AHI FACILITY Avian & Human Influenza 58050 MECIDS Trust Across Borders: the Middle East Consortium on Infectious Disease Surveillance (MECIDS) R egional disease surveillance networks are models under-resourced countries to collaborate on and for the kind of transnational cooperation that can coordinate capacity building. MECIDS has brought provide a flexible and coordinated response to the together public health experts and Ministry of Health spread of pandemic threats. Members of the Middle East officials from Israel, the Palestinian Authority, and Jordan Consortium on Infectious Disease Surveillance (MECIDS), to improve the region's ability to detect and respond to a network of public health experts and Ministry of Health infectious disease threats. officials from Israel, the Palestinian Authority, and Jordan, have developed an extremely effectively working relationship that not only managed the 2006 H5N1 Cooperation in Action outbreak but was most recently tested In response to an outbreak of avian influenza (H5N1) in following the 2009 H1N1 influenza Regional disease outbreak. 2006, the Ministries of Health of Israel, the Palestinian Authority, and Jordan coordinated preparedness plans surveillance networks and outbreak response to mitigate the potential public can be valuable health crisis. The outbreak crossed the borders of all 3 mechanisms for Regional Collaboration MECIDS member countries in under 10 days, but the under-resourced surveillance network's strategic planning and uniform The initial response to an infectious disease response helped maintain public confidence. countries to outbreak is primarily a domestic collaborate on and government function. However, national governments cannot handle global coordinate capacity microbial threats alone, and inadequate building. surveillance and response capacity in a single country can endanger national populations and the public health security of the entire World. Enhanced cooperation among states is increasingly vital to address the complexity of transboundary disease outbreaks and resulting health problems. Effective regional disease surveillance networks have the potential to support long-term health, stability, and security in a region and can be valuable mechanisms for Prompt reporting and sharing of information between Israeli and Palestinian contacts in the Ministries of Health and Agriculture allowed Jordanian authorities to swiftly cull 20,000 birds in a 3-km protective zone and fully contain the avian flu outbreak. After- action feedback from the MECIDS partners made clear that successful personal and working relationships fostered over years of cooperation had allowed transparent reporting and coordinated response and control measures to mitigate the impact of the outbreak. The MECIDS partners invited representatives from the World Health Organization (WHO) to conduct a work-shop on the International Health Regulations (IHR, 2005) implementation in November 2007. As a result of this workshop and supplementary joint meetings, the MECIDS had been preparing for an event like this for some time. In 3 partner countries developed a statement of understanding response to H1N1 cases in Israel, the partners held emergency regarding the IHR procedures, which they are implementing as part meetings and agreed to prompt and coordinated border and of their national avian influenza preparedness plans. airport screening, laboratory testing, information exchange, and common communication strategies. This In 2007 and 2008, MECIDS conducted coordination was in large part due to the existence Key Data a series of national pandemic of trust and to well-exercised national and regional influenza tabletop exercises to pandemic preparedness plans. Representatives Grant Amount: $0.98 million identify current gaps in preparedness from Egypt, which is not formally a member of and cross-sectoral cooperation and MECIDS, also participated in these discussions. Disbursement: (to end March 2010): to develop a plan of priority actions. $0.98 million In August 2008, the partners conducted a regional exercise to test, Closing Date: December 2009 Lessons for the Global Community in par ticular, cross-border Emerging and re-emerging diseases have cooperation and procedures. The increased the need for surveillance capabilities regional exercise not only brought to promote collaboration across sectors and together the public health experts country borders to ensure early identification and rapid response and Ministry of Health officials from the MECIDS countries, but also to disease outbreaks, so crucial to the prevention of pandemics. engaged representatives from multiple sectors in 3 countries, including transportation, education, interior, laboratory, and media. Important lessons from the Middle East partnership can be readily These exercises were conducted with the cooperation of WHO translated to the global community: Geneva and WHO's Eastern Mediterranean and European Regional · The trust built through developing collaborative action Offices and the Turkish Ministry of Health. plans has proven its worth across one of the most difficult boundaries in the world. Testing Preparedness: The 2009 H1N1 Outbreak · Neighboring countries facing common infectious disease threats can successfully build operational collaborative On April 29, 2009, in response to H1N1 influenza outbreaks surveillance networks to strengthen public health capacity throughout the world, WHO raised the influenza pandemic alert and to help meet their international legal obligations. from Phase 4 to Phase 5 and highlighted the opportunity for global · A regional or subregional network with a common plan to solidarity to address the pandemic. Two days earlier, a group of improve its capacities can collectively generate funding and Israeli, Palestinian, and Jordanian health officials had already held expert support that responds directly to the most urgent an emergency teleconference to discuss a joint plan of action to needs. mitigate the spread of the disease. · Sharing experience, innovative approaches, and best practices associated with regional networks can contribute to In the following months, WHO and the U.S. Centers for Disease enhancing the overall global capacity for infectious disease Control and Prevention (CDC), along with national and local health surveillance. officials, responded aggressively to the emergence of the disease. By September of that year the number of laboratory-confirmed The MECIDS alliance provides a valuable model for other parts of cases in the MECIDS region had risen to more than 4,000 with 32 the World experiencing conflict, suggesting that it is possible to deaths. find common ground and promote health security. Extracted from Gresham et al (2009) , "Trust Across Borders: Responding to 2009 H1N1 Influenza in the Middle East" in Biosecurity and Bioterrorism: Biodefense Strategy, Practice and Science, Vol7, No. 4. AHI The AHI Facility is a Multi-donor Trust Fund administered by the World Bank and supported by Australia, FACILITY China, the European Commission, Estonia, Iceland, India, Korea, Slovenia, the Russian Federation and the Avian & Human Influenza United Kingdom