CAIRO — Regional Director of the World Health Organization (WHO) for the Eastern Mediterranean Ahmed al-Mandhari warned that the coronavirus pandemic continues to be a cause for concern, as cases in the eastern Mediterranean region, which includes 22 countries, have topped 3 million, with 78,000 deaths as of early November.
In a Nov. 1 interview with Al-Monitor via WhatsApp, Mandhari said that there are currently around 200 coronavirus vaccine candidates under development, 40 of which have reached the human clinical evaluation stage, and a large number of vaccines are in phase three trials. He noted that several countries in the eastern Mediterranean region are participating in the third phase of vaccine trials.
Below is the full text of the interview.
Al-Monitor: How do you see the epidemiological situation of COVID-19 in the eastern Mediterranean region? Have the region's countries entered the second wave of the virus?
Mandhari: The COVID-19 situation remains a cause for concern in the eastern Mediterranean region, with more than 3 million confirmed cases so far reported in all 22 countries of the region, and the number of deaths exceeding 78,000 as of Nov. 1. The number of cases are on the rise at rates that cause great concern in a number of countries. The second wave depends on the end of the first wave. According to the World Health Organization, the first wave witnessed a “decline of at least 50% over a three-week period since the latest peak and continuous decline in the observed incidence of confirmed and probable cases.” However, we have recently noticed that the number of cases in some countries is rising in large numbers after a phase of decline, especially after the ease of restrictions. We must be prepared for all scenarios, including fierce COVID-19 aftershocks.
Mandhari: Health partners remain concerned about the persistent underreporting of COVID-19 cases in countries experiencing conflict and war. At the same time, the official epidemiological curve underestimates the spread of COVID-19 in conflict countries — which face the double burden of confronting conflict situations on the one hand and responding to the COVID-19 pandemic on the other — for reasons that include lack of testing facilities and official reports, people’s hesitation to get tested or seek treatment due to fear of stigma, difficulty in accessing treatment centers and perceived risks of seeking care.
There are some factors that have had a negative impact on the response to COVID-19, including the population’s lack of awareness to reduce transmission, severe shortages of funding for health workers and personal protective equipment, and prolonged delays in importing supplies needed to respond to the pandemic. For example, in Libya, the number of confirmed COVID-19 cases has doubled recently, and we believe the number of real cases are much higher than the reported one given the acute shortage of testing and laboratory capacities. The WHO supports the efforts made by the Libyan authorities to increase the number of coronavirus tests, track contacts, strengthen isolation measures and work closely with other partners to eliminate the stigma associated with having this disease. Yemen has registered 2,059 confirmed cases with 597 deaths in 11 governorates, and the numbers are still declining, which may be due to the lack of reporting of cases. Partners continue to work to increase tracking activities, and send dedicated personnel to deal with the pandemic and monitor the impact of the virus on routine, priority health programs.
Al-Monitor: What about the COVID-19 situation in Syria?
Mandhari: Despite the exceptional circumstances and implications of the yearslong conflict in Syria, the WHO seeks to strengthen technical capabilities, including rationalized use of personal protective equipment, case management, infection prevention and control, environmental disinfection, risk-related communication. We focus on procuring and enhancing medical supplies, including testing supplies and personal protective equipment. So far, the WHO has provided a wide range of screening devices, supplies and sample collection kits to conduct about 60,000 tests, but much more materials are needed to promote testing. Moreover, personal protective equipment supplies were delivered to cover six months. The Syrian Ministry of Health and the WHO are facing challenges in receiving some specific equipment and supplies that could affect the overall testing.
Al-Monitor: What is your assessment of the various plans that the countries of the region adopted to combat the coronavirus? What are the strengths and weaknesses?
Mandhari: All countries of the region have a plan to respond to the COVID-19 pandemic. We have been keen on supporting such plans from the early hours of the emergence of the virus. We sought to make sure that all countries have the basic capabilities necessary to activate their response to the pandemic. But of course the levels of response differ from one country to another according to many factors, including the financial and technical capabilities available to each country, and the security situation in terms of the degree of stability or the presence of conflicts affecting the health infrastructure as well as the strength or exhaustion of the health sector in each country. We noticed different levels of response activities and degrees of success. Overall, one might say that the main weaknesses include the lack of preparedness and plans in some countries to deal with epidemics and pandemics, the poor health system or its exhaustion due to long-term conflicts or disasters, and the lifting of restrictions, easing precautionary measures and opening borders without meeting the necessary preconditions to ensure that the pandemic does not resurges. Add to this, the weak societal role, and the failure of individuals and societies to adhere to preventive measures with sufficient seriousness. We noted that the most important reason for the spread of the virus in a number of countries is participation in marriage gatherings, religious occasions and public events without taking the necessary preventive measures.
