COVID-19 continues to overwhelm health systems across the globe, yet the United Arab Emirates (UAE) has thus far managed to keep the virus at bay. The UAE has ranked 11th amongst 200 countries and regions in COVID-19 Safety and Risk Assessment Rankings, while leading the vaccine distribution rate globally — having administered over 19 million vaccine doses to a population of 9.2 million individuals. The nation has successfully inoculated over 93% of its population. Since the pandemic’s emergence, the UAE has proactively adopted strategies to contain the virus’ transmission. To understand the role of a robust health system in a pandemic response, this column evaluates the effectiveness of the UAE’s health system during COVID-19 by examining the six building blocks of any health system: leadership and governance, financing, health workforce, medical products, vaccines and technologies, and service delivery.
Leadership and Governance
A country’s governance mechanisms are perhaps the most critical building blocks of any health system and even more so during a public health emergency. From the virus’ emergence, the UAE was vigilant and prompt in its response, issuing a nationwide alert about the outbreak, even before the WHO declared SARS-CoV-2 as a public health emergency of international concern. The government also adopted mask mandates well ahead of the WHO’s recommendation. During the initial months, the country had the highest testing records with tests conducted exceeding their total population. This begs an inquiry into how existing governance and policy mechanisms allowed their leadership to mount this response.
Legislative Framework of the UAE
The UAE’s Communicable Diseases legislation dates back to 1981, but was modernized following the MERS outbreak and subsequently amended in 2016. The legislation played a key role in the government’s quick response, as it outlined the protocols and policies in the event of a new communicable diseases threat.
Health Financing System
Like other countries in the region, the UAE has a well-funded universal health care system and mandatory health insurance in the emirates of Dubai and Abu Dhabi. It has also made substantial investments in the development of modern healthcare technologies and facilities. In October 2014, the government launched the country’s first 24/7 telemedicine center in Abu Dhabi, followed by the 24/7 ‘Doctor for every citizen,’ a free health consultation, in 2019. These platforms quickly adapted to the pandemic with specialized SARS-CoV-2 consultations. By April 2020, six new telehealth providers had been approved by the government, and free internet data via mobile phone was provided for all health applications and platforms. Thus, sustained investment in health infrastructure strengthened the UAE’s position when the virus attacked its borders.
Performance of Health Workforce
The UAE’s healthcare system is bolstered by the rising number of accredited health facilities and health workforce in the country. As of 2020, the physician population ratio and the nurse population ratio stands at 2.67 and 5.91 per 1,000 population, well above the WHO recommendation of 1 and 3 per 1,000 population, respectively. From the onset, the government focused on capacity building for both regular health workers and volunteers, as well as provided several training programs on disease prevention, diagnosis, reporting, and treatment to the health workforce. Subsequently, the government launched a special helpline for the mental wellbeing of frontline professionals, known as the “Mental Health Support Line.” Thus, the government ensured that a fully equipped and qualified health workforce worked around the clock to protect the nation from the pandemic.
Access to Medical Products, Vaccine, and Technologies
In 2019, the UAE adopted a new federal law that consolidated and modernized the legal framework governing medicines, medical devices, and health-related consumer goods. This law enhanced access to innovative solutions and treatments for COVID-19, including the recent FDA-approved Sotrovimab medication. The UAE is the first country to both license and enable immediate patient use of this novel antibody treatment. The government also efficiently secured adequate supplies of medicines and personal protective equipment (PPE) by collaborating with the private sector and international organizations. Additionally, home delivery services for free medication increased access for individuals, especially the elderly and those suffering from chronic diseases. The government also launched at-home COVID-19 vaccination services for elderly individuals to enhance vaccine access. All these measures facilitated access by regulating allocation, distribution, and utilization of medicinal supplies and other requisite pandemic logistics.
Functioning of Health Information System
An accurate and agile information system is foundational to effective decision-making within any health system. Even before the pandemic, the UAE had well-integrated electronic public health systems for surveillance and management of diseases and was the first country in the region to establish a health information exchange in Abu Dhabi, or “Malaffi HIE,” in 2019. This system uses advanced digital technologies, like artificial intelligence and machine learning, to store, exchange, and analyze data from the health sector. When COVID-19 hit, Malaffi quickly adapted its interface and connected with health facilities across Abu Dhabi to facilitate meaningful exchange of data — enabling quick decision-making about the target population’s needs. The National Emergency Crisis and Disasters Management Authority launched an electronic platform, “Weqaya,” to raise public health awareness on SARS-CoV-2. A new ‘Stay Home’ mobile application and smart bracelet obliged individuals in isolation to adhere to isolation measures. Additionally, technology bolstered surveillance and trace response by the launch of a national contact tracing app. Thus, the UAE was prompt in adapting existing technological innovations and establishing new active surveillance measures for effective containment.
Delivery of Health Services
While 90% of the countries worldwide experienced widespread disruptions to essential health services during the initial months, the UAE ensured them to its population with minimal disruption. SARS-CoV-2 treatment and testing strategies were centralized, with testing being provided free of charge. Drive-through testing centers and the National Home Testing Programme encouraged testing by facilitating convenience. Several field hospitals and quarantine facilities were also established for COVID-19 treatment with the dual objective of reducing the pressure on city-based hospitals and aiding faster, more specialized response to COVID-19. In addition, telehealth services, like the Virtual Doctor for COVID-19,’ and mobile applications, like ‘Remote Healthcare,’ commenced from the pandemic’s onset and facilitated delivery of health services that do not require a physical medium. These measures ensured unrestricted delivery of essential health services to the doorsteps of every individual — enhancing public trust and support in the country’s health system.
SARS-CoV-2 is perhaps the beginning of many biological outbreaks yet to affect humanity in the years to come. Amongst its crucial lessons, COVID-19 has taught us preparedness is quintessential to win any battle, even one against an invisible enemy. Learning from past epidemics, the UAE invested in the resilience of its health system by focusing on preparedness strategies for all six blocks indispensable to a health system — resulting in a proactive and timely implementation of containment strategies. Thus, the enhanced capacity of its robust health system allowed it to contain the pandemic at all levels and pace towards a new safer normal with the armor of vaccination. While a country’s response in any outbreak is tailored to its individual needs and circumstances, a lesson from this gulf nation in pandemic preparedness of health systems coupled with a quick, effective response can get us ahead of future potential pandemics.
Nishtha Arora was a COVID-19 Law Lab Research Assistant from January-August 2021. She is a final year student at National Law University Odisha.