Expansion of Laboratory Capacity in the Eastern Mediterranean Region During the COVID-19 Pandemic: Lessons Learned and Future Strategies for Sustainability

IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Influenza and Other Respiratory Viruses Pub Date : 2024-11-04 DOI:10.1111/irv.70030
John McCauley, Maria Van Kerkhove, Laith Jamal Abu Raddad, Luke Meredith, Richard Brennan, Abdinasir Abubakar, Amal Barakat
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The investment in strengthening testing capacity, through molecular platforms such as PCR and genomics, that play a pivotal role in detecting and monitoring COVID-19 and other respiratory viruses, are now being expanded to include detection of priority pathogens with epidemic and pandemic potential such as other respiratory pathogens (e.g., MERS-CoV), arboviruses (e.g., dengue), and hemorrhagic fevers (e.g. CCHF), which periodically threaten the region. These capacities are being strengthened and sustained through the development of and investment in national and regional strategies to support genomic surveillance in the region, with efforts underway to establish steering committees and technical working groups to sustain, standardize and enhance genomic sequencing in the region [<span>2</span>], as well as the continued expansion of quality assurance networks to ensure that laboratories continue to produce robust, reliable results to support public health initiatives [<span>3, 4</span>].</p><p>The launch of the International Pathogen Surveillance Network (ISPN) is well timed with member states in the region to support in the sustainability of novel genomic and molecular testing platforms into the future. While next-generation sequencing provides valuable insights into genomic characterization of pathogens and aids in the tracking of viral mutations and the identification of emerging SARS-CoV-2 variants, for example, the collective efforts need to focus on long-term strategies to ensure that the platforms are sustainable financially and technologically. Indeed, the WHO Eastern Mediterranean Regional Office is working with member states and international stakeholders [<span>2, 5</span>], including IPSN, to implement a regional strategy for genomic surveillance, which will support and empower member states to develop genomic sequencing and capacity. This proactive approach will enable healthcare systems to adapt and tailor their response strategies in ways that maximize the impact of genomics, while minimizing the potential impact of future outbreaks.</p><p>Collaborative surveillance and knowledge-sharing form the cornerstone of public health, with early detection, warning, and response being the key to preventing outbreaks from spreading. Key stakeholders in the region have been providing support for training in areas including laboratory protocols but focus now must turn to how to integrate these new platforms into existing surveillance networks to provide useable, epidemiologically relevant, and informative data that can support public health responses. Laboratories function as a key pillar of a public health response and need to work collaboratively with rapid response and surveillance teams to ensure that high quality samples and data are collected, to allow high quality results to be generated.</p><p>The investment in both research and development was also demonstrably helpful to the public health response in the region, ensuring that technological and infrastructure were deployed in the most useful way to provide diagnostic coverage to a broad population and to inform knowledge of the local outbreaks [<span>6-10</span>]. Information technology platforms developed during the pandemic supported the collation of patient data and subsequent dissemination of results, and these platforms can now be developed further to support data and sample management for a broad range of pathogens and disease states. Member states are now working with stakeholders to link these networks with existing surveillance platforms, to streamline data sharing across sectors as rapidly as possible [<span>11-13</span>]. The importance of streamlining and improving the capacity for data sharing cannot be understated, both in a multi-sectoral fashion within a country and collaboratively across borders to ensure all countries are aware of challenges as they arise, and can mount appropriate, measured responses in a timely manner before a threat emerges, rather than during an emergency.</p><p>An often-overlooked component of public health response is the investment in human resources. The COVID-19 pandemic placed an extreme burden on health workers across the region, and the world, often working under extremely challenging conditions with the sustained pressure of samples continually needing urgent analysis [<span>11</span>]. 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Through collective efforts, sustained commitment, and international engagement, the region can pave the way for a healthier and more resilient future for its population and at the same time inform global health responses.</p><p><b>John McCauley:</b> conceptualization, writing – original draft, writing – review and editing. <b>Maria Van Kerkhove:</b> conceptualization, writing – original draft, writing – review and editing. <b>Laith Jamal Abu Raddad:</b> conceptualization, writing – original draft, writing – review and editing. <b>Luke Meredith:</b> conceptualization, writing – original draft, writing – review and editing. <b>Richard Brennan:</b> conceptualization, writing – original draft, writing – review and editing. <b>Abdinasir Abubakar:</b> conceptualization, writing – original draft, writing – review and editing. <b>Amal Barakat:</b> conceptualization, writing – original draft, writing – review and editing.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":13544,"journal":{"name":"Influenza and Other Respiratory Viruses","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/irv.70030","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Influenza and Other Respiratory Viruses","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/irv.70030","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0

Abstract

The COVID-19 pandemic posed unprecedented challenges to healthcare systems globally, necessitating a rapid and robust response from all sectors, from public health to commerce. A key effort in response was the need for a substantial expansion in laboratory testing and diagnosis to monitor the spread of the virus and to provide critical data to support effective public health measures. The scale of the threat drove research and innovation in laboratory diagnostics and genomic surveillance, enhancing testing capabilities and providing technological support to countries that previously did not have access to the key capabilities for rapid detection of pathogens that are necessary to prevent the next outbreak from becoming a pandemic.

