Chapter 6. Covid-19 in MENA: A Stress Test

Main takeaways

• The Covid-19 outbreak put new and increased demands on governments that further depleted already limited functional and reserve capacities and exacerbated existing challenges. • On top of the direct morbidity and mortality burdens MENA countries experienced from Covid-19, the pandemic caused issues with staffing, displaced care of chronic and non-Covid acute conditions, and strained the physical resources of health systems. • While vaccination remains an important pathway out of the pandemic, the pace of immunization in the region is uneven as middle-income and low-income countries lag richer countries.

By late August 2021, there were more than 200 million confirmed cases of Covid-19 and more than 4 million confirmed deaths around the globe, although both are likely undercounts because of such factors as insufficient testing or inadequate reporting on deaths (WHO Corona Virus Dashboard 2021; The Independent Panel, WHO 2021). Various estimates suggest far higher death tolls and infections. Data gaps in the MENA region (and other regions) contribute to this uncertainty about the scope and devastation of the pandemic.

One thing is certain: the Covid-19 pandemic was an unprecedented shock capable of overwhelming even the most resilient health systems. The virus’s high transmissibility, particularly from asymptomatic cases,19 propelled it from epidemic to pandemic, while its severity persuaded many governments to take drastic and costly actions to control it. Nevertheless, the disease spread so rapidly that it overwhelmed public health interventions, such as contact tracing, leaving only blunt policy options like widespread shutdowns and universal masking to slow infections.

A response to the pandemic that relied on pre-emptive measures saved lives and livelihoods. Handling the pandemic requires a comprehensive and cross-sectoral health system response that involves both public, private and civil society sectors, and adapts to a country's transmission phase. As indicated by the GHS Index and other preparedness assessments, the resilience of public health infrastructure in December 2019 varied from country to country and even in countries with seemingly well-prepared systems, leaders were either unable or unprepared to make informed decisions based on emerging global surveillance information from abroad. Countries that implemented stringent policy responses early in the pandemic reduced Covid-19 transmission and deaths significantly (Chisadza and others 2021; Flaxman and others 2020; Fuller and others 2021). However, as national cases escalated from being isolated to being widespread, countries were forced to undertake increasingly blunt response strategies to adapt to the local situation, straining both leadership and the capacities of health systems.

The adaptive Covid-19 response required effective feedback systems to provide useful, real-time information, and response systems that could receive and process the information, make informed decisions, and deploy public health service resources. The systems had to rely on functional and/or reserve capacities for both public health functions and individual health service delivery.

19 See, for example, Johansson MA, Quandelacy TM, Kada S, and others, 2021.