Epidemic and pandemic-prone diseases: 2020 in retrospect
In 2020, the world had experienced one of the most devastating pandemics in recent history. The current COVID-19 pandemic is simply more than a health crisis, and it is affecting the lives, economies and livelihoods of billions of people around the world. This new virus is unprecedented in our lives and demands that the international community works together in solidarity to control the pandemic and its devastating consequences.
The first cases of COVID-19 were reported in the Eastern Mediterranean Region on 29 January 2020 among travellers coming from Wuhan, China. In 10 weeks, the virus had spread to all 22 countries and territories, despite collective efforts by Member States to implement strict public health and social measures. By the end of the year, approximately 5 million cases had been reported, including 121 778 associated deaths from all 22 countries of the Region, revealing a case–fatality ratio (CFR) of 2.5%. Islamic Republic of Iran registered the highest number of cases and fatalities, followed by Iraq and Pakistan.
WHO continues to support countries of the Region to scale up their preparedness and response interventions and bring the COVID-19 pandemic under control. Besides the pandemic, WHO continued to support countries in the Region to enhance their capacities to prevent, prepare for, detect and respond to other public health threats posed by emerging and pandemic-prone diseases. In 2020, 10 major outbreaks by other emerging infectious diseases occurred in 7 countries of the Region, including poliomyelitis in Afghanistan and Pakistan; chikungunya in Somalia and Sudan; cholera in Somalia and Yemen; dengue fever in Pakistan and Yemen; diphtheria in Sudan and Yemen; Crimean-Congo haemorrhagic fever in Afghanistan and Pakistan; chickenpox (varicella) in Pakistan; Middle East respiratory syndrome (MERS) in Saudi Arabia; and viral haemorrhagic fever in Sudan.
The WHO Health Emergencies programme (WHE) in the WHO Regional Office for the Eastern Mediterranean has led the pandemic response, while coordinating with other departments within the regional and country offices.
In 2020, WHO worked closely with Member States in the Region to:
lead the incident management system to better coordinate and support the COVID-19 response across the Region;
support countries in the Region to re-activate and maintain surveillance for severe acute respiratory infections (SARI) and influenza-like illnesses (ILI) while appropriately leveraging it for COVID-19 surveillance;
support Member States to improve their critical care and intensive care unit (ICU) capacities through mentoring, surge support and provision of supplies to better manage severe and critical COVID-19 patients at referral hospitals;
contribute to efforts by the Regional Office to support and build national capacities by running modelling and forecasting analyses that will guide governments’ strategies to limit disease transmission and implement appropriate public health and social measure interventions;
support the expansion and strengthening of public and private laboratory diagnostic capacities using reverse-transcriptase polymerase chain reaction (RT-PCR) across the Region;
continue to support Member States to build their laboratories capacities across different diagnostic capabilities for high-threat pathogens in line with International Health Regulations (IHR 2005);
support the expansion and strengthening of surveillance through the Early Warning Alert and Response Network (EWARN) in conflict and emergency settings, particularly in Libya and Yemen;
continue to build the capacities of national and subnational rapid response teams in outbreak investigation and response in the context of COVID-19, with over 300 trained virtually in Libya, north-east Syria, Pakistan, Saudi Arabia, Somalia, Sudan and Yemen;
maintain the production and dissemination of flagship publications to analyse the ongoing outbreaks and other important public health events, including Weekly Epidemiological Monitors, and weekly and monthly disease-specific bulletins;
coordinate Regional Office support for ongoing outbreak investigation and response to arboviral and zoonotic disease outbreaks in Sudan, Yemen and other countries, including the improvement of clinical management support in viral haemorrhagic fevers (e.g. dengue, Rift Valley fever, chikungunya, and Crimean-Congo haemorrhagic fever;
continue to contribute to risk communication and community engagement activities against the COVID-19 pandemic by developing messaging and producing communication products that simplify WHO guidance and address misinformation about the disease;
maintain an online presence through the website of the WHO Regional Office for the Eastern Mediterranean and continue to update visitors on active disease outbreaks, including COVID-19, MERS, cholera and influenza;
address gaps in knowledge, produce knowledge products and gather evidence and best practices and share those to help front-line health workers prevent and control emerging diseases.
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Presentations and discussions during the EWARN evaluation workshop. Credit: WHO
Evaluating Libya’s surveillance system
WHO organized a workshop that aimed to start a systematic evaluation of Libya’s early warning alert and response network (EWARN) surveillance system and ensure that the system was effectively meeting its objectives. The workshop, which took place in Tunisia in January 2020, provided an overview of the evaluation protocol and agreed on a road map for conducting the evaluation. A total of 10 senior surveillance officers attended the workshop, including the EWARN coordinator and 7 surveillance officers from the National Centre for Disease Control. Representatives from the International Organization for Migration and the International Medical Corps, partners reporting to the EWARN system, were also included in this training. Participants were briefed on the evaluation protocol and the evaluation methodology was discussed in detail. Presentations and discussions on the standard evaluation protocol for EWARN were undertaken, and previous experiences with the evaluation carried out in different countries were shared as practical examples.
