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Two years of COVID-19: What it takes to run an emergency response across 53 countries

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"For 2 years, the essential public health work of WHO/Europe has been dominated by the COVID-19 response. Working with the entire Regional Office, the Incident Support Management Team has been our engine, powering emergency operations with evidence-based, actionable and on-the-ground support to countries and partners" said Dr Dorit Nitzan, WHO/Europe's Regional Emergency Director.

On 24 January 2020, confirmation arrived that the first cases of COVID-19 had been detected in the WHO European Region. One day earlier WHO/Europe had set up its COVID-19 Incident Management Support Team (IMST) -- a multidisciplinary team, drawing on different areas of expertise -- to respond to the threat posed by the new coronavirus disease.

Explaining how the IMST works, Dr Nitzan said: "The WHO Health Emergency Programme was joined by experts from other parts of the Office as well as partners, to bring all the necessary 'brains' together in one place. As the situation evolved, so did the size and makeup of the team.

"When the impacts of the new virus on health systems became evident, in-house specialists joined in to strengthen the work in that field; as the first vaccines were developed, vaccine experts came to the fore with relevant knowledge and know-how. This enabled us to provide the best guidance and support to countries and communities at the right time."

In the weeks following confirmation of the first COVID-19 cases, WHO/Europe's experts were deployed to Kyrgyzstan, to support operational planning, as well as laboratory and hospital preparedness and readiness. This was followed by a high-level mission to Italy, the first hard-hit country in the European Region.

In numbers

Numbers tell the story of a mammoth effort over the 2 years of WHO/Europe's response that is visualized on the online regional situation dashboard, receiving over 12 million views by the end of 2021. The Regional Office organized 358 missions to 25 Member States, including 40 partner deployments through the Global Outbreak Alert and Response Network (GOARN) and deployment of emergency medical teams.

US$ 90 million-worth of critical supplies were delivered to COVID-19 frontlines; over 42 000 health-care workers were trained; 63 guidance documents were published; 800 laboratories received external quality assessment; and over 2.3 million people were supported by civil society organizations engaged by WHO/Europe.

Communication was open and regular across all channels, providing the latest evidence-based information and health advice, while also debunking the unprecedented volume of mis- and disinformation. There have been 35 000 media articles on COVID-19 and WHO/Europe, over 1.5 million web page views of the WHO/Europe COVID-19 content, over 3 million social media engagements on content related to COVID-19 on WHO/Europe accounts, and 4 million interactions with the HealthBuddy+ chatbot.

Pillars of stability, greater agility

The ever-changing and evolving situation demanded a stable yet agile team that could respond fast. The IMST achieved this by organizing around key response pillars: surveillance and laboratories, public health and social measures, clinical health interventions, essential health services, vaccines, risk communications and community engagement, and operations support.

This pillar structure ensured that individuals with different areas of expertise from across the Organization and beyond were brought together to share information and advise on best practice to develop a comprehensive response.

Putting countries at the core of the response

WHO country offices -- whose remit is to give direct health support to the country where they are located -- also needed to repurpose their resources and focus to address the enormous challenge. The expertise of their representatives, through familiarity with the cultures, political systems and public health capacities of their countries made them vital members of the IMST.

As Dr Catherine Smallwood, WHO/Europe's COVID-19 Incident Manager explains, this insight was crucial during large-scale outbreaks: "We've not seen a health emergency of this size in Europe since the Spanish Flu pandemic of 1918 and the Second World War. It is incredibly rare for us to have an event that is affecting every single country in the world in different ways, at different times".

Moreover, a "country business model" established just 18 months prior to the pandemic was a crucial innovation to provide tailored support. Covering the Balkans, Caucasus and central Asia, the "hub-and-spoke" structure -- resembling a bicycle wheel -- serves as an extended arm of the Regional Office in priority countries on emergency preparedness and response.

Life-saving vaccines

The development and rollout of the first COVID-19 vaccines, authorized for use in December 2020, proved a game changer in the world's fight against the virus -- only a year after its start. In the European Region alone, half a million people owe their lives to the COVID-19 vaccine.

The IMST also played a central role in increasing understanding and take-up of vaccines and supported the work of COVAX -- a joint collaboration led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the United Nations Children's Fund (UNICEF) and WHO -- to guarantee fair and equitable access to vaccines for citizens in every country of the European Region and the world.

Over the last year, countries in the European Region administered over 1.3 billion doses of COVID-19 vaccine, with many delivered through COVAX. Despite this, too many people in the Region, including those with vulnerabilities from marginalized groups, remain unvaccinated and unprotected.

A time for reflection and learning

Two years of COVID-19 in the European Region is indeed a grim milestone, given the tragic loss of life, suffering, social division, financial costs and uncertainty.

But it is also a time for reflection -- an opportunity to identify the lessons we have learned during this period that will form the basis for a stronger future. As the world enters the third year of the COVID-19 response, the IMST continues its work, while at the same time collaborating with countries in planning for the post-pandemic period of "building back better" for more inclusive and resilient health systems.

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