Many Arab countries still have time to prepare for the onslaught of Covid-19, the disease caused by the novel coronavirus, and reduce the inevitable surge of cases, while the worst of the pandemic now sweeps across Europe and the United States. But some Arab countries are missing an important element needed in the fight against the highly infectious virus: public health experts with research experience.
In addition, for public health researchers to be effective they need the ear of government ministries. Such collaborative relationships are lacking in some of the Arab countries that need them the most, academics say.
Diana Rayes, an associate research specialist at the University of California, Berkley, who specializes in public health in the Arab world, says collaboration between politicians and the region’s public health experts is critical.
“I would like to see governments turning to local academics and public health experts for help and advice rather than relying only on international institutions,” she says. “This is particularly important for producing public-health messaging and advice to Arabic-speaking populations that is culturally relevant.”
In Lebanon, Fadi El-Jardali, a professor of health policy and systems at the American University of Beirut and director of the World Health Organization’s Collaborating Centre for Evidence-Informed Policy and Practice, says that “the whole world is passing through the worst public health crisis in modern history, and our region is no different.
“There hasn’t been enough attention given to public health infrastructure over the years,” El-Jardali says. “There’s been investment in clinical settings, but I’m talking about prevention and protection against infections.”
In Qatar, which has one of the world’s highest GDPs per capita, the government seems to have quickly appreciated the need to work with the country’s public health researchers, says Hanan Abdul Rahim, associate professor of public health and dean of the college of health sciences at Qatar University
“I would like to see governments turning to local academics and public health experts for help and advice rather than relying only on international institutions.”Diana Rayes
A University of California, Berkeley, scholar of public health in the Arab world
“We didn’t have to go to the policy makers and say, ‘Look, I have something you need to hear,’ but instead from early on the ministry contacted us to ask how we could help,” she says. “My colleagues and myself are involved ministerial committees and we meet several times a week to discuss the evidence and what we think should be done. I’m very much busier now than I was before all this started.”
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On the whole, there aren’t many public health programs like those at Qatar University in the region, says Diana Rayes, the Berkeley specialist. But there are exceptions. “The Gulf has the advantage of hosting and collaborating with American and foreign universities,” she says. “Other countries such as Egypt and Jordan have also benefited from the presence of international NGOs and expatriate populations that provide public-health expertise.”
The Pandemic and Policy in Lebanon
Public health measures for the current Covid-19 pandemic include things like widespread testing; social-distancing; effective communication of quarantine policies; and using computer modelling to predict how the disease might spread through a given population.
Lebanon may have a higher number of public-health researchers compared to poorer Arab states, but politicians have so far not used these experts to their full potential, says El-Jardali. “There’s a lot of quality health policy research being produced, but what’s lacking is how to institutionalize the use of this evidence in policy.
“We need to streamline the flow of science and evidence into policy makers’ decisions, but that’s so far been delayed because there’s been too much politics at play,” he says. “That’s really not how to handle a public health crisis. It needs to be all about the evidence.”
Very recently, this has begun to change in Lebanon, says El-Jardali. The government is now using his policy papers, for example. “The hard lesson is that you need to have policy makers already in touch with public health experts before an epidemic in order to minimize delays in taking action,” he says.
El-Jardali’s experience is in stark contrast to that of Abdul Rahim, in Qatar, “I know there are examples where scientists have to fight with politics and I’m not just saying this to be politically sensitive, but it’s simply not the case here.”
“There weren’t many public health researchers in Syria in first place before the conflict. The few that we did have are mostly outside the country now, and the experts who are left in the country are not taken seriously and they’re not included in response planning.”Yazan Douedari
A scholar at the London School of Hygiene and Tropical Medicine who is from Syria
If there’s a spectrum of government engagement with public health academics and Qatar is at one end, then Lebanon is somewhere in the middle. The region’s most vulnerable countries, such as Yemen and Syria, have close to zero collaboration between policy makers and public health professionals, academics say.
Syria Is Suspected of Denial
Yazan Douedari, originally from Syria, is a research assistant at the London School of Hygiene and Tropical Medicine who specializes in studying Syria’s health system governance. “At the moment I’m of course focused on the response to Covid-19,” he says. “There weren’t many public health researchers in Syria in first place before the conflict. The few that we did have are mostly outside the country now, and the experts who are left in the country are not taken seriously and they’re not included in response planning.”
Iran is the most heavily infected country in the region, with more than 50,000 reported cases as of early April, putting nearby countries, such as Iraq and Syria, at high risk.
The first official case of Covid-19 in Syria was reported last week, but Douedari doubts the credibility of that announcement and says there are accusations that Damascus has tried to downplay the situation.
“It’s highly likely, although it’s hard to say for sure, but we suspect the virus has been in Syria for several weeks,” he says. “Iran is a hotspot and the relationship with Iran means there are plenty of fighters going back and forth and I find it unlikely that it hadn’t been spread by them.”
Officially, there were just 16 confirmed cases of Covid-19 in Syria as of April 2, and two deaths.
The quality of public health infrastructure in Syria is dependent on who is in charge of a particular area, says Douedari. Some opposition-controlled areas do have a rudimentary testing procedure in place where they send swab samples to a laboratory in Turkey to get testing results. That’s not because the opposition areas don’t have a suitable laboratories, but rather it’s the consequence of an absence of test kits. “At least they’re entertaining the fact that the virus has reached the area and they’re trying to do something,” says Douedari.
In some governorates of Syria there are no ventilators and camps for refugees and displaced persons often don’t even have the basics of soap and running water to wash hands.
“It’s just about one of the least prepared countries in the region, and denying the problem, which is often the temptation of authoritarian regimes, doesn’t help,” laments Douedari.
Back in Beirut, El-Jardali hopes this crisis will help those in charge to realize the importance of public health research in the long run.
“It has taken a pandemic to get policy makers to consider public health researchers to be important,” he says. “Late is better than never, but we still have a long way to go. This could be an opportunity to reimagine our public health strategies for the future.”