EMARIS Conference 2023: Convergence of science, policy, and practice on acute respiratory infections in post COVID‐19 Eastern Mediterranean Region

Acute respiratory infection (ARI) is consistently ranked among the leading causes of morbidity and mortality worldwide. It kills more than 4 million people each year globally yet has been referred to as a “forgotten pandemic.” ¹ New viral respiratory pathogens are emerging with increasing frequency and have demonstrated their potential for devastating global public health, socio‐economic and political impacts. ² Within two decades, the world has faced an influenza A(H1N1) pdm09 pandemic and the emergence of three highly pathogenic and deadly human coronaviruses, namely SARS‐CoV, MERS‐CoV and SARS‐CoV‐2, the last one causing a pandemic. ³ As a result of the of recent pandemic, WHO has estimated the excess mortality due to COVID‐19, disease caused by SARS‐CoV‐2, to be 13.3–16.6 million deaths in addition to colossal economic and social disruption. ⁴

The WHO Eastern Mediterranean Region (EMR) is home to nearly 700 million people across 22 diverse countries and territories spread over South and West Asia, the Middle East and North Africa with its unique geographical, political and health system challenges. ⁵ The 3rd Scientific Conference on Acute Respiratory Infections in the Eastern Mediterranean Region (EMARIS Conference) and the 6th Meeting of the EMARIS Network, brings together experts on acute respiratory infections (ARI), disease surveillance, preparedness and response to epidemics and pandemics. The conference is organized by the WHO Regional Office for the Eastern Mediterranean, in partnership with the Influenza Division of US Centers for Disease Control and Prevention and several other partner organizations and networks. ⁶

This special issue of Influenza and Other Respiratory Viruses (IORV) reflects the scientific knowledge, practice experiences and discussions held at the EMARIS Conference. The issue covers conference submissions and relevant knowledge from within the EMR and from across the globe. It includes studies and commentaries on diverse topics including influenza burden, genomics, seasonal vaccination, behavioral information, and the significance and surveillance of non‐influenza respiratory viruses.

There are several pertinent findings presented in this special issue. In the area of influenza burden, the paper by Salman et al. ⁷ on seasonal influenza burden used sentinel sites in Pakistan to demonstrate how influenza accounts for a significant proportion of respiratory morbidity and hospitalization in the country. The authors argue that estimates from sentinel sites could serve as a first step toward accurate estimation of national influenza associated disease burden.

A paper by Sadeghi et al. ⁸ on SARS COV‐2 strains during the COVID pandemic in Iran also highlights how genome sequencing, which is a key strategy in genomic surveillance systems, could help detect and monitor the prevalence of SARS‐CoV‐2 variants; foster monitoring of the viral evolution of SARS‐CoV‐2 and identification of new variants for disease prevention, control, and treatment; and help provide information for enhanced public health measures and policy actions.

Moreover, according to a study by Attia et al. ⁹ on seasonal influenza vaccine policies in the Eastern Mediterranean Region, about 64% countries reported having a national seasonal influenza vaccine policy, 44% countries recommended influenza vaccine for all SAGE recommended target groups, and approximately 69% of countries reported that COVID‐19 had an impact on influenza vaccine supply in the country—where the majority (about 82%) reported an increase in procurement and supply of influenza vaccine. The study urges countries to develop a roadmap for increasing influenza vaccine uptake, including assessment of the economic barriers and those related to vaccine acceptance and utilization.

Understanding factors that affect patient behaviors and health outcomes is important for reducing disease burden. ¹⁰ A study by Merza et al. ¹¹ on the factors associated with poor outcomes of inpatients with severe acute respiratory infections among patients who met World Health Organization's (WHO) SARI case definition at Salmaniya Medical Complex in Bahrain, found that age above 50 years, and pre‐existing kidney, lung, or heart disease were associated with worse outcomes. Authors are of the view that expansion of vaccination strategies targeting all individuals at high risk, and early diagnosis and treatment, could help reduce the burden of SARI.

The COVID‐19 pandemic has brought much attention to respiratory infections across the world. ¹² Today, human coronaviruses (HCoVs) continuously circulate in the human population. ¹⁰ A study by Karami et al. ¹³ in this issue assesses the impact of the coronavirus disease 2019 (COVID‐19) pandemic on the circulation of HCoVs. Their multi‐center survey provides a deeper insight into the low circulation of HCoVs during the COVID‐19 pandemic in Iran during 2021–2022. The study outlines the important role of public health measures such as hygiene practices and social distancing, in decreasing the burden of HCoVs transmission. But to sustain gains, the authors recommend further studies on surveillance systems to help track the pattern of HCoVs distributions and to detect changes in the epidemiology of such viruses.

Overall, papers in the issue highlight the importance of preparedness for high threat respiratory pathogens, such as influenza and other viruses, and argued that, to the extent possible, preparedness should include developing effective strategies within vaccination programmes to increase uptake, strengthening health systems resilience, enhancing surveillance and laboratory capacity, improving outbreak response through joint coordinated actions, and increasing public health awareness and education.

The papers in this issue highlight the significance of strengthening and sustaining health systems capacities for quick detection of possible cases, early diagnosis, and rapid response to outbreaks, reducing the severity of illness, and prevention of further spread of the disease. All of these elements are vital for effective preparedness for influenza and other respiratory viruses. ¹⁴

In summary, EMR countries have made considerable gains in the past two decades, but gaps still remain. Now countries must implement the lessons learned from the pandemic and other disease outbreaks to further invest in stronger and more resilient health systems that cannot only withstand the added burden imposed by a major epidemic or pandemic, but also scale up the response to effectively manage it. As the papers presented at EMARIS make clear, this requires strengthened capacities in disease surveillance, laboratory science, clinical management, infection prevention and control, risk communications and community engagement, vaccinations, and supply chain management. It also relies on the generation and use of local knowledge for improved policy and management decisions.

In the EMR, the EMARIS Conference and meeting is a unique platform where science, practice, and policy making on ARIs converge. Over the years, the EMARIS conference has highlighted science policies and experiences to guide countries toward improvements and also point towards needed future directions in surveillance, epidemic and pandemic preparedness and response. The 2023 Conference is yet another reminder of the importance of ARIs in the Region. It calls for learning from COVID‐19 pandemic experience, and stresses the need to revitalize country health systems to address ongoing challenges associated with respiratory disease surveillance, future epidemics and pandemics, and, indeed, all health emergencies.

AUTHOR CONTRIBUTIONS

Abdullah Assiri: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Ann Moen: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Rick Brennan: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Abdinasir Abubakar: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Wasiq Khan: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal). Ahmed Al Mandhari: Conceptualization (equal); writing—original draft (equal); writing—review and editing (equal).

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

PEER REVIEW

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1111/irv.13129.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable as no new data were generated.