In response to the identification of the first coronavirus case in Wuhan City (China), government institutions across the globe faced the challenge of outlining policy capacity to contain the spread of infection and overcome human tragedy. The first confirmed case in the UAE was reported on 29 January 2020.1 Up till now, UAE reported 1,024,457 diagnosed cases and 2342 COVID-19-associated deaths.
The first cases reported of COVID-19 in the UAE resulted in the implementation of policies and strategies to control the spread of this contagious disease. On March 11, 2020, the World Health Organization declared coronavirus officially a pandemic.2 The first case in the country was a 73-year-old woman from China who came to the Emirates on a holiday with her family. She was diagnosed with coronavirus after exhibiting flu-like symptoms on January 23.3 Even before the World Health Organization (WHO) generated the first alert on COVID-19, the UAE government indicated the country’s preparedness for the 'worst-case scenario with the spread of the virus in the Middle East. UAE managed to take all necessary steps needed to pre-empt the spread at all levels, without pushing the country into a state of unwarranted panic.3,4
Considering COVID–19 as an unprecedented global challenge, UAE realized the need for unparalleled cooperation. State reaction to the epidemic is guided by the basic concept that people are stronger together than separately, both domestically and internationally. During the pandemic’s first phase in 2020, UAE flew crucial medical supplies to over 128 countries through bilateral relationships as well as provided planes for the United Nations5 air bridge operation, testing kits, and personal protective equipment for the World Health Organization (WHO).4 To overcome this global public health crisis, the government of the United Arab Emirates (UAE) used a rigorous approach to mitigate the consequences of this non-communicable pandemic by effectively controlling COVID-19 spread and associated mortality rate. Some of these steps are related to governance and management responses through the whole government’s multispectral actions. Other steps are related to leadership and timely decisions, which involved risk communications and community engagements. Finally, and most importantly, the policies that the country has taken in implementing public health and social measures to achieve citizens’ and residents’ trust in the government.
Several research studies have been conducted on the regional side of the UAE about the pandemic coronavirus some of them were related to the impacts of stringent policies on the public.3,5 For instance, Abbas Zaher et al.3 examined the UAE’s leadership role in controlling the crisis with the help of the crisis management framework by the Organization of Economic Development (OECD) as well as figured out strengths, weaknesses, opportunities, and threats (SWOT) analysis. However, the study highlighted to adoption of a comparative approach for reviewing the UAE’s response and information integration in future studies.3 To fill this gap, this paper tried to explore the role of UAE leadership’s practical policies in controlling COVID-19 spread and attaining outcomes as a result of these policies’ implementation its compliance.
The significance of the study lies in offering an overview of the integrated policy management of the UAE. It also provides a comparative analysis of the policy management of China to control the COVID-19 spread through rigid policies and regulations.
METHODS
This paper adopted the scooping review of academic literature and online sources, following an iterative process. Initially, it explored basic issues related to the pandemic that were already visible in public discourse such as governance, physical or digital space, and emergence. For it, additional themes were identified progressively through snowballing. This review obtained lessons in light of disaster risk reduction (DRR), resilience, and post-disaster transitions.4 Since the study vowed to explore the role of UAE leadership and obtain comparative insights, it adopted the study design of a scoping review for mapping the published literature in this particular area of research.6 Adopting the scoping review methodology served to outline those leadership roles and collect comparative insights.
To control international crises and especially the elemental effects of the pandemic in society, effective coordination in terms of communication is key to fulfilling the success of planning mitigation measures. To identify an integrated policy system, it is necessary to communicate between the lines from regional to local levels under unique circumstances, and this should be done virtually. The study approaches based on the overview of the UAE policy approach to control the COVID-19 pandemic with a comparative case analysis of the regional country China. UAE showcased effective policy restrictions to control the pandemic coronavirus beside this China also used efficient tactics and strategies to control the outbreak of coronavirus based on the four phases. Their integrated policy management system was efficient enough to control the pandemic releases of coronavirus. Furthermore, the analysis of the study is based on reviewing different research related to the policy control of the UAE and China.