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Participants of the annual meeting held working group discussions over different areas of work. Credit: WHO
Reviewing infectious hazard preparedness across the Region
The annual Infectious Hazard Preparedness (IHP) technical group work meeting was held in Sharm El Sheikh, Egypt from 13 to 15 February 2020. The meeting was attended by 28 participants, including WHO staff from headquarters, the IHP team from the Regional Office and focal points from 13 WHO country offices (Djibouti, Egypt, Iraq, Jordan, Libya, Morocco, the occupied Palestinian territory, Pakistan, Somalia, Sudan, Syria, Tunisia and Yemen). The general aim of the meeting was to give an overview and discuss the progress of work in the Region, country needs and future areas of work.
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WHO expert providing support to emerging diseases laboratory in Syria. Credit: WHO
Support laboratory work in Syria
In the wake of the novel coronavirus disease outbreak, WHO Regional Office launched an early mission to Syria from 16 to 22 February 2020 to provide technical support to the national influenza centre to establish and sustain laboratory confirmatory capacity for the new virus. The mission supported the centre to build capacity for the collection, storage and transportation of samples within the country and establish a process for the shipment of specimens to international reference laboratories. Support was also provided to ensure the availability of testing kits and other essential supplies, while assessing, mentoring, and training laboratory staff on improving the quality and performance of the centre’s activities by using the standardized WHO laboratory tool. In-service mentorship was also provided to the staff on different influenza diagnostic tests and biosafety measures.
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Mission team visited health care facilities to learn about COVID-19 measures. Credit: WHO
COVID-19 support mission to Islamic Republic of Iran
The Iranian Ministry of Health and Medical Education agreed to a technical support mission from WHO, together with the participation of experts from the Robert Koch Institute and the China Center for Disease Control and Prevention, in March 2020. The final day of the mission, 11 March, also coincided with the public announcement by WHO’s Director-General Tedros Adhanom Ghebreyesus that the global COVID-19 outbreak could be characterized as a pandemic. By that date, Islamic Republic of Iran had already documented over 8000 confirmed cases and the global total was in excess of 118 000. The overall goal of the mission was to support the Ministry in its analysis and control of the COVID-19 outbreak.
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Working groups developed RCCE plans during the workshop. Credit: WHO
Risk communication and community engagement in Egypt
WHO along with the Ministry of Health and Population in Egypt, organized a multisectoral workshop from 2 to 5 March 2020 to help prepare risk communication and community engagement (RCCE) workplans for public health emergencies. Over 30 participants attended the 4-day workshop representing different sectors of the ministries of health and agriculture, as well as experts in biohazards and the Food and Agricultural Organization of the United Nations. A key outcome of the workshop was the development of 2 draft RCCE plans, one for influenza preparedness and the other for all-hazards to be taken forward and finalized by the Ministry of Health and Population. The workshop represented the first 3 steps of WHO’s 5-step package covering training, capacity-mapping and plan writing. The last 2 steps for plan testing and plan adoption usually take place after the workshop products had been reviewed by the relevant authorities.
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WHO team visited the Ministry of Health during their mission to Bahrain Credit: WHO
COVID-19 missions to Bahrain and Kuwait
A team of multidisciplinary experts from the WHO Regional Office conducted technical missions to Bahrain and Kuwait from 4 to 10 March 2020 to assess the readiness and capacities of the countries to prepare and respond to the COVID-19 outbreak, and to provide technical guidance and expertise to the countries to enhance their operational readiness and response. The mission teams engaged in field visits, working meetings and feedback sessions with the leadership of the respective ministries of health involved in the COVID-19 response. In keeping with the coordination mechanisms adhered to for outbreak response, the mission teams also met with the United Nations country teams.
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Marking the 20th anniversary of GOARN
The Global Outbreak Alert and Response Network (GOARN) marked its 20th anniversary on 28 April 2020. Working closely with WHO and United Nations partners, GOARN stands for saving lives and preventing unnecessary morbidity and mortality owing to the spread of infectious diseases. It grew from 60 to 250 partners of diverse affiliations and technical backgrounds in the past 20 years. In WHO’s Eastern Mediterranean Region, GOARN has been increasing the value it delivers to the international system of public health as it supports response to acute infectious disease outbreaks.
