Preparedness in a region defined by complexity and crisis
The Eastern Mediterranean Region (EMR) is one of the world’s most complex settings for infectious disease preparedness. Home to 22 Member States and more than 700 million people, the region experiences dozens of acute public health events each year, including seasonal influenza epidemics, zoonotic influenza infections, and other epidemic-prone respiratory diseases. Over half of EMR countries experience protracted conflict, political instability, or prolonged humanitarian emergencies, leading to the displacement of tens of millions of people within and across borders. These dynamics complicate surveillance, strain health systems, and heighten the urgency of robust preparedness.
Situated along major migratory bird flyways and global travel routes, the Region plays a critical role in global influenza surveillance. Viruses detected and shared by EMR countries inform global risk assessments and seasonal vaccine composition through the Global Influenza Surveillance and Response System (GISRS).
Effective preparedness in the EMR contributes not only to regional health security but also to global preparedness by reducing the risk of international spread and supporting global vaccine decision-making.
Building and sustaining core surveillance and laboratory capacities
When the Pandemic Influenza Preparedness (PIP) Framework was adopted in 2011, influenza preparedness in the EMR was uneven. Surveillance systems were limited, laboratory capacity varied widely, and most countries lacked formal vaccine policies. The PIP Partnership Contribution (PC) provided predictable, multi-year financing, that helped 11 PIP PC countries (Afghanistan, Iran, Iraq, Lebanon, Jordan, Egypt, Morocco, Somalia, Sudan, Syria and Yemen) build and sustain essential capacities, while indirectly supporting 11 others.
By 2025, 18 of the 22 countries reported influenza data regularly through the regional database (EMFLU-2) and the global databases FluNet and FluID, supported by a broad network of sentinel sites contributing epidemiological information. Eighteen countries maintained functional National Influenza Centres, and at least 14 routinely shared influenza viruses with WHO Collaborating Centres under GISRS. Despite conflict, population displacement, and resource constraints, laboratory and surveillance systems continued to function across the region.
During the COVID‑19 pandemic, countries rapidly integrated SARS‑CoV‑2 testing into influenza platforms, accelerating the shift towards multi‑pathogen surveillance. Today, 21 countries have implemented integrated sentinel surveillance for influenza, COVID‑19, respiratory syncytial virus (RSV) and other respiratory viruses. These capacities ensure early outbreak detection, inform public health action and protect communities even in the most fragile settings.
Capacity building, integration and community protection
Regional training initiatives have strengthened workforce skills in epidemiology, laboratory diagnostics, outbreak investigation, and genomic surveillance. As a result, many countries transitioned from single disease systems to integrated multi-pathogen surveillance platforms, enabling simultaneous monitoring of influenza, COVID-19, RSV and other respiratory viruses. Building on COVID-19 lessons, the Region developed the first regional community protection operational strategy for PIP, linking to the Health Emergency Preparedness and Response framework and the International Health Regulations (IHR 2005). This strategy guides the use of the PIP PC, supports evidence-based decision-making and strengthens community resilience.
Leveraging influenza capacities for broader outbreak response
Countries that invested in influenza and other respiratory pathogen capacities are able to leverage this system to respond effectively to a range of respiratory outbreaks, including MERS, avian influenza and emerging pathogens. Investments evolved from establishing core capacities to enhancing quality, integration, and advanced capabilities such as genomic surveillance. Regional technical teams strengthened virus characterization and risk assessment, ensuring that the EMR data contribute meaningfully to global decision-making.
Tailoring the approach to country needs
PIP PC funding also enabled countries to generate evidence on disease burden and vaccine effectiveness. Iraq endorsed a national influenza vaccination policy, while Tunisia, Lebanon and Jordan are progressing towards formal policy frameworks. These achievements reflect the region’s diversity: while some countries prioritized advanced innovation and system integration, others focused on sustaining core capacities or ensuring continuity in fragile settings. Together, these efforts contributed to a collective and equitable regional response.
Targeted support tailored to each country’s context strengthens health systems, informs policy and protects communities across diverse and complex settings.
Looking ahead
PIP implementation in the EMR has demonstrated how sustained investment, regional collaboration and flexible approaches in fragile contexts can build resilient preparedness systems. The integration of advanced capabilities, such as genomic surveillance, strengthens not only influenza response but overall health security. Continued alignment with the Global Influenza Strategy, the IHR 2005, the HEPR, and the Pandemic Agreement will help sustain these gains and protect both regional and global health.
The PIP journey in the EMR shows that collective preparedness and an equitable response save lives, protect communities and reinforce global health security, even in the most challenging environments.