Al-Monitor: What are the latest updates regarding the coronavirus vaccines and when do you expect the first vaccine to be used? How will it be distributed? Are war-torn countries a priority?
Mandhari: There are currently around 200 COVID-19 vaccine candidates under development, among which more than 40 are in the human clinical evaluation stage and a large number of them have reached phase three trials. Several countries in the eastern Mediterranean region are participating in the phase three of clinical trials, and we encourage the rest of the countries to participate in these trials.
When a safe and effective vaccine is found, the COVAX Facility [led by the WHO, the Vaccine Alliance and Immunisation and the Coalition for Epidemic Preparedness Innovations] aims to coordinate equitable access and distribution among all countries and territories, regardless of their economic situation.
In all cases, once a vaccine is proven to be safe and effective and is authorized for use, the WHO advises all countries to distribute doses covering 20% of their population, starting with the high-risk groups, including health-care workers, those with chronic diseases and the elderly. We must avoid the “nationalization of the vaccines” if we want to stop the pandemic quickly and effectively.
Al-Monitor: Some countries in the region are conducting clinical trials for the coronavirus vaccines. Are you following up on such experiments and what is your take on them?
Mandhari: Our role is based on coordination, not supervision. We are keen to ensure that all necessary standards are applied to guarantee that these experiments are conducted scientifically in accordance with the recognized standards. Each country has the right to conduct clinical trials on candidate vaccines, and in the end the WHO will consider the documented and evidence-based results of those trials, but it will only approve vaccines that have passed all stages and are proven by scientific evidence for their effectiveness and safety.
Al-Monitor: The WHO is supervising experiments on a number of medications to be used as a treatment for the coronavirus. What are the latest details about them and have any of them proven efficient so far?
Mandhari: The preliminary results of the trial coordinated by the WHO indicated that treating cases of COVID-19 using remdesivir, hydroxychloroquine, lopinavir and interferon over a period of 28 days apparently has little or no effect, whether at the level of the mortality rate of COVID-19 patients who receive treatment in hospitals or throughout the duration of their stay in the hospital. Global research efforts continue to search for a treatment for COVID-19, in tandem with a continuous update of the treatment protocols for patients to relieve their symptoms and improve the general health.
Al-Monitor: How does the WHO support countries in the region in confronting the virus?
Mandhari: The WHO continues to support the countries of the region on several levels, including providing technical and logistical support for all countries to enable them to respond to the pandemic, especially for the countries and regions most in need. The WHO seeks to strengthen national capacities in the field of pandemic response, coordinate global research efforts to reach a vaccine and treatment for COVID-19, provide and update data-based information and guidelines, and enhance awareness and community participation in combating the spread of the pandemic.
I would like to point out that, since the outbreak of the crisis, we have succeeded in enabling the countries of the region to possess basic capabilities for preparedness and response, especially in conflict countries whose health systems are overstretched and where the necessary resources are not available. Through the launch of the Ministerial Coordination Group on COVID-19, the WHO has strengthened work and coordinated cooperation between countries, and facilitated the daily exchange of successful experiences and information.
Al-Monitor: Some countries in the region decided to reopen schools again, despite fears of spikes in the number of cases of COVID-19, do you see this as an appropriate solution?
Mandhari: We understand and appreciate the motives behind this decision, but at the same time we assert that the decision to completely or partially close schools or reopen them should be based on a risk-based approach. Everyone hopes students, teachers and the wider community could get the maximum benefits of education while averting a new outbreak of COVID-19 in the local community.
Al-Monitor: To what extent is the WHO affected by the United States suspending its funding to the organization?
Mandhari: The WHO is working with all member countries in accordance with its charter, governing principles and mandate, on the basis of cooperation, consultation, joint work and mutual trust. Over decades of cooperation between the WHO and the United States, we have succeeded in adhering to these principles to achieve important health gains that countries participated in achieving through their contributions. Together we have succeeded in implementing many programs to support countries most in need and save millions of lives. There is no doubt that the suspension of any country’s commitment [funding] will have a negative impact on programs targeting the vulnerable, risk groups, internally displaced and refugees. We hope the causes of the disagreement will be eliminated and the bilateral relations will return to their previous state for the benefit of all countries. Again, we emphasize that health is a bridge for peace. This is a time for solidarity, unity and joint action under the umbrella of the 2023 Vision, that is “Health for All, by All” so that everyone in the eastern Mediterranean region can enjoy a better quality of life.