Projects

Middle East Consortium on Infectious Disease Surveillance (MECIDS)

Overview | Impact | Activities | Challenges | Supporters | Future Direction

Overview

NTI's Global Health and Security Initiative supports the development of an infectious disease surveillance system in the Middle East. This network, called the Middle East Consortium on Infectious Disease Surveillance (MECIDS), brings together public health leaders, academic institutions and private health care facilities in Jordan, Israel and the Palestinian Authority to improve the ability of nations to detect and respond to infectious disease threats through integrated surveillance systems and joint epidemiological and laboratory training. NTI also supports each country in meeting the capacity goals of the World Health Organization (WHO) International Health Regulations.

The partnership was highly functioning when the first outbreak of avian flu was detected in the region and the MECIDS partnership enabled rapid communication and coordination of efforts to help contain the spread of the disease.

Impact & Achievements

The common threat of emerging infectious disease has served as an opportunity to bridge political disputes and focus on humanitarian and health matters for the common good of all partner countries. Toward this end, MECIDS partners have made an impact in the following ways:

• Detected two significant outbreaks, salmonella and mumps, providing evidence that the system is functioning properly
• Coordinated cross-country planning helped mitigate a potential public health crisis due to multiple avian influenza outbreaks
• Built professional and personal relationships through joint efforts on preparedness created that have an infrastructure for cross border collaboration during emergencies
• Shared data and harmonized individual countries' preparedness plans for pandemic and avian influenza have helped synchronize efforts during the avian influenza outbreaks
• Engaged in cross country cooperation of veterinary and public health services that helped contain outbreaks of avian influenza in the partner countries
• Tackled across border outbreaks by taking extensive and uniform measures enabling the countries to avoid human infection, increase public confidence, and reduce adverse outcomes of the outbreaks.
  

Members of the MECIDS Secretariat and Executive Board and GHSI's Terence Taylor: (bottom, from left) Dr. Alex Leventhal, Dr. Adel Belbesi, Dr. Assad Ramlawi; (top, from left) General Mohammed Shiyyab, Dr. Bassam Hijawi, Dr. Daniel Cohen, Mr. Terence Taylor

Activities

Focus on food- and water-borne diseases

MECIDS members' priority concern is food and water-borne diseases. MECIDS has established protocols for specimen collection and diagnosis of diarrheal illnesses to assess food-borne disease in the region and to create a mechanism for identifying potential disease outbreaks due to common food products. Members are sending their data routinely to one another, opening the lines of communication between the Ministries of Health in each country.

Other biological threats

Laboratory and epidemiologic capacities initially focused on food- and water-borne diseases, with the plan to expand to other biological threats and to include other neighboring countries. Since the recent cases of avian influenza emerging in the region, MECIDS has demonstrated itself to be an important channel for rapid communication in responding to the most pressing threats facing the region.

Regular, cross-border information exchange

Each country submits their approved data monthly to the MECIDS program associate for compilation and distribution to all member countries in the form of a newsletter. Telephone and computer communications are used to obtain additional information as necessary.

Monthly executive council meetings

MECIDS Executive Council members meet regularly to discuss specific issues such as cross-border coordination, review their regional influenza preparedness plan, consult on emerging disease cases, and maintain a close working relationship among people responsible for infectious disease detection and response.

Regional scientific conferences

The human and animal health sectors from Jordan, Israel and the Palestinian Authority came together with experts from the WHO, and other invited technical experts to review the completed regional pandemic preparedness plan and to put into place a common plan of action. The regional conferences allow for an examination of the regional plan with regard to risk communication, vaccine policy, cross border transport, training and applied research.

For example, in November 2007, the MECIDS partners invited representatives from the WHO to conduct a workshop on the International Health Regulations (IHR). The IHR, which were recently amended to include a larger range of diseases, are legally binding regulations to contain the threats from diseases that may rapidly spread from one country to another. Israel and Jordan are both WHO Member States. The Palestinian Authority is not currently a Member State, but was engaged in the discussion about the value and challenges of IHR implementation.

Laboratory and risk communication training

The World Health Organization's guidance on avian and pandemic influenza recommends that countries receive training in laboratory methods needed for H5N1 diagnosis, epidemiologic investigation, and risk communication. MECIDS workshops have provided the added value of training in interpersonal communication and cooperative problem solving.

Information and communications technology

With the support of IBM a project is underway to develop and implement innovative software for a data-sharing network for the MECIDS partners. The project includes the supply of computers and servers as well as training for those that will be handling the epidemiological surveillance data. Private companies are also supporting capacity-building by donating critical laboratory equipment. In particular, NTI support for Pulsed Field Gel Electrophoresis (PFGE) laboratory equipment and training was instrumental to the formation of PulseNet Middle East as part of the larger PulseNet International.

Challenges

The MECIDS network faces many ongoing and day-to-day challenges in their efforts to protect human health and reduce the risk of disease outbreaks.

Political sensitivities

Regional conflicts can interfere with planned meetings, conferences and other events.

Information security

Because public health information can be very sensitive—especially if that information carries potential economic ramifications—security concerns remain a significant barrier to effective surveillance and data integration across borders. However, the trust and relationships that have developed through MECIDS now allow for much greater sharing of information.

Barriers between animal and human health sectors

MECIDS participants recognize a need for closer communication between programs within the human health sector, and with other sectors such as veterinary public health. Integration between animal and human health sectors' surveillance and response is a high priority.

Infrastructure

MECIDS participants continue to grapple with ongoing limitations in human resources and health systems. There is a need for capacity building in epidemiological investigation and laboratory capabilities.

Supporters

NTI's GHSI provides essential financial, technical and advisory support to MECIDS, and Search for Common Ground has provided day-to-day management of projects and activities. MECIDS is currently transitioning to a self-sustaining model run by the MECIDS members. In support of this transition, the World Bank has provided NTI with a grant that will allow the members to strengthen laboratory capacity and governance.

Becton Dickinson and Company has donated a three-year supply of reagents and other medical supplies needed for laboratory diagnosis. IBM is making an in-kind donation that includes the development of a new, innovative approach to handling epidemiological data through a shared laboratory information network for the MECIDS partners.

MECIDS advisors include the WHO and American and European organizations. MECIDS has created a tight network among senior officials in the region, including the heads of the public health services and centers for disease control of Jordan and Israel.

Future Direction

The focus of MECIDS will continue to be the improvement of national and regional infrastructure to detect and control infectious disease, especially through improved disease surveillance. MECIDS members have identified immediate goals that include:

• Meeting critical laboratory needs for pathogen species characterization
• Improving information sharing capacity
• Finalizing a common plan of action on avian influenza
• Writing and implementing pandemic influenza cooperation procedures according to the International Health Regulations
• Ensuring the financial stability and sustainability of MECIDS
• Engaging other countries in the region with a view towards membership
  

Links

1. BMJ Article "Regional Collaboration in the Middle East to deal with H5N1 flu."

2. MECIDS Website

MECIDS is a collaboration of national and international organizations including: Al Quds University • Cooperative Monitoring Center in Amman, Jordan • European Programme on Intervention Epidemiology Training • Ministry of Health, Israel • Ministry of Health, Jordan • Ministry of Health, Palestinian Authority • Sandia National Laboratories • Search for Common Ground • Tel Aviv University • NTI's Global Health and Security Initiative • World Health Organization