On March 2, 2020, when the first cases of COVID-19 appeared in Jordan, the Government enacted a strict nationwide lockdown, closed airports and schools, public and private institutions until early June 2020. Working in partnership with the Ministry of Health (MoH), the WHO Country Office (WCO) of Jordan supported national efforts to respond to COVID-19 immediately.

Despite the scarcity of supplies in the global market, WCO managed to support the MoH to procure and deliver seasonal influenza vaccines for the public sector, hospital and laboratory equipment and supplies, personal protected equipment, testing kits, medical products, IT equipment for contact tracing whilst building capacities of healthcare personnel. In March 2021, WCO procured the first shipment of COVID-19 vaccines through the WHO COVAX Facility.

The value of scientific evidence for guiding decision-making in Jordan is highly acknowledged. Evidence-generating activities have also been prioritized within the national plan for preparedness and response to COVID-19 across different public health areas. Accordingly, the WCO stood out in providing direct, strategic, and operational support to Jordan's Government, leveraging its access to a vast global network of technical expertise and the most up-to-date evidence-based guidance on responding to COVID-19 to support their evidence-generating activities implementation. 

With this support, Jordan was the first country in the Eastern Mediterranean Region to have completed three rounds of a national seroepidemiological investigation (that was population-based and age-stratified), one assessment of risk factors for healthcare workers in health facilities settings (as part of WHO's Unity Studies), and several behavioural insight surveys. WHO also helped organize the first country-specific online clinical case management training, involving more than 400 clinicians in Jordan and technical experts globally.

At the onset of the pandemic, numerous epidemiological models had been developed globally. The COVID-19 International Modelling (CoMo) Consortium modelling research group (initiated by the University of Oxford, encompassing research groups in more than 33 countries across the world) created a model estimating trajectories in COVID-19 cases and deaths as well as the impacts on healthcare systems, according to the adoption and relaxation of specific Public Health and Social Measures (PHSMs).[1] Recognizing the value in this scientific evidence approach, the WHO Country and Regional Offices for the Eastern Mediterranean Region worked together with the MoH and applied the CoMo Consortium model to Jordan. The first round of modelling results using national data was completed at the beginning of the pandemic, with successive rounds in October and November 2020, February 2021, and most recently, in March 2021.

The model incorporated the most up-to-date evidence on SARS-CoV-2 virology and epidemiology (including results from the WHO-supported national household seroprevalence survey) and complemented it with national data on Jordan's health system and health service delivery capacities to cope with COVID-19. The model allowed for the estimation of the relative impact of different PHSMs, such as enhancing social distancing, reopening schools and airports, and working from home.

In each round of modelling, the MoH requests a series of scenarios, works directly with WHO Country and Regional Offices to run the model, and present the model's findings to inform high-level and evidence-based decision making.

A significant achievement was the multi-sectoral impact of the modelling, which had not existed at the beginning of this endeavour. Starting after the second modelling round in October 2020, the Strategic Planning Department of the Jordanian Royal Hashemite Court, who had already engaged in some modelling of its own, showed a strong interest in such work. The Royal Court has supported these modelling techniques and bolstered them by expanding data availability, which was critical to initiate the process. In recent rounds of modelling, WCO and in the Regional Office meet regularly and work directly with senior management in the MoH. With such strong national support and inputs, and with more evidence on the virus' behaviour being generated, the estimations of relative impact have been constantly refined over time.

Through this modelling initiative for the pandemic, WHO demonstrated its comparative advantage in providing hands-on support to national health authorities for developing evidence-informed policies. It is clear that WHO was uniquely positioned to adopt a participatory approach (with the Jordanian authorities) in running COVID-19 modelling research, convey the model's caveats and limitations, and disseminate modelling results among governing bodies and partners as appropriate. By leveraging and investing in WHO's normative and research comparative advantage in addition to providing essential assistance for the pandemic (e.g. procurement, research, and capacity building), WHO created crucial evidence to help with decision-making within and beyond Jordan's health sector.

During recent years, WCO in Jordan has embarked on an intense transformation process in line with the Thirteenth General Programme of Work (GPW13) and repositioned work, programme and operations to be fit for the purpose. These endeavours, which notably provide scientific evidence for decision-making, have been received with high praise from the Jordan MoH and partners and will continue to strengthen already excellent WCO work to drive health impact in Jordan. Especially during a novel and unpredictable health crisis, these efforts were extremely valuable and will continue to support a coordinated and multi-sectoral response to COVID-19 in Jordan.[2]

[1] Aguas R, White L, Hupert N CoMo Consortium, et al Modelling the COVID-19 pandemic in context: an international participatory approach, BMJ Global Health 2020;5:e003126.

[2] Adib K, Hancock PA, Rahimli A, et al A participatory modelling approach for investigating the spread of COVID-19 in countries of the Eastern Mediterranean Region to support public health decision-making. BMJ Global Health 2021;6:e005207.

Photo caption: Minister of Health, Prof Feras Hawari during a TV interview talking about the epidemiological situation and the measures in Jordan.

Photo credit: WHO