The WHO Eastern Mediterranean Region (EMR) comprises the Occupied Palestinian Territories and 21 member states: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates, and Yemen. These countries have a diverse range of socio-economic and demographic conditions, and many are facing humanitarian crises caused by civil conflict and natural disasters. Despite these challenges, member states in the region, supported by national, regional, and international stakeholders, were able to mount variable but largely robust laboratory responses, increasing COVID-19 diagnostic and genomics capacity to covering 100% of the region [1]. This special issue provides an insight into the challenges faced in this rapid scale-up of capacity, as well as the extraordinary efforts taken to overcome them during the pandemic.

The key initiatives highlighted throughout this issue are now being redirected towards a sustainable laboratory network with the capacity to detect and respond to new and re-emerging pathogens that pose threats to public health in the region and globally, with the goal of preventing the next outbreak from becoming a pandemic. The investment in strengthening testing capacity, through molecular platforms such as PCR and genomics, that play a pivotal role in detecting and monitoring COVID-19 and other respiratory viruses, are now being expanded to include detection of priority pathogens with epidemic and pandemic potential such as other respiratory pathogens (e.g., MERS-CoV), arboviruses (e.g., dengue), and hemorrhagic fevers (e.g. CCHF), which periodically threaten the region. These capacities are being strengthened and sustained through the development of and investment in national and regional strategies to support genomic surveillance in the region, with efforts underway to establish steering committees and technical working groups to sustain, standardize and enhance genomic sequencing in the region [2], as well as the continued expansion of quality assurance networks to ensure that laboratories continue to produce robust, reliable results to support public health initiatives [3, 4].

The launch of the International Pathogen Surveillance Network (ISPN) is well timed with member states in the region to support in the sustainability of novel genomic and molecular testing platforms into the future. While next-generation sequencing provides valuable insights into genomic characterization of pathogens and aids in the tracking of viral mutations and the identification of emerging SARS-CoV-2 variants, for example, the collective efforts need to focus on long-term strategies to ensure that the platforms are sustainable financially and technologically. Indeed, the WHO Eastern Mediterranean Regional Office is working with member states and international stakeholders [2, 5], including IPSN, to implement a regional strategy for genomic surveillance, which will support and empower member states to develop genomic sequencing and capacity. This proactive approach will enable healthcare systems to adapt and tailor their response strategies in ways that maximize the impact of genomics, while minimizing the potential impact of future outbreaks.

Collaborative surveillance and knowledge-sharing form the cornerstone of public health, with early detection, warning, and response being the key to preventing outbreaks from spreading. Key stakeholders in the region have been providing support for training in areas including laboratory protocols but focus now must turn to how to integrate these new platforms into existing surveillance networks to provide useable, epidemiologically relevant, and informative data that can support public health responses. Laboratories function as a key pillar of a public health response and need to work collaboratively with rapid response and surveillance teams to ensure that high quality samples and data are collected, to allow high quality results to be generated.

The investment in both research and development was also demonstrably helpful to the public health response in the region, ensuring that technological and infrastructure were deployed in the most useful way to provide diagnostic coverage to a broad population and to inform knowledge of the local outbreaks [6-10]. Information technology platforms developed during the pandemic supported the collation of patient data and subsequent dissemination of results, and these platforms can now be developed further to support data and sample management for a broad range of pathogens and disease states. Member states are now working with stakeholders to link these networks with existing surveillance platforms, to streamline data sharing across sectors as rapidly as possible [11-13]. The importance of streamlining and improving the capacity for data sharing cannot be understated, both in a multi-sectoral fashion within a country and collaboratively across borders to ensure all countries are aware of challenges as they arise, and can mount appropriate, measured responses in a timely manner before a threat emerges, rather than during an emergency.

An often-overlooked component of public health response is the investment in human resources. The COVID-19 pandemic placed an extreme burden on health workers across the region, and the world, often working under extremely challenging conditions with the sustained pressure of samples continually needing urgent analysis [11]. This had a massive impact on staff wellbeing across the sector, and efforts need to be taken to ensure that laboratory and public health responses are sustainable and that the expertise gained from working under such conditions is not lost because of the pandemic slowing and investment reducing. Laboratories across the region took novel steps to support their staff, beyond wage investment, including areas such as staff mental health and physical well-being, and will now look to apply the lessons learned to sustainable laboratory operations in future.

In conclusion, laboratory support and expansion in the Eastern Mediterranean Region during the COVID-19 pandemic demonstrated the region's resilience and commitment to public health. By building on the lessons learned, sustaining investments in infrastructure, fostering collaboration, and prioritizing research and development, the Eastern Mediterranean Region can further strengthen its public health and healthcare systems to be better prepared to respond to future challenges. The COVID-19 pandemic has highlighted the critical role of laboratories in disease surveillance, diagnosis, and research, emphasizing the need for continued support and investment in this vital sector. Through collective efforts, sustained commitment, and international engagement, the region can pave the way for a healthier and more resilient future for its population and at the same time inform global health responses.

