, 6 models were identified by the WHO technical series on primary
care called “Closing the gaps between public health and primary care through
integration” to attain the integration of public health into primary health care
and provide a tool to help countries be prepared during threats and emergencies.
This, in turn, focuses the services on the population’s needs, achieving a
person-centered approach. These models can be applied either individually or in
combination, depending on the flexibility of the health systems, and they are
titled as follows [39]:

 1. Public health services are integrated into primary care

 2. Public health professionals and primary care providers are working together

 3. Comprehensive and proactive benefit packages that include public health

 4. Primary care services within public health settings

 5. Building public health incentives in primary care

 6. Multidisciplinary training of primary care staff in public health

With a focus on the first model, integrating public health professionals into
primary care, where they are involved in many public health functions, can be
easily achieved progressively. It is essential to understand that the primary
health team is complex and should not only include family medicine and freshly
graduated doctors; rather, it should include the public health workforce, such
as Field Epidemiology Training Program professionals. Additionally, building the
competencies of the public health workforce is crucial because, even though the
region has 2 public health academies—the International Academy of Public Health
and Weqaya Public Health Academy—most of the workforce is untrained [39,50].

Many aspects need to be considered when reshaping public health: (1) financial
allocation and establishing an independent national body for public health; (2)
investing in public health laboratories, whole genome sequencing, public health
analysis such as artificial intelligence, real-world data, real-world evidence,
research, and people; and (3) teaching for precision public health where people
are the center of health.

A hard lesson learned from this pandemic is that countries should not be
dependent on other countries to provide them with essential medicines and
vaccines. It is of great importance to strengthen health systems and work toward
universal health coverage and health security, as Dr Tedros Adhanom Ghebreyesus,
the Director General of the WHO, says that “Health security and global health
coverage are two sides of the same coin” [52]. Capacity building is the way
forward, including capacity building in integrated disease surveillance and in
ensuring the continuity of health services. Additionally, engaging all relevant
stakeholders, accelerating vaccine rollout, prioritizing COVID-19 response, and
investing in emergency preparedness and the health systems are essential.


CONCLUSION

The political instability and fragile health systems in some of the EMR
countries have hampered the effectiveness and efficiency of the strategies
adopted to combat the COVID-19 pandemic. The EMR IMST for COVID-19 pillars was
critical to the WHO’s role in coordinating the response during the pandemic.
Although multiple challenges affect the transmission of the virus in this
diverse region, there were many successes, and it is of great importance to
build on these successes and focus on building the human and regional capacities
as a way forward. Furthermore, focusing on public health is a key factor in
responding to pandemics and biological threats, with COVID-19 being a clear
example. The current health system faces many gaps and challenges, which can be
overcome by adopting different approaches—specifically, integrating public
health into primary care as an essential approach to reshape public health in
the region and be prepared against threats and emergencies.


RECOMMENDATIONS AND AREAS OF IMPROVEMENT

Several areas of improvement need to be taken into consideration at both the
national and regional levels to improve the response to future threats and
pandemics. Countries should develop and update a multisectoral emergency
preparedness plan and enhance government and political leadership capacity
toward biological threats. They must strengthen their health systems and work
toward universal health coverage and security. This can be achieved by
integrating public health into primary care as an essential approach to
reshaping public health through adopting 1 or more of the 6 models of
integration identified by the WHO. Moreover, there is a need to invest in
building human capacities, including epidemiologists; emergency responders;
community health workers; health economists; communication specialists; and most
crucially, health leaders. Countries should also work toward community
engagement and community trust by assessing people’s needs and engaging them in
the decision-making process because public health is about people, for people,
and by people. Finally, analyzing and interpreting collected data and using it
by policy makers is essential for action and decision-making.

On the other hand, different actions need to be taken at the regional level to
effectively control the spread of the pandemic. As the COVID-19 pandemic
demonstrated, certain countries have greater capacities than others in the
region and must facilitate cooperation, solidarity, and support. High-income
countries, for example, should ensure vaccine sharing, equity, and distribution
with low-income countries. Moreover, countries in the region can implement twin
programs where human resources can be shared across countries.


ABBREVIATIONS

EMR

Eastern Mediterranean Region

IMST

Incident Management Support Team

RT-PCR

reverse transcription polymerase chain reaction

UAE

United Arab Emirates

WHO

World Health Organization


FOOTNOTES

Conflicts of Interest: None declared.