RESULTS AND DISCUSSION
Diagnostic testing services were performed to identify the infected person with coronavirus and this strategy was proposed by the World Health Organization to control the spread of the SARS-COV-2. The mass testing services were executed by the country UAE as an initiative with a bigger strategy focusing on immediate testing to identify the infection in the persons, tracing contacts, and positive cases. The plan and strategy of UAE include a range of public awareness sessions with health interventions, including mobile driving and travel restrictions. Other policy mitigation measures were related to the public amenities, lockdown, and closure of schools and public gathering places during the time of the pandemic.7,8
UAE government use the technique of testing services of Oxford Covid-19 Government Response Tracker (OxCGRT) which was classified as “open public testing, (e.g., “drive-through” testing available to asymptomatic people)”.9 UAE government adopted the policy of testing services in the earliest month of April to control the spread of COVID-19 and take strict implementation of health care policy. Similarly, other countries like Canada, China, Germany, Saudi Arabia, and South Korea UAE also utilized the services of open testing.10
In the background information UAE has seven Emirates that associatively develop a plan for their society to sustain and strengthen national unity, promote continuous economic growth with the inclination of economic development and more significantly UAE health sector is working on the growth of personal health and well-being development.11 According to the World Bank demographics the UAE had a population of 9.68 million in the year of 2019.12 UAE population is relatively young, with an age median of 30, ~11% of the population are amongst the natives of UAE, and 79% are aged <35 years old.11 The population of the UAE has comparatively increased annually by 5% of growth in 2000 to 15% in 2007.
Accompanying the natural growth of the UAE the increased variation in population demographics, healthcare facilities, including hospitals and personal healthcare awareness sessions have also increased dramatically over the same years in the UAE. One study by Koornneef et al.13 reported a doubling of hospital beds in ten years (2005–2014), accompanied by a 5-fold increase in physician numbers.
Mechanism on Emergency Response
National Crisis and Emergency Management Authority (NCEMA) managed the emergency response system of the UAE and the government of UAE was vigilant to declare an outbreak of coronavirus in the first stance, even though it was discovered and declared by WHO as a public health emergency and international concern.14
The government of UAE is pro-efficient and comprehensive to facilitate high-standard health services and development for their population.4 During the pandemic, the entire system of health care was prepared and informed with all the measures and protocols in place for effectual handling of the crisis (Table 1) provides details of various circulars upheld and released by the government (DOH, ADPHC) relevant to control the infectious spread of COVID-19.4
United Arab Emirate government strategies and initiatives to control COVID-19
During the time of health emergency as a result of the newly diagnosed and novel coronavirus in 2019, the UAE government and legislative authorities took immediate and planned actions to protect citizens of the UAE from any suspected and unexpected loss at their best. Some of the strategies, policies, and procedures developed and followed by the UAE government are as follows:
Overview of Telemedicine
One of the most effective and responsive initiatives taken by the UAE government involving the use of technology to facilitate users is the use of telemedicine (Table 2).15 A study reported 31.3% population used telemedicine in UAE during the pandemic with the most frequently used services being tele-pharmacy (89.7%), tele-consultation (78.2%), and tele-diagnosis (20.3%).16 The Abu Dhabi, Department of Health also launched a remote care application named the “DOH Remote Care” app to deliver healthcare to patient doorstep. A study in UAE reported integration of mobile health technology “mHealth” during the pandemic in mobile appliances reported significant ease in appointment booking (OR 2.61, 95% CI: 1.63-4.18) (P<0.001).17 It has also facilitated clinicians in adhering to public health measures adopted by the UAE government and local administrations to fight against COVID-19 through the continued provision of care to citizens.18
Emergency response system
The National Crisis and emergency management authority (NCEMA) in collaboration with the UAE government introduced an emergency response system with hotlines assigned to facilitate diagnosis, information, vaccination or any inquiry related to COVID-19 disease (Table 1).4 The sustainability framework to maintain the quality of services provided by NCEMA is also required further to assure the proper allocation of resources and empowerment of human, logical, and specialized endeavours to react to catastrophes and crises situation in UAE.19
Use of Healthcare sustainability models
The SEAHIR model usage by healthcare authorities and legislative authorities aided in timely decision-making with the most relatable data availability to make important decisions related to an increase in a healthcare capacity, interventional approaches to reduce disease spread and design and upgrading of diagnostic and testing facilities (Table 2).20 It is primarily a mathematical model used for the estimation of infectious disease burden in the population.19 Additionally, this model also helps in the evaluation of compliance to newly introduced interventions by legislatures and precisely estimates the rate of asymptomatic and exposed individuals.21,22
Surveillance and tracing of contacts
The application “Stay Home” was launched by the UAE government on 3rd April 2020 for people who were in mandatory quarantine to assure adherence to COVID-19 protocols which is in the overall best interest of society at large.23 In addition, the “Weqaya” platform, made by NCEMA, was used to enhance the service through chatbots.24 Similarly, the Stay Home app supports quarantine and isolation of patients, while ALHOSN UAE is the official integrated digital platform for COVID-19 testing in the UAE.25 Furthermore, for those experiencing anxiety during the pandemic, the Ministry of Health and Prevention (MoHAP) established a dedicated coronavirus helpline and a mental health hotline (Table 2).
