Discussion
The pandemic was a challenge in the MENA region as some of which are
weak, fragile and conflict-affected countries, however, the situation is
not same in all the Gulf countries. In conflict-affected areas, where
health systems are already fragile and medical resources are scarce. The
common challenges faced in the EMR countries specially Lebanon, Syria
and Yemen were strained healthcare system due to various social and
economical issues12,13. In Syria, the WHO estimates
that 70% of health care workers have left the country as migrants or
refugees14. Lebanon had initially managed to contain
the first COVID-19, but following the explosion in the port of Beirut
destroyed medical centres and the health situation has gotten largely
out of control15,16. Moreover, the lack of testing
capacity has resulted in months of under-reporting, in particular in
Syria and Yemen17,18. At the same time, the region
suffers from a drop in demand at the regional and at global levels,
while most supply chains are disrupted. International organisations have
also mobilised to help the most fragile countries in the region in
strengthening their capacity to respond to the crisis19. UAE’s role in swift diagnosis of COVID-19 and
further strengthening its healthcare system specially to increase the
diagnostic capacity helped to tackle the pandemic successfully.
Furthermore, the UAE’s support to other countries in EMR in identifying
circulating strains was significant.
Genomics is a key tool that provides critical data to advise public
health responses, which has been illustrated throughout the COVID-19
pandemic20. Novel variants have emerged and become
dominant on no fewer than five occasions during the pandemic, with each
variant having differences in sensitivity to vaccination, transmission
frequency, and molecular detection21. Multiple
demonstrations have occurred throughout the pandemic, including the loss
of sensitivity of PCR testing due to S-gene mutation (SGTF) when the
delta variant emerged22,23 and the rapid expansion of
cases when the Omicron variant became dominant in
2021/202224,25. In each case, the wide availability of
sequencing data was a key that allowed public health responses to be
tailored to each situation.
The limited capacity of health systems and the lack of bioinformatics
expertise and trained laboratory personal to perform the sequencing were
the major constrained faced by most of the countries around the world26. Logistics and capacity to rapidly commence
sequencing, added to lack of expertise, are the primary challenges with
these countries. This was further worse in the EMR countries due to the
economical and logistical issues posed great challenge in implementing
genomics survellience27-29. In these situations, a
hub-and-spoke model can be adopted to ensure that some data is obtained
for these countries to allow for global awareness of the situation being
faced. In the case of the EMR, three hubs have been established by
WHO-EMRO, selected for their geographical location, capacity and
expertise in laboratory procedures (Figure 1). Under this hub-and-spoke
model, samples are collected in different location throughout EMR, and
then sent to the three central hubs for the final processing of genomic
sequencing and subsequent retrieval of the results to the country where
the samples are received from for the subsequent necessary action.
However, there were potential time gap in moving samples from conflict
affected countries to the sequencing hubs, which delayed the sample
receipt, processing and the report sharing. The success of this
sequencing hubs is depending on the scientific infrastructure and from
sample acquisition through reporting the results, meets or exceeds the
high-quality standards of the international community. Moreover, this
genomic hub-spoke model, need to have a schematic system to collect,
receive, store the samples and timely delivery of the results. Also,
adding a global unique identifier and a common data element to ensure
that the relevant data is collected enable data to be used across
multiples studies30.
The hub and spoke model was successfully adopted in several developed
and developing country to provide support to the far reached areas of
the country and provide necessary expertise in times of need interms of
medical, surgical support and vaccine distribution during COVID-1931-33. Genomic testing in the NHS England is being
provided through a national testing network, a hub-and-spoke model
consolidating and enhancing the existing laboratory provision to create
a world class genomic testing resource for the NHS and underpin the NHS
Genomic Medicine Service. The national genomic testing service is
delivered through a network of seven Genomic Laboratory Hubs (GLHs),
each responsible for coordinating services for a particular part of the
country 34.
RLID-AD in UAE is one of these hubs, with a wide array of diagnostic and
molecular capacity available on multiple platforms. During the COVID-19
pandemic, provision of genomic and diagnostic support to emergency
countries was a key aspect of the regional public health response, and
UAE, as a hub directly supported Yemen, Syria and Lebanon with
sequencing capacity while efforts were made to operationalize genomics
directly in-country. The primary challenge faced was logistical, taking
around 3-6 months to move the samples into the country, with transport
challenges at the country end and import issues faced in bringing
samples into the country. These delays in the critical information
required by the counties directly impact the quality of the data that
can be provided to support public health, and WHO/EMRO is working with
both member states and hubs to facilitate a more streamlined transfer of
samples in future.