REFERENCES

 * 1.WHO director-general's statement on IHR emergency committee on novel
   coronavirus (2019-nCoV) World Health Organization. 2020. [2024-01-24].
   https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on
   -ihr-emergency-committee-on-novel-coronavirus-(2019-ncov).[Accessed .
 * 2.Ghebreyesus TA. WHO director-general's opening remarks at the media
   briefing on COVID-19 - 11 March 2020. World Health Organization. 2020.
   [2024-01-24].
   https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-re
   marks-at-the-media-briefing-on-covid-19---11-march-2020 .
 * 3.Listings of WHO’s response to COVID-19. World Health Organization. 2021.
   [2024-01-24]. https://www.who.int/news/item/29-06
   -2020-covidtimeline.%5BAccessed .
 * 4.Szmigiera M. Share of Gross Domestic Product (GDP) lost as a result of the
   coronavirus pandemic (COVID-19) in 2020, by economy. Statista. 2024.
   [2022-01-01].
   https://www.statista.com/statistics/1240594/gdp-loss-covid-19-economy/#statisticContainer.[Accessed
   .
 * 5.Chi YL, Regan L, Nemzoff C, Krubiner C, Anwar Y, Walker D. Beyond COVID-19:
   a whole of health look at impacts during the pandemic response. Center for
   Global Development. 2020. [2024-01-24].
   https://www.cgdev.org/sites/default/files/PP1
   77-Beyond-COVID-scoping-paper.pdf .
 * 6.In WHO global pulse survey, 90% of countries report disruptions to
   essential health services since COVID-19 pandemic. WHO to roll out learning
   and monitoring tools to improve service provision during pandemic. World
   Health Organization. 2020. [2024-01-24].
   https://www.who.int/news/item/31-08-2020-in-who-global-pulse-survey-90-of-countries-report-disruptions-to-
   essential-health-services-since-covid-19-pandemic .
 * 7.Rose SM, Paterra M, Isaac C, Bell J, Stucke A, Hagens A, Tyrrell S,
   Guterbock M, Nuzzo JB. Analysing COVID-19 outcomes in the context of the 2019
   Global Health Security (GHS) index. BMJ Glob Health. 2021;6(12):e007581. doi:
   10.1136/bmjgh-2021-007581.
   https://gh.bmj.com/lookup/pmidlookup?view=long&pmid=34893478
   .bmjgh-2021-007581 [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 8.COVID-19 strategic preparedness and response plan: sustaining an effective
   response to end the acute phase of the pandemic and transitioning to recovery
   in WHO’s Eastern Mediterranean Region – 2022 edition. World Health
   Organization Regional Office for the Eastern Mediterranean. 2023.
   [2024-01-24].
   https://applications.emro.who.int/docs/WHOEMCSR513E-eng.pdf?ua=1 .
 * 9.Assessing national capacity for the prevention and control of
   noncommunicable diseases: report of the 2019 global survey. World Health
   Organization Regional Office for the Eastern Mediterranean. 2019.
   [2024-01-24]. https://www.who.int/publications/i/item/9789240002319 .
 * 10.Al-Mandhari AS, Brennan RJ, Abubakar A, Hajjeh R. Tackling COVID-19 in the
   Eastern Mediterranean Region. Lancet. 2020;396(10265):1786–1788. doi:
   10.1016/S0140-6736(20)32349-7. https://europepmc.org/abstract/MED/33220856
   .S0140-6736(20)32349-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 11.Brennan R, Hajjeh R, Al-Mandhari A. Responding to health emergencies in
   the Eastern Mediterranean Region in times of conflict. Lancet.
   2022;399(10332):e20–e22. doi: 10.1016/S0140-6736(20)30069-6.
   https://europepmc.org/abstract/MED/32135078 .S0140-6736(20)30069-6 [DOI] [PMC
   free article] [PubMed] [Google Scholar]
 * 12.Obied DA, Alhamlan FS, Al-Qahtani AA, Al-Ahdal MN. Containment of
   COVID-19: the unprecedented response of Saudi Arabia. J Infect Dev Ctries.
   2020;14(7):699–706. doi: 10.3855/jidc.13203.
   http://www.jidc.org/index.php/journal/article/view/32794457 . [DOI] [PubMed]
   [Google Scholar]
 * 13.Tackling infectious disease outbreaks in the Eastern Mediterranean Region.
   World Health Organization Regional Office for the Eastern Mediterranean.
   2020. [2024-01-24].
