COVID-19 pandemic and an Arab centre for disease control

Victor Hugo once said, “There is nothing more powerful than an idea whose time has come.”

In the following, I will try to explain why, for us in the Arab region, having lived, and some of us died, due to the COVID-19 pandemic,and also in order to collaborate on all other health issues for our population, the establishment of an Arab Centre for Disease Control is “an idea whose time has come”.

In the past few months, the whole world,the Arab World included, became occupied almost exclusively with one health entity, a disease called COVID-19. This infectious disease that is caused by a novel corona virus belonging to the same group of viruses that led to SARS-CoVepidemic in 2002, and MERS-CoV epidemic in 2012, spread so fast since first recognisedon December 31, 2019 in China, that it was announced a pandemic in record time four weeks later. This decision was made after an in-person visit to China by WHO Director General Dr Tedros, on January 27, 2020, following which the director became convinced that this is an issue that should be addressed soonest and decided to reconvene the International Health Regulations(IHR) Emergency Committee to declare the 2019 n-CoV outbreak a public health emergency of international concern (PHEIC). This is the sixth such announcement made by the WHO and the IHR committee, the previous five being the 2009 H1N1 or swine flu pandemic, the 2014 Polio declaration, the 2014 Ebola outbreak in West Africa, the 2015 Zika virus epidemic, the 2018 Ebola epidemic and the sixth is the current pandemic declared on January 30, 2020, the COVID-19 pandemic. The announcement of the COVID-19 pandemic set into motion many actions that were adopted by all countries and societies, which proved much more impactful on all aspects of life than initially thought.

A brief evaluation as viewed from one country, Jordan, exemplifies the events and actions adopted and how these actions impacted and continue to impact our life.  For the detailed progress of our outbreak as well as that of other countries regionally,the reader is referred to international sources of information online that provide data on the progress of the outbreak and actions taken by Jordan and other countries by reviewing such sites as “worldometer” and “our world in data” both of which are open source websites with a detailed amount of information about Jordan and other countries.

Having been a member of the National Outbreak Investigation and Control Committee with the Ministry of Health for this as well as previous outbreaks, which included, diphtheria, polio, influenza, salmonella diarrhea etc, I am well aware of the disruption to services in the country as well as the massive efforts needed to control these outbreaks. This also frequently led to diversion of much needed resources, both human and material, so as to control these outbreaks at times at the expense of other needed services.

While most prominent among these was the polio outbreak in 1991 and the H1N1 influenza outbreak in 2009, in both instances the presence of a vaccine and the fact that both agents were well known helped us control both in good time. Novel corona is, however,a different agent, which spread fast even before the knowledge about it was complete which made it more difficult to control and added to that a vaccine is not currently available and is still in development and will not likely be available before a few months. In addition, while in both previous examples there was little disruption to daily lives, disruption due to the shut downs and the curfews and interruption of many aspects of life including travel, education and communication banning of all mass gatherings, closures of coffee shops and restaurants  also impacted sectors that were not involved in the previous two outbreaks. These included the economy, employment, social and mental well-being in the population at large. Hence, every effort was made to control the spread of the virus at all cost which was accomplished in Jordan and several other countries after instituting at sometimes draconian measures that were difficult to live with but which the population accepted due to the danger of spread of infection.

However, while this control was accomplished at great expense some notable attributes of this virus that became clear with time and which we should take into account as we plan for the next phase of controlling COVID-19 from reemerging include the communicability of the virus as well as the disease manifestations that will help us detect infected individuals in the future. This, however, may prove more difficult than initially appreciated since the clinical manifestations may not be characteristic of any one manifestation, in addition to the fact that individuals may continue to harbour the virus in an asymptomatic manner which also may reintroduce the infection in the country.

Sadly, Jordan and other countries in the region must come to the conclusion that long term control measures have to be at least for now regional if we are to succeed in controlling the spread of the infection. In fact, this is already happening currently in Jordan since many of the recent cases have been among truck drivers who travel to Saudi Arabia and the Gulf region carrying goods back and forth from Jordan and these countries and who tested positive for COVID-19 upon examination at our borders. In one such example, it is notable that one truck driver caused 49 secondary cases which were widespread in the country.   Hence all of this makes it difficult to ascertain the disappearance of the virus to a level that allows for relaxation of the very time consuming and costly continuous surveillance activities.

From the above, it is obvious that controlling the infection in one country in the region in the absence of control in other countries is not likely to be successful in the long run and alternate modes of regional collaboration in this matter are needed. A brief review of how other regions in the world reacted to such an emerging threat leaves us with one major and highly successful endeavour and that is the establishment of one centre that will deliver all the needed components of control of disease including ability to prevent, detect, rapidly respond by helping in supporting the health system in the region if needed, and assure that we are able as a region to remain compliant and decrease the risk of the infection in the region and also decrease the risk of spread to other regions in the long run.

Given the experience of other regions this task of tracking health matters is best accomplished by establishing a regional entity dedicated to deliver all the needed matters listed above in the fastest and most efficient and timely manner. Such entities that proved their capability to deliver these services did fill that gap in previous outbreaks include the CDC Atlanta, which was founded in 1946 in order to control malaria and since then expanded to include many other health related centers,the Chinese Centre for Disease Control which was founded in 1983 and more recently the European Centre for Disease Control which was founded in 2004 with the stated mission to control infectious diseases in Europe. The latter two centres proved highly successful in the current outbreak and helped their population control COVID-19 in a timely and efficient sustainable manner even as the outbreak is still ongoing in many parts of the world.

These centres play a major role in upgrading knowledge, train and help the health providers in the epidemiologic investigation, as well as also increase the scientific research and from our region where the past few decades witnessed the establishment of many medical schools and research centres. In fact, the need for such a centre should go beyond the control of infectious disease but also help our region start planning for the control of some of the emerging noncommunicable diseases such as diabetes that are also assuming almost epidemic proportion due to the change in the life style in the region. That said, the time has come for the region to adopt the creation of such an entity to help the to be named, the Arab Centre for Disease Control.  

I do hope that this idea will be adopted by Arab countries soonest so as to upgrade the care for all health matters starting with the infectious diseases, but also addressing the increasing burden of the NCDs and also aim for our region to be able to better address and achieve Goal three of the SDGs.

Yes, I truly believe that, this is one idea that has become a necessity and is an idea whose time has come.

Najwa Khuri-Bulos is a distinguished professor of pediatrics and infectious diseases at the University of Jordan, and a consultant to the National Centre for Security and Crisis Management. E-mail:  [email protected]