Psychological and mental well being
Considering the tough situation of COVID-19 and its long-lasting impact on the health of UAE citizens, especially youth, the UAE government initiated free support services including webinars, hotlines, and counselling sessions. The UAE was one of the primary countries that efficiently adopted remote learning in all personal and government facilities. The federal and native governments within UAE adopted a far-off operating system to confirm the health and safety of its workers and customers. The government conjointly issued orders to quickly stop the distribution of all print newspapers, magazines, and promotional material to avoid transmission of the virus by contacting.26 UAE national program for Happiness and Well-being introduced hotline numbers in both English and Arabic to provide support related to psychological and mental well-being.27 For family counselling purposes, an initiative with four interactive channels named “Taaluf” was introduced as part of development services with free-of-cost services with answering queries and advising parents on counselling of children related to COVID-19 precautions and safety (Table 2).28
Policies and procedures related to COVID-19
The UAE Government suspended all closed social gatherings and sports works, business focuses, shopping retail plazas along the edge point, and meat and vegetable markets were shut yet for fundamental items. To contain the disease and to restrict part of people into the UAE, which is a central preliminary degree to check the spread, the UAE suspended visas for all outcasts, and all inbound and outbound voyager flights were cancelled (Table 2). The public authority announced a prerequisite of discipline for violators who disrupt open prosperity.29 Communication about the risks during a pandemic was imperative and the UAE government executed a comprehensive awareness campaign targeting different groups of the community to provide daily updates about disease status both locally and internationally.30
In March 2020, the UAE made mandatory use of facemasks well ahead of the WHO’s recommendation.21 The UAE successfully used a smart technology platform to combat COVID-19. Some examples of these platforms are the “Doctor for every citizen” app, made available for people to access COVID-19-related information and services.4 The rest assured initiative consisted of five core components including staff and the local population as well. The Kheta program is specially designed for rehabilitation purposes for children.28 The UAE has a comprehensive public and private health care system. The number of people who seek medical attention and the high standard of care that they provide evidence this. UAE implemented the WHO organization’s six priority areas of work that were released as a response to the breakout of the COVID-19 pandemic.31 In the event of this pandemic, the entire UAE healthcare system was prepared and alerted, and protocols were in place to ensure an efficient response. The UAE government, through the National Crisis and Emergency Management Authority (NCEMA), was quick to issue its first alert of this outbreak, even before WHO declared it.32 Tests were provided promptly to the majority of health facilities across the UAE, and the Abu Dhabi Department of Health and the SEHA for ease of testing established drive-through testing centres.1 The drive-through testing centres also featured the latest technology.
Contact testing and vaccination services
A mass testing strategy was adopted by the UAE government to identify and isolate people positive for COVID-19. From the start of the pandemic, 4,461,205 tests were conducted and 56,711 were diagnosed positive.28 For the same purpose, the UAE authorities turned the Dubai exhibition centre into a 3000-bed capacity hospital with 800 ICU beds. Virtual clinics were developed by the Ministry of Health and Prevention in addition to chatbots named virtual doctors for COVID-19. The introduction of wristbands by the Abu Dhabi government was a much-appreciated initiative to enforce isolation and reduction of virus spread in addition to tracking and tracing. Field hospitals were established to relieve pressure on city-based hospitals and aid in faster response to COVID-19.33 Dubai World Trade Centre opened the first field hospital with a capacity of 300 beds, which can be expanded to 3000 beds and all these facilities followed rigid COVID-19 protocols in handling and management of cases. Furthermore, active surveillance was implemented to identify Severe Acute Respiratory Infections 1 admitted to different hospitals where COVID-19 is required to be tested.