   https://applications.emro.who.int/docs/9789290224198-eng.pdf?ua=1 .
 * 14.COVID-19 pandemic response in the Eastern Mediterranean Region: progress
   report of the incident management support team, 2021. World Health
   Organization Regional Office for the Eastern Mediterranean. 2022.
   [2024-01-24]. https://iris.who.int/handle/10665/365838 .
 * 15.El-Jardali F. Impact of COVID-19 on health systems in the Mediterranean.
   IEMed Mediterranean Yearbook 2021. 2021. [2024-01-24].
   https://www.iemed.org/publication/impact-of-covid-19-on-health-systems-in-the-mediterranean/
 * 16.The work of WHO in the Eastern Mediterranean Region: annual report of the
   regional director 2020. World Health Organization Regional Office for the
   Eastern Mediterranean. 2021. [2024-01-24].
   https://www.emro.who.int/about-who/regional-dire ctor/rd-reports.html .
 * 17.Whittaker C, Walker PGT, Alhaffar M, Hamlet A, Djaafara BA, Ghani A,
   Ferguson N, Dahab M, Checchi F, Watson OJ. Under-reporting of deaths limits
   our understanding of true burden of COVID-19. BMJ. 2021;375:n2239. doi:
   10.1136/bmj.n2239. [DOI] [PubMed] [Google Scholar]
 * 18.COVID-19 pandemic response in the Eastern Mediterranean Region: 2020
   progress report of the incident management support team. World Health
   Organization Regional Office for the Eastern Mediterranean. 2021.
   [2024-01-24].
   https://applications.emro.who.int/docs/9789290226765-eng.pdf?ua=1 .
 * 19.Khalid A, Ali S. COVID-19 and its challenges for the healthcare system in
   Pakistan. Asian Bioeth Rev. 2020;12(4):551–564. doi:
   10.1007/s41649-020-00139-x. https://europepmc.org/abstract/MED/32837562 .139
   [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 20.Karimi A, Turkamani HS. U.S.-imposed economic sanctions on Iran in the
   COVID-19 crisis from the human rights perspective. Int J Health Serv.
   2021;51(4):570–572. doi: 10.1177/00207314211024912.
   https://journals.sagepub.com/doi/abs/10.1177/00207314211024912?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub0pubmed
   . [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 21.Alsabri M, Alhadheri A, Alsakkaf LM, Cole J. Conflict and COVID-19 in
   Yemen: beyond the humanitarian crisis. Global Health. 2021;17(1):83. doi:
   10.1186/s12992-021-00732-1.
   https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-021-00732-1
   .10.1186/s12992-021-00732-1 [DOI] [PMC free article] [PubMed] [Google
   Scholar]
 * 22.Contributions of the polio network to the COVID-19 response: turning the
   challenge into an opportunity for polio transition. World Health
   Organization. 2020. [2024-01-24].
   https://www.who.int/publications/i/item/9789240011533 .
 * 23.Health emergency preparedness after COVID-19: building for the future.
   World Health Organization. 2021. [2024-01-24].
   https://www.who.int/about/accountability/results/who-results-report-2020-mtr/featured-story-preparedness.%5BAccessed
   .
 * 24.Alsuwaidi AR, Al Hosani FI, ElGhazali G, Al-Ramadi BK. The COVID-19
   response in the United Arab Emirates: challenges and opportunities. Nat
   Immunol. 2021;22(9):1066–1067. doi: 10.1038/s41590-021-01000-5.
   https://www.nature.com/articles/s41590-021-01000-5
   .10.1038/s41590-021-01000-5 [DOI] [PubMed] [Google Scholar]
 * 25.Backhaus A. Common pitfalls in the interpretation of COVID-19 data and
   statistics. Inter Econ. 2020;55(3):162–166. doi: 10.1007/s10272-020-0893-1.
   https://europepmc.org/abstract/MED/32536714 .893 [DOI] [PMC free article]
   [PubMed] [Google Scholar]
 * 26.COVID-19 crisis response in MENA countries. Organisation for Economic
   Co-operation and Development. 2020. [2024-01-24].
   https://www.oecd.org/coronavirus/policy-responses/covid-19-crisis-response-in-mena-countries-4b366396/
 * 27.Responding to COVID-19 in Somalia: progress report: 6 months of resilience
   and strength. WHO Regional Office for the Eastern Mediterranean. 2020.
   [2024-01-24].
