Transportation challenges limited the utility of the hub-and-spoke model during the COVID-19 pandemic, taking 3-6 months to move samples between countries in EMR.
Complex emergency countries such as Yemen, Syria and Lebanon face extreme challenges in both importing and exporting reagents and samples44. It is estimated during the COVID-19 pandemic that, the cost of acquiring reagents and importing them into these countries was 5-7x higher than those found in other regions5,10. While this is partially due to geographical challenges with moving samples from conflict zones, it is also likely partially due to challenges with import and export embargoes imposed by suppliers and other countries in response to the situations in these countries11. A lack of courier networks and stable cold-chain logistics also impacts the time taken to move samples between countries. Despite the best efforts of UNHAS, WHO/EMRO and other stakeholders, it took 3-6 months to move samples from each country to RLID-AD for analysis. Import and export challenges were also faced, holding the samples up further and impacting the quality of testing that could be performed downstream. Samples were collected between 07/01/2021 and 10/06/2021, with sequencing and results performed in March and April 2022 upon receipt at RLID-AD, almost 12 months after collection in some cases. In spite of this, 170 samples were received intact at SKMC for further analysis.