The World Health Organization (WHO) says countries across the Eastern Mediterranean are steadily strengthening systems to detect and respond to respiratory diseases, even as conflict, displacement and political instability continue to strain public health infrastructure.

In a feature released on April 17, WHO described the Eastern Mediterranean Region (EMR) as one of the most complex operating environments for infectious disease preparedness. The region comprises 22 countries and more than 700 million people, with frequent outbreaks ranging from seasonal influenza to zoonotic infections and other respiratory illnesses with epidemic potential.

WHO data show that more than half of these countries are affected by prolonged crises, including armed conflict and humanitarian emergencies, resulting in large-scale population displacement that complicates surveillance and service delivery.The region’s geographic position along major migratory bird pathways and international travel corridors gives it added importance in global influenza monitoring.

Viruses detected in EMR countries are routinely shared with international networks, contributing to global risk assessments and informing seasonal vaccine composition through the WHO-led Global Influenza Surveillance and Response System.WHO attributes much of the region’s progress to the implementation of the Pandemic Influenza Preparedness Framework, adopted in 2011 to improve global readiness for influenza pandemics.

At the time of its introduction, surveillance coverage and laboratory capacity across the EMR varied significantly, and most countries lacked formal vaccination policies. Through the framework’s Partnership Contribution funding mechanism, 11 countries, including Afghanistan, Iran, Iraq and Egypt, received sustained financial and technical support to develop core capacities, while additional countries benefited indirectly.

By 2025, WHO reports that 18 of the 22 EMR countries were regularly submitting influenza data to regional and global platforms, including EMFLU-2, FluNet and FluID. These systems are supported by an expanding network of sentinel surveillance sites that provide epidemiological data.

At the same time, 18 countries had established functioning National Influenza Centres, with at least 14 routinely sharing virus samples with WHO collaborating centres under GISRS.Despite operational challenges linked to insecurity and resource limitations, WHO said laboratory and surveillance functions remained active across most of the region.

This continuity was tested during the COVID-19 pandemic, when countries adapted existing influenza systems to incorporate SARS-CoV-2 testing. WHO described this transition as a catalyst for broader integration, accelerating the shift from single-disease monitoring to multi-pathogen surveillance.

According to WHO, 21 EMR countries now operate integrated sentinel surveillance systems capable of tracking influenza, COVID-19, respiratory syncytial virus and other respiratory pathogens simultaneously.

These systems are designed to enable earlier detection of outbreaks and support more timely public health responses.WHO officials also highlighted efforts to strengthen workforce capacity through regional training programmes in epidemiology, laboratory diagnostics and outbreak investigation.

These initiatives have supported the adoption of genomic surveillance techniques, allowing for more detailed analysis of circulating viruses and improving risk assessment capabilities.The organisation said that lessons learned during the COVID-19 pandemic informed the development of a regional operational strategy focused on community protection under the PIP framework.

This strategy is aligned with broader global mechanisms, including the International Health Regulations (2005) and WHO’s Health Emergency Preparedness and Response framework. It is intended to guide the use of funding, support evidence-based policymaking and improve resilience at the community level.Countries that have invested in influenza preparedness infrastructure have also been able to apply these systems to other respiratory threats.

WHO cited responses to Middle East respiratory syndrome (MERS), avian influenza and emerging pathogens as examples of how established surveillance and laboratory networks can be leveraged beyond their original scope.Investment priorities have evolved over time, moving from the establishment of basic surveillance systems to improvements in quality, integration and advanced capabilities such as genomic sequencing.

WHO said regional technical teams have played a role in strengthening virus characterisation and ensuring that data generated in the EMR contribute effectively to global decision-making processes.The framework has also supported countries in generating national-level evidence on disease burden and vaccine effectiveness. WHO noted that Iraq has formally adopted a national influenza vaccination policy, while Tunisia, Lebanon and Jordan are in the process of developing similar frameworks.

These policy developments reflect varying national priorities, with some countries focusing on innovation and system integration and others concentrating on maintaining essential services in fragile settings.WHO emphasised that tailored approaches remain critical given the diversity of conditions across the region. Targeted support, adapted to individual country contexts, is seen as key to strengthening health systems and ensuring continuity of surveillance and response activities.

Looking ahead, WHO said continued alignment with global strategies, including the Global Influenza Strategy and ongoing discussions around a Pandemic Agreement, will be necessary to sustain progress.

The organisation highlighted the importance of long-term investment and regional collaboration in maintaining preparedness gains and mitigating the risk of cross-border disease transmission.