   https://applications.emro.who.int/docs/9789290223559-eng.pdf?ua=1 .
 * 28.Elhakim M, Tourab SB, Zouiten A. COVID-19 pandemic in Djibouti:
   epidemiology and the response strategy followed to contain the virus during
   the first two months, 17 March to 16 May 2020. PLoS One.
   2020;15(12):e0243698. doi: 10.1371/journal.pone.0243698.
   https://dx.plos.org/10.1371/journal.pone.0243698 .PONE-D-20-23350 [DOI] [PMC
   free article] [PubMed] [Google Scholar]
 * 29.COVID-19: WHO EMRO biweekly situation report #11. World Health
   Organization. 2021. [2024-01-24].
   https://www.emro.who.int/images/stories/coronavirus/documents/covid_19_bi_weekly_sitrep_11.pdf?ua=1
   .
 * 30.Grantz KH, Meredith HR, Cummings DAT, Metcalf CJE, Grenfell BT, Giles JR,
   Mehta S, Solomon S, Labrique A, Kishore N, Buckee CO, Wesolowski A. The use
   of mobile phone data to inform analysis of COVID-19 pandemic epidemiology.
   Nat Commun. 2020;11(1):4961. doi: 10.1038/s41467-020-18190-5. doi:
   10.1038/s41467-020-18190-5.10.1038/s41467-020-18190-5 [DOI] [PMC free
   article] [PubMed] [Google Scholar]
 * 31.Oxygen saves lives in Somalia on the path to UHC: country case study from
   the 2021 progress report on the implementation of the Global Action Plan for
   healthy lives and well-being for all (GAP) World Health Organization. 2021.
   [2024-01-24].
   https://www.who.int/news-room/feature-stories/detail/somalia2021.%5BAccessed
   .
 * 32.Eaton J, Rahman A, Gater R, Saxena S, Hammerich A, Saeed K. From adversity
   to resilience in the COVID-19 era: strengthening mental health systems in the
   Eastern Mediterranean Region. East Mediterr Health J. 2020;26(10):1148–1150.
   doi: 10.26719/2020.26.10.1148.
   https://applications.emro.who.int/emhj/v26/10/1020-3397-2020-2610-1148-1150-eng.pdf
   . [DOI] [PubMed] [Google Scholar]
 * 33.Mental health and psychosocial support. World Health Organization. 2023.
   [2023-09-21]. https://www.emro.who.int/mhps/mental_
   health_professionals.html.%5BAccessed .
 * 34.COVID-19 situation update for week 30 (19‒25 July 2020) World Health
   Organization. 2023. [2023-09-21]. https://www.emro.who.int
   /pandemic-epidemic-diseases/covid-19/covid-19-situation-update-for-week-30-1925-july-2020.html
   .
 * 35.Progress report on scaling up mental health care: a framework for action.
   World Health Organization Regional Office for the Eastern Mediterranean.
   2021. [2024-01-24].
   https://applications.emro.who.int/docs/EMRC68INFDOC3-eng.pdf .
 * 36.WHO report on the global tobacco epidemic 2021: addressing new and
   emerging products. World Health Organization. 2021. [2024-01-24].
   https://www.who.int/publications/i/item/9789240032095 .
 * 37.Adib K, Hancock PA, Rahimli A, Mugisa B, Abdulrazeq F, Aguas R, White LJ,
   Hajjeh R, Al Ariqi L, Nabeth P. A participatory modelling approach for
   investigating the spread of COVID-19 in countries of the Eastern
   Mediterranean Region to support public health decision-making. BMJ Glob
   Health. 2021;6(3):e005207. doi: 10.1136/bmjgh-2021-005207.
   https://gh.bmj.com/lookup/pmidlookup?view=long&pmid=33762253
   .bmjgh-2021-005207 [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 38.Coronavirus disease (COVID-19) technical guidance: the unity studies:
   early investigation protocols. World Health Organization. 2019. [2024-01-24].
   https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/early-inves
   tigations.%5BAccessed .
 * 39.Primary health care: closing the gap between public health and primary
   care through integration. World Health Organization. 2018. [2024-01-24].
   https://iris.who.int/handle/10665/326458 .
 * 40.Maintaining essential health services: operational guidance for the
   COVID-19 context: interim guidance, 1 June 2020. World Health Organization.
   2020. [2024-01-24].
   https://www.who.int/publications/i/item/WHO-2019-nCoV-essential_health_services
   -2020.2 .
