Infectious disease surveillance as a bridge to peace in the Middle East

by Dr. Alex Leventhal
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JERUSALEM – Against the backdrop of the Second Intifada, Search for Common Ground (SFCG) conceived a collaborative public-health effort among three neighbouring countries: the Hashemite Kingdom of Jordan, the Palestinian Authority, and the State of Israel. The initial basis for the endeavour was the notion that in the Middle East, public health has tremendous potential to serve as common ground. This idea became even more compelling during those times when bilateral meetings between Palestinian and Israeli public health professionals were scarce and the involvement of Jordan was unprecedented

Late in 2002, leaders and professionals from the public health arena from both respective Ministries of Health (MoH) and academia, met. This meeting was the catalyst for a joint partnership between SFCG and the Global Health and Security Initiative (GHSI), part of the Nuclear Threat Initiative (NTI), a Washington DC-based international NGO. Together, they formed the Middle East Consortium for Infectious Disease Surveillance (MECIDS) in 2003.

The pillars of MECIDS are trust, mutual respect, excellence in the field, equity among partners and low profile in public relations. Its first mission was to facilitate trans-border cooperation in response to food-borne disease outbreaks, a common public health issue in the Middle East. MECIDS selected a regional data analysis unit within the Cooperative Monitoring Center in Amman, and established a mechanism for sharing data among the national systems.

The intergovernmental partnership became effective on many levels, such as harmonising diagnostic and reporting methodologies; establishing common training programmes; encouraging data sharing and analysis; improving detection and control of food-borne infectious diseases and— facilitating cross-border communication between laboratory technicians and public health officials.

These achievements proved invaluable in supporting a platform from which to broaden surveillance of other serious emerging infections, such as the Avian Flu:
The Avian Flu threat was geographically closer to MECIDS partners with outbreaks taking place in poultry and humans in Turkey and Iraq in late 2005 and early 2006. MECIDS members immediately responded with a regional conference on the issue, organised by SFCG. The conference involved not only senior officials from the respective MoHs but also from Ministries of Agriculture as well as from the Egyptian MoH, experts from the World Health Organization, U.S. Center for Disease Control and Prevention and the European Union. Each country presented its national plan to combat the Avian Flu and therefore established a foundational template for exchanging information in real time in case of an outbreak.

Three months later, in March 2006, an Avian Flu epidemic actually broke out among poultry within the MECIDS participating nations. Established and effective lines of communication, assistance between the three partners, and cooperative control measures proved essential in the relatively quick mitigation of the human and economic impact of the outbreak. Concurrently, this example of regional cooperation has been an enormous boost to the sustainability of MECIDS in the respective MoHs and beyond. It has also attracted various donors which work in collaboration with MECIDS, and coordinated by GHSI: the World Bank, the Bill and Melinda Gates Foundation, the UK Government, IBM, and Becton -Dickenson.

Since January 2007, an Executive Board (EB) has presided over MECIDS. Comprised of representatives of the three founding partners, the board is headed by a rotating chairperson selected from the partner nations for a one year term, and agreed to run it only by consensus. The executive board carefully allocates financial and other forms of support in order to enhance capabilities and acquire technology particularly in early detection and identification by the public health labs. Resources are also implemented in efforts to standardise partner capabilities that efficiently run cooperative activities such as electronic data sharing.

The scope of MECIDS activity has been expanded by the EB to include ongoing workshops on building a memorandum of understanding in case of a Pandemic Flu. Initiating these workshops was a series of table-top exercises focused on preparedness at the country and regional levels. There is a plan of the EB to establish yearly Middle Eastern one week training courses in field epidemiology for health professionals from the partner countries like the one held during the summer of 2008. Supplementary information technology workshops conducted by IBM professionals for laboratory technicians provide a forum in which participants may foster lasting personal and professional relationships with colleagues from neighbouring countries.

In summary, MECIDS is a viable regional network that has far exceeded its set up goals and demonstrated great potential to expand its scope through inclusion of different communicable diseases and other countries of the region as well.

Finally, on a personal note, my work with MECIDS has altered my views on the Israeli Arab conflict and shown me the importance of international health and health diplomacy. After almost 16 years as the director of Public Health Services at the Israeli MoH, I have traversed the focus of my career towards international relations in the Ministry.

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* Alex Leventhal, MD, MPH, MPA is the director of the Department of International Relations in the Israeli Ministry of Health, a founding member of MECIDS, and the first chairman of the MECIDS Executive Board. This article was written for the Common Ground News Service (CGNews).

Source: Common Ground News Service, 27 November 2008, www.commongoroundnews.org.
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