John McCauley: conceptualization, writing – original draft, writing – review and editing. Maria Van Kerkhove: conceptualization, writing – original draft, writing – review and editing. Laith Jamal Abu Raddad: conceptualization, writing – original draft, writing – review and editing. Luke Meredith: conceptualization, writing – original draft, writing – review and editing. Richard Brennan: conceptualization, writing – original draft, writing – review and editing. Abdinasir Abubakar: conceptualization, writing – original draft, writing – review and editing. Amal Barakat: conceptualization, writing – original draft, writing – review and editing.

The authors declare no conflicts of interest.

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在 COVID-19 大流行期间扩大东地中海地区的实验室能力:经验教训与未来可持续性战略》。
COVID-19 大流行给全球医疗保健系统带来了前所未有的挑战,需要从公共卫生到商业等各个部门做出迅速而有力的反应。应对措施中的一项关键工作是需要大幅扩大实验室检测和诊断,以监测病毒的传播,并提供关键数据,支持有效的公共卫生措施。威胁的规模推动了实验室诊断和基因组监测方面的研究和创新,提高了检测能力,并为以前无法获得快速检测病原体的关键能力的国家提供了技术支持,而这些能力是防止下一次疫情爆发成为大流行所必需的:世卫组织东地中海区域包括巴勒斯坦被占领土和 21 个成员国:阿富汗、巴林、吉布提、埃及、伊朗、伊拉克、约旦、科威特、黎巴嫩、利比亚、摩洛哥、阿曼、巴基斯坦、卡塔尔、沙特阿拉伯、索马里、苏丹、阿拉伯叙利亚共和国、突尼斯、阿拉伯联合酋长国和也门。这些国家的社会经济和人口状况各不相同,许多国家还面临着国内冲突和自然灾害造成的人道主义危机。尽管面临这些挑战,但在国家、地区和国际利益相关者的支持下,该地区的成员国能够采取不同但基本有力的实验室应对措施,将 COVID-19 诊断和基因组学能力提高到覆盖该地区的 100%[1]。本期特刊深入探讨了在迅速扩大能力过程中所面临的挑战,以及在疫情期间为克服这些挑战所付出的非凡努力。本期特刊重点介绍的关键举措目前正转向建立一个可持续的实验室网络,该网络应具备检测和应对对该地区和全球公共卫生构成威胁的新病原体和再次出现的病原体的能力,其目标是防止下一次疫情爆发成为大流行。通过聚合酶链反应(PCR)和基因组学等分子平台加强检测能力的投资,在检测和监测 COVID-19 和其他呼吸道病毒方面发挥了关键作用,目前正在扩大到检测具有流行和大流行潜力的重点病原体,如其他呼吸道病原体(如 MERS-CoV)、虫媒病毒(如登革热)和出血热(如 CCHF),这些病原体定期威胁该地区。这些能力正在通过制定和投资国家和地区战略得到加强和维持,以支持该地区的基因组监测,目前正在努力建立指导委员会和技术工作组,以维持、规范和加强该地区的基因组测序工作[2],并继续扩大质量保证网络,以确保实验室继续提供可靠的结果,支持公共卫生行动[3, 4]。国际病原体监测网络(ISPN)的启动恰逢其时,该地区的成员国将为新型基因组和分子检测平台在未来的可持续发展提供支持。虽然下一代测序为病原体的基因组特征描述提供了宝贵的见解,有助于跟踪病毒变异和识别新出现的 SARS-CoV-2 变种,但集体努力需要侧重于长期战略,以确保这些平台在资金和技术上的可持续性。事实上,世卫组织东地中海地区办事处正在与成员国和国际利益相关者[2, 5](包括国际蛋白质组网络)合作,实施一项基因组监测区域战略,该战略将支持和授权成员国发展基因组测序和能力。这种积极主动的方法将使医疗保健系统能够调整和定制应对策略,最大限度地发挥基因组学的影响,同时将未来疫情爆发的潜在影响降至最低。该地区的主要利益相关方一直在为实验室规程等领域的培训提供支持,但现在的重点必须转向如何将这些新平台整合到现有的监测网络中,以提供可用的、与流行病学相关的、信息丰富的数据,从而支持公共卫生应对措施。实验室是公共卫生应对措施的关键支柱,需要与快速反应和监测团队合作,确保收集到高质量的样本和数据,从而得出高质量的结果。
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来源期刊
CiteScore
7.20
自引率
4.50%
发文量
120
审稿时长
6-12 weeks
期刊介绍: Influenza and Other Respiratory Viruses is the official journal of the International Society of Influenza and Other Respiratory Virus Diseases - an independent scientific professional society - dedicated to promoting the prevention, detection, treatment, and control of influenza and other respiratory virus diseases. Influenza and Other Respiratory Viruses is an Open Access journal. Copyright on any research article published by Influenza and Other Respiratory Viruses is retained by the author(s). Authors grant Wiley a license to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its integrity is maintained and its original authors, citation details and publisher are identified.
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