 * 41.The impact of the COVID-19 pandemic on noncommunicable disease resources
   and services: results of a rapid assessment. World Health Organization. 2020.
   [2024-01-24]. https://www.who.int/publications/i/item/9789240010291 .
 * 42.Presentation of preliminary results of 2021 assessment on NCD service
   disruption during COVID-19 pandemic. World Health Organization. 2021.
   [2024-01-24].
   https://www.who.int/publications/m/item/presentation-of-preliminary-results-of-2021-assess
   ment-on-ncd-service-disruption-during-covid-19-pandemic.%5BAccessed .
 * 43.Abubakar A, Al-Mandhari A, Brennan R, Chaudhri I, Elfakki E, Fahmy K,
   Ghoniem A, Hajjeh R, Hamam I, Hasan Q, Hutin Y, Langar H, Musa N, Rashidian
   A, Samhouri D. Efforts to deploy COVID-19 vaccine in the WHO Eastern
   Mediterranean Region within the first 100 days of 2021. East Mediterr Health
   J. 2021;27(5):433–437. doi: 10.26719/emhj.21.024.
   https://applications.emro.who.int/EMHJ/V27/05/1020-3397-2021-2705-433-437-eng.pdf
   . [DOI] [PubMed] [Google Scholar]
 * 44.Statement by WHO’s regional director for the Eastern Mediterranean on
   COVID-19. World Health Organizaton. 2021. [2024-01-24].
   https://www.emro.who.int/media/news/who-regional-directors-statement-on-covid-19-22-december-2021.html
   .
 * 45.Hasan Q, Elfakki E, Fahmy K, Mere O, Ghoniem A, Langar H, Musa N, Attia R,
   Othman MM, Samhouri D, Chaudhri I, Abubakar A, Hajjeh R, Hutin YJ. Inequities
   in the deployment of COVID-19 vaccine in the WHO Eastern Mediterranean
   Region, 2020-2021. BMJ Glob Health. 2022;7(Suppl 4):e008139. doi:
   10.1136/bmjgh-2021-008139.
   https://gh.bmj.com/lookup/pmidlookup?view=long&pmid=35764354
   .bmjgh-2021-008139 [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 46.WHO coronavirus (COVID-19) dashboard. World Health Organization. 2023.
   [2023-11-02]. https://covid19.who.int/table .
 * 47.WHA74. World Health Organization. 2021. [2024-01-24].
   https://apps.who.int/gb/e/e_wha74.html .
 * 48.Kabbash I, El-Sallamy R, Zayed H, Alkhyate I, Omar A, Abdo S. The brain
   drain: why medical students and young physicians want to leave Egypt. East
   Mediterr Health J. 2021;27(11):1102–1108. doi: 10.26719/emhj.21.050. doi:
   10.26719/emhj.21.050. [DOI] [PubMed] [Google Scholar]
 * 49.GBD 2015 Eastern Mediterranean Region Collaborators Danger ahead: the
   burden of diseases, injuries, and risk factors in the Eastern Mediterranean
   Region, 1990-2015. Int J Public Health. 2018;63(Suppl 1):11–23. doi:
   10.1007/s00038-017-1017-y. https://europepmc.org/abstract/MED/28776238
   .10.1007/s00038-017-1017-y [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 50.Al-Mohaithef M, Javed NB, Elkhalifa AM, Tahash M, Chandramohan S, Hazazi
   A, Elhadi FEM. Evaluation of public health education and workforce needs in
   the kingdom of Saudi Arabia. J Epidemiol Glob Health. 2020;10(1):96–106. doi:
   10.2991/jegh.k.191123.001. https://europepmc.org/abstract/MED/32175716
   .j10/1/96 [DOI] [PMC free article] [PubMed] [Google Scholar]
 * 51.Petrey A, Baisden T. COVID-19: make it the last pandemic: the independent
   panel for pandemic preparedness and response. NZ Sci Rev. 2021;77(1-2):19.
   doi: 10.26686/nzsr.v77i1-2.7752.
   https://ojs.victoria.ac.nz/nzsr/article/view/7752 . [DOI] [Google Scholar]
 * 52.COVID-19 virtual press conference transcript - 21 October 2021. World
   Health Organization. 2021. [2024-01-24].
   https://www.who.int/publications/m/item/covid-19-virtual-press-conference-transcript---21-october-2021
   .

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 * Abstract
 * Introduction
 * Challenges in the EMR
 * Achievements and Lessons Learned
 * COVID-19 Vaccination
 * Recommendations from the World Health Assembly That Benefit the EMR
 * Reshaping Public Health
 * Conclusion
 * Recommendations and Areas of Improvement
 * Abbreviations
 * Footnotes
 * References


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