Democratic support and relationship
The UAE holistically helped brotherly and friend countries to combat this crisis. This aid came as a part of UAE’s global response to address the pandemic internationally, and to strengthen the initiatives commenced by the state under the directives of wise leadership (Table 2).34 The purpose of this aid was to support international efforts to address the spread of COVID-19 and embody the interest to improve the ability of societies to confront the repercussions of health and humanitarian crises in general. The initiative is a step to mitigate the spread of the COVID-19 pandemic across the globe, and to strengthen aspects of prevention and protection for the local population there.35
Continuing the tradition of the UAE’s Founding Father, H. H. Sheikh Zayed bin Sultan Al Nahyan, and the country’s desire to help as many people as possible, the UAE has sent humanitarian aid to other countries to reduce their suffering and assist them in their rehabilitation. Here are some examples of assistance given to other countries. For example, an assistance plane was dispatched to Italy, carrying around 10 tons of medical supplies. Over 10,000 healthcare workers benefited from it. The supplies will allow medical personnel to carry out their professional obligations in countering the virus’ spread safely. Also, over 10,000 healthcare personnel will benefit from an assistance plane carrying approximately 13 tons of medical supplies that were delivered to Kazakhstan. Moreover, the UAE sent a plane to Colombia with 10 tons of medical supplies to help the country fight the COVID-19 pandemic, which will benefit over 10,000 healthcare workers. The UAE went beyond its boundaries to assist Britain in its fight against the new coronavirus COVID-19, which is posing a growing public health threat. The UAE aided the United Kingdom by converting a 4,000-bed field hospital it owns in London. Exceeding all the regional conflicts, UAE sent two emergency relief planes carrying 32 tons of medical supplies and relief equipment dispatched by the UAE to assist Iran in its ongoing attempts to stem the spread of COVID-19. Previously, the UAE facilitated a World Health Organization mission to transfer 7.5 tons of medical supplies and equipment to Iran to aid in the containment of the novel coronavirus.
The pandemic has brought the UAE and India closer together than they have ever been before, with both countries working in areas including healthcare and, more crucially, the economy. Expatriate population’s well-being nothing is impossible for an Indian. Now, more than ever, the evacuation of its residents working in numerous nations is critical. Given that India is the world’s largest democracy, this has become a strategic concern for New Delhi. On May 7, 2020, the UAE would release nationals in distress as part of an unprecedented relief effort.36 Finally, on May 4th of 2020, UAE sent its fourth Emirati aid plane carrying large quantities of COVID-19 vaccines arrived in Damascus today, conducted by the Emirates Red Crescent Authority in coordination with the Syrian Red Crescent Society, to support the ability of the Syrian health sector to face the repercussions of the Corona pandemic and strengthen preventive measures to reduce its spread. These vaccines aim to protect frontline medical workers in the Syrian arena, people with difficult humanitarian cases, the elderly, people with chronic diseases, and people in places of displacement from the repercussions of the pandemic and its health effects. These vaccines contribute to addressing the Corona pandemic and trapping the virus in light of the spread of a new strain of the pandemic in several countries.
Analysis of the integrated policy system of China to control the spread of COVID-19
According to the study results of Jin et al.37 the development stages of the COVID-19 epidemic in China, are categorized in phases based on the spread of the disease. The first phase of incubation shows potential epidemic has not attracted enough attention from the government. In the second phase, the combination of integrated policies about the lockdown, quarantine, novel diagnosis of corona cases, pre-treatment and testing services to treat the virus; are not only a significant reason for the epidemic control of the virus in the outbreak stage and resolution stage but also an important reason why the small-scale epidemic has not expanded in the stable stage. Furthermore, the extensive increase in Chinese public health expenditure for the rapid control of the epidemic is another important reason. The China government put an interest in the practices of public health care during the times of pandemic prospectively related to health expenditure and policy-making especially the expenditure on public health emergency treatment, by increasing government hospitals, and major public health service projects. Besides this, the study results provide a feasible method and case for dealing with a major public health crisis for the government. For instance, some countries spent a lot of expenditures on public health to deal with the pandemic but did not implement and adopt the compliance of effective policies and regulatory systems which led to the epidemic beyond control. On the contrary, some countries have formulated a series of systematic and scientific policies and regulations, but they were lacking in financial funding and do not assemble enough public health expenditure, which may ultimately lead to poor policy implementation effect.
Comparative analysis of policy control during COVID-19 between UAE and China
The results of this study provide an analysis of integrated policy management based on the comparison between the UAE as shown in (Table 3). Many proposed activities were adapted as a policy to mitigate the effect of COVID-19 in many countries. UAE and China show similarities in the integration of a policy system to control the spread of COVID-19. The coronavirus was initiated from China city of Wuhan and yet it was recorded that China faced the maximum disasters as a result of the pandemic. Eventually, China made integrated policy management to control the spread of coronavirus and fight against the spread of the disease. Similarly, UAE was also eager to spend maximum expenditures on public health care beside this the educational system was also maintained virtually for both countries. Being stringent towards the policy and funding for health care assessments both the country accomplishes in stabilizing their conditions during the pandemic.
