Laboratory workers supervize the production of vials of China's Sinovac vaccine, produced by Egyptian company VACSERA, in Cairo, on September 1, 2021. (Photo by KHALED DESOUKI/AFP via Getty Images)
Analysis

Reliable Health Data in the MENA Region: The Hard Pill to Swallow

How many people lost their lives to COVID-19 in the Middle East and North Africa (MENA) region? Where are the hotspots for spreading? Are women and men in the region equally impacted by COVID-19? What were the capacities of hospitals throughout the past year? How many lives could have been saved? What are the plans for mass vaccination? What is the rationale for resuming education at schools and universities? Many questions with partial, projected, or no answers at all. 

Unlike other countries across other regions, publicly available data from MENA countries about the age, sex, and geographical distribution of COVID-19 cases are lacking. For instance, U.S. COVID-19 data is readily available with various demographic, health settings, and geographic and genomic stratification. Canadas COVID-19 dashboard and India Fights Corona provide interactive information about COVID-19 cases, testing, and vaccination—all sorted by location. Canadas raw data are made accessible and stratified by age with clear notes about data collection methodologies and definitions. The European Center for Disease Prevention and Control provides comparable data across the European Union with data on intensive care unit occupancy, long term care facilities, and variants of concern. Sweden is providing a platform that features multidisciplinary research on COVID-19 by various research groups. In the United States, New York City and California are providing data about COVID-19 stratified by race and poverty levels, and Los Angeles County is making data about health comorbidities available to the public. Moreover, some public schools in the US reported to the public the vaccination coverage among their staff and students prior to resuming in-person education, so parents can decide to send their children to schools or to continue online learning.

The access to health information in the MENA region relies much on the political atmosphere and the quality of health surveillance systems. A World Bank report showed that the MENA region was the lowest in the world in all three dimensions of statistical capacities: methodology, source data, and periodicity in 2018. This restricted statistical capacity reflects on the development of the countries of the region. Generally, there is a complete lack of raw data or open access repositories for COVID-19 in the region. Most states in the region have not publicly provided credible economic or comprehensive epidemiological data about COVID-19, even higher income ones such as UAE, Saudi Arabia, and Qatar. These states only report basic epidemiologic data including daily new cases, hospitalizations, and deaths—in addition public health measures as communicated by official government platforms. 

Interestingly, Iraq, the Palestinian territories, Yemen, Syria, and Jordan might have by far the most organized and detailed data in the region, despite humanitarian crises there. This could be attributed to the role of United Nations agencies and relief organizations in these countries. That being said, and with the variation in testing capacities, access to service, and quality of reporting mechanisms, available data rarely play a role in evidence-based decision making. The top-down approach that is employed sees people not as part of the process, but merely as recipients. This approach involves states choosing ready-made solutions, instead of investing in participatory approaches that address the needs of citizens. Moreover, there are several constraints in researching domestic and international non-governmental organizations. Security and privacy issues usually hinder potential initiatives, and at most, organizations manage to conduct telephone surveys in an effort to reach some sort of community engagement to inform decision-making. UN reports rely on publicly available data and provide estimates based on interviews with local informants. The issue of information transparency and citizens right to know is another dimension of the problem. 

Experts estimate that excess daily death due to COVID-19 in the region was 3.2 times larger than officially reported numbers. Circulating new variants, especially the Delta variant—in addition to the relatively low vaccination rates and lack of adherence to public health measures—worsen the situation. The situation is even more complicated in conflict areas like Syria, West Bank, and Yemen, where despite having relatively better available data, the availability of testing and quality of reporting is a major concern that underestimates the extent and burden of the pandemic in those countries. 

Problems in data quality and availability in the MENA region are not new. The dearth of disaggregated and publicly available data about the epidemiology, social and economic impacts of COVID-19 is a consequence of years of underinvestment in scientific research and undervaluing the right to information. The absence or under-functioning of basic infrastructure for health surveillance and regulatory mechanisms for data governance increased the gap between citizens and governments. The officially reported numbers of daily cases and deaths are not reflective of the situation and citizens know that. 

Despite the disparities in income, capacities, political and humanitarian situations, the lack of quality data is almost the only common thing between MENA countries. Given the currently available data from MENA countries, neither a fair evaluation of the response to the pandemic nor a comprehensive understanding of its impact can happen. Public servants should acknowledge that a dearth of data looks worse than having bad” data. Working on creating open access to data about testing, incidence, hospitalization, mortality, long-term health impacts that are stratified by key demographic indicators is not a luxury or an extra mile. Knowing and communicating data stratification by age, gender, refugee status, foreign worker status, geographic location, and ethnicity is critical to reflect a near-real estimation of the situation. Disclosure of this information is a human right and many constitutions of MENA countries grant it. In addition, the technology needed to reach this is quite simple and can be adapted either at a low cost or with investments or aid. The COVID-19 pandemic and the data crisis should be a call for action to improve the health surveillance infrastructure starting from district-level and up to ministries. Meaningful partnerships with universities, research groups, entrepreneurs, and civil society organizations should be facilitated. Investment in outlining the barriers in each country context is critical to prioritize the action points whether financial, capacity building, or advocacy support need to happen first. The culture of measurement and benchmarking is existing but needs enforcement and many reforms.