Introduction
The COVID-19 pandemic presented an unprecedented challenge to the
already strained health system in the Eastern Mediterranean region
(EMR), with many countries already struggling with complex emergencies,
such as regional or national conflict, political struggles, existing
outbreaks, population displacement, poverty and more1.
Many countries lacked the capacity to rapidly implement diagnostic or
genomic support, which limited their ability to assess the national
burden of COVID-19 and identify circulating variants of concern, making
their informed decisions regarding vaccination and public health
interventions more challenging2,3.
COVID-19 came to the Middle East and North Africa (MENA) region early,
with the first instances occurring in the United Arab Emirates (UAE) in
January 2021, followed by Iran recording its first case in February
2020, and Yemen the last country to record its first case in April 2020.
The World Health Organization’s Regional Office for the Eastern
Mediterranean (WHO/EMRO), which includes the majority of MENA states,
reported 12.6 million cases and 236 thousand fatalities in early August
2021, and the total vaccination rate was less than 6.0% at the
time1,4.
UAE recognised the seriousness of the situation and rapidly
operationalised and implemented a nationwide COVID-19 diagnostic
laboratory network, building on existing capacity for SARI/ILI
surveillance programs. Molecular diagnostic capacity for SARS-CoV-2 was
validated and made ready for testing in January 2020, before the
pandemic was declared. To date, the country has tested an astonishing
168 million samples, identifying 1,055,334 positive cases (0.5%
positivity). The country has recorded 2,349 deaths due to COVID-19 (CFR
0.25%), which is comparable to or lower than most developed countries.
This is largely due to the timely and higher detection capacity,
healthcare capacity and available ICU beds, and widespread vaccination
campaigns implemented to respond to the virus5.
UAE also recognised the importance of assessing circulating variants in
the region, as the strains can directly impact the virus’s spread,
diagnostic sensitivity, case fatality and vaccine response and efficacy.
Through RLID-AD, and with funding from Abu Dhabi Public Health Center
(ADPHC), the country invested in and implemented whole genome sequencing
of SARS-CoV-2 on a number of platforms, including the Oxford Nanopore
Technologies Nanopore, Illumina MiSeq and Sanger sequencing platforms,
to ensure variants were monitored and assessed as they emerged. As of
the end of March 2023, UAE has shared 7,214 sequences through the Global
initiative on sharing All avian data (GISAID) platform, covering 5 waves
of infection. The investment in this capacity also allowed the country
to perform research and developmental studies into vaccine efficacy,
with publications shared or in preparation6,7.
RLID-AD facility was rapidly designated by WHO/EMRO as one of three
regional hubs for COVID-19 (Fig.1), providing support to countries in
the region with less technical or logistical capacity for molecular
diagnostics. WHO/EMRO, with the support of UNHAS and other stakeholders,
provisioned logistical networks to transport samples from some of these
countries to UAE, in support of both molecular diagnostics and genomics
despite the anticipated challenges.