First Four-Way Meeting on “Bird Flu”:
Palestinians, Jordanians, Israelis, and Egyptians Coordinate on Avian Influenza
Risk
Israeli, Jordanian, Egyptian, and Palestinian health and veterinary officials met in
Istanbul December 11-14, 2005, and discussed a framework for regional cooperation to
prepare for the possibility of a deadly influenza pandemic. They agreed to develop
recommendations for cooperation and coordination on disease surveillance, risk
communication, vaccination, training, research, and the movement of people and goods
before and during a “bird flu” outbreak.
While there have been Israeli-Jordanian and Israeli-Palestinian meetings since the “bird
flu” made headlines in the Mediterranean region in early October, this was the first
meeting in which experts from all four nations participated. These experts met under the
umbrella of the Middle East Consortium on Infectious Disease Surveillance (MECIDS).
The goals of MECIDS are to improve the ability of nations in the Middle East to respond
to outbreaks of disease and to build mutual trust through trans-border cooperation. It was
founded by Search for Common Ground, a global conflict-transformation organization,
and the NTI Global Health and Security Initiative, which focuses on strengthening global
disease surveillance, early detection and rapid response.
The meeting featured experts from the various disciplines required to respond to
influenza outbreaks, such as epidemiology, hospital administration, laboratory testing,
and veterinary services. They discussed objectives and actions for the pandemic phases
defined by the World Health Organization (WHO), and across categories also defined by
the WHO, namely:
1. Planning and coordination
2. Situation monitoring and assessment
3. Prevention and containment
4. Health system response
5. Communications
They agreed on a program of activities that they could undertake, as well as some
recommendations they could pass to the decision-makers in their countries, to cooperate,
coordinate, and assist each other in these different areas. Together, these constitute a
“Framework for Regional Influenza Preparedness.”
National Plans Presented
At the conference, countries presented their national pandemic influenza preparedness
plans. Following World Health Organization recommendations, all four have formed
national coordinating committees. Presentations on the plans can be viewed at
www.mecids.net.
Expert Presentations
World-renowned influenza expert Robert Webster of St. Jude’s Children’s Research
Hospital presented an in-depth discussion of the nature of avian influenza and suggested
that the development of a vaccine should be the highest priority of health officials. The
head of Malaysia’s Epidemic Intelligence Service described her country’s experience
with avian influenza, and a representative of the WHO Global Influenza Programme
spoke about international planning efforts. Finally, representatives of ProMed-Mail, the
Global Public Health Intelligence Network (GPHIN), IBM, and the Cooperative
Monitoring Center @ Amman elaborated several possible ways to use
telecommunications technology to enhance disease surveillance. Their presentations can
be viewed at www.mecids.net.
Framework for Regional Influenza Preparedness
Planning and Coordination:
The many subjects that arose require further elaboration and ongoing cooperation. The
participating nations will meet monthly at the King Hussein/Allenby Bridge border
crossing point to manage the emerging situation and work in depth on agreed-upon
subjects. A proposed schedule for the meetings is as follows:
January:
February:
March:
April:
June:
July:
August:
MECIDS strategy and fundraising
Risk Communication
Disease Surveillance
Avian Vaccine Policy
Movement Issues
Training
Applied Research
Surveillance
Meeting participants discussed several aspects of disease surveillance, focusing on the
types of information needed and the information flow within and among countries. To
facilitate the rapid sharing of data about suspected avian and pandemic influenza cases,
they recommended that nations take the following steps:
 Write common epidemiological investigation guidelines.
 Create common reporting form.
 Agree on common case definition.
 Conduct survey of laboratory capacity.
 Agree on who, what, where, when, why, and how for reporting both suspected and
confirmed cases to each other.
 Meet with representatives of IBM to discuss upgrading cross-border communications
technologies.
Prevention and Containment:
The primary subject discussed in the category of prevention and containment was the
movement of people and goods among the territories of the participating nations. Their
intermingled populations, combined with the unresolved political and security conflicts
among them, create a special set of problems. The group identified the following issues:
 Access between the West Bank and Gaza.
 The number of West Bank checkpoints.
 The Allenby/King Hussein Bridge border crossing.
 The movement of goods.
 Animals
 Foodstuffs.
 Airports.
 Access to hospitals.
Communication
The participants agreed on objectives for risk communication about an influenza
outbreak.
• To cooperate in preparing a regional communication plan for pandemic influenza
• To harmonize national public health messages in the region
• To coordinate local plans ensuring that they do not contain major contradictory
messages to the public
• To assist each other in developing risk communication materials
• To explain differences in public health actions in the countries of the region
Training
The participants agreed to pursue a comprehensive series of training courses on both
avian influenza and pandemic influenza. The trainings would cover different processes
related to influenza surveillance and response and would be geared toward specific target
audiences, as follows:
Process
Surveillance
Laboratories
Clinics
General
hospitals
Management
Target population:
Avian Influenza
Agriculture: veterinaries
MOH: PH physicians
and nurses
Human;
Veterinary
Physicians and nurses
Target population:
Pandemic Influenza
MOH: PH physicians
and nurses
Physicians and nurses
Infection control
specialist
Senior health care
officers in community
clinics, general hospitals
and the ministry of
health
Physicians and nurses
Infection control
specialist
Senior health care
officers in community
clinics, general hospitals
and the ministry of
health
Human;
Physicians and nurses
Risk
communication
Healthcare professionals
who are experts in the
subject (preferably a mix
of academicians,
hospitals well known
experts, etc)
Healthcare professionals
who are experts in the
subject (preferably a mix
of academicians,
hospitals well known
experts, etc)
Tabletop
exercise
Healthcare system;
Country level; Region
level
5 Healthcare
professionals per country
Healthcare system;
Country level; Region
level
5 Healthcare
professionals per country
Train the
trainer
Participants also planned to look for established educational materials regarding avian
and pandemic influenza that have been developed by other agencies, such as the United
States Centers for Disease Control and Prevention, the European Centre for Disease
Control, the WHO, and other national health ministries. They agreed that Search for
Common Ground should send a letter to these agencies requesting material, which they
will then adapt to the needs of the Middle East.
Israeli experts proposed that a pandemic influenza training CD and video they developed
be translated into Arabic and shared with their Palestinian and Jordanian colleagues.
The Cooperative Monitoring Center @ Amman offered to host a training session and to
put educational material on the MECIDS web site.
Research
Participants at the meeting discussed possible research strategies regarding avian
influenza and agreed that training and research should be integrated.
Topics for joint applied research in the region to support preparedness against
influenza pandemic (discussed and agreed upon at the meeting in Istanbul,
December 2005)
1. Assessment and monitoring of the risk of exposure to avian flu strains using the model
of serotype H9N2

Cross-sectional serological studies to determine the prevalence rates of H9N2
among subjects with occupational exposure to avian flu strains (poultry farmers,
veterinarians etc.)

Follow-up studies with baseline collected sera and periodical additional sampling
to monitor the extent of exposure to H9N2 and other avian flu serotypes. (identify
new subjects who show seroconversion in a "high risk cohort" under serologic
surveillance)
2. Assessment of potential cross-protection conferred by serotype H9N2 against infection
caused by serotype H5N1
3. Comparative molecular characterization of H9N2 isolates from Israel, Jordan and
Palestinian Authority. Evaluation of the extent of genetic polymorphism among the
regional isolates in comparison with H9N2 strains isolated all over the world.
Conclusion:
Participants praised the unique opportunity offered by the meeting. They were
enthusiastic about continuing to work together.