Visiting critical care units during mission to Yemen. Credit: WHO
COVID-19 critical care in Yemen
WHO organized technical missions to Yemen that aimed to support the country’s response measures to COVID-19 by improving care for critically-ill COVID-19 patients and strengthening surveillance and laboratory testing to find new cases. The missions took place from June to August 2020 in south Yemen and worked with the clinical management taskforce that was launched in late July 2020. They also reviewed the current surveillance and laboratory practices for COVID-19 implemented by local health authority and partners in south Yemen. Furthermore, mission members actively followed up on the reporting of COVID-19 cases from treatment centres run by partners and developed protocols for the recording and reporting of suspected, mild and moderate cases that had so far not been reported.
Meeting with EWARN focal points at ministry of health to discuss upgrading the electronic system. Credit: WHO
Early warning system in Yemen
At the request of the Ministry of Public Health and Population, WHO conducted a technical mission to Yemen from August to September 2020 to provide support to strengthen the country’s surveillance capacities through the electronic Integrated Disease Early Warning System (eIDEWS) and upgrade its real-time electronic application platform. The mission focused on the southern governorates where the system has been overstretched.
Visiting COVID-19 treatment centre at Al Hol refugees camp in north-east Syria. Credit: WHO
COVID-19 technical support for Syria
The WHO Regional Office provided a 3-month support mission to Syria from August to October 2020 to provide technical support to the WHO country office and the Ministry of Health to respond to the COVID-19 pandemic and support the Ministry in establishing a surveillance system for severe acute respiratory infections. A training workshop was organized during the mission on field investigation and rapid response to suspected outbreaks to strengthen the capacity of rapid response teams. It helped enhance their prompt and effective response to public health hazards with a focus on the COVID-19 pandemic, and to reduce morbidity and mortality to a minimum level by being constantly and adequately prepared for managing the outbreak.
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Visiting Jalalabad testing laboratory in Afghanistan during mission. Credit: WHO
COVID-19 support mission to Afghanistan
WHO organized a support mission to Afghanistan in September 2020 to help assess the response to the COVID-19 pandemic in the country. A number of activities were conducted during the mission, including reviewing infection prevention and control measures, visiting testing laboratories, surveillance and contact tracing, risk communication and community engagement, essential health services, and activities at points of entry. At the end of the mission, observations and recommendations were discussed with the relevant authorities.
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Participants of the EWARN transition meeting, held virtually due to pandemic. Credit: WHO
EWARN transition in the Eastern Mediterranean Region
WHO held a 3-day virtual meeting in October 2020 with ministry of health and WHO country office focal points from 9 countries of the Eastern Mediterranean Region to discuss commonalities and overlap between EWARN and routine surveillance, resource allocation, objectives of the transition and its timeline, and training needs. This was part of WHO’s support to countries experiencing acute or protracted humanitarian crises to transition from the Early Warning Alert and Response Network (EWARN) disease surveillance system, designed for emergencies, back to their routine surveillance systems without losing years of investment.
Mission team visited COVID-19 testing centre in the Horsh Beirut Field to review surveillance and testing strategies in Lebanon. Credit: WHO
COVID-19 support mission to Lebanon
As part of the continuing support provided by the WHO Regional Office to Lebanon, a technical mission was organized from 1 to 8 November 2020 to review the epidemiologic progress of COVID-19 in the country, discuss with key stakeholders COVID-19 surveillance and testing strategy, including case identification and reporting, isolation, contact tracing and quarantine measures. Priority strategic directions for COVID-19 surveillance and testing were proposed, along with the priority indicators that should be monitored. The mission made recommendations on: improving the coordination of surveillance activities; strengthening and streamlining data collection mechanisms; maximizing on the technical capacities of Ministry of Public Health staff; improving the efficiency, capacity and distribution of testing; leveraging the capacities of the municipalities, and other long-term recommendations to strengthen surveillance in Lebanon.
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Mission team visiting primary health care centre in Akouda, Tunisia. Credit: WHO
A technical mission was organized by the WHO Regional Office in November 2020 to support Tunisia in scaling up its operational readiness and response to the COVID-19 pandemic. The mission aimed to assess the epidemiological situation of the country and review its existing capacities in line with the 7 COVID-19 response pillars, namely coordination, surveillance, laboratory, infection prevention and control, case management, risk communication and community engagement, and continuity of health services. It provided tailored country-specific guidance regarding the effectiveness of the response, as well as on access to COVID-19 vaccines. The mission met with relevant national counterparts and made site visits related to the different areas of work.
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WHO team visited health care facilities as part of the intra-action review. Credit: WHO
COVID-19 intra-action review in Lebanon
Lebanon also received a team in December 2020 to support the intra-action review for COVID-19 response. the mission helped review the measures specifically for planning, coordination and monitoring, to identify and document strengths and areas for improvement, and to provide recommendations to scale up the overall response. Best practices and lessons learned were identified and shared with the relevant authorities to facilitate consensus-building among stakeholders, identify gaps and concrete recommendations to improve the current response, enable the strengthening of health systems and essential health services, and guide the process of updating the national response plan and other related strategic plans.