Recent advancements in emerging health solutions for the management of certain no communicable diseases
Some of the actions that the UAE took on the health front are the implementation of medical home visits for COVID-19 high-risk categories, novel coronavirus circular, covering Coronavirus tests in the activity-based funded mandates, rational use of personal protective equipment as per clinical setting in the context of COVID 19 response, regular updates of the National Protocol for clinical management and treatment of COVID-19, interim rules and the requirement to minimize chances for exposures and to prevent spreading COVID - 19 between KCWs.38 Additionally, UAE continued screening tests for all healthcare workers, employees, border checkpoints, students who are in the blended system, and all those who might be in contact with a COVID-19 patient.39
Communication about the risks during a pandemic is vital, which is why the UAE government executed a comprehensive awareness campaign targeting different groups of the community and providing daily updates about the status of the disease both locally and internationally.33 In March 2020, the UAE made mandatory use of facemasks well ahead of the WHO’s recommendation.33 The UAE successfully used a smart technology platform to combat COVID-19. Some examples of these platforms are the “Doctor for every citizen” app, made available for people to access COVID-19-related information and services.4
Health System in the UAE and policy research contribution to effective responsiveness
As part of its commitment to join the global effort to proactively fight COVID-19, the Department of Health has launched an open COVID-19 Research Registry platform to collect all research activities related to the SARS-COV2 coronavirus, which could provide critically important time-sensitive data for COVID-19 management. The national research registry can quickly gather the information needed to provide new and important insights as well as essential missing elements in the fight against the COVID-19 epidemic.40 This platform keeps track of all descriptive studies on this infectious disease and the healthcare offered over time. Clinical researchers are encouraged to submit research proposals relating to COVID-19. From the time of the pandemic outbreak, G42 Healthcare has been conducting a COVID-19 virus genome sequencing study to track the virus’s distribution and evolution. The advent of new strains has also been detected using this sequencing. The UAE has already published research on COVID-19 virus genome sequencing, which has contributed to the understanding of the global SARS-CoV-2 transmission network.41
Role of UAE political leadership in the development of a better and more equitable health system
Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, has pledged to cover all costs associated with stem cell therapy for COVID-19-infected critical patients. Sheikh Mohamed bin Zayed Al Nahyan took the initiative after the Abu Dhabi Stem Cell Centre (ADSCC) revealed the development of a novel and promising stem cell-based treatment for COVID-19 infections. Stem cells are extracted from a patient’s blood and activated before being reintroduced. COVID-19 patients in the UAE received the treatment, and all of them were cured of the virus. As responses to the pandemic require effective international collaboration, this paper will show the UAE’s experience in working with international partners and the impact of this cooperation on the UAE’s support for the local community and the region.
CONCLUSION
To conclude, in response to the global Novel Coronavirus (COVID-19) outbreak, UAE public health authorities took wide steps to ensure the safety and well-being of Emirati citizens, residents, and visitors. Professionally, the UAE government has handled the COVID-19 problem efficiently and continues to pioneer in health care and serves as a model of the Middle East in terms of comprehensive protection for the population and reopening of the economy. All the policy steps that have been taken by the UAE government guided by the political well in the country resulted in gaining the trust of residents and citizens to welcome the vacancies and fasten the going back to normal life. UAE not only supported their people in combating the pandemic but also topped the countries of the region in controlling COVID–19 and leading the region to safety and health. UAE is recorded as number one in the whole world of people taking the vaccine compared to the population size. The use of appropriate and proactive approaches by the UAE government and healthcare authorities can be used as a commendable model for the rest of the world to follow to deal with any public health crises. The paper provides comparative insights about the UAE leadership amidst the pandemic. One of its limitations included that it was conducted based on secondary or published data. Future studies can explore the requisites of leadership and different leadership styles in times of crisis with the help of primary data.
Practical Implications & Recommendations
The outcomes of this research provide a long-term frame of policies that can be implemented by other countries to fill their gap in terms of mitigation measures for COVID-19. The UAE government encourages research and development of newer technologies concerning the COVID-19 pandemic and aligned to the nation’s Healthcare. The leadership policies to control COVID-19 UAE have accomplished this hurdle and also set an example for other countries who can adopt the approaches of an integrated management system of policies to lower the impacts of the pandemic from their metropolitan burden. Thus, the UAE has been efficient and effective in handling the crisis of COVID-19. It continues to pioneer in health care and serves as a leading example in the Middle East in comprehensively protecting the population and responsibly reopening the economy.
Funding
This research is not funded by any resource.
Authorship contributions
T.A.S contributed in conceptualization, writing of original draft and final review, S.J.A contributed in data analysis and final review.
Disclosure of interest
The author declares no competing interest.
Correspondence
Taghreed M. Abu Sarhan
taghreed134@gmail.com, Taghreed.AbuSarhan@adfca.gov.ae
United Arab Emirates University, Sheik Khalifa Bin Zayed St - 'Asharij - Abu Dhabi - United Arab Emirates